10-28 L2 Alcohol dependence

Question 1

What time point is alcohol the highest in the blood?

What level and time is alochol blood level legal/ intoxication level?

Answer 1

• 2 hrs (175 mg/dl)
• 6-8 hrs (100 mg/dl)

Question 2

Describe the action of

• alcohol dehydrogenase
• aldehyde dehydrogenase

Answer 2

• Alcohol dehydrogenase: ethanol–>acetaldehyde
• Aldehyde dehydrogenase: acetaldehyde –> Acetate

both require NAD and produce NADH

Question 3

How is alcohol primarily and seconadarily eliminated?

Answer 3

• Eltahnol is primarily (90%) eliminated by oxidation in the liver
• The remaining (10%) is excreted by the lungs and in the urine
  
  • (UDS, breathalyzer testing)

Question 4

Neurochemical targets

• GABA
• Glutamate

Answer 4

• GABA: primary inhibitory neurotransmitter in the CNS.
• Glutamate: primary excitatory neurotransmitter in the CNS.

Question 5

Define

• Tolerance
• Withdrawal

Answer 5

• Tolerance: drink more and more to get the same effect.
• Withdrawal: experince physical symptoms w/out substance.

Question 6

What symptoms are seen with alcohol withdrawal syndromes?

• Early (minor)
• Late (major)

Answer 6

• Early (minor) (1-3 days after abstinence)
  
  • Tremulousness
  • Hallucinosis
  • Seizures
• Late (major) (3-8 days after abstinence)
  
  • Delirium tremens

Question 7

What are the physiological conditions seen with alcohol withdrawal syndromes?

• Early (minor)
• Late (major)

Answer 7

• Early (minor)
  
  • increased pH
  • decreased Mg²⁺
  • decreased PCO₂
• Late (major)
  
  • Respiratory alkalosis (partilaly compensated)
  • Hypomagnesmia not a factor

Question 8

Early (minor) withdrawal

clincial features

• Time
• Symptoms
• Signs
• Relieved by
• Prognosis

Answer 8

• Time: 6-60 hrs
• Symptoms: tremulousness, insomnia, nausea, anorexia, anxiety, weakness
• Signs: action tremor, inattention, easy startle, plethora, conjunctival injectino, hyperreflexia
• **Relieved by: **continued drinking or pharmacologic substitue
• Prognosis: excellent improvement w/o treatment

Question 9

Early withdawal

Seizures (Rum fits)

• what type of action is it?
• is it a single seizures?
• proceeds to what?
• heightened to what?
• 30% develops to what?
• alcohol withdrawal precipitates what?

Answer 9

• Usually generalized major motor
• Single seizures (40%) or bursts over several hours
• Proceeeds to status epilepticus in 2%
• Heightened sensitivity to photic stimultation during periond of seizure vulnerability
• 30% develop delirium tremens
• Alcohol withdrawal also precipitates idiopathic and post-traumatic seizures

Question 10

Late withdrawal

delirium tremens

• Symptoms
• Motor activity
• autonomic activity
• leads to what?
• Mortality?

Answer 10

• Symptoms: Profound confusion, disorientation, misperceptions, hallucinations, paranoid delusiosn
• Motor hyperactivity: tremor, restlessness, agitation, hyperreflexia
• Autonomic hyperactivity: tachycardia, profuse sweating, mydriasis
• Leads to dehydration, hypotenions, shock, hyperthermia
• Mortality: inadequately treated (10-15%), adequately treated (2-4%).

Question 11

What are the 9 organ systems effected by chronci heavy alcohol use?

• head and neck (2)
• chest (2)
• abdomin (2)
• rest of body (3)

Answer 11

• head & neck
  
  • CNS
  • endocrine
• chest
  
  • Cardiovascular
  • pulmonary
• abdomin
  
  • gastrointestinal
  • genitourinary
• rest of body
  
  • Dermatologic
  • Musculo-skeletal
  • Hemtological

Question 12

What was the most effective medication for alcohol dependence?

What is the least effective medication for alcohol dependence?

Answer 12

• Naltrexone in combination with medical mngt.
• behavioral intervention alone, least effective

Question 13

Disulfiram

‘negative reinforcement’

• MOA
• should it be monitored?
• side effects?

Answer 13

Disulfiram

• MOA: inhibits aldehyde dehydrogenase (thus you get a build up of acetaldehyde)
• use should be closely monitored
• Many potential side effects and compliance issues
• Support for effectiveness equivocal at best.

Question 14

Naltrexone

• MOA
• side effects
• other

Answer 14

Naltrexone

succes most likely in combination with psychosocial treatments

• MOA: non-selective opiate antagonist
• Side effects: Nausea and headache (relative safety)
• Reduces relapse rate, # of drinking days, alcohol cravings (FDA-approved in 1995)

Question 15

Acamprosate

• MOA
• side effects
• cautions

Answer 15

Acamprosate

derivative of amino acid, homotaurine

• MOA: modulates excitatory neurotransmission
• Side effects: typically midle GI distress
• caution and dose adjustment with renal insufficiency.