Alcohol Use Disorders

Question 1

Give examples of high risk occupations for alcohol misuse.

Answer 1

Bartenders.
Itinerant workers.
Professional autonomy ie. doctors

Question 2

Who do the highest rates of drinking occur in?

Answer 2

Adolescents and those in their 20’s

Question 3

1 unit =

Answer 3

10 ml

Question 4

How are number of units calculated?

Answer 4

(% x volume) / 10.

Question 5

How many units of alcohol are in 750ml of 40% ABV vodka?

Answer 5

(0.4 x 750)/10 = 300/10 = 30 units

Question 6

What is ‘high risk’ drinking defined as?

Answer 6

Regularly consuming over 35 units per week.

Question 7

What is ‘increased risk’ drinking defined as?

Answer 7

Regularly consuming between 15 and 35 units per week.

Question 8

What are the UK guidelines for low risk drinking?

Answer 8

Men and women should not regularly drink more than 14 units of alcohol a week. Ideally, this should be spread evenly over three days or more

Question 9

According to F10, what can harmful use for alcohol be described as?

Answer 9

A pattern of psychoactive substance use that is causing damage to health. The damage may be physical (as in cases of hepatitis from the self-administration of injected psychoactive substances) or mental (e.g. episodes of depressive disorder secondary to heavy consumption of alcohol).

Question 10

Outline the diagnostic criteria for alcohol dependence syndrome according to F10.2

Answer 10

• Strong desire or sense of compulsion to take drug
• Difficulty in controlling use of substance in terms of onset, termination or level of use
• Physiological withdrawal state
• Evidence of tolerance
• Progressive neglect of other pleasures /interests because of use /effects of substance
• Persistence with use despite clear evidence of harmful consequences

Question 11

AUDIT

Answer 11

Alcohol users disorder identification test

Question 12

CAGE

Answer 12

Cut dow, annoyed, guilt, eye opener

Question 13

TAGE

Answer 13

Tolerance, annoyed, guilt, eye opener

Question 14

What is lab testing not useful in?

Answer 14

Screening for alcohol disorders

Question 15

What may lab testing have a role in?

Answer 15

Monitoring a patients response to treatment

Question 16

What is GGT an indicator of?

Answer 16

Liver injury

Question 17

Measuring what can allow identification of men drinking 5 or more units per day for 2 weeks or more?

Answer 17

Carbohydrate deficient transferrin

Question 18

Alcoholism is the most common cause of raised what?

Answer 18

MCV (mean corpuscular volume)

- causes a macrocytosis

Question 19

Who are the target audience for brief interventions?

Answer 19

• Adults who have been identified via screening as drinking a hazardous or harmful amount of alcohol.
• Attending NHS, or NHS-commissioned services or services offered by other public institutes.

Question 20

What is the duration of a brief intervention?

Answer 20

5-15 mins

Question 21

Outline the FRAMES framework.

Answer 21

Feedback - review problems experienced because of alcohol.

Responsibility – patient is responsible for change.

Advice – advise reduction or abstinence.

Menu – provide options for changing behaviour.

Empathy – use empathic approach.

Self-efficacy –encourage optimism about changing behaviour.

Question 22

What model is used for brief interventions?

Answer 22

FRAMES

Question 23

What does alcohol inhibit?

Answer 23

The action of excitatory NMDA-glutamate controlled ion channels (chronic use leads to upregulation of receptors).

Question 24

What does alcohol potentiate the actions of?

Answer 24

Inhibitory GABA type A controlled ion channels

Question 25

What is the effect of chronic use of alcohol on GABA-A channels?

Answer 25

Chronic use leads to downregulation of receptors

Question 26

What does alcohol withdrawal lead to excess activity of?

Answer 26

Glutamate and GABA activity

Question 27

What is the effect of excessive glutamate activity on the nerve cell?

Answer 27

TOXIC

Question 28

What does acute withdrawal of alcohol in the dependent subject lead to?

Answer 28

CNS excitability + neurotoxicity

Question 29

When do symptoms of alcohol withdrawal occur?

Answer 29

Within hours

Question 30

When do symptoms of alcohol withdrawal peak?

Answer 30

24-48 hours

Question 31

List the symptoms of alcohol withdrawal syndrome.

Answer 31

Restlessness, tremor, sweating, anxiety, nausea and vomiting, loss of appetite and insomnia Tachycardia + systolic hypertension.

Question 32

What else can occur in the first 24 hours of alcohol withdrawal syndrome?

Answer 32

Delirium tremens | Generalised seizure

Question 33

In most people, when do symptoms of alcohol withdrawal resolve?

Answer 33

5-7 days

Question 34

In what % of cases of people with alcohol withdrawal foes delirium tremens occur?

Answer 34

5%

Question 35

When is the peak onset of delirium tremens?

Answer 35

2 days post abstinence

Question 36

How does delirium tremens present?

Answer 36

Presents insidiously, with night-time confusion (ask about drug/alcohol dependency in confused pt!!!!) Sx: confusion, disorientation, agitation, hypertension, fever, visual and auditory hallucinations, paranoid ideation.

Question 37

What causes death in delirium tremens?

Answer 37

CVS collapse and infection

Question 38

What are the 3 main areas of management of delirium tremens?

Answer 38

* General support. * Benzodiazepines. * Vitamin supplementation.

Question 39

What drug is cross-tolerant with alcohol?

Answer 39

BZD's

Question 40

Why are BZD's cross-tolerant with alcohol?

Answer 40

They both act on GABA-A receptors

Question 41

What should the duration of action of the benzos used be like? Give egs.

Answer 41

Long-acting – ie. diazepam, chlordiazepoxide

Question 42

What should BZD's be titrated against?

Answer 42

Severity of withdrawal symptoms

Question 43

After how many days can BZD's be reduced for treatment of alcohol withdrawal?

Answer 43

7 days

Question 44

What vitamin should be given in the management of alcohol withdrawal?

Answer 44

THIAMINE

Question 45

Why is thiamine given?

Answer 45

As a prophylaxis against Wernicke's Korsacoff

Question 46

Via what route is thiamine given?

Answer 46

Parenteral

Question 47

If you suspect Wernicke's encephalopathy, what should you do?

Answer 47

Increase dose of thiamine

Question 48

What is the classic triad of symptoms in Wernicke's?

Answer 48

Ocular findings, Cerebellar dysfunction Confusion i.e nystagmus, ataxia and confusion

Question 49

When should someone be considered as an inpatient for detox?

Answer 49

Severe dependence A history of Delirium Tremens or alcohol withdrawal seizures A history of failed community detoxifications Poor social support Cognitive impairment Psychiatric co-morbidity Poor physical health

Question 50

What does delirium tremens require?

Answer 50

Prompt transfer to general medical ward.

Question 51

What is there no need for beyond the detox period i.e only needed acutely?

Answer 51

BZD's

Question 52

Name 3 drugs that are used in relapse prevention.

Answer 52

Disulfiram (antabuse) Acamprosate Naltrexone

Question 53

What is the mode of action of disulfiram?

Answer 53

Inhibits acetaldehyde dehydrogenase, leading to accumulation of acetaldehyde if alcohol is ingested.

Question 54

What are some side effects of disulfiram?

Answer 54

Flushed skin, tachycardia, n+v, arrhythmias and hypotension, depending on the volume consumed

Question 55

Where does acamprosate act?

Answer 55

Centrally on glutamate and GABA systems

Question 56

What does acamprosate do?

Answer 56

Reduces cravings with a modest treatment effect.

Question 57

When should acamprosate be started?

Answer 57

As soon as detox is done

Question 58

What are the side effects of acamprosate?

Answer 58

Headache, diarrhoea, nausea

Question 59

What is the first line agent for relapse prevention?

Answer 59

NALTREXONE

Question 60

What type of drug is naltrexone?

Answer 60

An opioid antagonist

Question 61

What does naltrexone do?

Answer 61

Reduces the reward from alcohol