Which drug is not used for alcohol dependence?
. Ans: a (Buspirone) Ref: Ahuja, 6th ed; Katzung, Wh ed.Buspirone is an anti-anxiety drug, it is not used for alcohol dependence.Drugs used in alcohol dependence can divided into 2 groups1. Deterrant agents like disufiram2. Anti craving agents -acamprostate, naltrexone and SSRIsComplications seen in alcohol dependenceComplications of acute intoxication are:Emotional and behavioural disturbance, hypoglycaemia, aspiration of vomit, respiratory depression, accidents, and injuries sustained in fightsEffects on the central nervous system- blackouts, cerebellar degeneration, central pontine myelinolysis,Marchiafava-Bignami syndrome (thinning of the corpus callosum along with a change in consciousness, ataxia, and possible dementia) Wernicke's encephalopathy, Korsakoff's psychosis, dementia, cerebral haemorrhagePeripheral Neuropathy:Gastrointestinal problems- Fatty liver, liver failure leading to hepatic encephalopathy, acute pancreatitis, esophagitis, Mallory-Weiss syndrome, malabsorptionCerebrovascular and Cardiovascular Problems: enhanced risk for myocardial infarction and thrombosis, alcoholic cardiomyopathyCancer-High rates of most cancers are seen in alcoholic people, especially those of the head, neck, esophagus, stomach, liver, colon, lungs, and breast tissueFetal alcohol effect-Surviving infants of heavy-drinking mothers can evidence any mixture of the components of a syndrome that, in its full-blown form, can include severe mental retardation, a small head, a diminished physical size, facial abnormalities (including a flat bridge of the nose, an absent philtrum, and an epicanthal eye fold), an atrial septal heart defect, and syndactyly.Wernicke's encephalopathyThis is an acute reaction to a severe deficiency of thiamine, the commonest cause being alcohol use. It characteristically occurs after a period of vomiting.The important clinical signs are1. Ocular signs- Coarse nystagmus and ophthalmoplegia, with bilateral external rectus palsy occuring early. Pupillary irregularities, retinal haemorrhages and papilledema can occur, causing impairment of vision.2. Higher mental faction disturbance- Disorientation, confusion, recent memory disturbances, poor attention span and distractibility are also common. Ataxia and apathy are often seen. Peripheral neuropathy and serious malnutrition are often coexistent.Neuropathology - Neuronal degeneration and haemorrhage are seen in thalamus, hypothalamus, mammillaiy bodies and mid-brain.Korsakoff psychosisThis often follows Wernicke's encephalopathy. Usually caused by severe, untreated thiamine deficiency secondary to chronic alcohol use.Clinical features-Korsakoff psychosis presents as an organic amnestic syndrome, characterized by severe short-term memory deficits with confabulation.Insight is often impaired.Neuropathology- The most consistent changes are seen in bilateral dorsomedial nuclei of thalamus and mammillary bodies. Changes are also seen in periventricular and periaqueductal grey matter, cerebellum and parts of brain stem.CAGE questionnaire is used for screening purpose for detection of problem drinkers.Impairment Likely to be seen at Different Blood Alcohol ConcentrationsLevelLikely Impairment20-30 mg/dLSlowed motor performance and decreased thinking ability30-80 mg/dLIncreases in motor and cognitive problems80-200 mg/dLIncreases in incoordination and judgment errorsMood labilityDeterioration in cognition200-300 mg/dLNystagmus, marked slurring of speech, and alcoholic blackouts>300 mg/dLImpaired vital signs and possible deathAlcohol withdrawal syndrome-Withdrawal develops because the brain has physically adapted to the presence of a brain depressant and cannot function adequately in the absence of the drug. The most common withdrawal syndrome is a hangover on the next morning. Tremors are the most common symptom of alcohol withdrawal syndromeWithdrawal phenomena are likely to begin within approximately 8 hours of abstinence, reach a peak intensity on the second or third day, and markedly diminish by the fourth or fifth day.Delirium tremens (DT) is the most severe alcohol withdrawal syndrome. It occurs usually within 2-4 days of complete or significant abstinence from heavy alcohol drinking in about 5% of patients.The characteristic features are:1) Clouding of consciousness2) Poor attention span3) Visual and auditory hallucinations and illusions. Tactile hallucinations of insects crawling over the body may occur.4) Marked autonomic dysfunction with tachycardia, fever, sweating, hypertension, and papillary dilation5) Psychomotor agitation and ataxia6) Insomnia, with reversal of sleep wake cycle7) Dehydration with electrolyte imbalanceRum fits (Alcoholic seizures)GTC seizures may occur in about 10% of alcohol dependence patients usually after 12-48 hrs after heavy bout of drinking.Alcoholic hallucinosis is characterized by the presence of hallucinations (usually auditory) during partial or complete abstinence, following regular alcohol intake.TREATMENTDetoxification-It is the management of alocohol withdrawal symptoms.Drug of choice for detoxification are usually benzodiazepines. Chlordiazepoxide(80-100 mg/ day in divided doses), diazepam (40-80 mg/day) and lorazepam are the most frequently used benzodiazepines.In patients suffering from Wemicke-Korsakoff syndrome, 100 mg of thiamine administeredparenterally, twice daily for 3-5 days.
Buspirone
Naltrexone
Acamprostate
Disulfiram
Substance Abuse