Alcohol

Question 1

Three alcohols to worry about

Answer 1

ethanol, ethylene glycol, methanol

Question 2

What do you give an alcoholic who comes to the ED with withdrawal?

Answer 2

Thiamine + a benzo (lorazepam) + dextrose if comatose

Question 3

Treatments for alcohol dependence?

Answer 3

Disulfiram, naltrexone, acamprosate

Question 4

EtOH metbolism

Answer 4

Zero order kinetics. EtOH is converted to acetaldehyde by alcohol dehydrogenase (requires NAD/NADP). Acetaldehyde converted to acetate by aldehyde dehydrogenase

Question 5

Acetaldehyde effects

Answer 5

N/V, flushing

Question 6

Why do Asian people’s cheeks turn red with they have a sip of wine?

Answer 6

Asian flush. SNP in aldehyde dehydrogenase. It doesn’t degrade acetaldehyde as quickly, so it builds up.

Question 7

Disulfiram MOA

Answer 7

Inhibits acetaldehyde dehydrogenase, leads to buildup of acetaldehyde which makes you feel like crap whenever you have a drink.

Question 8

Naltrexone MOA

Answer 8

Mu antagonist. It decreases reward feeling and craving

Question 9

Other drugs with disulfiram like effect

Answer 9

Sulfonylureas, cefotetan, ketoconazole, procarbazine, metronidazole

Question 10

Acamprosate MOA

Answer 10

GABAa agonist / NMDA antagonist. Oral drug

Question 11

Treatment for tylenol OD?

Answer 11

N-acetylcysteine

Question 12

Normal acetaminophen metabolism

Answer 12

Sulfated or glucuronidated

Question 13

Acetaminophen metabolism in alcoholics

Answer 13

CYP2E1 is induced –> increases NAPQI pathway. NAPQI = toxic. NAPQI is eliminated by mercaptopuric acid conjugation. When mercaptopuric acid runs out –> hepatotoxicity from NAPQI

Question 14

What happens at BAL of <50?

Answer 14

Limited muscle coordination

Question 15

What happens at BAL of 50-100?

Answer 15

Pronounced uncoordination

Question 16

What happens at BAL of 100-150?

Answer 16

Mood and personality changes; intoxication over legal limit

Question 17

What happens at BAL 150-400?

Answer 17

N/V, ataxia, amnesia, dysarthria

Question 18

What happens at BAL > 400?

Answer 18

Coma, respiratory insufficiency, death

Question 19

What factors affect BAL?

Answer 19

Vd, BMI, gender. More body water = lower BAL. More fat = higher BAL. Female = higher BAL.

Question 20

EtOH effect on receptors?

Answer 20

Increase GABA release and receptor density
Inhibits NMDA / upregulated receptors in alcoholics
Increased synaptic DA (increased VTA/NA reward)
Increased ACTH
Increased beta endorphin (activates mu)
Increased synaptic 5-HT
Increased CB1 (modulates DA/GABA/Glu)

Question 21

EtOH liver ADEs

Answer 21

Decreased gluconeogenesis, fatty liver, cirrhosis, liver failure, hepatocellular carcinoma

Question 22

EtOH GI ADEs

Answer 22

Bleeding from portal HTN/retching, nutrient deficiency

Question 23

Fomepizole MOA

Answer 23

Inhibits alcohol dehydrogenase. Allows ethylene glycol/methanol to be excrete unmetabolized

Question 24

Treatment for methanol poisoning

Answer 24

Fomepizole. (Can also use EtOH as a competitive antagonist)

Question 25

Treatment for ethylene glycol poisoning

Answer 25

Fomepizole

Question 26

Effects of ethylene glycol poisoning

Answer 26

Acidosis + nephrotoxicity

Question 27

Effects of methanol poisoning

Answer 27

Acidosis + blindness (retinal damage)