Alcohol Flashcards
Why is the concentration of alcohol greater in the liver ?
Alcohol is absorbed in GI tract - stomach and small intestine - and absorbed into portal vein which goes straight to liver.
What drugs affect blood alcohol concentration ?
Antihistamines.
Cimetidine.
What enzyme will be increased in heavy drinkers ?
Gamma GT enzyme.
What percentage of alcohol is metabolised and excreted from liver ?
90%
What are patient factors which might influence alcohol metabolism ?
Age, gender, weight, previous exposure, food intake.
What is cimetidine effect on alcohol concentration ?
Increases absorption.
What is antihistamines effect on alcohol concentration ?
Decreases absorption.
What two factors make alcohol concentration higher in women ?
Reduced alcohol dehydrogenase enzyme in stomach - results in more absorption before metabolism.
Smaller blood volume.
What system is initiated in heavy drinkers ?
Microsomal ethanol oxidising system.
What is the safe weekly limit of alcohol ?
14 units spread across 3-4 days.
What is the legal driving limit of alcohol ?
80mg/100ml of blood.
What are the potential dental effects of vitamin deficiency (particularly B1, B2, B6, E and D) ?
Oral ulceration, glossitis, angular cheilitis, gingivitis.
What is the 3 blood related effects of alcohol ?
Thrombocytopenia, leucopenia, macrocytosis.
Name some dental effects of alcohol consumption.
Oral cancer.
Xerostomia.
Sialosis.
Caries.
Poor wound healing.
Osteomyelitis.
NCTSL.
OH and drug regime compliance.
Dental trauma.
What analgesia should be advised for patients who are heavy drinkers ?
Paracetamol (NSAIDs pose risk of gastric bleeding).
What should a patient who drinks heavily be warned of if they require metronidazole treatment ?
Nausea and vomitting.
What is the mechanism of metronidazole’s action on alcohol ?
Inhibits alcohol dehydrogenase in stomach causing build up of acetylaldehyde = nausea.
What are signs of alcoholic liver disease ?
Jaundice. Ascites. Cachexia. Enchephalopathy. Bleeding. Bruising.
Infection.
If patient has no liver damage but drinks alcohol regularly - what outcome will it have on drug metabolism ?
Increased metabolism as liver enzymes are increased.
If patient has liver damage but drinks alcohol regularly - what outcome will it have on drug metabolism ?
Reduced metabolism as liver enzymes are not being produced from fibrosed tissue.
Patient has alcoholic liver disease, what LA should be used ?
Articaine.
What % of people diagnosed with oral cancer consume alcohol ?
75-80%
What is the survival rate % of oral cancer within 5 years ?
45-55%
What are the 4 ways which alcohol (ethanol metabolite - acetylaldehyde) can cause oral cancer ?
Ethanol metabolite (acetylaldehyde) -
Promotes tobacco initiated tumours.
Facilitates carcinogenic absorption in oral mucosa.
Damages DNA.
Alters oncogene production.
Name two questionnaires for assessment of alcohol intake.
FAST and AUDIT
What alcohol assessment questionnaire is most commonly used in dentistry ?
FAST questionnaire.
What is the function of alcohol assessment questionnaires ?
Identifies risk factors for dentist.
Identifies need for more comprehensive assessment for substance misuse.
What are the five stages to the cycle of change ?
Precontemplative.
Contemplative.
Preparation.
Action.
Maintenance.
(Relapse).
What type of intervention should a dentist take in alcohol prevention ?
Brief motivational interventions - opportunistic (5-20 mins) non-judgemental to encourage patient to recognise and differ actual and ideal behaviour with respect to alcohol intake.
