Alcohol Flashcards
what advice is given for safe alcohol consumption. (2)
Do not drink > 14 units per week regularly
If you regularly drink 14 units per week, spread evenly over 3 days
why is the concentration of alcohol greater in the liver? (1)
due to the portal vein draining the stomach directly into the liver
what percentage of alcohol is metabolised in the liver?
90% of alcohol is metabolised in the liver
2-5% is excreted in bodily fluids i.e. sweat, urine and breath
what commonly used drug increases alcohol absorption?
Antihistamines
why does alcohol have a quicker effect on women? (2)
lower levels of the enzyme alcohol dehydrogenase in the stomach - more alcohol is absorbed before it begins to be metabolised
Woman have smaller blood volume than men
how much alcohol is removed per hour?
15mg/100ml of blood per hour
what is a fatal dose of alcohol?
> 400mg/100ml
what are the dental problems associated with heavy drinking? (10)
Oral cancers - Risk increases if used alongside smoking
malnourished - this causes oral ulceration, glossitis, angular chellitis, gingivitis.
Neglect for personal care = why oral cancer patients present very late on Trauma Lost dentures Salivary gland enlargement - sialosis Xerostomia Poor wound healing and osteomyelitis which are partly due to the suppression of the immune system. Erosion Bruxism
describe how liver damage increases bleeding? (5)
Reduced production of clotting factors
Reduced Megakaryocyte maturation = few platelets
Reduced Platelet aggregation (reduced number & function)
Reduced absorption of vitamin K (which is used to produce clotting factors) therefore this affects the production of clotting factors 2, 7, 9 and 10
Thrombocytopenia (less platelets) from splenomegaly associated with portal hypertension
describe how liver damage interferes with drug metabolism? (3)
Induces the liver enzymes which increases the metabolism of some drugs which in turn would reduce plasma concentration of the drug and weaken it’s effects.
The liver damage associated with heavy drinking also reduces drug (analgesics, sedatives, antibiotics) and LA metabolism
Alcohol paired with sedative drugs can also suppress the nervous system and prolong the effects of the drug
what problems can arise in patients who drink heavily? (3)
prolonged bleeding
interferes with drug metabolism
GI bleeding - can’t prescribe NSAIDS
describe what occurs when alcohol and warfarin interact?
low amounts of alcohol ( 3 units per day) consumed regularly enhances warfarin metabolism = more powerful
describe what occurs when alcohol and paracetamol interact?
alcohol converts it to an intermediate metabolite which is hepatotoxic (however this is still the analgesic of choice)
describe how disulfiram works in deterring patients from drinking. (4)
Inhibits alcohol dehydroganase which converts acetaldehyde to acetate
If the patient does costume drink this drug inhibits the conversion of acetaldehyde and it accumulates within the body and causes the patient to feel nauseous and start to vomit.
The consumption of large amounts of alcohol with these drugs can lead to arrhythmias and hypotensive collapse
Other drugs can also cause these effects i.e. metronidazole, cephalosporins and ketoconazole.
what is holiday heart syndrome?
those who don’t drink regularly have a period of time where they drink increased amounts = sudden death.
what are the effects of alcohol on the heart/CV system ? (5)
Woman can develop problems whilst consuming less alcohol for smaller lengths of time
Cardiomyopathy Arrhythmias Hypertension Stroke Protective effect
what are the benefits of drinking moderate amounts of alcohol? (3)
reduces the risk of coronary artery disease mostly in older men and post-menopausal women.
Reduces gallstone formation
Reduces macular degeneration
what is alcohol’s role in oral cancer? (4)
Ethanol metabolite acetaldehyde promotes tobacco initiated tumours (synergic effect)
Alcoholics tends to have a nutritional deficiency which thins the mucosa
Damages DNA and alters oncogene production
Alcohol facilitates the absorption of carcinogenic substances across the oral mucosa
define and describe the 3 types of drinking.
Hazardous Drinking:
Risks for problems are likely
Harmful drinking:
Problems associated with alcohol are usually present (social i.e. not making work in the morning etc and medical problems)
Dependant drinking:
Alcohol needed to fundtion
what type of drinker requires specialist intervention?
dependant
name examples of alcohol screening tools and when they are used. (3)
FAST - the most practical and relevant in the GDP setting - recommended
CAGE - can be used in GDP but not on young people
CRAFFT - can be used in GDP specifically on young people
FAST screening; what score does the patient need to achieve before becoming FAST positive?
> or equal to 3
what intervention should we give as the dentist?
The (SIGN) Guidelines state that We should identify those who are harmful and hazardous drinking and deliver a brief 10 minute intervention
AUDIT screening; what score for a woman indicated that they are a hazardous drinker?
7 - 13
AUDIT screening; what score for a man indicated that they are a hazardous drinker?
8-15
AUDIT screening; what score for a woman indicated that they are a harmful drinker?
14 - 20
AUDIT screening; what score for a man indicated that they are a harmful drinker?
16 -19
list what questions are asked in a CAGE screening (4) and what score indicated the patient has a problem (1)?
If you answer ‘yes’ to > 2 of these questions = problem
Have you ever felt you have to cut down on drinking?
Do you get annoyed at criticism of your drinking?
Do you feel guilty about your drinking?
Do you ever take a dink in the morning to get you started/ eliminate the shakes? (detecting dependant drinkers)
describe the teachable moment. (2)
when people may be more receptive to change i.e. after witnessing someone else be injured or after experiencing other negative consequences of drink.
They need to be able to relate to the adverse effect to drinking
how do we assess readiness to change?
use the readiness to change ruler
describe the stages in the cycle of change.
contemplative
preparation
action
maintenance
relapse
precontemplative
describe what a brief motivation intervention should include. (5)
We use behaviour change counselling
We should be non-judgemental
Should last between 5 - 2 minutes
We should encourage people to recognise their conflicting feelings towards their actual and ideal behaviour
We should encourage people to recognise that the responsibility of change lies with them
