Alcohol dependence

Question 1

In severely dependent patients who have been drinking excessively for a prolonged period of time, what might an abrupt reduction in alcohol intake case?

Answer 1

1) Development of an alcohol withdrawal syndrome

2) In the absence of medical management|: Can lead to seizures, delirium tremens, and death

Question 2

which patients might be considered for assisted alcohol withdrawal?

Answer 2

1) assistance not usually needed in mild alcohol dependence
2) moderate- treated in community setting patient is at high risk of developing alcohol withdrawal seizures or delirium tremens
3) Severe dependence should undergo withdrawal in an inpatient setting.

Question 3

which benzodiazepines aren recommended to attenuate alcohol withdrawal symptoms? (2)

Answer 3

A long-acting benzodiazepine, such as chlordiazepoxide or diazepam

Question 4

In primary care, fixed-dose reducing regimens are used to assist with alcohol withdrawal. what is a fixed dose regimen?

Answer 4

This involves using a standard, initial dose (determined by the severity of dependence or level of alcohol consumption), followed by dose reduction to zero, usually over 7–10 days

Question 5

In inpatient or residential settings, a fixed-dose regimen or a symptom-triggered regimen can be used. What is a symptoms-triggered regimen?

Answer 5

1) Involves tailoring the drug regimen according to the severity of withdrawal and any complications in an individual patient
↳Adequate monitoring facilities should be available

Question 6

Apart from benzodiazepines, which other drugs can be used to Assist alcohol withdrawal?

Answer 6

1) Carbamazepine

2) Clomethiazole is an alternative to benzodiazepines

Question 7

Clomethiazole should only be used in an inpatient setting. Explain who this drug should no be prescribed for and why

Answer 7

1) not be prescribed if the patient is liable to continue drinking alcohol.
2) Alcohol combined with clomethiazole, particularly in patients with cirrhosis, can lead to fatal respiratory depression even with short-term use

Question 8

1) When managing withdrawal from co-existing benzodiazepine and alcohol dependence, the dose of benzodiazepine used for withdrawal should be increased. How should the dose be calculated?
2) is it better to use a single benzodiazepine or multiple?

Answer 8

1) based on the requirements for alcohol withdrawal plus the equivalent regularly used daily dose of benzodiazepine
2) A single benzodiazepine (chlordiazepoxide or diazepam) should be used rather than multiple benzodiazepines

Question 9

How long should inpatient withdrawal regimens last for compared to community regimens when treating co-existing benzodiazepine and alcohol dependence?

Answer 9

Inpatient withdrawal regimens should last for 2–3 weeks or longer, depending on the severity of benzodiazepine dependence.

Question 10

When withdrawal is managed in the community, or where there is a high level of benzodiazepine dependence what is the minimum period that withdrawal a withdrawal regimen should last for?

Answer 10

regimen should last for a minimum of 3 weeks

Question 11

If alcohol withdrawal seizures occur what drug should be considered?

Answer 11

1) A fast-acting benzodiazepine e.g. lorazepam to reduce the likelihood of further seizures.
2) If seizures develop during treatment for alcohol withdrawal, review the drug regimen

Question 12

Delirium tremens is a medical emergency that requires specialist inpatient care. What are the characteristic symptoms of this condition?

Answer 12

1) Agitation,
2) Confusion,
3) Paranoia
4) visual and auditory hallucinations

Question 13

what is first line treatment for delirium tremens?

Answer 13

1) lorazepam should be used as first-line treatment

2) if symptoms persist or oral unsuitable, parenteral lorazepam or haloperidol can be given as adjunctive therapy

Question 14

In harmful drinkers or patients with mild alcohol dependence what therapy should be offered initially for alcohol dependence?

Answer 14

A psychological intervention e.g. cognitive behavioural therapy

Question 15

In those who have not responded to psychologcal interventions, which drugs are recommended for relapse prevention, to start after assisted withdrawal?

Answer 15

1) Acamprosate or oral naltrexone hydrochloride can be used in combination with a psychological intervention
2) Disulfiram is an alternative if above are unsuitable

Question 16

Nalmefene is recommended for the reduction of alcohol consumption in which patients?

Answer 16

in patients with alcohol dependence who have a high drinking risk level, without physical withdrawal symptoms, and who do not require immediate detoxification

Question 17

Patients with severe alcohol-related hepatitis can be given corticosteroids if they have a discriminant fraction of what?

(Discriminant function- used to eveluate the severity and prognosis in alcoholic hepatitis and evaluates the efficacy of using alcoholic hepatitis steroid treatment)

Answer 17

Discriminant function of 32 or more- only after any active infection or GI bleeding is treated, any renal impairment is controlled

Question 18

Has corticosteroid treatment been shown to improve survival in patients with severe alcohol-related hepatitis?

Answer 18

1) Been shown to improve survival in the short term (1m)

2) not over a longer term (3 months to 1 year)- due to risk of serious infections

Question 19

Patients with chronic alcohol-related pancreatitis should be offered what treatment?

Answer 19

1) Nutritional support
2) For steatorrhoea or those who have poor nutritional status due to Exocrine pancreatic insufficiency prescribe pancreatic enzyme supplements

Question 20

Patients with alcohol dependence are at risk of developing Wernicke’s encephalopathy. Which patients are especially at high risk of this condition?

Answer 20

Those who are malnourished, at risk of malnourishment, or have decompensated liver disease

Question 21

what treatment should be given to those with suspected suspected Wernicke’s encephalopathy, those at risk of malnourishment, or those that have decompensated liver disease?

Answer 21

1) Parenteral thiamine, followed by oral thiamine

2) Prophylactic oral thiamine also given to dependent drinkers or those in acute /assisted withdrawal