Alcohol

Question 1

alcohol metabolism pathway

Answer 1

methanol (add on ethanol to prevent abuse)
–>formaldehyde –> formic acid

ethylene glycol (anti freeze in car engines) –> glycol aldehyde –> glycolic acid + oxalic acid

first step by alcohol dehydrogenase and 2nd step by aldehyde dehydrogenase

Question 2

adverse effects of toxic alcohols

Answer 2

formic acid - neurotoxic (Parkinson) , blindness (permanent retina damage)

glycolic/oxalic acid - oxalate crystals/stones in urine

Question 3

Treatment of methanol and ethylene glycol poisoning

Answer 3

sodium bicarbonate - treatment of metabolic acidosis
hemodialysis - best and most effective treatment
Fomepizole antidote (orphan drug)
Folinic acid
Ethanol (oral)- most commonly used - to saturate dehydrogenase enzyme

Question 4

Acute alcohol withdrawal

Answer 4

Delirium Tremens - DOC is iv Diazepam (if liver disease: Lorazepam or Oxazepam)

Korsakoff Psychosis- Antipsychotics (Haloperidol, Olanzapine) and thiamine

Question 5

Maintenance in alcohol poisoning

Answer 5

Oral chlordiazepoxide

Liver disease: Lorazepam or Oxazepam

Question 6

Prevents alcohol relapse

Answer 6

Anticraving - Naltrexone and acamprosate(NMDA antagonist)

Deterrent (fear)- Disulfiram (Antabuse)

Question 7

Off label anticraving for alcohol

Answer 7

Topiramate
Gabapentin

Question 8

Off level deterrant for alcohol

Answer 8

Metronidazole

Question 9

harmful symptoms of aldehyde accumulation

Answer 9

nausea/vomiting
flushing
abdominal pain/chest pain/headache
hypotension (–> death)

Question 10

Drugs with disulfiram like action

Answer 10

Chlorpropamide (DM)
Griseofulvin (fungal)
Metronidazole (antibiotic)
Procarbazine (cancer)
Cephalosporin (Cefoperazone - due to methyl this tetrazole ring, Cefamandole, Cefoxitin, Cefotetan)