Successfully reported this slideshow.
We use your LinkedIn profile and activity data to personalize ads and to show you more relevant ads. You can change your ad preferences anytime.

Pharmacological management of alcohol withdrawal and newer medicines

1,020 views

Published on

Pharmacological management of alcohol withdrawal and newer medicines

Published in: Healthcare
  • Be the first to comment

Pharmacological management of alcohol withdrawal and newer medicines

  1. 1. PHARMACOLOGICAL MANAGEMENT OF ALCOHOL WITHDRAWAL AND NEWER MEDICINES FOR RELAPSE PREVENTION Dr. Prasanna P. Khatawkar M.B.B.S.,D.P.M.,F.A.G.E.,D.N.B.(PSYCHIATRY) Consultant Psychiatrist Aadhar Hospital – Specialty Centre for Psychiatry and De-addiction Solapur
  2. 2. PHARMACOLOGICAL MANAGEMENT OF ALCOHOL WITHDRAWAL www.mhgi.in
  3. 3. TEAM  PSYCHIATRIST  PHYSICIAN  GOOD NURSING STAFF  COOPERATIVE RELATIVES www.mhgi.in
  4. 4. SETUP  SPECIALITY PSYCHIATRY SETUP WITH SOS MEDICAL / ICU BACKUP  GENERAL HOSPITAL SETUP WITH ATTACHED PHYSICIAN AND PSYCHIATRIST www.mhgi.in
  5. 5. ALCOHOL INTOXICATION STATE  SAFE ENVIRONMENT  ADEQUATE HYDRATION AND NUTRITION  MAINTAIN VITALS AND PHYSIOLOGICAL HOMEOSTASIS  THIAMINE  ANTIEPILEPTICS  ANTIPSYCHOTICS  BENZODIAZEPINE AVOIDED IN THIS STATE  WAIT FOR THE EFFECT TO WAN OFF www.mhgi.in
  6. 6. ALCOHOL WITHDRAWAL STATE  ALSO CALLED AS ‘ABSTINENCE SYNDROME’  IT IS A COMPLEX SYNDROME OCCURING IN PATIENTS DEPENDENT ON ALCOHOL DUE TO SUDDEN CESSATION OF ALCOHOL www.mhgi.in
  7. 7. SYMPTOMS  CONFUSION  GENERALISED TREMELOUSNESS  AUTONOMIC ARROUSAL  DISORGANISED SYMPTOMS  PSYCHOMOTOR AGITATION  INSOMNIA  PERCEPTUAL DISTURBANCE  GRAND MAL SEIZURES  DELIRIUM TREMENS www.mhgi.in
  8. 8. DURATION  MAY START ANYTIME WITHIN 6 TO 8 HOURS AFTER LAST DRINK  MAY LAST UPTO 96 HOURS  DEPENDS UPON VARIOUS FACTORS www.mhgi.in
  9. 9. COMMON MEDICINES USED IN ALCOHOL WITHDRAWAL www.mhgi.in
  10. 10. BENZODIAZEPINES  LFT’s NORMAL : LONG t ½ (CHLORDIAZEPOXIDE, DIAZEPAM)  LFT’s DERRANGED : INTERMEDIATE t ½ OR SHORT t ½ ( LORAZEPAM, OXAZEPAM)  AVOID BENZODIAZEPINES WITH ULTRA SHORT t ½  HIGH POTENCY DRUG LIKE MIDAZOLAM CAN BE HELPFUL FOR IMMEDIATE EFFECT www.mhgi.in
  11. 11. DOSE CALCULATION FOR BENZODIAZEPINES  LFT STATUS  INTAKE OF ABSOLUTE ALCOHOL  t ½ OF THE BENZODIAZEPINE USED  PRESENT CLINICAL STATUS www.mhgi.in
  12. 12. THIAMINE  B1 VITAMIN (ANEURIN)  IMPORTANT ROLE IN VARIOUS CELLULAR PROCESSES SPECIFICALLY IN CNS  RDA 1.5 MG  DEPLETED BODY RESERVES IN ALCOHOLICS  BOLUS DOSE AND REGULAR PARENTAL DOSE ESSENTIAL IN ACUTE WITHDRAWAL STATE  100 MG MAY BE ESSENTIAL FOR 7 DAYS www.mhgi.in
  13. 13. ANTIEPILEPTICS ACUTE WITHDRAWAL  CARBAMAZEPINE  OXCARBAZEPINE ANTICRAVING  TOPIRAMATE www.mhgi.in
  14. 14. ANTIPSYCHOTICS  USED IN ALCOHOL WITHDRAWAL AS AN ADD-ON TO FIRST LINE MEASURES SUCH AS BENZODIAZEPINES TO CONTROL AGITATION OR PSYCHOSIS www.mhgi.in
  15. 15. BETA BLOCKERS  USED TO REDUCE SIGNS OF AUTONOMIC NERVOUS SYSTEM HYPERACTIVITY AND AT HIGHER DOSES, ARRYTHMIAS  HELPFUL TO REDUCE DOSE OF BENZODIAZEPINES USED IN THIS PHASE  NOT FIRSTLINE DRUGS DUE TO THEIR INEFFICACY IN PREVENTING SEIZURE www.mhgi.in
  16. 16. ELECTROLYTES  MAINTAINING PROPER ELECTROLYTE BALANCE ESSENTIAL FOR GOOD AND SPEEDY OUTCOME  RAPID CORRECTION TO BE AVOIDED www.mhgi.in
  17. 17. MAGNISIUM  MAGNISIUM IS AN IMPORTANT COFACTOR IN VARIOUS CELLULAR PROCESSES  HYPOMAGNESEMIA ? IMPORTANT PRECIPITATING FACTOR FOR ACLCOHOL WITHDRAWAL SEIZURES  DEPLETIONS CORRECTED ORALLY OR PARENTALLY www.mhgi.in
  18. 18. NEWER MEDICINES FOR RELAPSE PREVENTION www.mhgi.in
  19. 19. ACAMPROSET  AMINO ACID DERIVATIVE OF TAURIN  HYPOTHESIZED TO HAVE ABILITY TO NORMALIZE ABERRENT GLUTAMATE SYSTEM  DOSE – 2 GM / DAY  CAN BE USED IN LIVER DYSFUNCTION  CAUTIOUS USE IN DERRANGED RENAL FUNCTION www.mhgi.in
  20. 20. NALTREXONE  OPIATE RECEPTOR ANTAGONIST  ACTS BY PREVENTING OPIATE RECEPTORS MEDIATED EUPHORIC AND REWARDING EFFECTS OF ALCOHOL  HEPATOXICITY NEEDS TO BE MONITERED  DOSE : 25 – 100 MG – DAILY INITIALY :50 MG ON ALTERNATE DAYS - LATER www.mhgi.in
  21. 21. SSRI’s  SEROTONIN KNOWN TO MODULATE BEHAVIOURAL EFFECTS OF ALCOHOL  HELPFUL MAINLY FOR REDUCTION OF SHORT TERM ALCOHOL USE  HELPFUL FOR PATIENTS HAVING COMORBID ANXIETY AND DEPRESSIVE DISORDERS  ALL SSRI’s FOUND TO BE HELPFUL www.mhgi.in
  22. 22. DISULFIRAM  CHEMICAL DETERENT (AVERSIVE AGENT)  INHIBITS ALDEHYDE DEHYDROGENASE  USED TO PREVENT IMPULSIVE DRINKING  NEVER USE WITHOUT KNOWLEDGE AND CONSENT OF THE PATIENT  MULTIPLE ADVERSE EFFECTS  DOSE : 250 TO 500 MG / DAY www.mhgi.in
  23. 23. BACLOFEN  DERIVATIVE OF GABA (AGONIST FOR GABA-B RECEPTORS)  USED FOR SPASTICITY  NEWER USE AS AN ANTICRAVING AGENT FOR ALCOHOL AND COCAIN  CAN CAUSE WITHDRAWAL SYMPTOMS  DOSE : 10-20 MG / DAY www.mhgi.in
  24. 24. OTHER MEDICINES  LITHIUM  TCA’s  5HT-3 ANTAGONIST (ONDENSETRON)  METRONIDAZOLE www.mhgi.in
  25. 25. CHOICE OF BENZODIAZEPINE, ANTIEPILEPTIC AND ANTIPSYCHOTIC www.mhgi.in
  26. 26. IF NO IMPROVEMENT IN 72 HOURS……  HYPOMAGNESEMIA  HEAD INJURY  INCREASED LEVELS OF AMMONIA  POLYSUBSTANCE USE www.mhgi.in
  27. 27. COMMON MISTAKES  NOT USING THIAMINE  USE OF IV DEXTROSE WITHOUT USING THIAMINE  RAPID CORRECTION OF ELECTROLYTES  IF PATIENT HAS FEVER AVOID INJECTION HALOPERIDOL  SUBTHERAPUTIC DOSE OF BENZODIAZEPINES TO BE AVOIDED www.mhgi.in
  28. 28. RESTRICTION OF PHYSICAL ACTIVITIES  ESSENTIAL IN INITIAL FEW DAYS  PROPER CONSENT ESSENTIAL  WATCH FOR FINGER-TIP INJURIES www.mhgi.in
  29. 29. THANK YOU www.mhgi.in

×