• Shuffle
    Toggle On
    Toggle Off
  • Alphabetize
    Toggle On
    Toggle Off
  • Front First
    Toggle On
    Toggle Off
  • Both Sides
    Toggle On
    Toggle Off
  • Read
    Toggle On
    Toggle Off
Reading...
Front

How to study your flashcards.

Right/Left arrow keys: Navigate between flashcards.right arrow keyleft arrow key

Up/Down arrow keys: Flip the card between the front and back.down keyup key

H key: Show hint (3rd side).h key

A key: Read text to speech.a key

image

Play button

image

Play button

image

Progress

1/63

Click to flip

63 Cards in this Set

  • Front
  • Back
Onset of stage 1 of acute EtOH withdrawal
0-8 hours
Symptoms of stage 1 of acute EtOH withdrawal
Mild tremors, nervousness, tachycardia, nausea
Onset of stage 2 of acute EtOH WD
12-24 hrs
Symptoms of stage 2 of acute EtOH WD
Marked tremors, hyperactivity, hyperalertness, increased startle response, pronounced tachycardia, insomnia, nightmares, illusions, hallucinations, EtOH craving
Onset of stage 3 of acute EtOH withdrawal
12-48 hrs
Symptoms of stage 3 acute EtOH WD
Same symptoms but more severe than stage 2
Onset of stage 4 acute EtOH withdrawal
3-5 days
Symptoms of stage 4 acute EtOH withdrawal
Delirium tremens
What are S&S delirium tremens?
Confusion, agitation, tremor, insomnia, tachycardia, sweating, hyperpyrexia (high fever)
Is stage 4 a medical emergency?
YES, it is life-threatening
What type of access is necessary for the tx of patients with acute EtOH withdrawal?
IV
What drugs can be used to tx or prevent seizures in patient with acute EtOH withdrawal?
Benzodiazepines
Chlordiazepoxide
Haloperidol
Lorazepam & Diazepam are what type of drug?
Benzodiazepines
Different ways to dose benzodiazepines
1. Scheduled
2. Intermittent
3. Loading
Scheduled BZD dosing
ATC dosing, then taper dose over 3-4 days until S&S decreased
Intermittent BZD dosing
Prn dosing based on S&S and severity
Loading BZD dosing
Do until S&S are alleviated
(Usually 2-3 doses of diazepam)
Haloperidol is better at managing ____ than BZDs?
Hallucinations
Haloperidol should be used with caution b/c...
Can lower the seizure threshold
BZD MOA
Binds to GABA-BZD-receptor complex w/o displacing GABA & improves GABA affinity to its own receptor site
BZD properties
Anxiolytic, anticonvulsant, & sedative
BZD ADEs
Sedation, dizziness, unsteadiness, vertigo
BZD absorption
IV (rapid); PO (1hr); IM (3 hrs)
BZD distribution
Highly protein-bound
BZD metabolism
Hepatic
BZD elimination
Renal
BZD DIs
Opioids, muscle relaxants, barbiturates (inc. CNS effects)
Chlordiazepoxide MOA
BZD-prototype with anxiolytic, sedative, appetite-stimulating, & weak analgesic effects
Chlordiazepoxide ADEs
Edema, constipation, nausea, somnolence, confusion, hepatic dysfxn, agranulocytosis
Chlordiazepoxide absorption
Takes several hrs to get to peak conc.
Chlordiazepoxide DIs
Opioids, muscle relaxants, & barbiturates (same as BZD)
Is BZD or Chlordiazepoxide used more often?
BZD b/c its 1/2 life is shorter & less ADEs
Haloperidol Drug Class
Atypical antipsychotic
Haloperidol MOA
Inhibits postsynaptic dopamine receptors in brain
Haloperidol ADEs
Hypotension, constipation, xerostomia, EPS, somnolence, dystonia, blurred visioin, prolonged QT interval, torsades de pointes, agranulocytosis, tardive dyskinesia
Haloperidol Metabolism
Hepatic
Haloperidol elimination
Renal & biliary
Haloperidol DIs
MANY!
Venlafaxine, quetiapine, fluoxetine, lithium, Class Ia antiarrhythmics, octreotide, vasopressin, fluoroquinolones, risperidone, amiodarone, TCAs, clarithromycin
How should you monitor haloperidol?
EKG
What can thiamine use prevent?
Wernicke-Korsakoff Syndrome
Thiamine Dosing
100 mg IM x1 on admit
Then PO x 3 days
Should you worry about the patient's electrolytes with acute EtOH withdrawal?
Yes, if electrolytes are low give IV riders or add to IVF's
Should you give vitamins to patient's electrolytes with acute EtOH withdrawal?
Yes, and they are typically given in IVF's
What is included in the "Banana Bag"?
Dextrose 5.5 normal saline + KCl + Magnesium + Thiamine + Folic Acid + multi-vitamin infusion
Why are beta-blockers given for patients with acute EtOH withdrawal?
Given for increased BP & tachycardia
What type of drug helps with withdrawal symptoms?
Alpha-agonists (clonidine)
What drugs are given for chronic EtOH treatment?
disulfiram, naltrexone, & acamprosate
What happens when the patient drinks with disulfiram?
They will become sick.
How does disulfiram work?
Blocks acetaldehyde dehydrogenase
How does naltrexone work?
Reduces EtOH craving when combined with behavioral therapy
What is acamprosate?
Analog of gamma-aminobutryic acid
How does acamprosate work?
Decreases the craving for EtOH
What is the MOA of disulfiram?
Irreversible inhibition of enzyme responsible for oxidation of ethanol metabolite acetaldehyde
What are the ADEs of disulfiram?
Dermatitis, garlic/metallic aftertaste, hepatitis, peripheral neuropathy, optic neuritis, & psychotic disorder
How is disulfiram absorbed?
Slow systemic absorption
How is disulfiram metabolized?
Hepatic metabolization
How is disulfiram eliminated?
Fecal, pulmonary, and renal elimination
What drug does disulfiram interact with?
Metronidazole: risk of CNS toxicity
What is naltrexone's MOA?
It is a pure opioid antagonist
What are the ADE's of naltrexone?
Injection site rxns, N/V/D, abdominal pain, arthralgia, increased creatinine kinase level, h/a, syncope, & anxiety
How is naltrexone metabolized?
Hepatically
How is naltrexone eliminated?
Renally
What drug class does naltrexone interact with?
Opioids