alcohol

Question 1

impact of ETOH on

GABAa

Answer 1

increase GABA releae; increase receptor density

Question 2

NMDA

Answer 2

inhiibiton of postsynaptic NMDA receptor; with chronic use up-regulation

Question 3

DA

Answer 3

increaed synaptic DA, increase effects on VTA/NaC reard

Question 4

ACTH (1)

Answer 4

increases CNS and blood levels of ACTH

Question 5

opiod and alcohol

Answer 5

release of beta endorphins, activation of mu receptors

Question 6

5-HT and alochol

Answer 6

increase in 5-HT synaptic space

Question 7

cannabionoid

Answer 7

increase CB1 activity –> changes in DA, GABA, glutamate activity

Question 8

what are the acute effects on alcohol on CV and vasculature?

Answer 8

CV depressant

relaxes vascular smooth muscle –> vasodilation, possible hypothermia, increased gastric blood flow

RELAXES uterine smooth muscle(used to prevent premature labor??)

Question 9

BAL

more weight = larger vol of distribution== low or high BAL

Answer 9

lower BAL

Question 10

BMI

more body fat = smaller volume of distribution = low or high BAL?

Answer 10

high

Question 11

female gender = what type of BAL

Answer 11

higher.

b/c: increased absorption (5-10%) compared to men

wieght is lower

higher % body fat

Question 12

metabolism of ETOH

Answer 12

zero order process (1 drink/hour)

Question 13

adaptation

behavioral and neural adaptation(more significant)

enzyme induction(less significant)

Question 14

chronically, which body systems does ETOH affect?

(7)

Answer 14

Liver+GI

CNS

endocrine

CV

neoplasia

immune sytem

Question 15

effects of alcohol on Liver? (3)

Answer 15

1. decreased gluconeogenesis –>hypoglycemia
2. fatty liver - hepatitis, cirrhosis + liver failure
3. decreased coritcosteroid synthesis ==> endocrine failure

Question 16

effects of etoh on GI?

Answer 16

bleeding, scarring –> asporptive and nutritional deficiency

Question 17

chronic alchool effects on CNS? (2)

Answer 17

1. peripheral neuropathy
2. Wernicke-Korsakoff syndrome = ataxia, confusion, ocular muscle paralysis (treat with thiamine)

Question 18

what is triad of wernicke-korsakoff syndrome?

how do you tx?

Answer 18

wernicke-korsakoff = ataxia, confusion, ocular muscle paralysis

tx w/thiamine

Question 19

effects of ETOH on endocrine?

Answer 19

gynecomastia + testicular atrophy secondary to steroid insufficiency

Question 20

consequence of this defiency = inability to synthesize and replenish cricial AA and proteins, esp those in the CNS

Answer 20

thiamine def

Question 21

chornic effect of alcohol on heart?(3)

Answer 21

1. HTN, anemia, dilated cardiomyopathy
2. arrhythmia w/binge drinking
3. modest alcohol consumion increase HDL and may protect against CHD

Question 22

which neoplasia associated with ETOH?

Answer 22

GI cancer

Question 23

how ETOH affects immune system:

Answer 23

1. enhaned inflamation in liver + pancreas but reduced immune response in other tissues
2. chronic alcoholics = pneumonia

Question 24

how do you tx an intoxicated pt in the ED

4 ways

Answer 24

1. ABC
2. dextrose - compensate for hypoglyemia
3. thiamine - protect from wernicke-korsakoff syndrome
4. correct electrolytes

Question 25

how do you tx withdrawing pt? (3 ways)

Answer 25

1. BNZ sedative (diazepam or lorazepam in hepatic dysfunction)
2. thiamine
3. correct electrolyte issues.

Question 26

when would you use lorazepam in withdrawing pt?

why?

Answer 26

use lorazepam in hepatic dysfunction b/c processed only by glucoronidation = phase II therefore less sucsecptible to prolongation in t 1/2.

Question 27

4. types of drugs that alcohol interacts with?

Answer 27

1. additive CNS depression
2. increases tox of acetaminophen
3. increase risk of bleeding with NSAIDs and anticoagulatnts
4. increse risk of hypoglycemia in diabetics on meds

Question 28

sulfonylreas, cefotetan, ketoconazole, and procarbazine all produce what?

Answer 28

disulfiram like rxns