SUD II: Alcohol & Cannabis

“safe,” non-disordered drinking limits.

heavy-drinking threshold

males: 2 drinks/day

females & older adults: 1 drink/day

heavy male: ≥ 15/week

heavy female: ≥8/week

BAC: mg/dL to % conversion

100 mg/dL = 0.1%

severe alcohol withdrawal can cause a phenomenon called (1). this is identified by serious CNS complications like (2) and (3)

1. delirium tremens

2. hallucinations

3. seizures/convulsions

gold standard test for alcohol withdrawal is (1). score of (2) indicates only need for thiamine, (3) for moderate need of meds, (4) for severe, need of meds

1. CIWA-Ar

2. <8

3. 8-18

4. >18

test to identify alcohol use disorder is (1). score of (2) in men or (3) in women or older adults indicate possible AUD

1. AUDIT-C

2. ≥4

3. ≥3

BAC levels greater than or equal to (blank) are when death becomes a serious risk

0.3

all alcohol withdrawal patients should receive supplemental (1) to prevent (2)

1. thiamine (B1)

2. Wernicke-Korsakoff syndrome

most alcohol withdrawal is treated with (1), however milder cases that can be managed without inpatient care can be started on (2) for AUD

1. BZDs

2. gabapentin

Wernicke-Korsakoff: (1) is reversible and characterized by acute confusion. (2) is irreversible and is associated with confabulation, memory loss, and gait abnormality. the symptom triad of Wernicke-Korsakoff includes (3,4,5)

1. Wernicke encephalopathy

2. Korsakoff syndrome

3. nystagmus

4. altered mental status

5. ataxia

Wernicke-Korsakoff: symptomatic therapy vs. preventive therapy

treatment: thiamine 200-500 mg IV TID x2-7 days, followed by 250 mg IV for 3-5 days WITH folic acid IV daily

• indicated when patient is exhibiting symptoms of WKS

prevention: thiamine 100-200 mg PO once daily

• indicated in all withdrawal patients, even if CIWA is <8

acamprosate: brand, MOA, contraindication, avoid in SP (blank)

brand: Campral

MOA: NMDA antagonist

CI: CrCl ≤ 30 mL/min

avoid in pregnancy

disulfiram: brand, MOA, CIs (4), cannot be started within (blank) of alcohol ingestion, avoid in SP (blank)

Brand: Antabuse

MOA: inhibits aldehyde dehydrogenase (ALDH), acetaldehyde accumulation

CIs: severe myocardial disease, severe hepatic dysfunction, psychosis, cognitive disorders

do not start within 12 hours of alcohol ingestion

avoid during lacattion

naltrexone: brand, MOA, avoid with impairment of (blank),

brand: Vivitrol

MOA: blocks pleasurable effects of alcohol, not understood

avoid with impairment of the liver

anticonvulsants included in some AUD therapy: avoidance for one, reduction for other

topiramate & gabapentin

topiramate: avoid pregnant, avoid combined with metformin (met acidosis)

gabapentin: reduce renal