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