Reading...
Play button
Play button
Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
41 Cards in this Set
- Front
- Back
|
Alcohol Abuse
definition by DSM IV |
A maladaptive pattern of substance use leading to clinically significant impairment or distress, as manifested by one (or more) of the following, occurring within a 12-month period:
1) recurrent substance use resulting in a failure to fulfill major role obligations at work, school, home (e.g., repeated absences or poor work performance related to substance use; substance-related absences, suspensions, or expulsions from school; neglect of children or household) 2) recurrent substance use in situations in which it is physically hazardous (e.g., driving an automobile or operating a machine when impaired by substance use) 3) recurrent substance-related legal problems (e.g., arrests for substance-related disorderly conduct) 4) continued substance use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the substance (e.g., arguments with spouse about consequences of intoxication, phyPattern of ETOH use in which 1 or more of the criteria are present in a 12 month period. Recurrent ETOH use Failure to fulfill major role obligation Placing self and others in potentially hazardous situations Legal problems Cont’d use despite persistent social/interpersonal problems due to effects of ETOH sical fights) |
|
|
Alcohol Dependence (from DSM IV)
|
A maladaptive pattern of substance use, leading to clinically significant impairment or distress, as manifested by three (or more) of the following, occurring at any time in the same 12-month period:
1) tolerance, as defined by either of the following: a need for markedly increased amounts of the substance to achieve intoxication or desired effect markedly diminished effect with continued use of the same amount of substance 2) withdrawal, as manifested by either of the following: the characteristic withdrawal syndrome for the substance the same (or a closely related) substance is taken to relieve or avoid withdrawal symptoms 3) the substance is often taken in larger amounts or over a longer period than was intended 4) there is a persistent desire or unsuccessful efforts to cut down or control substance use 5) a great deal of time is spent in activities to obtain the substance, use the substance, or recover from its effects 6) important social, occupational or recreational activities are given up or reduced because of substance use 7) the substance use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance (e.g., continued drinking despite recognition that an ulcer was made worse by alcohol consumption) |
|
|
Why do women experience higher blood alcohol concentrations than men who consume similar amounts of alcohol?
|
women have lower levels of gastric alcohol dehydrogenase, the enzyme primarily responsible for metabolizing alcohol
|
|
|
How is dependence diagnosesd? (following what criteria? 7)
|
3 or more criteria in a 12 month period
Physical tolerance Withdrawal symptoms Larger amounts used than intended Unsuccessful efforts to control use Much time and energy Activities are reduced because of use Continued use despite problems |
|
|
If an illness does not respond the way you think it should what should you consider?
|
alcohol abuse/ dependence
|
|
|
Name some typical presentations of people w/ alcohol abuse/ dependence
|
Skin manifestations
Dentition problems cheilosis, leukoplakia, sweet pungent breath odor Recurrent pneumonia, GI bleeding, heartburn, gastritis, abd pain, pancreatitis diarrhea, hematemesis, jaundice, melana Trauma/ bruising / falls HTN/CV (afib, SVT, hypertrig) disease Chronic illness that is not responsive to Rx. Erectile dysfunction, testicular atrophy Weight loss, gain Secondary gout Palmer erythema Nausea, sweating, tachycardia, palpitations Dupuytren’s contracture Fatigue Mood swings, depression, anxiety, agitation, insomnia Work/ family issues Macrocytic anemia |
|
|
What type of anemia is most common in alcoholics?
|
Macrocytic anemia
|
|
|
US Govt. Recommended ‘Safe’ Levels for ETOH Consumption
|
Men 2 drinks per day
Women one drink per day >65 y.o. one drink per day |
|
|
Define Excessive drinking
|
Men – 14 drinks per week and 4 drinks on any given day
Women – 7 drinks per week and 3 drinks on any day |
|
|
What is binge drinking?
|
Pattern of drinking that brings a person’s BAC >.08 or above
Typically happens with 5 or more drinks consumed in less than 2 hours |
|
|
What is the recommedation for alcohol use in the elderly?
|
Recommendation is no more than one drink per day.
|
|
|
What drug has been found effective in decreasing depressive sx and the level of alcohol consumption in depressed alcoholics?
|
Prozac
|
|
|
3 screening instruments for alcohol abuse
|
Alcohol Use Disorders Identification Test
See lecture addendum CAGE MAST (Michigan Alcohol Screening Test) |
|
|
In alcoholics what does a chronic deficiency of thiamine contribute to?
|
degeneration of nerve cells, reactive gliosis, and atrophy of the cerebellum and peripheral nerves. It produces the ataxia, disturbed cognition, ophthalmoplegia, and nystagmus characteristic of Wernicke syndrome
|
|
|
What is Korsakoff syndrome and what is it believed to be a result of?
|
severe memory loss
this is believed to result from a combination of toxicity and thiamine deficiency. |
|
|
How does alcohol affect the GI system?
|
Acute gastritis is a direct toxic effect of ethanol use
|
|
|
How does alcohol use affect the heart?
|
Causes cariomyopathies
|
|
|
How does alcohol affect the skeletal muscle?
|
Direct ethanol toxicity can also injure skeletal muscles, leading to muscle weakness, pain, and breakdown of myoglobin
|
|
|
How does alcohol affect the reproductive system?
|
Chronic ethanol use leads to testicular atrophy and decreased fertility in both men and women. Women who drink alcohol also have an increased risk of spontaneous abortion. The mechanisms responsible for these adverse reproductive effects are unknown
|
|
|
What are characteristics of fetal alcohol syndrome?
|
This syndrome is characterized by growth and developmental defects, including microcephaly; facial dysmorphology; and malformations of the brain, cardiovascular system, and genitourinary system ( Chapter 10 ). Affected infants show growth retardation, microcephaly, atrial septal defect, short palpebral fissures, maxillary hypoplasia, and several other minor anomalies.
|
|
|
Deficient in several vitamins, especially thiamine, pyridoxine, folate, and vitamin A
|
Protein Calorie Malnutrition
|
|
|
Elevated lab test results as suggestive of alcohol misuse
|
Blood alcohol level (BAC) of > .08
Gamma-glutamyltransferase 2x’s normal MCV , PLT HDL cholesterol and triglyceride levels AST:ALT 2:1 Alk phos Uric acid |
|
|
Some minor withdrawl symptoms
|
occur w/i 6 hours of cessation
-insomnia, tremulousness, mild anxiety, GI upset, diaphoresis, HA, palpitations, and anorexia. |
|
|
How soon can withdrawl seizures occur?
|
w/i 48 hours of last drink
|
|
|
How soon can Alcoholic Hallucinosis start?
|
12- 24 hr. onset after last drink
- usually visual - Resolve w/i 24-48 hr. |
|
|
Delirium Tremens:
When do they usually begin? |
typically begin b/w 48 and 96 hours
- typically last 1-5 days - longer periods requiring massive doses of medications have been described |
|
|
Who is at greater risk of DTs
|
1. Elderly
2. Concomitant lung disease 3. Core body temp >104 4. Co-existing liver Dz. |
|
|
What is death from DTs usually due to?
|
arrhythmia or secondary complications. (pneumonia,liver failure)
|
|
|
Risk factors for DTs
|
History of sustained drinking
Previous DTs >30 Greater number of days since last drink Presence of other illnesses |
|
|
Hallmarks of DTs
|
Hallucinations
Disorientation Tachycardia Hypertension Low Grade Fever Agitation Diaphoresis Elevated cardiac indices, oxygen delivery and oxygen consumption Hyperventilation and Respiratory alkalosis which result in reduced cerebral blood flow Sensorium Clouding |
|
|
Complications Associated With Delirium Tremens
|
Fluid and electrolyte concerns
Hypokalemia is common Hypomagnesemia - may predispose to sz. Activity Hypophosphatemia - may be present and contribute to heart failure and rhabdomyolysis. |
|
|
Treatment of Alcohol Dependence
|
Detoxification is NOT treatment
Behavioral Counseling Motivational Cognitive-behavioral (Cue exposure, contingency management, coping skills) 12 step Psychotherapy |
|
|
TRIAD of compulsive drug use:
|
1) Psychological dependence—craving and the behavior involved with procurement of the drug
2) Physiological dependence—withdrawal symptoms on discontinuation of the drug 3) Tolerance—the need to increase the dose to obtain the desired effects |
|
|
How quickly are water soluble drugs excreted?
|
In a day or so
ETOH, stimulants, opiods |
|
|
What do you check if you suspect dilution of urine in a drug screen?
|
Specific gravity
|
|
|
How long will marijuana and barbituates appear in the urine?
|
1-2 months
|
|
|
Signs of Intoxication:
|
Change in mood
Euphoria Drowsiness Nausea with occas emesis Miosis (constricted pupils) |
|
|
Signs of opiod withdrawl
|
Similar to flu when drug is discontinued
Craving Anxiety Lacrimation Rhinorrhea Tremors Myalgias Emesis/diarrhea Elevated BP, respirations and HR |
|
|
Signs of Benzo intoxication
|
Disinhibition
Ataxia Sedation Nystagmus Delerium Confusion Dysarthria Anterograde amnesia |
|
|
Signs of Benzo withdrawl
|
Can be fatal and is a medical emergency
Seizures Anxiety Disturbed sleep Myalgias Paranoia Depression Psychosis Tremors Can mimic DTs (similar to etoh withdrawal |
|
|
Signs of intoxication
of stimulants |
Diaphoresis
Tachycardia Mydriasis (dilated pupils) Elevated BP Hyperactivity Acute brain syndrome (confusion and disorientation) Paronoia Bruxism Tactile hallucinations (insects) Aggression Psychoses |
