Alcohol Flashcards
How heritable is alcoholism?
50%
DSM-V criteria for AUD
-Can’t fulfill roles
-Can’t stop even when inappropriate/hazardous
-Withdrawal/tolerance
-Can’t stop, drink more than planned
-Craving
etc
What are the 4 stages of AUD treatment?
- Identification
- Detox/withdrawal
- Detox: goal is to prepare pt for entry into rehab.
- Withdrawal: tremor, insomnia, anxiety, irritability, sweating, nausea, vomiting, delirium tremens - Rehabilitation
- Psychosocialtherapy and pharmacotherapy helpful - Aftercare
What meds are used to detox alcohol?
Benzodiazepines and anticonvulsants
What medication should you use to treat alcohol dependence?
Disulfiram, Naltrexone, Acamprosate, Topiramate (not yet FDA approved)
How does disulfiram work to treat alcohol dependence?
There is a disulfiram-ethanol (inhibits ALDH) reaction that causes flushing, nausea, palpitations and lightheadedness (at the acetaldehyde stage)
How does naltrexone work?
Oral antagonist of opioid receptors, reduces dopamine release with alcohol expectation and ingestion (ie reduces craving and pleasure). Nausea is the most common side effect. Have long-acting IM injection that lasts 1 mo
-Naltrexone reduces risk of heavy drinking, but doesn’t increase likelihood of abstinence
How does acamprosate work?
GABA agonist, reduces deprivation-induced drinking
- liver sparing, not good for renal insufficiency
- diarrhea most common adverse event
How does topiramate work?
Reduces heavy drinking days and increases abstinence. Dirty drug (GLUK1 glutamate receptor)
Where does absorption of alcohol happen the most?
Small intestine, accelerated by CO2
Who had a higher volume of distribution for alcohol?
Women (more body fat)
What 3 enzymes are involved in alcohol metabolism?
Alcohol Dehydrogenase (ADH), Acetaldehyde Dehydrogenase (ALDH) and Microsomal ethanol oxidizing system (MEOS=cytocrome 450E1)
How does ADH work? Where is it located and who has higher levels? Is it saturable?
It converts alcohol to acetaldehyde. Located in liver, brain, stomach. Men have more so women metabolize less alcohol overall. ADH is saturable.
How does ALDH work?
Acetaldehyde is hepatotoxic and can’t be excreted. ALDH converts it to acetate which is excreted via the kidney. Disulfiram inhibits ALDH and Asians have an ALDH deficiency
How does MEOS work?
When ADH is saturated, it converts ethanol to acetaldehyde in the liver. This system is highly inducible, so habitual drinkers have more MEOS. Leads to tolerance and increased drug metabolism interactions