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CASE BASED LEARNING 1

ROY AND ALCOHOL

1. N U R U M A I R A H H U DA
2. N U R H A Z I R A H I Z Z AT I
3. NASRUL NAZIM HUSNA
4. NURQISTINA
5. NURUL HAFIZAH
6. S A F WA N A H
7. SITI ZUHAIRAH
OBJECTIVE
1. Difference between types of consumed alcohols and their harmful
effects to humans.
2. Goals of pharmacotherapy in this case?
3. List the common signs and symptoms of acute alcohol
withdrawal.
4. The occurrence of seizure in patients experiencing alcohol
withdrawal?
5. Treatments are available in the management of alcohol withdrawal
and the pharmacologic treatments that are currently marketed
(FDA-approved) for the treatment of alcohol dependence.
6. Alcohol-related treatment Web sites that can be recommended
to patients with alcohol dependence.
Roy is a 54-year-old man who is brought to the emergency department
(ED) by his wife. At the ED, her wife complains to the doctor:
My husband has been acting strange, sweating and shaking all day. I think
he had a seizure an hour ago.
She states that her husband has abused alcohol since she met him in
college. She states that his typical daily consumption for the past 25 years
has averaged about 14-18 alcoholic beverages. She reports that he has not
been able to afford drink recently due to a recent layoff from his job. In an
effort to save money, he has decided to quit drinking cold turkey. He has
not had any alcohol to drink in the previous 48 hours. Roy is an
unemployed construction worker. He has not worked for the past 6
months. He has been married for 22 years and has been a heavy drinker for
the past 25 years. He drinks an average of 16 drinks (usually beer- or
whiskey-containing drinks) per day. He denies any illicit drug use.
This case is due to a patient named Roy who had an alcohol withdrawal symptoms
due to abrupt stop in alcohol consumption named cold turkey

Heavy drinker!
Men: More than 4 drinks on any day or 14 per week
Women: More than 3 drinks on any day or 7 per week

NIAAA defines binge drinking as a pattern of drinking that brings blood alcohol
concentration (BAC) levels to 0.08 g/dL. This typically occurs after 4 drinks for
women and 5 drinks for menin about 2 hours.
HIGHLIGHT OF THE CASE

Roy has been acting strange


Sweating
Hes been shaking all day
Had seizure
HISTORY WITH ALCOHOL

Daily consumption of 14-18 alcoholic beverages for over 25 years


He start to stop consume alcohol cold turkey
Do not consume alcohol for the last 48 hours before admitted to
emergency department
He drinks of an average 16 beer or whiskey containing drinks per
day.
http://www.ias.org.uk/News/2015/16-December-2015-Health-
Survey-England-2014-Well-off-most-likely-high-risk-
drinkers.aspx
https://pubs.niaaa.nih.gov/publications/arh291/63-67.htm
TYPE OF
ALCOHOL

DIFFERENCE BETWEEN TYPES OF CONSUMED ALCOHOLS


A N D T H E I R H A R M F U L E F F E C T S TO H U M A N S .
TYPE OF ALCOHOL
BEER CIDER WINE SPIRITS
Is brewed from Is made from Is made from Is alcoholic drink
cereal grains fermented apple fermented that have been
Undergoes juice. grapes without distilled after
fermentation of Tends to be the addition of fermentation of
starch sugar anywhere from sugars or other grains,fruits or
produces 2% to 8% nutrients. vegetables.
ethanol The ABV can be Has higher
The alcohol by from 9% to 16%. average of ABV
volume is 2% up between 20% to
to 12% 80%

http://alcoholrehab.com/alcoholism/types-of-alcoholic-
beverages/
HARMFUL EFFECT OF ALCOHOL

https://www.healthline.com/health/alcohol/effects-
on-body
GOALS OF
PHARMACOTHERAPY

W H AT A R E T H E G O A L S O F P H A R M A C O T H E R A P Y I N T H I S
CASE?
1.Recovery of the alcohol dependence

1. 2.
Naltrexone Disulfiram

3. Acamprosate
1. Naltrexone 2. Disulfiram 3. Acamprosate

Naltrexone blocks the Disulfiram will cause Indicated for maintenance


receptors of opiod unpleasant reaction after of alcohol abstinence in
Drinking is less consumption of ethanol. patients who are abstinent
pleasurable Patients will feel flushing, at treatment initation.
Patient will try to avoid headache, palpitation,
alcohol intake dizziness, nausea.

Less dependence to
alcohol.
Goal is achieved
2. Recovery of withdrawal symptoms

Alcohol withdrawal syndrome (AWS) is the name for the


symptoms that occur when a heavy drinker suddenly stops or
significantly reduces their alcohol intake. Appear anywhere from six
hours to a few days after your last drink.

The most severe type of withdrawal syndrome is known as delirium


tremens:

hallucinations fever seizure extreme agitation


Other symptoms include sweating, anxiety, headache, nausea,
vomiting and etc .
IN ORDER TO ACHIEVE RECOVERY
FROM AWS,
Patients are treated with sedatives/depressants called
benzodiazepines. Commonly prescribed benzodiazepines include:

1. Ativan (lorazepam)
2. Klonopin (clonazepam)
3. Xanax (alprazolam)
4. Valium (diazepam)

In addition, vitamin supplements may be given to replace essential


vitamins that are depleted by alcohol use.
SIGN AND
SYMPTOMS

L I S T T H E C O M M O N S I G N S A N D S Y M P TO M S
OF AC UTE AL C OHOL W I T H D R AWA L .
ALCOHOL WITHDRAWAL STAGES:

Can be broken down into 3 stages:


- Stage 1 (mild) : Anxiety, insomnia, nausea, and abdominal pain characterize this stage,
which begins 8 hours after the last drink.
-Stage 2 (moderate) : High blood pressure, increased body temperature, unusual heart rate,
and confusion come with this stage, which begins 24-72 hours after the last drink.
- Stage 3 (severe) : Hallucinations, fever, seizures, and agitation come with this stage, which
tends to begin 72+ hours after the last drink.
https://americanaddictioncenters.org/withdrawal-timelines-treatments/alcohol/
SEIZURE

H O W S E I Z U R E S O C C U R I N PAT I E N T S E X P E R I E N C I N G
A L C O H O L W I T H D R AWA L ?
It is a symptoms of a brain problem.
Occurs due to abnormal electrical activity in the brain.
Can be classified into :
Focal Seizure : Occurs in one part of brain
Generalized seizure : Occurs in both side of the brain
HOW ALCOHOL AFFECT CNS?
Brain communication system that affected by alcohol involve neurotransmitter
GABA - Inhibitory
Glutamate Excitatory

Acute consumption of alcohol:


Reduce the activity of NMDA receptor ( reduce excitatory effect)
Increase the activity of GABA receptor (increase inhibitory effect)
Prolong consumption of alcohol leads to activation of brain adaptation
body synthesis more NMDA receptor, and less GABA receptor to maintain
the homeostasis
Sudden cold turkey - more NDMA receptor than normal leads to hyper-
excitability of the brain function that cause:
Seizure, Tremors,
Hallucintaion Aging
http://www.sketchrn.com/mechanism-of-alcohol-withdrawal/
TREATMENT

T R E AT M E N T O F A L C O H O L W I T H D R A W A L & A L C O H O L
DEPENDENCY
WHAT IS ALCOHOL WITHDRAWAL?
MANAGEMENT
OF ALCOHOL
WITHDRAWALS
MILD WITHDRAWAL TREATMENTS:
MORE SERIOUS WITHDRAWALS :
1. Supportive care
2. Drug treatment
SUPPORTIVE CARE

Thiamine (Vitamin B1) Wernickes encephalopathy


BENZODIAZEPINE (DEPRESSANT)

Benzodiazepine work by enhancing the effects of gamma-aminobutyric acid (GABA)


in the brain.
P H A R M A C O LO G I C
A L T R E AT M E N T
O F A LC O H O L
DEPENDENCE
A P P R OV E D B Y F DA
DISULFIRAM (ANTABUSE)
High acetaldehyde levels cause
unpleasant symptoms after drinking
alcohol such as:
1. Palpitation
2. Low blood prerssure
3. Chest pain
4. Nausea
5. Vertigo
6. Thirst
7. Flushing
8. Headache
9. Several other symptoms
NALTROXENE (REVIA)

Helps to reduce the pleasure that alcoholics receive from drinking and the
cravings to seek out more alcohol.
CAMPRAL (ACAMPROSATE)

It appears to reduce the symptoms that alcoholics may experience when


they abstain from booze over long periods.
WEBSITE

A L C O H O L - R E L AT E D T R E AT M E N T W E B S I T E S T H AT C A N B E
R E C O M M E N D E D T O PAT I E N T S W I T H A L C O H O L
DEPENDENCE.
ALCOHOL-RELATED TREATMENT WEB
SITES
https://www.niaaa.nih.gov/
http://www.aamalaysia.org/
http://www.niaaa.nih.gov
National Institutes of Health
Leads the national effort to reduce alcohol-related problems by:
- Conducting and supporting alcohol-related research in a wide range
of scientific areas
- Collaborating with international, national, state, and local institutions
in alcohol-related work.
- Coordinating with other research institutes and federal programs on
alcohol-related issues.
- Translating and disseminating research findings
AIMS OF NIAAA
Better understand about health risks and benefits of
consuming alcohol -can cause addiction.
Reveal the biological and socio-cultural origins
Remove the stigma
Develop effective prevention and treatment strategies
that address the risks that result from alcohol
consumption.
http:// www.aamalaysia.org
Primary purpose: To stay sober and help other alcoholics to achieve sobriety.
Men and women who share their experience how they may solve (alcoholic)
common problem and help others to recover from alcoholism.
The only requirement for membership is a desire to stop drinking.
No dues or fees for A.A. membership
Not allied with any sector
Programme offers the alcoholic a way to develop a satisfying life without alcohol.
CONCLUSION