Addiction - Alcohol

Question 1

What are some high risk occupations for alcoholism?

Answer 1

Itinerant workers, bartenders and professionals

Question 2

1 unit = how much alcohol?

Answer 2

10mls

Question 3

How can you calculate the number of units in an alcoholic drink?

Answer 3

(Percentage x volume) / 10

Question 4

What is the definition of high risk drinking?

Answer 4

Regularly consuming 35+ units of alcohol per week

Question 5

What is the definition of increased risk drinking?

Answer 5

Regularly consuming 15-35 units of alcohol per week

Question 6

Explain the drinking regulations for men and women?

Answer 6

Men and women should both not exceed 14 units per week, ideally spread over at least 3 days

Question 7

What is the definition of the harmful use of alcohol?

Answer 7

A pattern of use which is causing damage to health - this can be physical or mental

Question 8

What are the defining factors of alcohol dependence?

Answer 8

A strong desire to take the substance / difficulty controlling the use of the substance / physiological withdrawal state / tolerance / neglect of other pleasurable activities / persistence despite evidence of harm

Question 9

What is the most common tool used to screen for alcohol dependence in Scotland?

Answer 9

AUDIT

Question 10

What is the pro and con of using CAGE screening for alcohol use?

Answer 10

Good for detecting dependence but not good at detecting evidence of harm

Question 11

Describe the process of stopping alcohol if a person is mildly dependent?

Answer 11

It is mostly possible to stop, there may be a few withdrawal symptoms but they will be transient

Question 12

If a person is any more than mildly dependent on alcohol, what is the management for stopping and why?

Answer 12

Medication - to avoid severe withdrawal

Question 13

When would hospital admission for stopping alcohol be required?

Answer 13

If there are lots of medical co-morbidities or an SADQ test result of 30+

Question 14

What is the role of lab testing in alcohol misuse?

Answer 14

Not good for detecting alcohol related problems, but may play a role in monitoring response to therapy

Question 15

GGT is an indicator of what?

Answer 15

Liver injury

Question 16

Carbohydrate deficient transferrin is able to identify what?

Answer 16

Men drinking 5+ units per day for 2+ weeks

Question 17

Why is MCV a useful test in the investigation of alcoholism?

Answer 17

Alcohol is the most common cause of a raised MCV

Question 18

Who is the target audience for brief interventions related to alcohol?

Answer 18

Adults who have been identified by screening as drinking hazardous or harmful amounts of alcohol, and those attending NHS or NHS commissioned services

Question 19

How long should a brief intervention last? What should you ask them to consider?

Answer 19

5-15 minutes, ask them to consider alternative behaviours

Question 20

Brief interventions are very useful at decreasing alcohol consumption in who?

Answer 20

Adults who are not dependent

Question 21

When should you consider referring patients for specialist alcohol withdrawal treatment?

Answer 21

If they have moderate-severe dependence or a severe alcohol related impairment OR if they have failed to benefit from brief advice but want further help

Question 22

What is detoxification?

Answer 22

The process by which patients become alcohol free

Question 23

What is relapse prevention?

Answer 23

A combination of psychosocial and pharmacological interventions aimed at maintaining abstinence or problem free drinking following detoxification

Question 24

What type of neurotransmitter is a) NMDA-glutamate? and b) GABA?

Answer 24

a) excitatory b) inhibitory

Question 25

What effect does alcohol have on NMDA-glutamate controlled ion channels? Chronic use leads to what?

Answer 25

Inhibition / upregulation of receptors

Question 26

What effect does alcohol have on GABA controlled ion channels? Chronic use leads to what?

Answer 26

Stimulation / downregulation of receptors

Question 27

Overall, what effect does chronic alcohol use have on glutamate and GABA activity?

Answer 27

Excess glutamate activity and reduced GABA activity

Question 28

What is the effect of excess glutamate activity?

Answer 28

Nerve cell toxicity

Question 29

How long after stopping drinking do the first symptoms of alcohol withdrawal occur? When do they peak?

Answer 29

Within hours / 24-48 hours

Question 30

What are the main features of alcohol withdrawal?

Answer 30

Restlessness, tremor, sweating, anxiety, N+V, loss of appetite and insomnia

Question 31

What are some evident signs of alcohol withdrawal?

Answer 31

Tachycardia and systolic hypertension

Question 32

When can generalised seizures occur as a result of alcohol withdrawal?

Answer 32

The first 3-5 days

Question 33

What is delirium tremens? When can it start to occur following alcohol withdrawal? When does it peak?

Answer 33

An acute confusional state / 24 hours / 2 days

Question 34

In most people, symptoms of alcohol withdrawal resolve within how long?

Answer 34

5-7 days

Question 35

In what % of cases of alcohol withdrawal is DT seen? How does it present?

Answer 35

5% / Insidiously, with nighttime confusion

Question 36

What are some features of DT?

Answer 36

Confusion and disorientation, agitation, hallucinations and paranoia

Question 37

DT has a 2-5% mortality rate - what is this associated with?

Answer 37

CV collapse or infection

Question 38

How should DT be managed?

Answer 38

In a medical ward with IV fluids and antibiotics

Question 39

What are the 3 key factors in managing alcohol withdrawal?

Answer 39

General support, benzodiazepines and vitamin supplementation

Question 40

How do benzodiazepines work in alcohol withdrawal?

Answer 40

They are cross tolerant to the alcohol as they act on GABA-A receptors

Question 41

Which benzodiazepines could be used for alcohol withdrawal? Why are these used?

Answer 41

Diazepam or chlordiazepoxide / they are long-acting

Question 42

Benzodiazepines used for alcohol withdrawal should be reduced how?

Answer 42

Gradually over 7 days or more

Question 43

What vitamin supplementation must be given in alcohol withdrawal? How? Why?

Answer 43

Parenteral thiamine / prophylaxis against Wernicke's encephalopathy

Question 44

Why do people who drink alcohol need thiamine supplements?

Answer 44

They don't eat enough food containing it and also don't absorb it

Question 45

What are some psychosocial interventions that can be used for alcohol relapse prevention?

Answer 45

CBT, motivational enhancement therapy, 12 step facilitation therapy, behavioural training, couples/family therapy

Question 46

What is the first line pharmacological agent for relapse prevention? How does it work?

Answer 46

Naltrexone - opioid antagonist works to reduce the reward from alcohol

Question 47

How does acamprosate work?

Answer 47

Acts centrally on GABA and NMDA receptors to reduce cravings for alcohol

Question 48

When should acamprosate be started if you are going to use it? Should it be continued through a relapse?

Answer 48

Straight away after detoxification / yes

Question 49

What are some side effects of acamprosate?

Answer 49

Headache, diarrhoea and nausea

Question 50

How does disulfiram (antabuse) work?

Answer 50

Inhibits acetaldehyde dehydrogenase leading to an accumulation of acetaldehyde when alcohol is consumed, making the effects of drinking unpleasant

Question 51

If you are taking disulfiram and ingest alcohol, what kind of symptoms does this cause?

Answer 51

Flushing, tachycardia, N+V, arrhythmias