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Psych Pharm > Alcohol > Flashcards

Alcohol Flashcards

1
Q

Alcoholic pt comes into ER with withdrawal. What to give?

A

Thiamine and Benzos (Lorazepam).. And dextrose if they’re in a coma (after thiamine of course)

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2
Q

What drugs do you give for alcohol dependence?

A

Disulfiram, Naltrexone, or Acamprosate (modify alcohol metabolism or VTA/NA reward response)

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3
Q

What order kinetics is the metabolism of alcohol in the liver?

A

Zero order (PEA: Phenytoin, Ethanol, Aspirin).. Means that it is metabolized at a constant rate despite the amount in ur system

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4
Q

Steps of alcohol metabolism?

A

EtOH –> acetaldehyde (via alcohol dehydrogenase or MEOS.. both require NAD/NADP) –> acetate (via aldehyde dehydrogenase)

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5
Q

Chronic alcoholism induces what?

A

CYPs

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6
Q

What intermediate metabolite of alcohol makes you “feel like shit”.. N/V & skin flushing

A

Acetaldehyde (aldehyde dehydrogenase gets overwhelmed when you drink too much)

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7
Q

What group of ppl have SNPs in aldehyde dehydrogenase?

A

Asians –> Asian flush

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8
Q

Some alcoholics find acetaldehyde build up pleasurable due to?

A

SNPs (AlDH21/22)

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9
Q

This drug blocks acetaldehyde dehydrogenase –> accumulation of acetaldehyde

A

Disulfuram

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10
Q

What drugs have disulfiram effects?

A

Sulfonylureas, cefotetan, ketoconazole, procarbazine, metronidazole

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11
Q

This drug is a mu antagonist –> decreases reward feeling & craving

A

Naltrexone

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12
Q

This drug is a GABAa agonist & weak NMDA antagonist

A

Acamprosate

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13
Q

Why is acetaminophen so toxic for alcoholics?

A

Alcoholics induce CYP2E1 –> increase NAPQI pathway –> NAPQI is toxic and is eliminated by Mercaptopuric acid (MA) conjugation

  • MA gets overwhelmed –> BOOM hepatotoxic
  • Give N-acetylcystine (replinishes glutathione by donating sulfhydryl groups)
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14
Q

BAL < 50 does what?

A

Limited muscular coordination

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15
Q

BAL 50-100 does what?

A

Pronounced incoordination

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16
Q

BAL 100-150 does what?

A

Mood & personality changes; intoxication over legal limit

17
Q

BAL 150-400 does what?

A

N/V, ataxia, amnesia, dysarthria

18
Q

BAL >400 does what?

A

Coma, respiratory insufficiency, death

19
Q

Other effects not listed?

A

CV depression, relaxes vascular and uterine smooth muscle (can be used to prevent premie birth)

20
Q

What are the factors affecting BAL?

A
  1. Vd (high weight = low BAL)
  2. BMI (high fat = high BAL)
  3. Female (high BMI, low Vd, high absorption)
  4. EtOH doesn’t go to adipose so more body water = low BAL
21
Q

What are the EtOH receptors?

A
  1. GABA (increased release & receptor density)
  2. NMDA (receptors upreg in alcoholics)
  3. DA (increased VTA/NA reward)
  4. ACTH (increased)
  5. Opioid (increased Bendorphin, activate mu)
  6. 5HT (increased)
  7. Cannabinoid (increased –> modulates DA/GABA/Glutamate)
22
Q

Additive EtOH AEs?

A

CNS depression, acetominophen toxicity, bleeding w/ NSAIDs, anti-coags, teratogen

23
Q

Liver AEs?

A
  1. Decreased gluconeogenesis
  2. Fatty liver
  3. Cirrhosis
  4. Liver failure
  5. HCC
24
Q

GI AEs?

A
  1. Bleeding from portal HTN or retching

2. Nutrient deficiencies

25
Q

CNS AEs?

A
  1. Peripheral neuropathy

2. Wernicke-Korsakoff (thiamine def –> ataxia, confusion, opthalmoplegia).. mammillary bodies

26
Q

Endocrine AEs?

A
  1. Gynecomastia

2. Testicular atrophy from decreased steroidogenesis

27
Q

CV AEs?

A
  1. HTN
  2. Folate deficiency anemia
  3. Dilated cardiomyopathy
  4. Arrhythmia (binge drinking)
  5. Modest use can increase HDL
28
Q

Immune AEs?

A
  1. Increase inflammation in liver & pancreas
  2. Decrease inflammation everywhere else
  3. Increased risk of pneumonia
29
Q

Describe the complications of FAS

A

Alcohol crosses placenta –> increased neuronal apoptosis –> growth retardation, microcephaly, ataxic, flat face, joint anomalies, VSD/ASD

30
Q

Toxicity of ethylene glycol (antifreeze)

A

Acidosis & nephrotoxicity

31
Q

Toxicity of methanol?

A

Acidosis & retinal damage

32
Q

Ethylene glycol & methanol are metabolized by?

A

Alcohol dehydrogenase

33
Q

Tx of ethylene glycol/methanol poisoning?

A
  1. Fomepizole: blocks alcohol dehydrogenase –> allows the ethylene/methanol to be excreted unmetabolized
  2. EtOH: competes with the other alcohols

Psych Pharm (10 decks)

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