alcohol

Question 1

what are the effects of a low dose of alcohol

Answer 1

euphoria
reduced anxiety
relaxation
sociability

Question 2

what are the effects of higher doses (intoxication) of alcohol

Answer 2

impaired attention 
impaired judgement 
flushing 
unbalanced 
nystagmus 
mood instability 
disinhibition 
slurring 
stupor 
unconsciousness

Question 3

what are the criteria for ‘harmful use’ of alcohol

Answer 3

using alcohol >1 month or repeatedly over 12 resulting in damage to physical or mental health

Question 4

what are the requirements for ‘dependence’ on alcohol

Answer 4

3 of the following for > 1 month or repeatedly over 12 
cravings/compulsions
difficulty controlling use 
primacy 
increased tolerance
persistent use despite consequences

Question 5

what is a withdrawal state

Answer 5

symptoms caused by complete/relative withdrawl of a psychoactive substance

Question 6

what are symptoms of alcohol withdrawal

Answer 6

tremor 
nausea
weakness
vomiting 
dehydration
anxiety
seizures
confusion
agitation

Question 7

what are some screening tools used for alcoholism

Answer 7

CAGE
AUDIT
FAST
PAT

Question 8

how do you manage alcohol dependence

Answer 8

depends on patient
offer advice, education
holistic approach involving support for family/friends, psychological help, social workers, community support (AA)

Question 9

what medications could you use in alcohol withdrawal

Answer 9

benzodiazepines - usually chlordiazepoxide but can use diazepam

Question 10

what is disulfiram used for

Answer 10

its a deterrent drug for alcohol

Question 11

what drugs can be used for alcohol cravings

Answer 11

acamprosate
naltrexone
nalmefene

Question 12

what are cautions for naltrexone and nalmefene

Answer 12

avoid any kind of alcohol (in foods, mouthwash etc) because ingestion of alcohol will cause rapid increase in BP, tachycardia, flushing

Question 13

how does alcohol create a relaxing effect

Answer 13

stimulates GABA receptors
inhibits glutamate receptors
this causes inhibition of electrical activity

Question 14

what is the pathophysiology of delerium tremens

Answer 14

alcoholics have a down regulated GABA and upregulated glutamate system because of tolerance to alcohol
if alcohol is removed from their system there will be extreme excitability causing excess adrenergic activity

Question 15

what are symptoms of delirium tremens

Answer 15

confusion
severe agitation
delusions 
hallucinations
tachycardia
hypertension
hyperthermia
ataxia
arrhythmias 
sleeplessness
autonomic overactivity 
usually come on in 48-72hrs of stopping

Question 16

how do you manage delirium tremens

Answer 16

benzodiazepine (high dose titrated to low over about 5 days)
IV B vitamins
thiamine at a low oral dose

Question 17

what is wernicke’s encephalopathy

Answer 17

reversible condition caused by thiamine deficiency

Question 18

symptoms of wernikes

Answer 18

triad of ataxia, oculomotor disturbance, confusion

Question 19

how do you manage wenickes

Answer 19

IV fluids

thiamine

Question 20

what is korsakoffs syndrome

Answer 20

!medical emergency!
wernickes can develop into this if not treated
irreversible

Question 21

symptoms of korsakoffs

Answer 21

memory impairment
behavioural changes
this is a serious disease and often requires institutional care

Question 22

how do you manage korsakoffs

Answer 22

emergency
thiamine
fluids

Question 23

how does alcohol consumption cause thiamine deficiency

Answer 23

thiamine is poorly absorbed across gut in presence of alcohol
alcoholics also normally have poor diets and get most of their calories from alcohol

Question 23

how does alcohol consumption cause thiamine deficiency

Answer 23

thiamine is poorly absorbed across gut in presence of alcohol
alcoholics also normally have poor diets and get most of their calories from alcohol
alcohol also intervenes with thiamine storage and conversion

Question 24

what is alcoholic ketoacidosis

Answer 24

condition where there is a metabolic acidosis due to alcohol and lack of food 
hypoglycaemia 
acidosis 
low bicarbonate 
increased resp rate

Question 25

why are there increased ketones in AKA

Answer 25

The alcohol puts extra stress on the body, this increases cortisol and catecholamine levels
These hormones increase lipolysis resulting in FFAs in the blood
The FFAs get metabolised into ketones

Question 26

how does alcohol impair glucose production and lactate metabolism

Answer 26

he metabolism of ethanol results in B-hydroxybutyrate production (a ketone) and it also increases NADH/NAD in the liver
The NADH/NAD levels impair ability to make glucose and metabolise lactate - this causes hypoglycaemia and acidosis

Question 27

what is the role of thiamine in relation to lactic acid

Answer 27

thiamine is needed to metabolise lactic acid and prevent build up

Question 28

what is acetaldehyde

Answer 28

a substance produced in metabolism of ethanol

it is toxic to hepatocytes

Question 29

what will happen to clotting time in alcoholic liver disease

Answer 29

it will increase because the liver is damaged and less able to produce clotting factors for the cascade

Question 30

why are chronic users of alcohol usually malnourished

Answer 30

tend to replace meals with alcohol

alcohol requires vitamins to be metabolised

Question 31

would the Na, K, PO4 valued be raised or lowered in chronic users of alcohol

Answer 31

usually lowered because most chronic users are malnourished