Delirium Although confusion and changes in the level of consciousness are not criteria for alcohol withdrawal, delirium may occur. Individuals with delirium are dangerous to themselves and others (Boland & Verduin, 2022). Delirium tremens occurs on the third day after the reduction or cessation of alcohol and has a mortality of 20% if left untreated. Individuals demonstrate confusion, disorientation, hallucinations, delusions, autonomic hyperactivity, anxiety, and fluctuating levels of psychomotor activity (Boland & Verduin, 2022). Alcohol induced disorders Wernicke encephalopathy (alcoholic encephalopathy) is characterized by ataxic gait, vestibular dysfunction, confusion, horizontal nystagmus, lateral orbital palsy, and gaze palsy (Boland & Verduin, 2022). The condition is reversible but may progress to Korsakoff syndrome (Boland & Verduin, 2022). Korsakoff syndrome is a chronic amnestic syndrome that follows Wernicke encephalopathy (Boland & Verduin, Antidipsotropic medications Acamprosate is the most effective medication for abstaining from alcohol use disorder (Burnette et al., 2022). Acamprosate is thought to target GABA and N-methyl-D-aspartate glutamatergic receptor activity, thereby decreasing cravings and (Burnette et al., 2022). The individual must be alcohol-free at initiation and is contraindicated in severe renal disease. Side effects include diarrhea and nausea. Dosing is weight-based, and titration is not required (Mariani, 2014). Disulfiram is a second-line treatment to treat individuals who are dependent on alcohol but are motivated to discontinue use (Stokes & Abdijadid, 2022). Alcohol consumption increases serum acetaldehyde causing diaphoresis, palpitations, facial flushing, nausea, vertigo, hypotension, and tachycardia. These
Healthcare Consideration: Delirium tremons should be considered a medical emergency and can be fatal if not managed. The best-validated tool to assess the severity of alcohol withdrawal is the Clinical Institute Withdrawal Assessment for Alcohol, Revised (CIWA-Ar). The main treatment objectives for alcohol withdrawal are controlling agitation, lowering seizure risk, and reducing morbidity and mortality. Benzodiazepines are the first-line treatment for all alcohol withdrawals. Barbiturates are used for those patients who are refractory to benzodiazepines. Propofol, in conjunction with benzodiazepines, could be used in patients refractory to barbiturates. However, this would require mechanical ventilation (Hoffman & Weinhouse, 2023). 2022). The main feature is anterograde amnesia, with possible confabulation (Boland & Verduin, 2022). Thiamine deficiency is pathophysiologic between these two syndromes (Wernicke- Korsakoff syndrome) (Boland & Verduin, 2022). Thiamine is involved in the conduction of axon potential and synaptic transmission (Boland & Verduin, 2022). symptoms are known as disulfiram-alcohol reactions and discourage alcohol intake (Stokes & Abdijadid, 2022). Side effects include headache, skin rash, and drowsiness, metallic aftertaste; Adverse reactions include hepatitis and peripheral neuropathy. Naltrexone is a first-line treatment for alcohol and opioid dependence by blocking the µu receptor (Singh & Saadabadi, 2022). Additionally, naltrexone modifies the hypothalamic- pituitary-adrenal axis to suppress alcohol consumption (Singh & Saadabadi, 2022). Absorption is almost complete after administration but has an extensive first-pass effect. Nausea and abdominal pain are common. Caution is needed in hepatic and renal impairment. Benzodiazepines (BZDs) are one of the most widely prescribed drug classes in the United States, known for depressant effects on the central nervous system (Edinoff et al., 2021). BZDs are Federal Drug Administration (FDA) indicated for anxiety disorders, insomnia, acute status epilepticus, induction of amnesia, spastic disorders, and agitation (Edinoff et al., 2021). Non-FDA-approved indications include Tourette’s syndrome, delirium, delirium tremens, sleep disorders, and abnormal medication movements (Edinoff et al., 2021). Barbiturates were popular prior to the introduction of benzodiazepines. Pentobarbital and secobarbital have short half-lives and are lethal, producing coma and death. Barbiturates produce profound respiratory depression, especially when added to another substance. Therefore, these drugs are not widely utilized. Individuals with sedative-hypnotic or anxiolytic disorders are frequently treated in the outpatient setting, as the overall stability requires less monitoring.
ANXIOLYTICS OR SEDATIVE-HYPNOTIC RELATED DISORDERS
Sedative hypnotics are among the most commonly prescribed psychoactive drugs by clinicians in primary care (Ehrlich, 2022). These drugs are frequently taken orally to obtain a steady intoxicated state. Individuals with sedative-hypnotic or anxiolytic use disorders are frequently treated in the outpatient setting, as the overall stability requires less monitoring. Sedative drugs decrease activity diminishes excitement, and calm the individual (Mihic & Mayfield, 2023). In addition, sedatives are often used to alleviate unwanted side effects of other substances (APA, 2013). Hypnotic drugs produce drowsiness and facilitate the onset and maintenance of sleep that resembles an electroencephalograph, where the individual is easily aroused (Mihic & Mayfield, 2023). The usual course of these disorders begins in the teens or 20s, with social patterns, moving into daily use with high tolerance levels (APA, 2013). A less frequent pattern begins with prescription use and reports of anxiety, insomnia, or other complaints (APA, 2013). Individuals demonstrating a problematic pattern of substance use that leads to significant impairment as manifested by two or more criteria over 12 months meet the criteria for sedative, hypnotic, or anxiolytic use disorder (APA, 2013).
EliteLearning.com/Nursing
Book Code: AUS3024
Page 7
Powered by FlippingBook