Alcohol Use Disorder Flashcards
(30 cards)
Define: Delirium Tremens (DTs)
disturbances in attention, awareness, memory, orientation, language, and hallucinations along with tremors or even seizures
When would you expect your patient to experience delirium tremens (DTs)?
-2-4 days after last drink
-developes abruptly and ends abruptly
-can occur several days later
Define: Wernicke-Korsakoff Syndrome
vitamin B1 (thiamine) deficiency caused by long-term alcohol use
What are the symptoms of wernicke-korsakoff syndrome?
confusion. ataxia (trouble walking), eye muscle weakness or paralysis, hypothermia
What are the goals of treatment for alcohol withdrawal?
-prevent and treat withdraw symptoms and severe complications
-correct electrolyte imbalances
-promote long-term abstinence
-encourage treatment of alcohol-dependence
What can be use to assess a patient in alcohol withdraw?
CIWA
Describe: CIWA
symptom monitoring protocol and allows for intermittent symptom-triggered use of withdrawal medications (not valid in ICU pt)
What is the first line treatment for alcohol withdraw?
benzodiazepines
What is the mechanism of action of benzodiazepines?
GABA agonist, same MOA as alcohol
How can benzodiazepines be given to the patient?
-symptom triggered using CIWA (preferred)
-scheduled dosing (may be helpful for pt that have history of seizures)
either way they must be tapered
What does the CIWA score determine for the patients treatment?
-dose of benzodiazepines
-frequency of future assessments
What are the adverse effects of benzodiazepines?
dizziness, sedation, hypotension, respiratory depression, delirium
What is the preferred benzodiazepine to treat alcohol withdrawal and why?
lorazepam because it can be used in liver dysfunction
What is the mechanism of action of phenobarbital?
increases GABA activity, same MOA as alcohol
What drugs can only be used in ICU settings for alcohol withdrawal?
propofol(only for patients requiring mechanical ventilation) and dexmedetomidine
What is the use of Gabapentin in alcohol withdrawal?
increases GABA activity, could provide a bridge from withdrawal -> maintenance (mostly recommended outpatient)
What is the use of clonidine in alcohol withdrawal?
controls BP, HR, tremor, and sweating
What is the use of antipsychotic agents in alcohol withdrawal?
controls severe agitation and delirium
What are common electrolyte abnormalities due to alcohol use disorder?
-hypokalemia (low K+)
-hypophosphatemia (low PO4-)
-hypomagnesemia (low Mg+)
How can supplemental Thiamine (vitamin B1) be dosed for a patient?
-preventative dose for Wernicke-Korsikoff (100mg/day for 3-5days)
-treatment dose for Wernicke-Korsikoff(500mg TID)
What are the goals of treatment for alcohol use disorder(AUD)?
-appropriately manage acute withdrawal
-successfully initiate maintenance treatment
-sustain/prolong abstinence
-alleviate stigma
What is the first-line therapy for treatment of alcohol use disorder (AUD)?
acamprosate or naltrexone
What is the mechanism of action of acamprosate?
increases GABA, decrease glutamate
How does acamprosate treat AUD?
reduces cravings and prevents delayed withdrawal symptoms
