Alcohol Withdrawal Flashcards
What changes in the brain lead to alcohol withdrawals?
- down-regulation of GABA receptors
- up-regulation of glutamate receptors
How much alcohol and how long does it take to experience withdrawals?
7 days straight of heavy drinking (case of beer, gallon of vodka)
What are the complications of withdrawal?
- alcoholic hallucinations (more visual)
- alcohol withdrawal seizures (up to 2 days out from last drink)
- delirium tremens (up to 7 days from last drink)
What are the uncomplicated symptoms of alcoholic withdrawals?
- agitation
- tachycardia
- tachypnea
- HTN
What benzos are used for alcohol withdrawals?
- Diazepam
- Lorazepam
- Midazolam
- Chlordiazepoxide (out-patient)
Which benzo used for AW does not have active metabolites?
Lorazepam
Which benzo used for AW has the longest half life?
Diazepam
What are SEs with benzos?
- sedation/dizziness
- delirium
- hypotension
4.respiratory depression
Why are extended infusions of Lorazepam controversial in crit ill?
may lead to metabolic acidosis
What interactions does Midazolam have?
CYP3A4 inhibitors
What barbs are used for AW?
Phenobarbital
What alpha-2 agonists are used for AW?
- Clonidine
- Dexmedetomidine PRECEDEX- adjunct only
How does propofol work to treat AW?
- decrease GABA receptor channel closing, potentiates effect of GABA
- NMDA antagonist
- must be on mechanical ventilation
How does Ketamine work to treat AW?
NMDA/ glutamate antagonist
What are SEs with Ketamine?
- HTN
- disassociation
- respiratory depression
