Alcohol 1 Flashcards by Adhana Asfaw

Current Drinker

Have had one drink in the past 30 days

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Binge Use

Have had 5 or more drinks in the past 30 days

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Heavy Use

Have had 5 or more drinks on 5 or more occasions in the past 30 days

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Drinks with the same alcoholic content

All at .6 oz of alcohol
Beer- 12 oz
Malt Beer- 8 oz
Table Wine- 5 oz
Fortified Wine- 3.5 oz
Cordial Liquer- 2.5 oz
Brandy- 1.5 oz
80 Proof Shot- 1.5 oz

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Absorption

Rapidly absorbed via the GI tract
Subjected effects detected quickly- some may be due to expectancy
Plasma ethanol levels of 20 mg/dl can be detected
Placebo use due to olfactory and taste factors

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Excretion/Absorption

Stomach serves as holding area- contains 20% of ethanol
92-94 % of ethanol absorbed metabolized and excreted
Remaining is directly excreted through sweat, tears, and breath

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Racial Differences

Asian populations have low levels of alcohol dehydrogenase - increased flushing and greater levels of intoxication
Due to genetic variation between ethnicities

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Enzyme Location

80-90% of alcohol dehydrogenase in the liver

Both enzymes are polypeptides, and are genetically controlled

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Breathalyzer

Direct excretion through the breath is basis of breathalyzer
Ethanol concentration is in equilibrium between blood and tissues
Alveolar sacs are right next to capillaries
Values parallel the blood, except are artificially higher directly after drinking

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Factors that speed absorption

Carbonation- Speeds gastric emptying rate
Aspirin- irritates gastric walls and causes faster gastric emptying rate
Empty stomach- causes alcohol to go straight to small intestine

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Factors that slow absorption

Food- slows gastric emptying rate
Water- Dilutes concentration
Marihuana- slows GI motility

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Male/ Female Differences

Females have higher BAL with same amount of alcohol
Males typically have a higher muscle to fat ratio- alcohol is more diluted
Females with a higher fat ratio than males- alcohol not fat soluble, so it is concentrated in plasma
Females have 50% less gastric alcohol dehydrogenase than males

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Theories on Mechanism of Action

Lipid Theory- Alcohol perturbates cellular membranes at the CNS
Protein Theory- Alcohol interacts with a neuronal protein site, neurotransmitter ion gates
Alcohol has some effect on protein function

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Alcohol Sensitive Neurotransmitters

GABA
Glutamate
Dopamine 
Serotonin
Nicotinic Acetylcholinergic

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GABA

Major inhibitory neurotransmitter
Stimulation results in dampening of the signal
Receptor of several complex proteins
Activity of protein kinase C controls GABAa sensitivity to alcohol
Binding to GABA causes Cl ions to flow into the cell- ethanol enhances this
As a result, reduced anxiety and reduced motor coordination
Another binding site of these receptors for benzodiazepines

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Glutamate

Major excitatory transmitter
Accounts for 40% of transmitters
NMDA subtype
Involved with learning and memory
May be involved in physical dependence
Normally allows Ca2+ to flow into the cell
Ethanol dampens Ca2+ flow into the cell by inhibiting NMDA like glutamate receptors

CNS and Physiological Effects

Euphoria- sense of well being, greater self esteem, feelings of confidence, increased talking and social ability

Varied effects on heart rate and blood pressure
Increased skin temperature due to vasodilation

Rate of Consumption vs BAC

Higher BAC with increased rates of consumption

Metabolism

Alcohol Dehydrogenase in liver- first line in breaking alcohol down- rate limiting step
Individual variations in rate, but falls within a predictable range of between 12-20 mg/dL/hr
Remains constant within an individual
Alcohol –> Acetaldehyde –> Acetate

Acetaldehyde

Generally toxic to tissues in the body- irritant to skin and carcinogen
Causes a number of negative signs and symptoms- nausea, vomiting, facial flushing, headache, heart palpitations
Major contributor to hangovers
Buildup causes Alcohol Flush Reactions

Aldehyde Dehydrogenase

Acetic acid is less toxic to the body
Polymorphic variants on the genes that encode ALDH that alter the kinetic profile
Mutant form of ALDH genes causes low levels of enzyme that results in high amounts of flushing and intoxication

Social

Small amount on occasional basis

Spree

Binge drink occasionally, but stay sober for the most part

France drinkers

Consume large amounts of alcohol over a long time period

Chronic Alcoholic drinking pattern

Drink heavily for a few days, and then go on a self imposed sober period for 2-3 days. Then repeat this cycle

Functional Tolerance

NMDA receptors allow for Ca2+ to flow into the cell Ethanol dampens NMDA stimulated Ca2+ flow Tolerance develops at different rates to different effects- more quickly to mental functions, less quickly to motor control Brain compensates by up-regulating and decreasing sensitivity at these receptors Rapid tolerance to unpleasant effects of alcohol increase alcohol consumption

Reverse Tolerance

Increased sensitivity to alcohol after major liver damage

Metabolic Tolerance

Resistance to alcohols effects by increasing the enzymes that break alcohol down Increased rate in breaking alcohol down

Behavioral Tolerance

Resistance to alcohol's effects that develops with repeated experiences of intoxication Learned associations Behaviors learned when intoxicated are better performed later when equally intoxicated

Physical Dependence

Results in hyper excitability during withdrawal period 8-12 hours after last drink Begin: Mild agitation, nausea, vomiting, sweating, tremors, irregular heart rate Hallucinations, clouded senses, seizures and delirium follow Acute phase can last 7-10 days Delirium tremens characterized with profound disorientation, perception disorders, severe tremors, restlessness and hallucination Rare now with improved treatment of benzodiazepines, but death is possible

Alcohol Blackouts are not

- Act of passing out - Only happen to chronic alcoholics - Only happen at excessively high BAC - Can only happen when doing shots - Early signs of dementia

Alcohol blackouts

Loss of memory during certain time points of alcohol consumption Interfere with processing that allows short term memory to be converted into long term meory Can carry conversations, drive, but cannot remember what was done minutes before Long term memory remains intact Both in social and heavy drinkers Complete (en bloc, or fragmentary) Complete- full loss of any memories for the time period when drinking

Alcohol Blackout Risk Factors

Women at higher risk When taken with other amnesia causing drugs High BAC Combining with other psychoactive drugs like marihuana

Personal Breathalyzers

Handheld devices | Advertised to avoid getting a ticket, or to know BAC levels

On Roads

Sobriety Checkpoints- Locations where law enforcement officers assess drivers BAC Ignition Interlocks- Car will not start without a low BAC

Public Health Issue

- Alcohol related incidences are 1/3 of all traffic related deaths - Fatal crashes include younger populations