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neuro psych & abuse exam 1 > AAD > Flashcards

AAD Flashcards

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1
Q

ALcoholism

A

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

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2
Q

DSM 5

A

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

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3
Q

DSM 5 and AUD severity

A

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

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4
Q

type I alcoholism

A

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

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5
Q

type II alcoholism

A

early onset
much more prevalent in men
more severe health consequences

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6
Q

AUD labs for dx

A

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

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7
Q

AAD most prevalent in which age group and sex

A

18-29 males

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8
Q

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

A

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”

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9
Q

alcohol and dopamine system

A

inc DA in mesolimbic system –> reinforcing and rewarding effects

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10
Q

alcohol and opioid peptide system

A

activates it
reinforcing and rewarding effects (mu)
craving

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11
Q

alcohol acutelystimulating gaba system causes what

A

sedative and anxiolytic effects
w drawal

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12
Q

alcohol inhibiting glutamate system causes

A

neuroadaptation and w drawal

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13
Q

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

A

inc

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14
Q

ethanol pk

A

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

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15
Q

ethanol pk

A

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

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16
Q

rapid gastric emptying and alcohol graphs

A

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

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17
Q

6 things that slow abs rate

A
  1. food in stomach
  2. carbs and amino acids
  3. cigarettes
  4. anticholinergics propantheline (delay gastric emptying)
  5. trauma, shock, massive blood loss
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18
Q

6 things that inc rate of absorption

A
  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)
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19
Q

rank Vd of alcohol, and why
male female obese

A

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

20
Q

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

A

1

21
Q

male vs female alcohol dehydrogenase

A

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

22
Q

inc Vd _______ BAC

A

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

23
Q

CNS and chronic AUD effects

A

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

24
Q

hepatic and pancreatic effects of AUD chronic

A

steatosis, fatty liver
alcohol hepatitis
cirrhosis
pancreatitis

25
Q

wernickes encephalopathy s/sx and patho

A

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

26
Q

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

A

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

27
Q

wernicke-korsakoff syndrome
patho
s/sx

A

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

28
Q

FAS (fetal alcohol syndrome)
s/sx

A

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

29
Q

tolerance is due to

A

GABA receptor downregulation

30
Q

in withdrawal …

A

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

31
Q

minor withdrawal timing and sx

A

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

32
Q

major withdrawal timing and sx

A

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

33
Q

delirium tremens timing and sx

A

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!!

34
Q

ethanol vs heroine withdrawal

A

higher risk of seizures, metabolic crisis, CV risks

35
Q

w/drawal seizures
timing
s/sx

A

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

36
Q

Delirium tremens mortality risk is greater in the

A

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

37
Q

management / prophylaxis of alcohol withdrawal
4 things

A

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

38
Q

CIWA score
definition
scale

A

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

39
Q

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

A

see note sheet

40
Q

sobriety maintenance

A

group support
disulfram, naltrexone, acamprostate

41
Q

drugs that can ppt disulfram rxn

A

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

42
Q

disulfram moa
dose

A

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

43
Q

disulfram AE

A

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

44
Q

disulfram-disease concerns

A

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

45
Q

naltrexone
dose

A

50mg qd
IM 380mg q4wk

46
Q

acamprostate
moa
dose

A

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

neuro psych & abuse exam 1 (5 decks)

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