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Alcohol Flashcards

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1
Q

What are the effects of alcohol at low doses?

A

1 - Euphoria

2 - Reduced anxiety

3 - Relaxation

4 - Sociability

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2
Q

What are the effects of alcohol at high doses?

A

1 - Impaired attention and judgement

2 - Unsteadiness

3 - Flushing

4 - Nystagmus

5 - Mood instability

6 - Disinhibition

7 - Slurring

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3
Q

What are signs of alcohol dependence?

A

1 - Increased tolerance

2 - Physiological withdrawal

3 - Neglecting other interests

4 - Difficulty controlling use

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4
Q

How is ‘harmful use’ of alcohol diagnosed?

A
  • A pattern of use causing damage to physical or mental health
  • Used alcohol > 1 month or repeatedly over 12 months
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5
Q

How is alcohol dependence diagnosed?

A

3 or more of the following for > 1 month or repeatedly over 12 months:

  • Cravings/compulsions to drink
  • Difficulty controlling use
  • Primacy (drinking before eating)
  • Increased tolerance
  • Physiological withdrawal on reduction/cessation
  • Peristent drinking despite harmful consequences
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6
Q

What is a withdrawal state relating to alcohol?

A

1 - Group of symptoms of variable clustering and severity caused by complete/relative withdrawal of a psychoactive substance

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7
Q

Which neurochemical is released when alcohol is consumed?

A

Opiate

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8
Q

What neurochemicals increase in volume during alcohol consumption?

A

GABA A

Glycine

Adenosine

Opioids

Endocannabinoids

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9
Q

What neurochemicals decrease in volume during alcohol consumption?

A

NMDA glutamate

Aspartate

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10
Q

What are the symptoms of an alcohol withdrawal state?

A

1 - Tremor

2 - Weakness

3 - Nausea

4 - Vomiting

5 - Anxiety

6 - Seizures

7 - Confusion

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11
Q

What is delirium tremens and what is it associated with?

A

Associated with alcohol withdrawal state

Symptoms of delirium tremens:

  • Profound confusion
  • Tremor
  • Agitation
  • Hallucinations
  • Delusions
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12
Q

How long after stopping alcohol does delirium tremens usually start?

A
  • Occurs 48-72 hours after alcohol stopped
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13
Q

What are the 4 L’s usually associated with alcohol problems?

A

1 - Liver

2 - Livelihood

3 - Lover

4 - Law

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14
Q

What are the mental health problems associated with alcohol abuse?

A
  • Anxiety
  • Depression
  • Sleep disruption
  • Morbid jealousy
  • Alcoholic hallucinosis
  • Deliberate self-injury
  • Suicidal thoughts
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15
Q

What are the physical health problems associated with alcohol abuse?

A
  • Brain damage
  • Poor control of diabetes
  • Loss of muscle
  • Chest infections
  • High blood pressure
  • Liver cirrhosis
  • Hepatitis
  • Pancreatitis
  • Trembling hands
  • Impotence
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16
Q

How does a moderate drinkers brain compare with an alcoholics brain?

A
  • Cerebral atrophy
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17
Q

What are the symptoms of wernicke’s encephalopathy?

A

1 - Confusion

2 - Ataxia

3 - Opthalmoplegia

4 - Nystagmus

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18
Q

What are the symptoms of korsakoff’s psychosis?

A

1 - Prominent impairment of recent and remote memory

2 - Immediate recall preserved

3 - Impaired learning and disorientation

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19
Q

What is the cause of both wernicke’s encephalopathy and korsakoff’s psychosis?

A

Thiamine (Vitamin B1) deficiency caused by:

  • Poor intake and absorption
  • Poor hepatic function
  • Increased requirement for alcohol metabolism
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20
Q

What effects can alcohol have on relationships?

A

1 - Verbal & physical aggression

2 - Marital difficulties (morbid jealousy)

3 - Poor parenting

4 - Loss of friendships and social supports

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21
Q

What are the screening tools that can be used to assess alcohol problems?

A

CAGE

AUDIT

FAST

PAT

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22
Q

What is the CAGE screening tool and how is it used?

A

Cut down (Have you tried?)

Annoyed (by people criticising your drinking?)

Guilty (about your drinking?)

Eye-opener (ever needed one?)

Answering Yes to 2 or more of the above questions = likely alcohol problem

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23
Q

What is the most appropriate treatment to commence in an inpatient who is at risk of alcohol withdrawal?

A

Chlordiazepoxide

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24
Q

How is wernicke-korsakoff syndrome prevented?

A

Give Thiamine

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25
What medications are given to manage alcohol withdrawal?
1 - Benzodiazepines (Chlordiazepoxide)
26
What is the commonly used drug to help deter alcoholics from using alcohol?
**Disulfiram** - produces an acute sensitivity reaction to alcohol
27
What are some common anti-craving medications?
1 - Acamprosate 2 - Naltrexone 3 - Nalmefene
28
What is the UK government low risk alcohol consumption guidance (2016)?
Men & woman should not regulalrly exceed **14 units/week** **14 units =** - 6 pints of beer (4% ABV) - 6 glasses of wine (13% ABV) - 14 shots of spirits
29
How do you calculate the number of units of alcohol in your drink?
Units = ABV x volume of drink/1000
30
What is the best way to tell if your patient is drinking above the low risk guidelines?
Use the screening tools (CAGE, FAST, Paddington etc.)
31
When should patients be screened for their alcohol consumption levels?
1 - New patient registration 2 - As part of condition management
32
What should be done if your patient is drinking more than the low risk guidance?
1 - Explain they have a chance to reduce their risk of health harm 2 - If alcohol dependence likely = refer to treatment services 3 - Assess how willing they are to change
33
What are the societal vulnerability factors that can affect someones likelyhood of drinking excessively?
1 - Alcohol pricing, availability & regulation 2 - Drinking context 3 - Socio-economic status 4 - Culture
34
What are the individual vulnerability factors that can lead someone to exceeding the minimum alcohol guidelines?
1 - Mental health 2 - Homelessness 3 - Gender 4 - Age
35
What is the licensing act which regulates the sale of alcohol?
Licensing Act 2005
36
During which times of the week and where do common and serious assaults mostly occur?
- During weekend - In city centre
37
What happens to your risk of commiting or becoming the victim of a crime when intoxicated with alcohol?
Increased
38
What are the top 5 causes of hospital admissions due to alcohol?
1 - Unintentional injuries 2 - Mental ill health & benahioural disorders 3 - Heart conditions & strokes 4 - Liver disease & pancreatitis 5 - Cancer
39
How is alcohol processed by the body?
In the liver
40
What are the functions of the liver?
1 - Carbohydrate metabolism 2 - Fat metabolism 3 - Protein metabolism 4 - Storage of glucose, iron, copper, vitamins 5 - Production of fibrinogen & thrombopeitin 6 - Kupffer cells - collect bacteria and old cells 7 - Bile production (breaksdown fat in small intestine) 8 - Metabolism of drugs and alcohol
41
Once alcohol arrives at the liver, what does it turn into?
1 - Alcohol 2 - Acetyaldehyde 3 - Acetate
42
What enzymes does the liver use to process alcohol?
**ADH** - Alcohol dehydrogenase **ALDH** - Acetyldehydrogenase
43
Which component of the alcohol breakdown process is a harmful **carcinogen**?
Acetaldehyde
44
Which cells of the liver are activated to produce cytokines & oxidants?
Kupffer cells
45
Which cells of the liver are **activated** and **injured** by cytokines and oxidants?
Stellate cells - **activated** Hepatocytes - **injured**
46
Activation of stellate cells results in what?
Fibrosis of liver
47
Which cofactors lead to a fatty liver due to chronic ethanol consumption?
NAD+ NADH
48
What are the causes of Liver Cirrhosis?
1 - Alcohol related liver disease (majority) 2 - Fatty liver disease 3 - Hepatitis C 4 - Autoimmune dieases
49
What is the disease progression of alcohol related liver disease?
1 - Normal liver 2 - Fatty liver (steatosis) 3 - Steatohepatitis 4 - Fibrosis 5 - Liver cirrhosis
50
What is the pathophysiology of fatty liver disease?
1 - Alcohol ingestion 2 - Acetaldehyde produced by liver 3 - Acetate produced from acetaldehyde 4 - Defects in fatty acid metabolism lead to build up of lipids in liver
51
What effect does abstaining from alcohol have on fatty liver disease?
Fatty liver disease is reversed and liver returns to normal
52
What are the indicators of chronic alcohol use?
1 - Elevated Gamma GT (Liver enzyme) 2 - Macrocytosis (large red blood cells) 3 - Low platelets 4 - Elevated Ferritin 5 - Enlarged smooth edged liver on AUSS
53
Which larger vein is the central vein a branch of?
Hepatic vein
54
Which larger vein is the interlobular vein a branch of?
Portal vein
55
What are the structures that make up the portal triad?
Interlobular: - **V**ein - **A**rtery - **B**ile duct
56
What is alcoholic hepatitis?
Fatty change within the liver
57
What are the features of alcoholic hepatitis?
1 - Infiltration with leucocytes 2 - Hepatic necrosis 3 - Hepatomegaly 4 - Jaundice 5 - Abdo pain 6 - Fever 7 - Hepatic decompensation
58
What system is used to score the severity of alcoholic hepatitis?
Glasgow alcoholic hepatitis score
59
What are the components of the Glasgow alcoholic hepatitis score?
Age WBC Urea Bilirubin PT (Prothrombin time)
60
What is the cut-off score used to decide whether a patient with alcoholic hepatitis has a good or poor chance of survival?
**9** GAHS \< 9 = 87% survival rate GAHS \> 9 = 46% survival rate
61
How are patients with alcoholic hepatitis managed?
1 - Steroids 2 - Management of infection & nutrition 3 - Abstinence
62
What are the features of Liver Fibrosis & Cirrhosis?
1 - Chronic Inflammation 2 - Activation of Stellate cells 3 - Collagen production between veins/tracts 4 - Loss of lobule structure
63
What type of lobules are associated with Liver Cirrhosis?
Pan lobular - Pseudo lobules
64
What are the complications of Liver Cirrhosis?
1 - Variceal Haemorrhage 2 - Encephalopathy 3 - Ascites 4 - Hepatocellular Carcinoma
65
What effect does alcohol abstinence have on Liver Cirrhosis?
5 year survival if **abstinent** = **65%** 5 year survival if **ongoing alcohol consumption** = **35%**

Psychiatry (18 decks)

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