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KEY CONCEPTS

KEY CONCEPTS

  • image Globally, more than 3 million people, predominantly males, died in 2016 from alcohol consumption, which represents 1 in 20 deaths.

  • image Studies have identified genotypic and functional phenotypic variants that either serve to protect patients or predispose them toward alcohol dependence.

  • image Except at very high and very low blood concentrations, the metabolism of alcohol is considered to follow zero-order pharmacokinetics, and this has important implications for the time course in which alcohol can exert its effects.

  • image Disulfiram, naltrexone, and acamprosate are FDA-approved drug therapies for the treatment of alcohol dependence. The clinical utility of these agents to improve sustained abstinence and reduce heavy drinking remains controversial.

  • image Tobacco is the number one preventable cause of death in the United States.

  • image It is recommended that clinicians ask all adults about tobacco use, advise on how to stop using tobacco products, and provide pharmacotherapy and behavioral treatment options to aid in smoking cessation.

  • image All forms of nicotine replacement therapy are effective in reducing the amount smoked and achieving abstinence.

  • image Varenicline may be more efficacious than all other single nicotine replacement therapies (NRTs) (except for similar efficacy to the nicotine patch) and is approved by the FDA for up to 6 months of maintenance therapy.

  • image Caffeinism is the term coined to describe the clinical syndrome produced by acute or chronic overuse of caffeine. As many as one in five adults consume doses of caffeine generally considered large enough to cause clinical symptoms.

  • image Energy drinks continue to be popular particularly among adolescents and emerging adults. Concerns have been raised regarding the safety of these products.

PATIENT CARE PROCESS

Patient Care Process for Alcohol Use Disorder

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Collect

  • Patient characteristics (eg, age, sex, pregnant)

  • Patient medical history (personal and family)

  • Social history (eg, tobacco/alcohol use) and dietary habits

  • Utilize CAGE questionnaire or Alcohol Use Disorders Identification Test (AUDIT) to assess alcohol dependence/abuse

  • Current medications including over-the-counter (OTC), herbal products, dietary supplements

  • Objective data

    • Blood pressure (BP), heart rate (HR), respiratory rate (RR), height, weight, O2-saturation

    • Labs including serum creatinine (SCr), liver function tests (LFTs)

Assess

  • Hemodynamic instability (eg, systolic BP <90 mm Hg, HR >110 bpm, O2-sat <90% (0.90), RR >20) to assess for signs of acute alcohol withdrawal

  • Utilize motivational interviewing to assess the patient's readiness to quit

  • Ability/willingness to pay for pharmacotherapy options for Alcohol Use Disorder (AUD), and abstain from alcohol with disulfiram and avoid opiates with naltrexone

  • Ability/willingness to obtain laboratory monitoring tests (eg, SCr [eg, naltrexone, acamprosate], LFTs [ie, disulfiram])

  • Emotional status (eg, presence of anxiety, depression)

Plan*

  • Drug therapy regimen including specific AUD agent, dose, route, frequency, and duration (see Table 83-4)

  • Monitoring parameters including efficacy (eg, decrease in craving, adherence) and safety (eg, adverse effects specific to selected agent, SCr, LFTs); frequency and timing of follow-up

  • Patient education (eg, purpose of treatment, drug-specific information, importance of adherence)

  • Self-monitoring for adverse effects from pharmacotherapy treatment

  • Referrals to other ...

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