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SUD II | Alcohol, Benzo's, and Stimulants Cheat Sheet by

MOA of Alcohol

• Multiple; Not well understood
• GABA receptor agonist
• NMDA (glut­amate) receptor antagonist
• Believed to have either a direct or indirect effect on the mu-opioid receptor (asso­ciated with alcohol cravings and euphoria; reward pathway)
GABA is an inhibitor NT
Glutamate is an excitatory NT

Alcohol | Signs and Symptoms of Intoxi­cation

Slurred speech
Loss of coordi­nation
Unsteady gait (stagg­ering)
Nystagmus (rapid, involu­ntary eye movement)
Impaired memory or attention
Stupor or coma
Can be mistaken for sedative intoxi­cation ⇨ If the patient is conscious, ask them what they took

Signs & Symptoms of Alcohol Withdrawal

Sweating or HR > 100 BPM
⬆ hand tremor
Insomnia
Nausea ± Vomiting
Transient visual, tactile, or auditory halluc­ina­tions
Psycho­motor agitation
Anxiety
Tonic-­Clonic Seizures
Tonic­-Clonic Seizure: a seizure that involves a loss of consci­ousness and violent muscle contra­ctions
 

PK of Alcohol

Absorption
Small intestine
 
Delayed gastric emptying and/or presence of food delays absorption
Metabolism
Zero-Order
 
Metabo­lized by alcohol dehydr­ogenase
Elimin­ation
Mostly into CO2 and water

Treatment of Alcohol Intoxi­cation

ED visit, hospit­ali­zation, ICU admissions
Supportive care based on symptoms and BAC
ABC's [Airway, Breathing, Circul­ation]
Manage nausea and vomiting
Prevent aspiration
Replace fluids (ie banana bags)
Banana bags: Thiamine 100 mg, Folic Acid 1 mg, Multiv­itamin, ± magnesium

Clinical Presen­tation of Alcohol Withdrawal

6 to 12 hours
Minor Withdrawal
12 to 24 hours
Alcohol Halluc­inosis
24 to 48 hours
Withdrawal Seizures
72 to 96 hours
Delirium Tremens (DT)
Onset is measured based on the time of the patient's last drink
Could be sooner in more severe cases

Alcohol Withdrawal Presen­tations Defined

Minor Withdrawal
Peaks at 24 to 36 hours
 
May last up to 5 days
 
Presence of 2 to 3 symptoms of withdrawal
 
Tremors, anxiety, headache, diapho­resis, palpit­ations, nausea
Severe Withdrawal
Presence of ≥ 6 symptoms
 
Alcoholic halluc­inosis (visual is most common; auditory or tactile); generally resolves within 48 hours
 
Seizures (gener­alized, tonic-­clonic; can happen within hours of last drink)
Delirium Tremens (DTs)
Delirium, Disori­ent­ation, agitation, mydriasis, tachyc­ardia, HTN, Temp > 104F, diapho­resis
 
Onset: 2 to 5 days after last drink
 
Preval­ence: 3 to 5% of pt's with untreated alcohol withdrawal
 
Mortality rate: 5 to 15%
Risk Factors of Withdrawal
• Enviro­nme­ntal: increased frequency of quantity of consum­ption, prior withdr­awals, concom­itant sedative, hypnotic, or anxiolytic drugs
• Genetic: family history of withdrawal
                                                                               
 

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