AAD

Question 1

ALcoholism

Answer 1

chronic disease that when active, results in compulsive, out of control use of alcohol and neg. consequences

Question 2

DSM 5

Answer 2

in the last yr have you
1. more than once tried to cut down drinking or tried and couldnt
2. spent a lot of time drinking or sick w after effects
3. wanted to drink so badly you couldnt think of anythign else
4. drinking interferes w taking care of home, family, job school
5. continued to drink even though in interfered w fam or friends
6. cut back on activities once important to you
7. more than once got into situation while drinking that inc chances of injury
8. continued to drink even though it was affecting mental health
9. have to drink more and more to get desired effect
10. withdrawal sx

2+ of these sx in past yr–> dx

Question 3

DSM 5 and AUD severity

Answer 3

2-3 sx mild
4-5 mod
6+ severe

Question 4

type I alcoholism

Answer 4

develops gradually over lifespan
equally prevalent in men and women
generally less severe health consequences

Question 5

type II alcoholism

Answer 5

early onset
much more prevalent in men
more severe health consequences

Question 6

AUD labs for dx

Answer 6

inc MCV
inc GGT
inc AST ALT (ALT x2 = AST)
inc uric acid, TG
ethyl glucuronide and ethyl sulfate

Question 7

AAD most prevalent in which age group and sex

Answer 7

18-29 males

Question 8

alcohol inhibits/simulates GABA-DA(inhibitory) and NMDA-glutamate(stimulatory) pathways?

Answer 8

stimulates GABA and inhibits NMDA
with time GABA down regulates and NMDA upregulates which precipitates withdrawal sx
“downreg the inhibitory and upreg the excitatory _ w/drawal = BAD”

Question 9

alcohol and dopamine system

Answer 9

inc DA in mesolimbic system –> reinforcing and rewarding effects

Question 10

alcohol and opioid peptide system

Answer 10

activates it
reinforcing and rewarding effects (mu)
craving

Question 11

alcohol acutelystimulating gaba system causes what

Answer 11

sedative and anxiolytic effects
w drawal

Question 12

alcohol inhibiting glutamate system causes

Answer 12

neuroadaptation and w drawal

Question 13

alcohol results in an increase/decrease of DA release in the nucleus accumbens

Answer 13

inc

Question 14

ethanol pk

Answer 14

lipid sol
non ppb
2 carbon moiety
1st order abs!!
metabolism is ) order (mikhaelis menten, capacity limited/fixed amt drug metab per unit time)
VERY low kM (conc where 50% of metabolism is saturated)
vMax (max amt cleared per hr) unrelated to how much drank

Question 15

ethanol pk

Answer 15

begins w in 5 min of ingestion
lipids and proteins delay abs
75% abs in small int, 25% stomach

Question 16

rapid gastric emptying and alcohol graphs

Answer 16

inc rate of gastric emptying–> more to small int–. more abs–> inc peak conc, inc curve sharpness, inc AUC

Question 17

6 things that slow abs rate

Answer 17

1. food in stomach
2. carbs and amino acids
3. cigarettes
4. anticholinergics propantheline (delay gastric emptying)
5. trauma, shock, massive blood loss

Question 18

6 things that inc rate of absorption

Answer 18

1. drinking in am after overnight fast
2. drinks w higher % etOH
3. carbonated drinkfs
4. metoclopramide, erythromycin, cisapride (inc gastric emptying)
5. low BG
6. gut surgery (gastric bypass, gastrectomy)

Question 19

rank Vd of alcohol, and why
male female obese

Answer 19

obese–> female–> male (highest)
alcohol distributes into TBW and lean, not fat. obese patients have dec TBW, females have more fat than males and a lower Vd compared to a male

Question 20

who would get the highest BAC on the same beverage, all weigh 160lb
1. obese male who has not eaten all day
2. male who works out regularly and had light lunch
3. male drinking in the morning after no breakfast and going to the gym like he does 5x/week

Answer 20

1

Question 21

male vs female alcohol dehydrogenase

Answer 21

women have less efficient pre-hepatic alcohol dehydrogenase –> greater bioavailability

Question 22

inc Vd _______ BAC

Answer 22

(inc fat –> dec TBW) dec Vd –> inc BAC

Question 23

CNS and chronic AUD effects

Answer 23

addiction
wernicke-korsakoff syndrome (wernicke’s encephalopathy)
cortical atrophy/dementia

Question 24

hepatic and pancreatic effects of AUD chronic

Answer 24

steatosis, fatty liver
alcohol hepatitis
cirrhosis
pancreatitis

Question 25

wernickes encephalopathy s/sx and patho

Answer 25

d/t acute deficiency in thiamine
sx: confusion, ataxia, leg tremor, visoin changes, nystigmus, dyplopia, eyelid drooping

Question 26

wernickes encephalopathy pt in ER and MD wants to give D5W, is this ok?

Answer 26

NO! per krebs, thiamine is needed first to allow utilization of glucose

Question 27

wernicke-korsakoff syndrome
patho
s/sx

Answer 27

results from long-standing wernickes
antegrade amnesia
memory loss
confabulation
hallucinations

Question 28

FAS (fetal alcohol syndrome)
s/sx

Answer 28

small head, face deformities, hands and feet too
heart liver and renal defects
vision and hearing problems
CNS issues and developmental delays
short attention span
hyperactivity, anxiety, social w drawal

Question 29

tolerance is due to

Answer 29

GABA receptor downregulation

Question 30

in withdrawal …

Answer 30

GABA activation is low, NMDA is high and neurons are hyperexcitable

Question 31

minor withdrawal timing and sx

Answer 31

5-10 hours
autonomic hyperactivity, tremors, hyperhydrosis, tachy c, HTN, GI upset, anxiety, insomnia, vivid dreams

Question 32

major withdrawal timing and sx

Answer 32

12-72 hours
hallucinations (sensory bugs on skin), seizures generalized tonic-clonic

Question 33

delirium tremens timing and sx

Answer 33

48-96 hours
in 5% of pts who w drawal
lasts 1-5 days
visual and auditory hallucinations
disordered consciousness
low grade fever
agitation
diaphoresis
disorientation
hypervent and resp alkalosis
sensorium clouding
life-threatening state - medical emergency!!

Question 34

ethanol vs heroine withdrawal

Answer 34

higher risk of seizures, metabolic crisis, CV risks

Question 35

w/drawal seizures
timing
s/sx

Answer 35

within 48 hours of last drink
generalized tonic-clonic
3% who seize develop status epilepticus

Question 36

Delirium tremens mortality risk is greater in the

Answer 36

elderly
concominant COPD
core body temp >104
death usually dt arrhythmia or secondary complications (pneumonia, liver failure)

Question 37

management / prophylaxis of alcohol withdrawal
4 things

Answer 37

thiamine 50 - 100mg daily
D5 and 1/2 NS
multivitamin
standing orders clonidine, benzos

Question 38

CIWA score
definition
scale

Answer 38

measures sx of wd
<8-10: monitor q4-8h, non-pharm supportive care
8-15: benefit from pharm tx to redice complicaiton risk
>15: high risk for severe complications if no tx

Question 39

benzos in alcohol w drawal
med, dose, freq, CIWA score correlation,

Answer 39

see note sheet

Question 40

sobriety maintenance

Answer 40

group support
disulfram, naltrexone, acamprostate

Question 41

drugs that can ppt disulfram rxn

Answer 41

nitromidazoles (metronidazole)
1st gen SUs (tolbutamine)
cephalosporins (cefoperazone, cefotetan)
griseofluvin

Question 42

disulfram moa
dose

Answer 42

inhibits aldehyde dehydrogenase so acetylaldehyde builds up
do not admin until abstained for 12+ hrs
50mg qd x1-2 weeks initial
maintenance: 250mg qd

Question 43

disulfram AE

Answer 43

CNS: drowsy, HA, fatigue
rash, allergic dermatitis
GI: metallic or garlic taste
hepatitis
peripheral neuropathy, neuritis
ocular neuritis

Question 44

disulfram-disease concerns

Answer 44

diabetes, hepatic impairment, hypothyroidism, nephritis, seizures!!

Question 45

naltrexone
dose

Answer 45

50mg qd
IM 380mg q4wk

Question 46

acamprostate
moa
dose

Answer 46

structurally similar to GABA R’s, enhances GABA activity, dec glutamate activity
666mg po TID