14. alcohol and drug abuse Flashcards
Alcohol goes through 3 phases in the body:
- absorptive phase: taken up by all tissues according to their water content, blood level rises until it reaches a peak after about 60 minutes
- equilubration phase : after about 60 minutes the blood:urine ration = 1:1.3
- metabolic phase: alcohol ets broken down in the liver at the rate of about 15 mg per hour
describe alcohol metabolism
alcohol gets metabolized in the liver into acetaldehyde and then to acetate which gives of H2O and CO2
if the system is overwhelmed, then there is a build up of acetaldehyde that leads to increase of lactate and lipids, and decrease of glucose
there are 3 outcomes of drinking leading to death and harm from alcohol abuse
- acute intoxication
- trauma while intoxicated
- chronic illness
what re physiological effects of alcohol (3)
- CNS depressant
- acts on GABA A inhibitory receptors
- at very high alcohol levels, the respiratory centre in the brain is paralysed and breathing stops
Clinical and behavioral effects of increasing levels of blood alcohol: 0.08 g/dl
euphoria, impaired co-ordination
Clinical and behavioral effects of increasing levels of blood alcohol: 0.08-0.2 g/dl
unsteadiness, slurring of speech, drowsiness, poor judgement and reaction
Clinical and behavioral effects of increasing levels of blood alcohol: 0.2-0.3 g/dl
increasing unsteadiness, falling, slurring, drowsiness, nausea
Clinical and behavioral effects of increasing levels of blood alcohol: 0.2-0.4 g/dl
semi-consciousness, labored breathing
Clinical and behavioral effects of increasing levels of blood alcohol: 0.4 g/dl
coma, respiratory depression, death
legal level of alcohol for driving: England, Scotland (europe), B&H
England: 0.08 g/dl
Scotland 0.05 g/dl (europe)
B&H (0.03 g/dl)
Death from acute intoxication occurs at what level?
usually 0.35 g/dl but could be higher
death is due to respiratory depression but may be contributed to by: (4)
- other substances (additive effects of medication or drugs of abuse)
- inhalation of vomit (Alcohol stimulates vomiting and it can block airways)
- postural asphyxia (lying awkwardly while intoxicated, thus compromising breathing)
- natural disease (people with chronic heart or respiratory disease can die at lower levels of intoxication)
what are examples of trauma while intoxicated (6)
- frowning
- falls
- fights
- fire
- hypthermia
- RTCs
what are some things that affect vulnerability to intoxication?
- drinking habits
- young people (become comatose earlier, hypoglycemia more likely)
- older persons (achieve higher blood alcohol levels with lesser consumption)
- women (allegedly)
what are alcohol related diseases (chronic illness) 6
primarly:
1. liver disease
2. pneumonia
3. general neglect
less often:
1. cardiomyopathy
2. seizures
3. various cancers
what changes in the liver do we observe in chronic abuse?
- fatty change = globules of fat accumulate in the hepatocytes
- alcoholic hepatitis = individual hepatocytes die off and trigger and inflammatory response
- cirrhosis = the inflammation heals by scarring, creating irregular nodules of hepatocytes surrounded by fibrous tissue
what is a fatty liver disease
specific cause of sudden death i.e. within hours
mechanism is probably alcoholic ketoacidoss (AKA, reflected by high levels of beta hydroxybutarate in the blood
Cirrhosis kills by __ and __
hepatic failure (jaundice, ascites, encephalopathy)
ruptured oesophageal varices (GIT hemorrhage)
Drugs that give effect of: relaxation and a sense of wellbeing (2)
cannabis
benzodiazepines
Drugs that give effect of: stimulation, energy, a feeling of strength
cocaine, amphetamine
Drugs that give effect of: heightened sensory appreciation, hallucinations (6)
MDMA, ketamine, LSD, khat, NPS, solvents
Drugs that give effect of: indifference to pain, hunger, tiredness (3)
heroin, methadone, buprenorphine
Drugs that give effect of: muscle building
anabolic steroids
Drugs that give effect of: sexual stimulation and muscle relaxation (2)
amyl nitrates, GHB
