Alcohol and GI bleeds Flashcards
(46 cards)
What is the AUDIT questionnaire used for?
Assess the nature and severity of alcohol misuse.
What should be done if AUDIT suggests alcohol dependence?
Consider using the SADQ or LDQ questionnaire to assess the severity of the dependence.
What is the onset of alcohol withdrawal symptoms?
Typically start within 6-12 hours of the last drink and can last 3-7 days after cessation.
What are some mild-moderate symptoms of alcohol withdrawal?
Anxiety
Nausea and vomiting
Autonomic dysfunction - tremor, tachycardia, sweating, palpitations
Insomnia
What are some severe symptoms of alcohol withdrawal?
Delirium - medical emergency. Rapid onset and appears 48-72 hours after last drink. Can include confusion, hallucinatons, tremor, and features of clinical instability such as tachycardia, fever, ketoacidosis, and circulatory collapse. Can be treated with oral lorazepam, or parenteral lorazepam or haloperidol (both unlicensed) if necessary.
Seizures - occurs 12-24 hours after last drink. Generalised tonic-clinic seizures require urgent treatment.
How should advice about lowering alcohol consumption be approached?
FRAMES:
F eedback - on the person’s alcohol problems.
R esponsibility - their responsibility to change.
A dvice - explain the harm caused by the person’s level of drinking and offer reasons for changing their behavior such as health, well-being, and finances.
M enu - what are the options for change?
E mpathy - use a warm, reflective, and understanding approach.
S elf efficacy - be optimistic about their ability to change their own behaviour.
Give some examples of options for changing alcohol habits?
Identify and avoid high-risk situations for drinking.
Recognise personal cues for drinking such as stress and loneliness.
Try alternatives for managing these such as exercise, reading, meeting friends.
Alternate between alcoholic and non-alcoholic drinks.
Switch from higher to lower alcohol content drinks.
Keep a drinking diary.
Ask close contacts to hold you accountable.
What pyschological methods can be used for alcoholics which fail to improve initially?
A brief intervention of motivational interviews, therapy and addressing issues.
If this fails, a psychological intervention focused on alcohol-related cognitions, behaviour, issues, and social networks can be done. Also, suggest AA and information for families and carers.
What pharmacological therapy can be used for alcohol dependance?
Acomprosate calcium
What is the mechanism of acamprosate?
Anti-craving medication which acts as a GABA mimetic to antagonise the same NMDA-receptor system affected by chronic alcohol use.
How is acamprosate prescribed?
ASAP after assisted withdrawal and for up to 6 months, or longer if beneficial.
> 60kg: 666mgs tds (1998mg daily_
<60kg: 666mg od wth breakfast and 333mg at lunch and dinner (1332mg daily).
What monitoring is required with acamprosate?
Patient should be supervised for 6 months.
LFTs not required but can be used to monitor recovery of liver function and may aid motivation.
What are some side effects of acamprosate?
Abdominal pain and discomfort
Sexual dysfunction
Skin reactions
What medicines can be given to alleviate symptoms during assisted alcohol withdrawal?
A long-acting benzodiazepine such as chlordiazepoxide hydrochloride.
How is chlordiazepoxide dosed for alcohol withdrawal in primary care?
Fixed-dose regimen: Standard initial dose 10-50mg is determined by severity of alcohol dependance/ consumption and is weaned over 7-10 days.
How is chlordiazepoxide dosed for alcohol withdrawal in inpatient facilities?
Symptom-triggered approach: drug regimen tailored to severity of withdrawal and any complications as and when.
What are some side effects of chlordiazepxide hydrochloride?
Benzodiazepine:
Dizziness/hypotension
Drowsiness
Nausea
Respiratory depression
What are some symptoms of chlordiazepoxide overdose?
Ataxia
Dysarthria (difficulty speaking)
Nystagmus (involuntary rhythmic eye movements)
Respiratory depression
Coma
What can be given if a patient shows signs of chlordiazepoxide toxicity?
If awake and breathing well: oral activated charcoal within 1 hour.
If more severe: IV flumazenil
What paradoxical symptoms can occur in some patients taking benzodiazepines?
Hostility and aggression. Can be attenuated by adjusting dose up or down.
What is Wernicke’s encephalopathy?
A neurological condition caused by thiamine (B1) deficiency. It affects peripheral and central nervius system, resulting in opthalmoplegia (paralysis of eye muscles), ataxia (impaired balance and coordination), and confusion.
Who is at risk of Wernicke’s disease?
People with alcohol dependence who are malnourished or have decompensated liver disease.
What can be given to drinkers startring/in withdrawal at risk of Wernicke’s encephalopathy?
1 pair (15ml ampoule) of Pabrinex IM for 5 days into the gluteal muscle.
If possible, switch to oral prophylactic thiamine:
Mild deficiency: 25-100mg daily
Severe deficiency: 200-300mg daily
(usually 50mg tds)
For 6 weeks after successful withdrawal.
What can be given in a case of suspected/confirmed Wernicke’s encephalopathy?
2 pairs (2x15ml ampoules) of Pabrinex IM for 3 days into the gluteal muscle.
If possible, switch to oral prophylactic thiamine:
Mild deficiency: 25-100mg daily
Severe deficiency: 200-300mg daily
(usually 50mg tds)
For 6 weeks after successful withdrawal.
