Alcohol Flashcards
Alcoholic pt comes into ER with withdrawal. What to give?
Thiamine and Benzos (Lorazepam).. And dextrose if they’re in a coma (after thiamine of course)
What drugs do you give for alcohol dependence?
Disulfiram, Naltrexone, or Acamprosate (modify alcohol metabolism or VTA/NA reward response)
What order kinetics is the metabolism of alcohol in the liver?
Zero order (PEA: Phenytoin, Ethanol, Aspirin).. Means that it is metabolized at a constant rate despite the amount in ur system
Steps of alcohol metabolism?
EtOH –> acetaldehyde (via alcohol dehydrogenase or MEOS.. both require NAD/NADP) –> acetate (via aldehyde dehydrogenase)
Chronic alcoholism induces what?
CYPs
What intermediate metabolite of alcohol makes you “feel like shit”.. N/V & skin flushing
Acetaldehyde (aldehyde dehydrogenase gets overwhelmed when you drink too much)
What group of ppl have SNPs in aldehyde dehydrogenase?
Asians –> Asian flush
Some alcoholics find acetaldehyde build up pleasurable due to?
SNPs (AlDH21/22)
This drug blocks acetaldehyde dehydrogenase –> accumulation of acetaldehyde
Disulfuram
What drugs have disulfiram effects?
Sulfonylureas, cefotetan, ketoconazole, procarbazine, metronidazole
This drug is a mu antagonist –> decreases reward feeling & craving
Naltrexone
This drug is a GABAa agonist & weak NMDA antagonist
Acamprosate
Why is acetaminophen so toxic for alcoholics?
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)
BAL < 50 does what?
Limited muscular coordination
BAL 50-100 does what?
Pronounced incoordination
BAL 100-150 does what?
Mood & personality changes; intoxication over legal limit
BAL 150-400 does what?
N/V, ataxia, amnesia, dysarthria
BAL >400 does what?
Coma, respiratory insufficiency, death
Other effects not listed?
CV depression, relaxes vascular and uterine smooth muscle (can be used to prevent premie birth)
What are the factors affecting BAL?
- Vd (high weight = low BAL)
- BMI (high fat = high BAL)
- Female (high BMI, low Vd, high absorption)
- EtOH doesn’t go to adipose so more body water = low BAL
What are the EtOH receptors?
- GABA (increased release & receptor density)
- NMDA (receptors upreg in alcoholics)
- DA (increased VTA/NA reward)
- ACTH (increased)
- Opioid (increased Bendorphin, activate mu)
- 5HT (increased)
- Cannabinoid (increased –> modulates DA/GABA/Glutamate)
Additive EtOH AEs?
CNS depression, acetominophen toxicity, bleeding w/ NSAIDs, anti-coags, teratogen
Liver AEs?
- Decreased gluconeogenesis
- Fatty liver
- Cirrhosis
- Liver failure
- HCC
GI AEs?
- Bleeding from portal HTN or retching
2. Nutrient deficiencies
CNS AEs?
- Peripheral neuropathy
2. Wernicke-Korsakoff (thiamine def –> ataxia, confusion, opthalmoplegia).. mammillary bodies
Endocrine AEs?
- Gynecomastia
2. Testicular atrophy from decreased steroidogenesis
CV AEs?
- HTN
- Folate deficiency anemia
- Dilated cardiomyopathy
- Arrhythmia (binge drinking)
- Modest use can increase HDL
Immune AEs?
- Increase inflammation in liver & pancreas
- Decrease inflammation everywhere else
- Increased risk of pneumonia
Describe the complications of FAS
Alcohol crosses placenta –> increased neuronal apoptosis –> growth retardation, microcephaly, ataxic, flat face, joint anomalies, VSD/ASD
Toxicity of ethylene glycol (antifreeze)
Acidosis & nephrotoxicity
Toxicity of methanol?
Acidosis & retinal damage
Ethylene glycol & methanol are metabolized by?
Alcohol dehydrogenase
Tx of ethylene glycol/methanol poisoning?
- Fomepizole: blocks alcohol dehydrogenase –> allows the ethylene/methanol to be excreted unmetabolized
- EtOH: competes with the other alcohols
