OVERVIEW Alcohol Benzodiazepines Opoid Pharmalocology Signs & Symptoms Management Pharmacology Acute effect Stimulatio of Gamma-Amniobutryic Acid (Gaba) System Neurohibitory Chronis use Configuration changes of GABA Induces an intensitivity to GABA .. more inhibitor is required to maintain a constant inhibitory tone. As alcohol tolerence develops the individual retains arousal at alcohol concentrations which would normally produce lethargy or even coma in relatively alcohol naïve individuals. Cessation of alcohol or a rduction from chronically elevated concentrations results in decreased inhibitory tone. EXCITATORY AMINO ACIDS-GLUTAMATE Binds to the N-METHHYL-D- ASPARTATE (NMDA) receptor, calcium influx leads to Neuronal excitation. Ethanol inhibits Glutamate induced excitation Adaption occurs by increasing the number of Glutamate receptors in an attempt to maintain a normal state of arousal. Cessation of alcohol or a reduction from chronically elevated concentrations results in unregulated excess excitation. Non -Pharmacological Management A calm, non threatening , protective environment with frequent verbal orientation and reassurance. To relieve anxiety and fear and to minimize agitation. Intravenous hydration and electrolyte replacement. Thiamine Pharmacological Therapies The agent of choice is a Benzodiazepine Given orally in milder cases or I.V. in more severe withdrawal states. Options include 1. Midazolam administered by infusion and titrated to effect 2. Diazepam… given initially in titrated doses of 5-10mg at intervals as frequent as every 10 min if necessary until a calm but awake level of consciousness is achieved. Subsequent dosing at 5-20 mg every 4-6 hours typically required.