Alcohol withdrawal

Question 1

What medication is used to relieve anxiety and to control agitation caused by alcohol withdrawal?

Answer 1

Chlordiazepoxide

Question 2

What can be given instead of chlordiazepoxide to help relieve alcohol withdrawal symptoms?

Answer 2

Diazepam

Question 3

What class of drug is chlordiazepoxide?

Answer 3

Long-acting benzodiazepine

Question 4

How does chlordiazepoxide work?

Answer 4

Chlorodiazepoxide binds to GABA-a receptors leading to increased frequency of Cl- channels opening so the neurons are hyperpolarised (more negative than resting) making them less excitable.

This results in a calming, sedative, and anti-anxiety effect.

Question 5

How does chlordiazepoxide get matabolised?

Answer 5

Metabolised in liver by hepatic oxidation via the cytochrome P450 system.
(Significantly impaired in cirrhosis)

Question 6

What are the risks of chlordiazepoxide in patients with liver failure?

Answer 6

Toxic accumulation leading to sedation and hepatic encephalopathy.

Question 7

What is the main inhibitory neurotransmitter in the brain?

Answer 7

GABA

Question 8

True or false: Alcohol enhances GABA

Answer 8

True
GABA is inhibitory so alcohol cuases sedation and loss of control

Question 9

Simply, why can seizures be a feature of alcohol withdrawal?

Answer 9

Normally GABA is enhanced by the alcohol, so used to a baseline with lots of inhibitory signals. When alcohol taken away, fewer inhibitory signals so the brain becomes overstimulated/ excited and can cause tremors and seizures.

Question 10

In what time period may an individual experience a seizure after stopping taking alcohol.

Answer 10

36 hours (think: day one and a bit, have a fit)

Question 11

How long after stopping alcohol can delirium tremens occur?

Answer 11

48-72 hours
(Think: DT = deux, trois, day 2 to day 3)

Question 12

What should be given prophylactically for individuals experiencing alcohol withdrawal?

Answer 12

IV or IM Thiamine
Often deficient, can lead to Wernicke’s encephalopathy

Always give before glucose

Question 13

Thiamine is essential for ______ metabolism and neuronal function

Answer 13

Glucose

Question 14

Thiamine deficiency causes damage and haemorrhage to the m________ b______ of the h______ and the m____ t_______

Answer 14

mamillary bodies
hypothalamus
medial thalamus

Question 15

What is the classic triad of Wernicke’s encephalopathy?

Answer 15

Confusion
Ataxia
Ophthalmoplegia

Question 16

If Wernicke’s encephalopathy is left untreated, what can it lead to?

Answer 16

Korsakoff’s
Chronic, irreversible severe memory loss

Question 17

What are 3 features of Korsakoff’s syndrome?

Answer 17

Anterograde amnesia (ability to form new memories)
Retrograde amnesia
Confabulation (making up new memories)

Question 18

What are signs of delirium tremens?

Answer 18

Autonomic hyperactivity (tachycardia, fever, htn, diaphoresis, tremor)

Delirium (hallucinations, confusion, paranoia, agitation, disorientation)

Seizures
Ataxia

Question 19

What are addictive behaviours?

Answer 19

Repeated behaviours that dominate the patient’s life to the detriment of social, occupational, material and family values and commitments

3 or more symptoms from the ICD-10 criteria for over 1 month

Question 20

How do you assess for substance misuse?

Answer 20

MSE
Physical exam
Bloods
Urine toxicology
CXR
ECG/echo