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Pharmacy 409 exam > Alcohol abuse > Flashcards

Alcohol abuse Flashcards

1
Q

What is 1 standard drink? (4 points)

A
  • 10g alcohol
  • 1 port/sherry/small glass wine
  • 1 nip cocktail
  • 1 small glass beer
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2
Q

What are the safe alcohol limits for women to reduce long term health risks? (3 points)

A
  • No more than 2 SD daily
  • No more than 10 SD a week
  • at least 2 alcohol free days/week
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3
Q

What are the safe alcohol limits for women to reduce risk of injury?

A

-no more than 4 SD on any single occassion

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4
Q

What are the safe alcohol limits for men to reduce long term health risks? (3 points)

A
  • No more than 3 SD daily
  • no more than 15 SD a week
  • at least 2 alcohol free days per week
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5
Q

What are the safe alcohol limits for men to reduce risk of injury?

A

-no more than 5 SD on any single occassion

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6
Q

When is alcohol consumption more risky? (6 points)

A
  • Pregnancy: risk of birth defects is greater. No safe drinking limit in pregnancy
  • Thin people, young people, older people: metabolise alcohol slower
  • Alcohol dependant
  • Strong family Hx of alcoholism
  • Are, or have been dependant on other drugs
  • Poor diet, or are under-nourished
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7
Q

What activities are alcohol consumption more risky in? (6 points)

A
  • When driving, operating machinery
  • Boating, scuba driving etc
  • with medication: sedatives, antidepressants, narcotics, NSAIDs,
  • acute/chronic physical disease
  • recovering from an accident, injury or operation
  • mental illness
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8
Q

How do we define problematic drinking? (2 points)

A
  • traditionally binary view,

- spectrum view more informative and less judgmental

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9
Q

What are the main categories on the alcohol continuum use? (6 points)

A
  • no use
  • moderate
  • problematic
  • hazardous
  • harmful
  • dependence
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10
Q

What is moderate use? (2 points)

A
  • experimental use/social use

- no major problems

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11
Q

What is problematic use? (3 points)

A

some problems such as:

  • missed work
  • comedown/hangover
  • family/whanau quarrels
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12
Q

What is hazardous use? (2 points)

A

problems AND increased risk of long term harm such as:

  • relationship problems
  • crime
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13
Q

What is harmful use? (4 points)

A

Problems AND increased risk of harm and long term damage such as :

  • health
  • violence
  • break ups
  • loss of job
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14
Q

What is dependence? (5 points)

A

All problems AND 3 or more of:

  • withdrawal
  • using to relieve withdrawal
  • not able to predict/control use
  • persist despite harm
  • rapid return to dependence if relapse after abstinence
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15
Q

What are the 4L problem areas?

A
  • Liver: (health problems)
  • Lover: relationship problems
  • Livelihood: employment-related issues
  • Law: legal problems
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16
Q

What treatments are available for dependent drinking? (4 points)

A
  • medication supported detox to manage withdrawal
  • management of craving
  • Psychosocial support
  • prevent vitamin B deficiency
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17
Q

What is alcohol withdrawal? (5 points)

A
  • affects 50% of dependent individuals
  • onset 6-24 hours
  • peaks 48 hours
  • most severe Sx (delirium tremens) occurs after 3-7 days
  • severe withdrawal can last up to 10 days
18
Q

What are the withdrawal signs and symptoms? (9 points)

A
  • Tremor
  • Sweating
  • Anxiety
  • N&V
  • diarrhoea
  • insomnia
  • tachycardia
  • Hypertension
  • dehydration
19
Q

What are examples of severe alcohol withdrawal? (3 points)

A
  • seizures
  • hallucinations
  • confusion
20
Q

What is delirium tremens? (9 points)

A
  • occurs 2-5 after cessation
  • lasts 3-14 days
  • autonomic instability
  • paranoid delusions
  • hypersensitivity to stimuli
  • hallucinations (usually visual)
  • confusion and disorientation
  • agitation
  • exclude head injury, sepsis etc.
21
Q

What is detoxification?

A

short course medicine to prevent withdrawal symptoms when stopping alcohol

22
Q

What does detox allow? (4 points)

A
  • proactively apply motivational techniques
  • facilitate insight building
  • explore opportunities for after care
  • facilitate links and transfer to aftercare
23
Q

What medications are used in detox? (5 points)

A
  • long acting benzo like diazepam

- start Tx early, when breath alcohol

24
Q

What causes weincke encephalopathy and korsakoff syndrome?

A

thiamine deficiency (vitamin B1)

25
Q

What are the symptoms of Wernicke’s? (3 points)

A
  • eye movement abnormalities
  • imbalance/other cerebellar signs
  • confusion
26
Q

What are the symptoms of Korsakoff? (5 points)

A
  • memory
  • blackouts
  • minimal content in conversation
  • lack of insight
  • apathy
27
Q

How is WE and KS treated and prevented? (2 points)

A
  • Tx: B1 injection, nutrition and hydration. May be irreversible
  • Prevention: healthy diet, thiamine supplements, may reduce development of WKS
28
Q

What are some pharmacological supports for abstinence? (2 points)

A
  • Antabuse

- Naltrexone

29
Q

How does Antabuse work? (4 points)

A
  • causes disulfiram reaction by inhibiting adlehyde dehydrogenase
  • results in build up of acetaldehyde which is toxic
  • within 5-30min of alcohol, hot flushes, throbbing of head and neck occur.
  • Lasts up to several hours and may be ill for several days
30
Q

Is disulfiram effective? (2 points)

A
  • does not reduce craving for alcohol, but likely to deter drinking
  • best with psychosocial support
31
Q

What are the contraindications to disulfiram? (5 points)

A
  • frailty
  • Hx serious heart disease
  • pregnancy
  • advanced liver disease
  • psychotic illness, severe personality disorder, risk of suicide
32
Q

What cautions should be taken with disulfiram use? (5 points)

A
  • may interact with metronidazole, isoniazid
  • warn about sauces, mouthwash, cough mixtures, perfume, aftershave
  • Px must be alcohol free for at least 24 hours
  • must have full Px consent, disulfiram reaction explained, Family informed
  • 3 weeks washout period if they want to drink again.
33
Q

How does naltrexone work? (4 points)

A
  • opioid antagonist which can be used after detox
  • reduces craving for alcohol
  • reduces feeling of intoxication
  • reduces continuation of drinking
34
Q

How much naltrexone is given? (2 points)

A
  • 50mg daily
  • initial dosage for Px at risk of ADRs are 12.5mg/day or 25mg/day for 1 week taken with food (2 weeks if necessary); then gradually increase to 50mg/day
35
Q

Why does naltrexone work with alcohol abstinence?

A

-alcohol facilitates the brain opioid systems

36
Q

What are the side effects and C/Is with naltrexone? (5 points)

A
  • nausea, headache, dizziness, fatigue, insomnia, anxiety, sleepiness
  • usually mild and short duration
  • can have toxic effects on liver so LFTs are performed before Tx
  • C/Ied in Px receiving opioid analgesics
  • SA required for Px in Tx programmes
37
Q

What is Audit C? (3 points)

A
  • screening tool to identify Px who are risky drinkers
  • enables health professionals to bring up the conversation without stigmatising and judging them
  • total of 5+ indicates increasing or higher risk drinking: auditC positive
38
Q

What are the questions in the shortened version of audit C? (3 points)

A
  • how often do you have a drink containing alcohol?
  • how many units of alcohol do you drink on a typical day when you are drinking
  • how often hae you had 6+ units if female, or 8+ if male, on a single occasion in the lats year?
39
Q

Once Px have been screened, what can we do? (5 points)

A
  • determine how harmful the drinking currently is
  • advise or refer
  • willingness to change (HCPs and patients)
  • teachable moments
  • appropriate environment
40
Q

What is the NNT for alcohol interventions?

A

-for every 7 interventions, 1 Px will reduce drinking to safer levels

41
Q

What brief advice can you give to Px? (5 points)

A
  • explain units/guidelines
  • give feedback (risk level)
  • offer info/advice
  • establish goals/strategies
  • empathy and encouragement
42
Q

What are some barriers to alcohol intervention in pharmacies? (5 points)

A
  • preventative health not my responsibility
  • screening/brief intervention are not the things i should be doing
  • don’t know who to refer to
  • Px won’t take my advice and change their drinking behaviour

Pharmacy 409 exam (7 decks)

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