Alcohol

Question 1

alcohol - absorption

Answer 1

*liver - first pass
*quickly distributed through body
*absorbed in GI tract:
-stomach (mostly men)
-small intestine
-colon
*rate of absorption affected by weight, body fat, body chemistry, emotional state, and health status

Question 2

alcohol - metabolism

Answer 2

*liver metabolizes alcohol:
alcohol -> acetaldehyde -> acetic acid -> carbon dioxide & water
*heredity can have a strong impact on metabolism and elimination

Question 3

gender differences in alcohol absorption

Answer 3

*women absorb 30% more alcohol into the bloodstream than men of the same weight (therefore, higher BAC than men from same amt; feel effects faster & more intensely)
*contributors:
-lower percentage of body water than men
-less alcohol dehydrogenase enzyme in stomach which breaks down alcohol, so less alcohol metabolized before entering bloodstream

Question 4

spectrum of alcohol use

Answer 4

1. no alcohol use/low risk use
2. binge use
3. risky use
4. alcohol use disorder

Question 5

lower-risk drinking for men

Answer 5

*no more than 2 a day
*no more than 14 a week
*no more than 4 at any one time

Question 6

lower-risk drinking for women & people over 65

Answer 6

*no more than 1 a day
*no more than 7 in a week
*no more than 3 drinks at any one time
*do not drink at least 2 days a week

Question 8

MOA of action of alcohol

Answer 8

*binds to many receptors:
-allosteric activation: GABA-A, glycine, nicotinic, 5-HT3 receptors
-allosteric inhibition: NMDA and kainate-type glutamate receptors, nicotinic receptors
*modification of neurotransmitter release (DA, NE, 5-HT)
*modification of lipid bilayer

Question 9

acute alcohol effects

Answer 9

*euphoria
*relaxation
*loss of inhibition
*impairment in motor coordination
*vomiting, incoherence, other signs of significant intoxication

Question 10

effects of chronic alcohol consumption

Answer 10

*tolerance
*physical dependence
*multiple organ systems affected
*multiple neurological effects

Question 11

alcohol tolerance

Answer 11

*acute tolerance - body’s immediate response to protect itself from effects of ethanol
*pharmacokinetic (metabolic) tolerance - specific groups of liver enzymes activated due to chronic use
*pharmacodynamic tolerance - cellular/molecular adaptations to chronic drinking
*behavioral (learned) tolerance

Question 12

alcohol withdrawal - pathophysiology

Answer 12

*acute withdrawal sx represent rebound from dependent state
-reduced influence of GABA systems
-increased influence of glutamate systems

Question 13

alcohol withdrawal - symptoms

Answer 13

*major sx: tachycardia, transient hallucinations, psychomotor agitation, grand mal seizures, delirium tremens
*minor sx: sweating, increased body temp, hand tremors, rapid pulse, anxiety, depression, insomnia, nausea, vomiting

Question 14

alcohol withdrawal assessment

Answer 14

*CIWA-Ar scale
*score of < 10 does not usuaully need meds for withdrawal
*on a scale of 0-7 (0 = no sx, 7 = very severe), rate the following sx

Question 15

risk factors for alcohol use disorders

Answer 15

*biology: family hx, other mental health disorders, gender differences (SUD in women progress at a faster rate than men = telescoping; women more susceptible to craving and relapse)
*environment: family, peer pressure, chronic stress, hx of trauma/abuse, ACEs
*development: earlier drug use, etc

Question 16

comorbid alcohol use disorder & psychiatric illnesses lead to

Answer 16

substantially worse course of both illnesses, with greater severity of symptoms

Question 17

medications for alcohol use disorder

Answer 17

*acamprosate
*naltroxone