Alcohol Use Disorder Flashcards
What are the basic pharmacokinetic characteristics of ethanol?
- Lipid soluble
- Non protein bound
- First order absorption
- Capacity limited metabolism
- 2 carbon moiety
Symptoms of Minor Alcohol Withdrawal
5-10 hrs
Autonomic hyperactivity
- tremulousness
- hyperhidrosis
- tachycardia
- HTN
- GI upset
Anxiety
Insomnia/vivid dreams
Symptoms of Major Alcohol Withdrawal
12-72 hrs
Hallucinations
Seizures
Symptoms of Delirium Tremens
48-72 hrs withdrawal
Disordered consciousness
- hallucinations
- disorientation
- tachycardia
- HTN
- low grade fever
- agitation
- diaphoresis (sweating)
THIS IS A MEDICAL EMERGENCY
General treatment for Ethanol Withdrawal
1.) Thiamine (50-100mg QD)
2.) D5W and 0.45 NS
3.) Multivitamin
4.) standing orders for clonidine and a benzodiazepine
Symptom triggered ethanol withdrawal regimen
admin 1 of the following every hour when CIWA >/= 8-10
- diazepam 10-20mg
- lorazepam 2-4mg
Fixed schedule ethanol withdrawal regimen
- Diazepam 10mg Q6H for 4 doses -> 5 mg Q6H for 8 doses
-Lorazepam 2mg Q6H for 4 doses -> 1mg Q6H for 8 doses
Disulfiram MOA
blocks aldehyde dehydrogenase -> build up of acetaldehyde -> sick
this reaction is triggered by alcohol, as well as many antibiotics and antifungal medications
How long must a patient be alcohol free before starting disulfram?
at least 12 hours
Disulfiram ADE
drowsiness
H/A
psychosis
rash
metallic/garlic-like aftertaste
impotence
hepatitis
peripheral neuropathy
optic neuritis
Naltrexone MOA
competitive antagonist at opioid receptor sites (highest affinity for Mu receptors)
Acamprosate MOA
increases activity of GABA system
decreases activity of glutamate
GABA
inhibitory neurotransmitter
Ethanol’s acute and chronic effects on GABA
Acute: enhances effectiveness
Chronic: down regulation of GABA receptors
Glutamate (NMDA receptors)
excitatory neurotransmitter
