Alcohol Withdrawal Research Paper
In a medical setting, alcohol dependence is among the common ailments that patients have. This condition implies that an individual is fixed in a substance, in this case is alcohol, to an extent that one cannot live without it. The cessation of alcohol consumption to an alcohol dependent patient will then lead to alcohol withdrawal which is usually accompanied by disheartening symptoms. For instance, patient exhibiting alcohol withdrawal symptoms (AWS) may end up experiencing tonic-clonic seizures after an approximate 48 to 96 hours of abstinence from alcoholism and this has been proven in 15% of the patients with AWS. 5% of the AWS patients move ahead and indulge in the delirium tremens (DTs) which involves confusion, major hallucinations and unstable autonomy. The paper identifies the role of carbamazepine and oxcarbazepine in withdrawal syndrome and also evaluates the clinical programs for management of AWS and the efficacy of a symptom-triggered guideline in the management of AWS.
According to the Clinical Institute Withdrawal Assessment-Alcohol revised (CIWA-Ar), a patient with a score of less than 8 on the CIWA-Ar scale is not in a any immediate danger and so prophylaxis is not a necessity. Alcohol Withdrawal Research Paper. A score ranging between 9 and 15 are at moderate risk whereas those on a score way above 15 are at a severe risk of developing complications related to the alcohol withdrawal syndrome which includes the seizures and the delirium tremens. The biology behind the alcohol withdrawal syndrome relates to the fact that there is a decreased level of the GABA neurotransmitter and increased N-methyl-D-aspartate glutamate receptors. AWS presents itself with the cessation of ethanol supply which reveals the neuroadaptations which presents itself as AWS.
In the United States as well as Europe, recommendations favor the use of benzodiazepines in the moderate and severe alcohol withdrawal. Barrons and Roberts (2010) performed a study trying to distinguish the role of carbamazepine and oxcarbazepine in the therapy for alcohol withdrawal syndrome. The study yielded promising results where the 612 patients demonstrated that the carbamazepine is more effective in comparison to the benzodiazepines. The use of oxcarbazepine resulted in the reduced alcohol craving than the carbamazepine even though the trials were not enough to provide enough evidence that the two could treat alcohol withdrawal symptoms. Despite the inconclusive results, the carbamazepine is effective in the AWS treatment, especially in the management of moderate to severe AWS. On the other hand, oxcarbazepine’s role in the AWS is still inconclusive considering that there were not enough subjects enrolled into the study.
When it comes to the treatment of the alcohol withdrawal syndrome (AWS), there are two distinct therapies involved.Alcohol Withdrawal Research Paper. Short-acting benzodiazepine which includes the lorazepam and lorazepam are used when the therapy is symptom-triggered and usually employed when the score on the CIWA-Ar is between 9 and 15, or moderate AWS. On the other hand, there is the fixed dose therapy which employs the use of the long-acting benzodiazepines like diazepam and chlordiazepoxide. The symptom triggered therapy implies a lot of resources allocated towards using it as medical or clinical conditions might produce similar symptoms such as the AWS. Therefore, resources are allocated in a bid to identify the AWS. The fixed-dose therapy is risky in the sense that the patients might end up getting a lot or little of the benzodiazepine in combination with high levels of sedation. This risky situation in the fixed- dose therapy is worsened in those patients that are still heavily intoxicated and might lead to death.
In the symptom-triggered therapy, the alcohol withdrawal syndrome has distinct symptoms which are classified accordingly as either Type A, Type B or Type C symptoms. With this regard, the Type A symptoms revolve around the excitation of the central nervous system (CNS), Type B symptoms revolve around the “adrenergic hyperactivity” and finally, the type C symptoms covers the delirium tremens (DTs). In the guidelines used by Karen et al. (2007), the type A symptoms were managed by the benzodiazepine lorazepam, a short-acting benzodiazepine. The Type B were also managed similarly but sometimes reinforced using the alpha-adrenergic agonist clonidine. The Type C was managed effectively by the neuroleptic haloperidol. In their study, Karen et al. (2007) tried to test the efficacy of the symptom-triggered and the results implied that the use of the therapy is indeed efficient in those patients diagnosed with the clinical symptoms but it implies several aspects to conclude that the symptoms are caused by AWS.
Management of the alcohol withdrawal syndrome is not only by prophylaxis using drug therapies. The best method in terms of management has always been education. The education of a patient is indeed important as the care provider opens the eyes of the client to the possible positives and negatives that would result from a condition. Alcohol Withdrawal Research Paper. However, the provision of this information is affected by several factors including the environment in which the information is being offered. Daly, Kermode and Reilly (2009) carried out a research study in a bid to evaluate which mode of education serves best to counter the alcohol withdrawal syndrome. There are two types of education considered. The first type of education is the in-service education provided by the nurses where the nurses are educated within the confines of the hospitals during their shift hours. On the other hand, there is the self-directed learning (an open-book exam) where the competency of each nurse is tested through the discussion of scenic case study relevant to AWS.
The main aim of educating the nurses is to increase their competency levels in the management of various health conditions in the hospitals. In this case, the aim is to improve the management of the AWS in the hospital setting. The in0service delivery was seen to be a poor form of information delivery since the nurses appear to the classes after a whole shift is over and so they are awfully tired to learn. On the other hand, the self-directed learning served to indulge the nurses into finding the various solutions for the case study problems directed towards them. The study carried out by the Daly, Kermode and Reilly (2009) implied that the self-directed approach proved effective as the nurses who took it improved their skills in the management of AWS as could be seen in the files that were perused. On the other hand, the in-service learning proved to be more cumbersome and the nurses did not learn much even though there was a slight betterment in the management of AWS, though lower than the self-directed strategy. Alcohol Withdrawal Research Paper.
In consideration, the use of the carbamazepine in the management of the alcohol withdrawal syndrome is therefore acceptable following the study by Barrons and Roberts (2010) in trying to understand the role of carbamazepine and oxcarbazepine in AWS. However, the latter’s role in the management of this condition is unknown since the trials did not have enough subjects for the study to be concluded therefore its use is limited. On the other hand, the use of the symptom-triggered therapy proves to be an efficient method in dealing with the AWS since it involves detecting the AWS symptoms, categorizing it as either Type A, B or C, and then using the appropriate prophylaxis as indicated (Karen et al, 2007). Finally, educating the nurses further on the management of this condition is a proper path to manage AWS. However, the best form of education is through the self-directed procedure as proven by Daly, Kermode and Reilly (2009).
Barrons, R., & Roberts, N. (2010). The role of carbamazepine and oxcarbazepine in alcohol withdrawal syndrome. Journal of Clinical Pharmacy and Therapeutics 35: 153-167. DOI: 10.1111/j.1365-2710.2009.01098.x
Daly, M., Kermode, S., & Reilly, D. (2009). Evaluation of clinical practice improvement programs for nurses for the management of alcohol withdrawal in hospitals. Contemporary Nurse 31(2): 98-107.
Karen, S. M., Cathy, L. W., Shayna L. L., Deborah, J. C., & Norcross, D. E. (2007). Efficacy of a Symptom-Triggered Practice Guideline for Managing Alcohol Withdrawal Syndrome in an Academic Medical Center. Journal of Addictions Nursing 18: 207-216. DOI: 10.1080/10884600701699255. Alcohol Withdrawal Research Paper.