alcohol Flashcards
(22 cards)
outline the stages of change cycle
- pre-contemplation
- contemplation
- preparation/determination
- action
- maintence
- +/- relapse at any time
describe the behaviour change wheel
- 3 categories: sources of behaviour (COM-B), intervention function + policy categories
- used to help clinicians identify + address barriers to bahviour change in patients + to develop public health interventions
What is the weekly alcohol limit?
What is the limit for binge drinking?
- weekly: 14 units a week spread across 3 days
- binge: 6 units for women |8 units for men
What is harmful/high risk drinking?
A pattern of alcohol consumption causing health problems directly related to alcohol e.g. depression, pancreatitis, cirrhosis
What is the CAGE questionnaire?
- Have you ever felt you need to Cut down your drinking?
- Have people Annoyed you by critiquing your drinking?
- Have you ever felt Guilty about drinking?
- Have you ever felt you need a drink first thing in the morning (Eye opener) to steady your nerves or to get over a hangover?
. - if score is >/= 2, further exploration is needed > AUDIT or SADQ
What CAGE score prompts further exploration?
What could this include?
- score >/= 2
- AUDIT: alcohol use disorders identification test
- SADQ: severity of alcohol dependence
What supplements may alcoholic be prescribed and why?
Thiamine + other vitamin B
- risk of Wernicke’s Korsakoff syndrome
- risk of low vit B levels
Alcohol withdrawal symptoms
- anxiety
- feeling low or depressed
- shakiness/trembling
- irritability
- fatigue
- sweating
- delirium tremens at 48-72 hours
What is delirium tremens?
Presentation
- medical emergency associated with alcohol withdrawal
- confusion
- severe agitation
- delusions
- visual halluciantions
- coarse tremor
- tachycardia, hypertension + hyperthermia
How does delirium tremens happen?
- Long term alcohol use results in GABA system becoming down regulated + glutamate system becomes up regulated
- and inhibition of NMDA type glutamate receptors
- when alcohol is removed, GABA under functions + glutamate over functions > excitability + adrenergic activity
Pharmacological management of alcohol withdrawal
- first line: Oral Chlordiazepoxide/diazepam - long acting benzodiazepine
- in hepatic failure: lorazepam
- high dose B vitamins IM/IV then long term oral thiamine
Long term management of alcohol dependence
- turning point
- alcohol detoxification programme
- oral thiamine
- CBT
- inform DVLA
- disulfiram, acamprosate or naltrexone
How to calculate units in a drink
(Multiple millilitres by the ABV) divide by 1000
Outline alcohol metabolism
- alcohol > acetaldehyde by alcohol dehydrogenase
- acetaldehyde > acetate by aldehyde dehydrogenase
What causes hangover feeling?
Accumulation of acetaldehyde
Describe disulfiram use in alcohol dependence
- inhibits aldehyde dehydrogenase
- prevents breakdown of toxic acetaldehyde into acetate
- causes accumulation of acetaldehyde
- causes hangover symptoms: N+V, flushing, palpitations, hypotension
Advice to patients on disulfiram
- All amounts of alcohol can cause hangover symptoms - in perfume, foods, mouthwashes
- no alcohol 48 hours before starting
Contraindications of disulfiram
Ischaemic heart disease
Psychosis
Describe acamprosate in alcohol dependence management
Weak antagonists of NMDA receptors
Reduces cravings
Outline Wenicke’s Korsakoff syndrome
- alcohol excess > thiamine deficiency > Wernicke’s encephalopathy + Korsakoff syndrome
- Wernicke’s encephalopathy: an acute neurological emergency
- Korsakoff syndrome: chronic memory disorder
Features of wernicke’s encephalopathy
- nystagmus
- ophthalmoplegia
- gait ataxis
- confusion, disorientation
- peripheral sensory neuropathy
Features of Korsakoff syndrome
- anterograde amnesia - inability to make new memories
- retrograde amnesia
- confabulation - fabrication of false memories
