Background
AUDIT
AUDIT-C
CAGE
Which patients should be offered non-pharmacologic interventions alone?
Mild AUD
Name two symptoms of alcohol withdrawal.
increase autonomic activity (e.g. tachycardia, sweating)
Tremors
Insomnia
GI distress
Visual, tactile, auditory hallucinations
Seizures
What two vitamins and their doses are needed for all patients admitted to the hospital with heavy alcohol use?
Thiamine (B1) 100 mg daily
Folic Acid 1 mg daily
(higher loading and initial doses in sicker patients)
What are the two first-choice pharmacotherapy options for maintenance treatment of alcohol use disorder?
Naltrexone
Acamprosate
(NNTs in the 9-25 range for heavy drinking, daily drinking, etc.)
Which patients should be screened for alcohol use disorder according to the USPSTF?
All adults
What is the gold standard psychosocial intervention for treating alcohol use disorder?
12-step program (i.e. AA)
How soon after alcohol cessation will a patient start withdrawal?
6-24 hours after last drink
How long after the last drink will you most likely time you will see DT?
2-3 days (then usually lasts for 2-3 days)
Name the two contraindications to naltrexone therapy?
Opioid use
Elevated liver enzymes
How sensitive are the CAGE questions at detecting alcohol use disorder?
82% sensitive
(79% specific)
Which patients should be prescribed pharmacotherapy?
Those with moderate-to-severe AUD
Which medications are the standard therapy for treating alcohol withdrawal? (include the specifier for length of action as well)
Intermediate or long-acting benzodiazepines
What are the criteria for DT?
Alcohol withdrawal PLUS cognitive impairment
(awareness, alertness, visual or auditory distortion, memory, etc.)
When should you start acamprosate treatment?
2-5 days after abstinence from alcohol
What is the overall prevalence of alcohol use disorder in the United States?
Estimates of up to 16% of people meet criteria
What percentage of patients with alcohol use disorder receive treatment?
24%
What are 2 contraindications to outpatient withdrawal treatment?
history of DTs
heavy or prolonged alcohol use
severe withdrawal present
What CIWA score range indicates severe withdrawal?
Mild 9-14
Moderate 15-20
Severe >20
During which stages of change is naltrexone effective?
Contemplative and onward
Name two criteria (not withdrawal or tolerance) from the DSM 5 for AUD?
Drinking more than intended
Desire to cut back
Time spent trying to get alcohol
Cravings
Functional impairment because of alcohol
Function impairment as a result of trying to drink
Continuing despite knowing its bad
Name two psychotherapies for AUD.
CBT for AUD
MET (motivational interviewing based therapy)
BT
Which is better: fixed dosing or symptom-triggered dosing of medication to treat withdrawal?
They are equal BUT symptom triggered reduces the total amount of medication received
20%
Name two medications to use after a patient has failed first-choice therapy (second-choice therapy)
Topiramate
Gabapentin
(both with low-quality and/or limited evidence support)
Disulfram (doesn't treat cravings)