Tag Archives: withdrawal

The Standard Drink

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standard_drink

A “standard drink” is a measure of pure ethanol consumed. One standard drink represents 10 grams of pure ethanol.

This means that based on the alcohol percentage of certain drinks, the “standard” size changes. The important thing to be aware of is to think of it as a Standard Drink because the size that equals 10 g of ethanol isn’t necessarily the standard size that is served. This is why it’s a good habit when asking “how many glasses of _______ do you drink” to ask about the size of the glass.

This design was actually originally made for an event, but I’m reposting it here because it’s useful and I like it and I haven’t had a chance to draw anything new recently.

Toxidromes

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toxidromes

BUY THIS AS A STUDY CARD

A toxidrome is a syndrome (set of symptoms) caused by specific medications or toxins.

There are 5 big ones to know:

  1. Anticholinergic: low potency antipsychotics, oxybutynin, ACh receptor antagonists (ipratropium, atropine, scopolamine)
  2. Cholinergic: ACh recptor agonists (pilocarpine), AChEIs (organophosphates, phyostigmine)
  3. Opioid: Morphine, heroin, hydromorphone, etc
  4. Sympathomimetic: epinephrine, cocaine, amphetamine (Aderol), methylphenidate (Ritalin)
  5. Sedative-Hypnotic: Benzodiazepines, barbituates, “Z-drugs” (zopiclone, zolpidem), antihistamines

Alcohol and Benzodiazepine Withdrawal

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The thing to remember with both alcohol and benzodiazepine withdrawal is that THEY CAN KILL YOU!

What to watch out for

Withdrawal seizures and alcoholic hallucinosis (hallucinations that develop within 12 – 24 h and resolve within 24 – 48 h)

Delirium Tremens (DTs): hallucinations, disorientation, tachycardia, hypertension, fever, agitation, and diaphoresis. Symptoms can persist for up to 7d

Wernicke’s Encephalopathy: Happens in hours to days, it has a classic triad

  1. Encephalopathy: profound disorientation, indifference and inattentiveness
  2. Oculomotor dysfunction: nystagmus, lateral rectus palsy, conjugate gaze palsies (affecting the CN III, VI and VIII nuclei)
  3. Gait ataxia: affecting the vermis of the cerebellum

How it works

Since alcohol and benzodiazepines both work on the GABA receptor (potentiating the effect of GABA by increasing the frequency of channel opening) they are cross-reactive. This means that you can treat alcohol withdrawal with a tapering dose of benzos (and you can treat benzo withdrawal also with a tapering dose of more benzos).

The thing to watch out for with someone who has chronically used benzodiazepines and has suddenly stopped is that the onset of symptoms will depend on the half-life of that particular drug.

  • Alprazolam (Xanax): 10 – 20 h
  • Lorazepam (Ativan): 10 – 25 h
  • Clonazepam (Rivotril): 20 – 50 h
  • Diazepam (Valium): 30 – 200 h

To minimize benzodiazepine withdrawal symptoms if someone has extended use (>3 months): taper by 1-20% over 6 or more weeks and/or switch to longer-acting agents.