Alcohol use disorder

Question 1

Substance Abuse

Answer 1

Acronym: WILD
Work, school, home obligation failure
Interpersonal or social consequences
Legal problems
Dangerous use

Question 2

Substance Dependence

Answer 2

tolerance
withdrawal
increased use more than originally intended
persistent desire or unsuccessful attempts to cut down
significant time spent on obtaining, using, or recovering from the substance
decreased social, work, recreational activities
continued use despite physical and psychological consequences

Question 3

What are the most commonly used substances?

Answer 3

Alcohol and Nicotine

Question 4

How do you differentiate whether mood symptoms are primary or substance induced?

Answer 4

If symptoms improve with abstinence then mood is substance induced. If symptoms persist then mood disorder is primary.

Question 5

What is the leading cause of mental retardation in the US?

Answer 5

Fetal Alcohol syndrome

Question 6

Asian people often have a gene variant that affects alcohol use by……

Answer 6

often have less aldehyde dehydrogenase which then leads to flushing, headache, nausea/vomiting with alcohol use.

*serves as a protective factor against alcohol dependence

Question 7

What is the most common co-ingestant in drug overdoses?

Answer 7

Alcohol

Question 8

Most adults will show some signs of intoxication with BAL of:…….

Answer 8

> 100

Obvious signs of intoxication with BAL >150

Question 9

Causes of metabolic acidosis with increased anion gap to consider….

Answer 9

Ethanol
Methanol
Ethylene glycol

Question 10

What should a patient with alcohol intoxication, especially if chronic drinker, be supplemented with?

Answer 10

Thiamine (B1) and Folate

Question 11

If alcohol intoxication also involves co-ingested opioids, this may be necessary to administer

Answer 11

Naloxone

Question 12

What is more likely in a home with a ale who has a substance use disorder, especially alcoholism?

Answer 12

Spousal Abuse

Question 13

What BAL is likely to induce coma in a novice drinker?

Answer 13

300 mg/dL

Question 14

What BAL can cause respiratory depression and possibly death?

Answer 14

400 mg/dL

Question 15

What is the most commonly abused substance in the U.S.?

Answer 15

Alcohol

Question 16

Attempted suicide is associated commonly with these three factors:

Answer 16

psychiatric illness
young female
alcoholism

Question 17

Withdrawal from which two substances can be deadly?

Answer 17

Alcohol and Barbiturates

Question 18

When do earliest symptoms of EtOH withdrawal begin?

Answer 18

6-24 hours after last drink

Can last 2-7 days

Question 19

Mild Alcohol Withdrawal Symptoms:

Answer 19

irritability
tremor
insomnia

Question 20

Moderate Alcohol Withdrawal Symptoms:

Answer 20

Diaphoresis
HTN
Tachycardia
Fever 
Disorientation

Question 21

Severe Alcohol Withdrawal Symptoms

Answer 21

Tonic Clonic Seizures
Delirium Tremens
Hallucinations

Question 22

When do generalized tonic-clonic seizures occur in alcohol withdrawal?

Answer 22

6-48 hours after cessation of drinking

peak around 13-24 hours

Question 23

about 1/3 of patients with seizures in EtOH withdrawal will develop….

Answer 23

delirium tremens (DTs)

Question 24

What can predispose to seizures in EtOH withdrawal?

Answer 24

hypomagenesemia

Question 25

How are seizures in EtOH withdrawal treated?

Answer 25

Benzodiazepines Long-term treatment with anticonvulsants is not recommended for withdrawal

Question 26

most serious form of EtOH withdrawal....

Answer 26

DTs

Question 27

Timeline for DTs

Answer 27

Usually begins 48-72 hours after alcohol cessations 90% happen within first 7 days

Question 28

What condition predisposes to DTs?

Answer 28

Physical Illness | **Remember 1/3 of seizures in alcohol withdrawal will develop DTs

Question 29

Symptoms of DTs

Answer 29

``` Delirium Hallucinations (most commonly visual) Gross Tremor Autonomic Instability Fluctuating levels of psychomotor activity ```

Question 30

What is the drug of choice for treatment of EtOH with drawal

Answer 30

Chlordiazepoxide (librium) Other benzodiazepines used: Diazepam and Lorazepam

Question 31

How do you monitor withdrawal?

Answer 31

CIWA-A Scales Q4Hrs

Question 32

Signs of hepatic failure:

Answer 32

Ascites Jaundice Caput Medusae Coagulopathy

Question 33

Confabulations

Answer 33

memories of events that never occurred Patients are unaware that they are making these up

Question 34

If alcoholic starts to have confabulations what condition should you be worried about?

Answer 34

Korsakoff Syndrome (psychosis)

Question 35

Heavy drinking for men =

Answer 35

.4 drinks/day or >14/week

Question 36

Heavy drinking for women =

Answer 36

>3 drinks/day or >7/week

Question 37

What labs suggest excessive alcohol use?

Answer 37

``` AST:ALT ratio > 2:1 Increased GGT (GGT reflects recent alcohol use last 3-7 days) ```

Question 38

Alcohol can cause what type of anemia?

Answer 38

Macrocytic Anemia (increased MCV)

Question 39

What medication can be used to treat EtOH dependence?

Answer 39

Disulfiram

Question 40

Disulfiram mechanism of action?

Answer 40

``` inhibits aldehyde dehydrogenase causes adverse reaction to alcohol: flushing headache N/V palpitations SOB ```

Question 41

Contraindications for Disulfiram?

Answer 41

severe heart disease pregnancy psychosis

Question 42

what medication would you consider in an alcoholic with family history of alcoholism?

Answer 42

Naltrexone

Question 43

Naltrexone mechanism of action

Answer 43

Opioid receptor blocker | decrease desire/craving and "high" associated with alcohol

Question 44

How would naltrexone affect a person with opioid dependence?

Answer 44

precipitate opioid withdrawal....they would feel awful

Question 45

which medication should be used for EtOH dependence in patients with severe liver disease?

Answer 45

Acamprosate

Question 46

Acamprosate mechanism of action:

Answer 46

structurally similar to GABA Thought to inhibit glutamatergic system

Question 47

Contraindication of acamprosate

Answer 47

severe renal disease

Question 48

what anticonvulsant can be used to treat EtOH dependence and what is the mechanism of action?

Answer 48

Topiramate | potentiates GABA and inhibits Glutamate receptors, decreasing craving for alcohol

Question 49

Wernicke's Encephalopathy features:

Answer 49

Ataxia (wide-based) confusion ocular abnormalities: nystagmus and gaze palsies

Question 50

If untreated Wernicke's encephalopathy can progress to

Answer 50

Korsakoff's syndrome