Improving Nurse’s Knowledge of Alcohol Use Disorder

Alcohol Use Disorder (AUD) can have devastating consequences such as seizures and substance withdrawal delirium, so it is crucial for nurses to recognize alcohol withdrawal syndromes and start appropriate interventions in a timely manner to avoid further deterioration of the patient’s health, hospitalization risks and costs. The significance of this study is to allow health care providers, and other professionals in healthcare services to gain a better understanding about the withdrawal symptoms experienced by those recovering from AUD or those experiencing alcohol withdrawal. The PICOT question for this project is: For nurses at a detox facility and hospital in Punjab, India, does the use participation in an educational program on alcohol withdrawal syndrome improve their knowledge and confidence level when treating patients undergoing alcohol withdrawal, compared with nurses who do not participate in such an educational program? The proposed clinical change is an effective educational program presented to the participating nurses to increase their knowledge on the screening of and treatment for alcohol withdrawal syndrome, eradicate any stigmatized perceptions they may have of patients with AUD, and increase their confidence when caring for patients suffering from alcohol withdrawal syndrome. The desired outcome is a significant difference in the post survey scores of the experimental group compared to those of the control groups. This outcome will support implementing an educational program to improve nurses’ knowledge and self-efficacy levels when dealing with individuals suffering from alcohol abuse

Drug Utilization Evaluation of Lorazepam in Alcohol Withdrawal Syndrome Patients: A Secondary Care Teaching Hospital Based Study

Background: Drug utilization evaluation is an important parameter for the safe, effective and rational use of medications in medical care. Alcoholism results in abundant cases of alcohol withdrawal which can prove to be life-threatening if untreated, lorazepam is a drug of choice for Alcohol Withdrawal Syndrome and requires close monitoring as its over-dosing or under-dosing is common in case of withdrawal. Objective:  ensures the safe and rational use of Lorazepam in the management of Alcohol Withdrawal Syndrome. Materials and Method: This prospective, observational study was conducted among alcoholic patients admitted in the KC General Hospital, Karnataka, India. Baseline data for Clinical Institute Withdrawal Assessment for Alcohol revised scale (CIWA-Ar) was collected on the day of admission and the response to lorazepam treatment was recorded using the same with respect to the baseline data every 12th hourly after the initial administration until withdrawn. Results: Statistical analysis for 72 patients was done using ANOVA to calculate the overall progression of the syndrome with treatment. Among 72 patients 94.44% were male and 5.55% were female. The mean age of patients reported with AWS was found to be 44.90 years. A significant CIWA-Ar score reduction was observed with a p-value of <0.0001. Conclusion: Our study revealed a strong predominance of male patients with alcohol withdrawal syndrome, where maximum patients started consuming alcohol before the age of 20 years. After the administration of lorazepam, a significant CIWA-Ar score reduction was observed. Keywords: Alcohol Withdrawal Syndrome, CIWA-Ar scale, Drug utilization evaluation, Lorazepam

Endocannabinoid Regulation of Acute and Protracted Nicotine Withdrawal: Effect of FAAH Inhibition

Evidence shows that the endocannabinoid system modulates the addictive properties of nicotine. In the present study, we hypothesized that spontaneous withdrawal resulting from removal of chronically implanted transdermal nicotine patches is regulated by the endocannabinoid system. A 7-day nicotine dependence procedure (5.2 mg/rat/day) elicited occurrence of reliable nicotine abstinence symptoms in Wistar rats. Somatic and affective withdrawal signs were observed at 16 and 34 hours following removal of nicotine patches, respectively. Further behavioral manifestations including decrease in locomotor activity and increased weight gain also occurred during withdrawal. Expression of spontaneous nicotine withdrawal was accompanied by fluctuation in levels of the endocannabinoid anandamide (AEA) in several brain structures including the amygdala, the hippocampus, the hypothalamus and the prefrontal cortex. Conversely, levels of 2-arachidonoyl-sn-glycerol were not significantly altered. Pharmacological inhibition of fatty acid amide hydrolase (FAAH), the enzyme responsible for the intracellular degradation of AEA, by URB597 (0.1 and 0.3 mg/kg, i.p.), reduced withdrawal-induced anxiety as assessed by the elevated plus maze test and the shock-probe defensive burying paradigm, but did not prevent the occurrence of somatic signs. Together, the results indicate that pharmacological strategies aimed at enhancing endocannabinoid signaling may offer therapeutic advantages to treat the negative affective state produced by nicotine withdrawal, which is critical for the maintenance of tobacco use

A COMPARATIVE CLINICAL STUDY ON WITHDRAWAL SYMPTOMS OF MADATYAYA WITH PUNARNAVADI GHRITA

The disease caused by the excessive and regular us of Madya is called Madatyaya which can be correlated to Alcoholism on basis of withdrawal symptoms. In present world of modernisation the unlimited pressure of carrier and livelihood the youth and middle age generation easily get addicted to alcohol which is a big hazard to social and economic development and deteriorates the health services. The addicted alcoholic patients cannot come out of the condition easily because the withdrawal symptoms. The present study has been done to manage the withdrawal symptoms of Madatyaya. In this study the clinical efficacy of medicine given by the Drug De-addiction centre and Punarnavadi Ghritt was compared on 20 patients of withdrawal symptoms divided in 2 groups i.e. A and B for 30 days. Hb gm%, TLC, DLC, ESR, LFT were also done to assess the efficacy of the drug. Group-A was treated with the medicine provided by the Drug De-addiction centre, which was statistically significant (P<0.05) in subjective parameters. Group-B treated with Punarnavadi Ghritta, showed significant (P<0.05) results in objective parameters. Follow-up was on 15th day and after treatment. Our study revealed that the test drug Punarnavadi Ghritta is more effective on objective parameters than modern medicine which is more effective on subjective parameters in treatment of withdrawal of Madatyaya. Hence the trial drug can be used as a medicine to improve laboratory findings for patients of withdrawal symptoms of Madatyaya

Effect of acetaldehyde intoxication and withdrawal on NPY expression: focus on endocannabinoidergic system involvement

Acetaldehyde (ACD), the first alcohol metabolite, plays a pivotal role in the rewarding, motivational, and addictive properties of the parental compound. Many studies have investigated the role of ACD in mediating neurochemical and behavioral effects induced by alcohol administration, but very little is known about the modulation of neuropeptide systems following ACD intoxication and withdrawal. Indeed, the neuropeptideY (NPY) system is altered during alcohol withdrawal in key regions for cerebrocortical excitability and neuroplasticity.The primary goal of this research was to investigate the effects of ACD intoxication and withdrawal by recording rat behavior and by measuring NPY immunoreactivity in hippocampus and NAcc, two brain regions mainly involved in processes which encompass neuroplasticity in alcohol dependence. Furthermore, on the basis of the involvement of endocannabinoidergic system in alcohol and ACD reinforcing effects, the role of the selective CB1 receptor antagonist AM281 in modulating NPY expression during withdrawal was assessed. Our results indicate that (i) ACD intoxication induced a reduction in NPY expression in hippocampus and NAcc; (ii) symptoms of physical dependence, similar to alcohol’s,were scored at 12 h from the last administration of ACD; and (iii) NPY levels increased in early and prolonged acute withdrawal in both brain regions examined. The administration of AM281 was able to blunt signs of ACD-induced physical dependence, to modulate NPY levels, and to further increase NPY expression during ACD withdrawal both in hippocampus and NAcc. In conclusion, the present study shows that complex plastic changes take place in NPY system during ACD intoxication and subsequent withdrawal in rat hippocampal formation and NAcc. The pharmacological inhibition of CB1 signaling could counteract the neurochemical imbalance associated with ACD, and alcohol withdrawal, likely boosting the setting up of homeostatic functional recover

Withdrawal symptoms in children after long-term administration of sedatives and/or analgesics: A literature review. "Assessment remains troublesome"

Background: Prolonged administration of benzodiazepines and/or opioids to children in a pediatric intensive care unit (PICU) may induce physiological dependence and withdrawal symptoms. Objective: We reviewed the literature for relevant contributions on the nature of these withdrawal symptoms and on availability of valid scoring systems to assess the extent of symptoms. Methods: The databases PubMed, CINAHL, and Psychinfo (1980-June 2006) were searched using relevant key terms. Results: Symptoms of benzodiazepine and opioid withdrawal can be classified in two groups: central nervous system effects and autonomic dysfunction. However, symptoms of the two types show a large overlap for benzodiazepine and opioid withdrawal. Symptoms of gastrointestinal dysfunction in the PICU population have been described for opioid withdrawal only. Six assessment tools for withdrawal symptoms are used in children. Four of these have been validated for neonates only. Two instruments are available to specifically determine withdrawal symptoms in the PICU: the Sedation Withdrawal Score (SWS) and the Opioid Benzodiazepine Withdrawal Scale (OBWS). The OBWS is the only available assessment tool with prospective validation; however, the sensitivity is low. Conclusions: Withdrawal symptoms for benzodiazepines and opioids largely overlap. A sufficiently sensitive instrument for assessing withdrawal symptoms in PICU patients needs to be developed

Evidence for Endogenous Opioid Dependence Related to Latent Sensitization in a Rat Model of Chronic Inflammatory Pain

Studies performed in a mouse model of chronic inflammatory pain induced by intraplantar injection of complete Freund’s adjuvant (CFA) have shown that constitutive activation of the endogenous opioid signaling, besides serving as a mechanism of endogenous analgesia that tonically represses pain sensitization, also generates a state of endogenous opioid dependence. Since species‐related differences concerning pain biology and addictive behaviors occur between mice and rats, the present study explored whether the coexistence of endogenous opioid analgesia and endogenous opioid dependence also characterizes a homologous rat model. To this aim, CFA‐injured Wistar rats were treated with either 3 mg/kg or 10 mg/kg of the opioid receptor inverse agonist naltrexone (NTX) during the pain remission phase and monitored for 60 min for possible withdrawal behaviors. At 3 mg/kg, NTX, besides inducing the reinstatement of mechanical allodynia, also caused a distinct appearance of ptosis, with slight but nonsignificant changes to the occurrence of teeth chatters and rearing. On the other hand, 10 mg/kg of NTX failed to unmask pain sensitization and induced significantly lower levels of ptosis than 3 mg/kg. Such an NTX‐related response pattern observed in the rat CFA model seems to differ substantially from the pattern previously described in the mouse CFA model. This supports the knowledge that mice and rats are not identical in terms of pharmacological response and stresses the importance of choosing the appropriate species for preclinical pain research purposes depending on the scientific question being asked