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31 Cards in this Set
- Front
- Back
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Describe the timeline associated with alcohol withdrawal symptoms
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Withdrawal symptoms typically present within 4-12 hours, peak during the second day and resolve in about 4-5 days
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What are the symptoms of mild-moderate withdrawal?
severe withdrawal? |
GI distress, anxiety, irritability, elevated BP, tachycardia
Delirium, hallucinations, grand mal seizures, respiratory alkalosis and fever |
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What can you use to reduce CNS irritability during moderate-severe withdrawal?
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Benzodiazepine
Lorazepam 1-4 mg every 2-4 hours as needed for signs and symptoms of withdrawal - Taper over next 2-5 days |
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What can you use to prevent withdrawal seizures?
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An anti-convulsant (which one?)
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What can you use short-term for psychosis or delirium?
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Anti-psychotic (which one?)
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What do you want to observe in the patient during this withdrawal period?
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Reemergence of withdrawal symptoms and alcohol relapse as medications are tapered
Emergence of signs and symptoms of a co-occuring psychiatric disorder |
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What are your pharmacologic options for treating alcohol dependence?
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Naltrexone
Disulfiram Acomprosate |
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What is Korsakoff's syndrome?
How is it treated? |
Alcohol memory loss disorder treated with thiamine 50-100 mg/day IM or IV
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Signs and symptoms of depression and anxiety may not require pharmacotherapy in these patients b/c they may be due to alcohol intoxication/withdrawal. Treatment of non-depressed alcoholic patients with SSRI's appears to be ineffective.
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For alcoholic hallucinosis during or after cessation of prolonged alcohol use, anti-psychotic medication should be considered.
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What is the dose of Naltrexone given?
What are the side effects? |
50 mg/day PO
NV, Headache, Fatigue, Heptatoxicity (higher doses) |
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Describe how you manage Opioid Intoxication.
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If the level of intoxication is mild-moderate (drowsy, pupillary constriction, slurred speech) specific treatment is usually not required
If intoxication is severe (respiratory depression, stupor, coma) then emergency treatment with naloxone and ventilatory assistance may be required. |
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What dose of naloxone do you want to use?
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0.05-0.4 mg IV
With significant respiratory depression, 2.0 mg IV is suggested |
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When should a positive response be seen?
What do you do if no response is seen? |
Within 2 minutes
The same dose or a higher dose of naloxone can be given twice more at 5 min intervals |
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How do you manage a patients opioid withdrawal?
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Methadone
or Buprenorphine When opioids are d/c abruptly, consider using clonidine to suppress nausea, vomiting, diarrhea, cramps and sweating (This however does little for muscle aches, insomnia and drug craving) - Be cautious of clonidine dropping their blood pressure too much |
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What are the side effects of clonidine?
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insomnia, sedation, hypotension
Will not ameliorate some symptoms of opioid withdrawal such as insomnia and muscle pain. Contraindicated in patients with severe hypotension, cardiac, renal or metabolic disease |
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In what patients would you consider giving agonist maintenance treatment (Methadone or Buprenorphine)?
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Patients with a prolonged history of dependence (greater than 1 year)
Morbidity, mortality and other deleterious effects of opioid dependence are minimized with agonist therapy even if abstinence is never achieved. |
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What is the alternative to agonist therapy?
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Antagonist therapy with Naltrexone
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What are the side effects of Methadone?
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Constipation, increased sweating, sexually dysfunction.
Overdose --> respiratory depression Side effects with Buprenorphine are minimal, but also will cause respiratory depression (especially when combined with a benzo) |
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What are the side effects of Naltrexone?
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Dysphoria, anxiety, GI upset, liver function abnormalities (at higher doses)
Can precipitate severe withdrawal symptoms |
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***Slide Questions***
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***Slide Questions***
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What is the scale for scoring someone's level of alcohol withdrawal?
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0-9 = Absent or minimal
10-19 = Mild-Moderate 20 or more = Severe |
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What lab values would we expect to be abnormal in a patient with alcohol abuse?
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Elevated LFT's
TG's INR BP SCr, BUN Electrolytes (K, Cl, Phosphate, Mg) Fluid status |
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What are your short and long term goals for an alcohol abuser?
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Short-term (Limit complications - Seizures, Cessation of drug use, Cessation of drug seeking behavior, prevention/treatment of withdrawal symptoms)
Long-term (Prevent relapse, Entry into medical and alcohol dependence treatment) |
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What pharmacologic treatments are available for alcoholic withdrawal?
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Lorazepam (short acting benzo is better because you don't want it o build up in the tissues, you want to be able to monitor his symptoms, and longer acting drugs mask symptoms in addition to the fact that the patient needs immediate relief)
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What is the advantage of giving Lorazepam over another benzo?
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It has multiple routes of adiminstration (IV, IM, PO)
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What is another option other than benzo's?
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Anti-pyschotics - Not enough data to be given over benzo's, but have shown to help with withdrawal symptoms
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What would you do for a patient with an alcohol withdrawal seizure?
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Increase the benzo dose
Diazepam Taper the benzo and give supportive care b/c these seizures are usually short-lived. Anti-epileptics are not used unless the patient enters status epilepticus |
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Your pharmacologic options in reducing cravings for alcohol include Disulfiram, Naltrexone and Acamprosate. In what type of patient would you want to give Disulfiram?
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In patients that are predictable and not impulsive. Someone that is very motivated to quite.
Otherwise, this product can hurt the patient if they relapse. |
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When would you want to avoid Naltrexone?
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In a patient who is also dependent on opioids.
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Is there pharmacologic treatment for alcohol intoxication?
Opiate intoxication? |
No
Yes - Naloxone |
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Describe how you would taper a patient off of an opioid agonist after treatment for withdrawal.
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Try to withdraw 5 mg of methadone/day. They may reach a point at a low dosage where withdrawal symptoms come back, but they will be more mild.
Then keep them at that dose for a while and continue tapering again after a couple of days. You can also give clonidine as adjunctive therapy if they start having withdrawal symptoms during titration. Taper Buprenorphine by 2 mg/day over 10-15 days |
