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4. Pharm III > 1- Alcohol > Flashcards

1- Alcohol Flashcards

1
Q

What is the most psychoactive drug in the US?

A

Alcohol

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2
Q

How is alcohol abuse defined?

A

Social life impaired for at least 1 month

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3
Q

How is alcoholism defined?

A

Prolonged alcohol use leading to tolerance and dependence (also continuous or periodic lack of control over drinking, preoccupation with alcohol, use of alcohol despite adverse consequences, and distortions in thinking (especially denial))

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4
Q

How does genetic predisposition contribute to alcoholism?

A

Increased release of beta-endorphins in dopamine reward pathway

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5
Q

What are the MOAs of alcohol? (4)

A
  1. CNS depressant
  2. Binds to/ enhances inhibitory GABA transmission
  3. Increases dopamine in mesolimbic pathway
  4. Inhibits effects of glutamate on NMDA receptor
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6
Q

Do plasma levels of alcohol change in pharmacokinetics or pharmacodynamics?

A

Pharmacokinetics (pharmacodynamics = plasma levels NOT changing but body is changing)

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7
Q

What parts of the body is alcohol absorbed from?

A

Stomach and small intestine

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8
Q

When does BAC peak?

A

Within 30-90 min after last drink

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9
Q

What 2 things does alcohol cross?

A

BBB and placenta

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10
Q

Chronic alcohol use can lead to up and down regulation of what?

A

Down regulation of GABA receptors Up regulation of NMDA receptors

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11
Q

Chronic alcohol use is associated with cross tolerance with what 2 drug classes?

A

Benzodiazepines and barbiturates (due to both binding to GABA receptors)

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12
Q

What order kinetics does alcohol display?

A

Zero order (metabolism rate independent of concentration)

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13
Q

What metabolizes alcohol? (2)

A

ADH > MEOS/CY2E1

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14
Q

What is the metabolism pathway of alcohol? (3 steps)

A

Alcohol → acetaldehyde (via ADH) → acetate (via ALDH, requires NAD+)

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15
Q

How does an ALDH deficiency affect alcohol metabolism?

A

Metabolize alcohol more slowly (women have lower ALDH levels)

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16
Q

What is the MOA of Disulfiram?

A

Inhibits aldehyde dehydrogenase (ALDH)

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17
Q

How are MEOS/ CYP450s and CYP2E1 affected by chronic ethanol consumption?

A

Induced by chronic ethanol consumption (→ increased ethanol metabolism → need more alcohol to get drunk)

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18
Q

Alcohol + Acetaminophen can lead to what?

A

Liver damage

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19
Q

How does alcohol interact with phenytoin and oral hypoglycemic agents?

A

Increases metabolism

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20
Q

How does alcohol interact with benzodiazepines, barbiturates, phenothiazines and tricyclic antidepressants (TCAs)?

A

Synergistic CNS depression

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21
Q

What are the effects of alcohol at low levels?

A

Disinhibition

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22
Q

When does alcohol cause impaired motor function and judgement, CNS depression/ sedative effects, anterograde amnesia (blockade of NMDA receptors)?

A

Higher doses

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23
Q

What can alcohol toxicity result in? (4)

A

Emesis, coma, respiratory distress, death

24
Q

Alcohol exhibits effects on what system as a vasodilator resulting in hypothermia and uterus relaxation (can prevent preterm labor)?

A

Smooth muscle

25
Q

How does alcohol affect the heart?

A

↓ contractility (↓ CO/BP)

26
Q

How does alcohol affect the kidney?

A

↓ ADH → diuretic effect

27
Q

How is alcohol toxicity managed? (2)

A

Manage respiratory depression and prevent emesis

28
Q

If a pt with alcohol toxicity is having seizures, what is the treatment?

A

Lorazepam (benzo) and Phenytoin (anticonvulsant)

29
Q

What is the main cause of a hangover (in addition to dehydration and beginning of withdrawal)?

A

Buildup of acetaldehyde

30
Q

What is the general cause of the complications seen with chronic alcohol use/ alcohol tolerance?

A

Decreased glutathione concentrations = oxidative stress and tissue damage

31
Q

What are the 3 most common complications associated with chronic alcohol use?

A

Gastritis, pancreatitis, liver disease

32
Q

What are the most common liver complications associated with chronic alcohol use? (3)

A
  • Alcoholic hepatitis
  • Liver cancer- most likely 10 yrs after stopping alcohol consumption due to liver attempting to heal itself
  • Fatty liver → fibrosis → cirrhosis
33
Q

Chronic alcohol use leads to malnutrition specifically related to what 2 things?

A

Folate and thiamine

34
Q

What CNS complication of chronic alcohol use is defined as a thiamine deficiency leading to paralysis of eye muscles, ataxia, confusion, coma/ death?

A

Wernicke-Korsakoff syndrome

35
Q

What CNS complication of chronic alcohol use is defined as chronic disabling memory loss?

A

Korsakoff’s psychosis

36
Q

Aside from Wernicke-Korsakoff syndrome and Korsakoff’s psychosis, what other CNS complication can be associated with chronic alcohol use?

A

Peripheral neuropathy

37
Q

What are the most common CV complications seen with chronic alcohol use? (5)

A

Cardiomyopathy (toxic effects of acetaldehyde), arrhythmias, HTN, stroke, CHD

38
Q

How does alcohol affect tobacco use?

A

Increases carcinogenicity

39
Q

The following are associated complications of what?

Mild anemia, sexual dysfunction, immune system suppression, skeletal muscle atrophy, hypothermia, teratogenicity

A

Chronic alcohol use

40
Q

What is the most effective treatment for alcohol abuse?

A

Combo of pharm and psychosocial

41
Q

What is the MOA for Naltrexone? (3)

A

Opioid receptor antagonist → blocks ability of alcohol to stimulate reward pathway → reduces cravings & relapse

42
Q

What is the contraindication for Naltrexone?

A

Liver failure

43
Q

What is the MOA for Acamprosate? (3)

A

Structural analogue of GABA → restores normal balance of GABA and glutamate → decreases cravings and relapse

44
Q

How is Acamprosate excreted?

A

By kidneys (no liver toxicity)

45
Q

When should Disulfiram be taken to be effective?

A

Prior to alcohol consumption

46
Q

What is the action of Disulfiram? (3)

A

Inhibits aldehyde dehydrogenase → acetaldehyde builds up → flushing, HA, nausea, confusion (makes drinking alcohol unenjoyable)

47
Q

Does Disulfiram have a long or short duration of action?

A

Long

48
Q

What are the severe effects of Disulfiram? (7)

A

Vomiting, sweating, chest pain, hypotension, vertigo, blurred vision, shock

(dangerous and not recommended)

49
Q

What is the MOA for Topiramate?

A

Anticonvulsant (alcohol role not well understood)

50
Q

What is the effect of Topiramate?

A

Decreases craving and increases abstinence in recovering alcoholics

51
Q

The following are sxs associated with what?

Anxiety, irritability, nausea, tachycardia, insomnia

A

Mild alcohol withdrawal

52
Q

The following are sxs associated with what?

Hallucinations, delirium, tremors, seizures, fatal arrhythmias, hypotension

A

Severe alcohol withdrawal

53
Q

What is the general treatment for alcohol withdrawal? (non-pharmacologic)

A

Restore electrolyte imbalances, hydration

54
Q

What do Diazepam (Valium) and chlordiazepoxide do with respect to treatment of alcohol withdrawal?

A

Prevent seizures and delirium/ tremors, tapers sxs

55
Q

What does Lorazepam (Ativan) do with respect to treatment of alcohol withdrawal?

A

Used to TREAT seizures

56
Q

What does Phenytoin (Dilantin) do with respect to treatment of alcohol withdrawal?

A

Secondary drug to TREAT seizures

4. Pharm III (16 decks)

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