History of Alcohol Use

History of Alcohol Use Consumption of Alcohol and Heavy Drinking in the United States... 

Determine if the client has a history of alcohol use or is currently drinking alcohol. 

Jaundice with possible toxic liver damage was reported in a 71-year-old man who had been taking an unspecified amount of chaparral capsules daily for an unspecified amount of time. Symptoms of flu-like illness, ascites, and jaundice abated 2 months after cessation of chaparral. The man had a history of alcohol use (14 oz wine daily). One month after restarting chaparral use, the man developed jaundice, ascites, scleral icterus, and nausea. Liver biopsy indicated diffuse necrosis with inflammation, portal tract expansion, mild cholestasis, and mild fibrous septation. A biopsy 3 months later indicated marked improvement (Batchelor et al. 1995). 

Roger Baccus, age 23 years, is prescribed Demerol for postoperative pain. You discover in his health history on the chart that he has a history of alcohol and drug use. Determine what further assessments you would need to make Explain how Roger s answers would influence the actions that you as a nurse would take. 

Category X) and lactation. The HMG-CoA reductase inhibitors are used cautiously in patients with a history of alcoholism, acute infection, hypotension, trauma, endocrine disorders, visual disturbances, and myopathy. 

Mueller TI, Goldenberg IM, Gordon AL, et al Benzodiazepine use in anxiety disordered patients with and without a history of alcoholism. J Clin Psychiatry 57 83-89, 1996... 

Obtain a complete history of alcohol intake and hepato-toxic drug use, including over-the-counter products and dietary supplements. 

Cluster headache disorders are the most uncommon and severe primary headache syndromes.9 The estimated point prevalence is less than 1%. Unlike migraine and TTH, cluster headaches occur more frequently in men. Onset commonly occurs prior to age 30.6 A genetic predisposition seems apparent, although affected individuals often provide a history of tobacco use and alcohol abuse.6 Attacks consist of debilitating, unilateral head pains that occur in series lasting up to months at a time, but that remit over months to years between occurrences. In rare instances, cluster headache can be a chronic disorder without remissions.4... 

Single, one daughter. He works as an undercover agent and just returned from an operation in Cambodia. He denies smoking or intravenous drug use. He had a 20-year history of alcohol abuse but has been sober for 10 years. 

It is considered a second-line agent for GAD because of inconsistent reports of efficacy, delayed onset of effect, and lack of efficacy for comorbid depressive and anxiety disorders (e.g., panic disorder or SAD). It is the agent of choice in patients who fail other anxiolytic therapies or in patients with a history of alcohol or substance abuse. It is not useful for situations requiring rapid antianxiety effects or as-needed therapy. 

Elevations of serum aminotransferase activity (up to three times normal) occur in some patients. This is often intermittent and usually not associated with other evidence of hepatic toxicity. Therapy may be continued in such patients in the absence of symptoms if aminotransferase levels are monitored and stable. In some patients, who may have underlying liver disease or a history of alcohol abuse, levels may exceed three times normal. This finding portends more severe hepatic toxicity. These patients may present with malaise, anorexia, and precipitous decreases in LDL. Medication should be discontinued immediately in these patients and in asymptomatic patients whose aminotransferase activity is persistently elevated to more than three times the upper limit of normal. These agents should be used with caution and in reduced dosage in patients with hepatic parenchymal disease, Asians, and the elderly. In general, aminotransferase activity should be measured at baseline, at 1-2 months, and then every 6-12 months (if stable). 

The death of a 36-year-old patient with a history of alcohol dependence who was taking tramadol, venlafaxine, trazodone, and quetiapine has highlighted the increased risk of seizures with concomitant use of tramadol and selective serotonin re-uptake inhibitors (125). 

Substance abuse Do you currently use any illegal substances Do you currently use any legal substances in an illegal way Do you have a history of alcohol or drug abuse Do you smoke Do you drink Are you taking any medications ... 

Several classes of pharmacologic agents are available for insomnia. Barbiturates are the oldest agents that have been used for insomnia and include pentobarbital, secobarbital, and amobarbital. Barbiturates are currently not recommended because of their high abuse potential (due to rapid development of tolerance) and lethal potential in overdose situations. Barbiturates potentiate the GABAergic-induced increase in chloride ion conductance at low doses, and at high doses they depress calcium-dependent action potentials. Caution should be exercised in patients with marked renal or liver dysfunction, severe respiratory disease, suicidal tendencies, or history of alcohol/drug abuse. 

Carbon tetrachloride, which has been used in fire extinguishers as a fire suppressant, is a known renal toxin. In a study of people exposed to carbon tetrachloride vapors during fire fighting activities, it was found that those individuals with histories of alcohol abuse experience greater nephrotoxic effects (including renal failure) than those who do not abuse alcohol. The authors of the study conclude that ethanol potentiates the nephrotoxic effects of carbon tetrachloride. 11 This is an example of a potentiated effect being observed when exposure is to a mixture of a lipophile (carbon tetrachloride Kow = 2.83) and a hydrophile (ethanol Kow = -0.32). 

A thorough history of alcohol or drug use, with the input of family and friends is importanL as the patient often underestimates the amount of alcohol consumed. Family history can also provide clues regarding problems such as hemochromatosis. The social history provides information regarding potential occupational exposures to toxic agents. A history of acute pain and fever may indicate an obstructive process due to gallstones or an inflammatory condition such as viral or alcoholic hepatitis. 

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