Tutorial 3- Alcohol Misuse Flashcards
What are the 5 classes of alcohol drinkers
T-Total Occasional drinker Casual drinker Binge drinker Alcohol dependant
What are some symptoms of alcohol withdrawal
Physical- Tachycardic, clammy/sweaty, termor, seizures
Psychological- Irritability, low mood, cravings, delirium/hallucinations
What are some signs of alcohol dependence?
Daily drinking
Narrowing of their repertoire
Tolerance (don’t tend to get drunk like other drinkers)
What sort of things should you look out for when taking the history?
Involved with drinking/ heavy machinery
Trouble with the police- violence/drink driving
Crept up through the years, exacerbated by incidence
Salience- working their day around alcohol
What are some good questions to ask during a history?
Have you ever though about giving up?
What happend when you gave up?
Calculate how many units they roughly drink a day (%x volume in litres)
CAGE questionaire (good for OSCE)
C- cut down, ever thought about it
A- annoyed when other criticise
G- guilty about drinking
E- eye opener (drinking in the morning)
What health problems can alcoholics develop?
Liver damage
Varices
Traumatic injuries (typically head injuries)
Impaired cognitive function due to thiamine deficiency
What are the two cognitive diseases that alcoholics can develop
Wernicke’s- acute cognitive impairment, typically presents with confusion and ataxia.
Korsakoffs- Chronic, develops from wernicke’s, confabulation (making up stories), caused by damage to mammilary bodies
How do you treat Wernicke’s?
How do you treat Korsakoffs?
Wernicke’s- Pabronecs (strong vit B vitamins plus others)
Once stable, thiamine for 3-6 months
Korsakoff’s- not readily reversible, start thiamine and try get off of alcohol
How can you get a patient to cut down their drinking?
AA
Motivatoinal interviewing,
Motivational family/couples therapy
Cognitive based therapy
Want to get the drinking to a constant level and then slowly reduce e.g. by 1 unit per day
Alternatively can do a patient detox where they come into hospital
Various drugs that can be given
What pharmacological treatments are available for alcohol withdrawal?
Diazepam/Cordiazapoxide- acts on GABA receptors to reduce cravings. Start on high dose and titrate down.
Acamprosate- stabilises brain chemistry and eases cravings
Disulfiram- inhibits acetaldehyde dehydrogenase so alcohol cant be broken down leading to patients vomiting
Nalfemene/Naltrexone- reduces feel good factor that drinking produces
How do you stop someone smoking?
Motivational interviewing Nicotine patches Nicorette sprays- preferable Nicotine vapes Champix- reduces cravings and pleasurable aspect of smoking
Why do people inject heroin?
What are the withdrawal symptoms of heroin?
First start smoking and then develop tolerance.
irritability, flu like symptoms, diarrhoea, piloerection
What are the risks of injecting heroin?
Blood born viruses (sharing needles/spoons)
Lemon juice can lead to endocarditis due to it inducing candida endophthamitis
Cellulitis at injection sites or abscess,
Emboli develop from knackered veins leading to DVT
What pharmacological options are there to help someone get off of heroin?
Methadone- opiate substitute, doesn’t give pleasurable effects but stops withdrawal as acts on opiate receptors in brain and is available in liquid form.
Noloxone (narcan)- reverses high immediately. Patients are very angry upon waking.
Suboxone- Buprenorphine/naloxone. Tablet, Cant get high on it, good for withdrawals.
What are the negative affects of using marijuana
around 50% of people in adult psychiatry use it.
Can develop marijuana lung,
under 18’s who use it more likely to develop schizophrenia, psychosis.
THC more likely to induce psychosis
