Alcohol Misuse Disorders

Question 1

what screening tool is used to assess for alcohol dependence?

Answer 1

CAGE

Question 2

what screening tool is used to assess for harmful and hazardous drinking?

Answer 2

AUDIT

Question 3

what management is indicated by each result of the AUDIT test?

Answer 3

0-7 = none 
8-19 = brief intervention 
20+ = specialist referral

Question 4

what alcohol screening tool can be done in A+E?

Answer 4

FAST

Question 5

how do you calculate units of alcohol?

Answer 5

strength x volume/1000

Question 6

what seven types of cancer are associated with alcohol?

Answer 6

mouth/throat 
larynx 
oesophagus
breast 
liver 
bowel

Question 7

what is hazardous drinking?

Answer 7

a pattern of alcohol consumption that increases someones risk of harm

over the recommended limit

Question 8

what amount of alcohol consumption is considered harmful drinking?

Answer 8

regular consumption of >35 units in a week

Question 9

what acronym represents the elements of a brief intervention?

Answer 9

FRAMES

Question 10

what does FRAMES stand for?

Answer 10

feedback 
responsibility 
advice 
menu 
empathy 
self efficacy

Question 11

what does the feedback section of the FRAMES model involve?

Answer 11

reviewing the problems experienced because of alcohol

Question 12

what does the responsibility section of the FRAMES model involve?

Answer 12

explaining that the patient is responsible for change

Question 13

what does the advice section of the FRAMES model involve?

Answer 13

advise reduction or abstinence

Question 14

what does the menu section of the FRAMES model involve?

Answer 14

providing options for changing behaviour

Question 15

what does the empathy section of the FRAMES model involve?

Answer 15

use an empathic approach

Question 16

what does the self efficacy section of the FRAMES model involve?

Answer 16

encourage optimism about changing behaviour

Question 17

what is the general pathophysiology behind alcohol withdrawal?

Answer 17

chronic CNS depression from alcohol results in increased CNS excitation

this is unopposed when alcohol is removed

Question 18

when do the symptoms of alcohol withdrawal syndrome begin?

Answer 18

within hours

peak at 24-48 hours

Question 19

what are the symptoms of alcohol withdrawal syndrome?

Answer 19

restlessness
tremor
sweating 
anxiety 
N+V
loss of appetite 
insomnia

Question 20

what serious symptom can occur in the first 24 hours of alcohol withdrawal syndrome?

Answer 20

generalised seizures

Question 21

what medical emergency can alcohol withdrawal syndrome progress to?

Answer 21

delirium tremens

Question 22

how long does it usually take for the symptoms of alcohol withdrawal syndrome to resolve?

Answer 22

5-7 days

Question 23

when is the peak onset of delirium tremens?

Answer 23

within 2 days of abstinence

Question 24

how does delirium tremens often present?

Answer 24

insidiously, with night time confusion

Question 25

what are the symptoms of delirium tremens?

Answer 25

``` confusion agitation hypertension hallucinations paranoid ideation ```

Question 26

how can delirium tremens result in death?

Answer 26

CV collapse | infection

Question 27

what medication can be given to manage alcohol withdrawal syndrome?

Answer 27

benzodiazepines

Question 28

what benzodiazepines should be used for alcohol withdrawal syndrome?

Answer 28

long acting agents diazepam, chloriazepoxide

Question 29

why is thiamine given in alcohol withdrawal syndrome?

Answer 29

as prophylaxis against Wernicke's encephalopathy

Question 30

why is thiamine given in alcohol withdrawal syndrome?

Answer 30

as prophylaxis against Wernicke's encephalopathy

Question 31

what are the possible psychosocial interventions for relapse prevention?

Answer 31

``` CBT MET 12 step behavioural self control family/couple therapy ```

Question 32

what three medications can be used to prevent alcohol relapses?

Answer 32

disulfiram acamprosate naltrexone

Question 33

what is another name for disulfiram?

Answer 33

Antabuse

Question 34

how does disulfiram work?

Answer 34

inhibits acetaldehyde dehydrogenase leading to accumulation of acetylhyde if alcohol consumed causes unpleasant side effects

Question 35

what are the side effects of taking disulfiram and consuming alcohol?

Answer 35

``` flushing tachycardia N+V arrhythmia hypotension ```

Question 36

what is one negative to using disulfiram?

Answer 36

relies on the patients compliance

Question 37

how does acamprosate work?

Answer 37

acts centrally on glutamate and GABA systems reduces cravings

Question 38

when should acamprosate be started?

Answer 38

as soon as the detox is complete

Question 39

what are the possible side effects of acamprosate?

Answer 39

headache diarrhoea nausea

Question 40

what should acamprosate be prescribed alongside?

Answer 40

psychological intervention

Question 41

what is the first line drug for alcohol relapse prevention?

Answer 41

naltrexone

Question 42

what type of drug is naltrexone?

Answer 42

opioid antagonist

Question 43

how does naltrexone prevent a relapse?

Answer 43

reduces the reward a patient experiences from alcohol