What is harmful use of alcohol?
Pattern of alcohol use which causes damage to physical or mental health
How long does a patient need to be misusing alcohol to qualify as having harmful use disorder?
What are the criteria of alcohol dependence syndrome?
3 or more of:
Strong compulsion to take alcohol
Difficulties in controlling use of alcohol
Using alcohol despite evidence of harm
Preoccupation with alcohol use
Increased alcohol tolerance
What is the biopsychosocial model?
Focuses on the body + the mind
i.e psychology and social factors
international classification of diseases - f code is alcohol use disorders
What screening tests are used to determine a patient's dependence on alcohol before and after treatment?
What does MAAW stand for?
Medically assisted alcohol withdrawal
Which drugs are used to help patient's withdraw from alcohol use?
Chlordiazepoxide / Diazepam
What is the Child-Pugh score?
Used to calculate prognosis in chronic liver disease / cirrhosis
AND to assess patient's suitability for drugs e.g MAAW drugs like chlordiazepoxide
alcohol withdrawal asspit
chlordiazepoxide mechanism of action
What are supportive treatments given to patients with alcohol use disorders?
Oral thiamine for low risk patients
IM/IV pabrinex (variety of vitamins) for high risk patients (inpatients usually)
B vitamins like thiamine are ___ stored in the body.
A chronic alcoholic is likely to be thiamine ___.
Thiamine is essential for which biochemical process?
What does it act as?
What happens to the Kreb's Cycle when a patient is thiamine deficient?
Shuts down, switch to anaerobic respiration
Why can patients with thiamine deficiency suffer brain damage?
Lactic acid accumulation in the brain due to anaerobic respiration
What should be given to any alcohol-use disorder patient who is nutritionally deficient?
What is withdrawal state with delirium?
Alcohol withdrawal + sudden mental/NS changes
What should be the next step if you suspect a withdrawal patient is delirious?
Admit to hospital
What usually occurs 2-3 days into alcohol withdrawal and is associated with hallucinations like shrunken people and the sensation of insects under the skin?
clinical presentation of alcohol withdrawal
Wernicke's encepalopathy is ___.
Korsakoff's syndrome is ___.
(irreversible / reversible)
Wernicke's - reversible
Korsakoff's - irreversible
What causes Wernicke's encephalopathy?
Lactic acidosis in the brain
What causes Korsakoff's syndrome?
Irreversible brain damage re: lactic acidosis in brain
How does disulfiram (antabuse) work?
Blocks action of acetaldehyde dehydrogenase
so when the patient drinks alcohol it's converted to acetaldehyde but no further, which makes them nauseous, flushed etc.
Apart from disulfiram, what are some other drugs used to prevent relapse in alcohol-dependent patients?
Acamprosate - neuroprotective, reduces cravings
also baclofen, naltrexone
What must be considered before giving patients drugs to prevent relapse?
Liver function - LFTs, history, interactions with other drugs
What psychological condition is similar to delirium tremens, but seen in chronic drinkers and tending to have a better prognosis?