Alchohol - French

Question 1

At what rate is alcohol metabolized?

Answer 1

7-10 grams/hour. (Coors light has 12,000 mg = 12g).

Results in a 0.015 - 0.020 decrease in BAC/hr.

Question 2

What is the elimination kinetics of EtOH?

Answer 2

Zero order. (Once the enzyme pathways are saturated, it proceeds at a constant rate, regardless of the amount ingested/BAC)

Question 3

What is the primary metabolic pathway for EtOH? Where is it located, and what are the enzymes involved. What is the end product?

What other metabolites are formed?

Answer 3

Alchohol dehydrogenase in the liver is responsible for the majority of metabolism.

EtOH–dehydrogenase–> Acetaldehyde –> Acetic acid

Also see INcrease in NADH and LACTATE

Question 4

At higher BAC (0.05 - 0.18), what enzyme system kicks in?

Answer 4

CYP2E1. Metabolizes 10-25% at high BAC.

Question 5

On what enzyme does disulfiram act?

What are the effects?

Answer 5

Inhibits acetaldehyde dehydrogenase, which normally converts acetaldehyde–> acetic acid. This is the same enzyme missing in some asians.

Buildup of acetaldehyde causes orthostatic hypotension, flushing, nausea, headache.

Question 6

Women generally have higher body fat percentages than men. Why does this make their BAC higher for a given amt of alcohol (assume same kg mass)?

Answer 6

EtOH distributes in water. Fat contains little water, so the concentration in the blood/plasma ends up being higher.

Question 7

What does a brethalyzer measure?

Answer 7

0.05% of the BAC is exhaled as EtOH, unmetabolized.

Question 8

What is the effect of EtOH on GABA/Glu neurons?

Answer 8

A CNS depressant, so

facilitate GABA
inhibit Glu-NDMA

Question 9

Which reaction, alcohol dehydrogenase or acetaldehyde dehydrogenase, reduces NAD to NADH?

Answer 9

Both.

Question 10

What are some effects of NADH buildup (eg failure to regenerate NAD)

Answer 10

1) increased blood lactate–> acidosis
2) increased Mg secretion–> convulsions
3) increased Acetyl CoA–> increase fatty acid synthesis and decrease fat breakdown = fatty liver
4) Increase NADH–> hypoglycemia (stop krebs, stop gluconeogenesis.
5) Decrease uric acid excretion–> gout attack

Question 11

What causes pancreatitis in heavy drinkers?

Answer 11

Increased digestive secretions.

Question 12

What are long-term effects of drinking on the liver?

Answer 12

Fatty change–> collagen deposition–> cirrhosis –> increased venous pressure leads to esophageal varicosities, ascites, increased bleed time due to clotting factor decrease.

Question 13

What are some features of Alcohol Withdrawal Syndrome (AWS)? At what time (hours) does each typically occur?

Answer 13

Seizures (6-48 hours)
Visual hallucination (12-48 hours)
Delirium tremens (48-96 hours)

In mild withdrawal, see anxiety, restlessness, tremor, etc.

Question 14

A patient presents with no medical history, exhibiting external ophthalmoplegia, nystagmus, ataxia of gait, pain, loss of sensation, and weakness of the arms and legs.

Treat with?

Answer 14

Thiamine. B1

Wernicke’s encephalopathy

Response is good, most patients recover fully.

Question 15

What differentiates Korsakoffs psychosis from Wernickes?

Answer 15

Symptoms of Korsakoffs include severe amnesia and personality alterations.

Irreversible.

Question 16

What is the diagnostic criteria for Fetal Alcohol syndrome?

What is the incidence?

Answer 16

Prenatal or postnatal growth retardation AND altered morphogenesis (especially facial dysmorphology) AND CNS involvement (often mental retardation).

1 in 1000 to 1 in 300 (1 in 3 for heavy drinkers).

Question 17

What are the effects of FAS by trimester?

Answer 17

1st: Major morphologic abnormality
2nd: Increased risk of spontaneous abortions
3rd: Decreased fetal growth

Question 18

The FDA has not established a safe maximum for alcohol during pregnancy. At what level of drinking is risk established?

Answer 18

3 oz/day (6 drinks)

**Peak BAC is critical, probably should not excceed 2 drinks/day

Question 19

Aspirin + alcohol =

Answer 19

GI bleed

Question 20

An alcoholic with normal liver function would be at (increased or decreased) risk for acetaminophen toxicity?

Answer 20

increased. (CYP2E1 induction)

Question 21

A non alcoholic will have (faster/slower) metabolism when intoxicated?

Answer 21

Slower

Question 22

An alcoholic with severe liver disease will have (faster/slower) metabolism when intoxicated?

Answer 22

Slower

Question 23

An alcoholic might experience withdrawal symptoms after taking which two drugs?

Answer 23

Metronidazole

oral hypoglycemics

Question 24

Treat AWS with?

Answer 24

Benzos (chlordiazepoxide, lorazepam)

Clonidine

Question 25

Name 3 drugs that can reduce alcohol consumption (tx of alcoholic) and their mode of action.

Answer 25

Disulfiram–> Antabuse. Inhibit acetaldehyde dehydrogenase

Naltrexone–> Opioid antagonist. Can be used in Tx of alcohol (reduces craving, used in combo with psychotherapy)

[ OR opioid addiction (will not reduce craving in opioid addiction, only block effects) pp104 handout]