Alcohol

Question 1

Alcohol- MOA

Answer 1

Increases duration of GABA channel opening and acts at GABA/ Cl.
Acts on other NT’s receptors, and disrupts membrane fluidity

Question 2

Alcohol absorption

Answer 2

passive diffusion in stomach but mostly in the SI.

Affected by food, gastric rate, and concentration

Question 3

Alcohol distribution and BAC

Answer 3

Distributes through all of the body water

BAC therefore depends on BW: M vs F, young vs old, weight, dehydration

Question 4

What BAC corresponds to psychomotor impairment

Answer 4

.1

Question 5

what BAC is the legal limit

Answer 5

.08

Question 6

What happens at BAC .3-.4%

Answer 6

alcohol becomes as strong as a surgical anesthetic

Question 7

What order kinetics is alcohol metabolism?

Why?

Answer 7

zero order- alcohol metabolism is independent of concentration and time
Even a small amount of alcohol saturate the receptors

Question 8

What system/s metabolize alcohol

Answer 8

Both in liver
alcohol dehydrogenase system
CYPP450 (microsomal) ethanol oxidizing system- this system causes lots of drug interactions

Question 9

Describe the alcohol dehydrogenase pathway

Answer 9

EtOH –> acetaldehyse via (Alcohol dehydrogenase
acetaldehyde –> acetate via aldehyde dehydrogenase
Acetate is broken down to CO2 and Water via metabolism which provides calories –> dec appetite –> nutrient deficiencies

Question 10

CNS side effects of alcohol

Answer 10

dec inhibitions
reduces REM sleep
respiratory depression
coma/death- linear slope from anesthesia to death

Question 11

Process of alcohol intoxication that leads to death

Answer 11

Inhibitions dec –> Anxiolytic –> sedation –> hypnosis –> anesthesia –> respiratory depression –> coma –> death
most alcohol related deaths are from the respiratory depression

Question 12

Non CNS effects of Alcohol

Answer 12

cutaneous vasodilation resulting in flushing and feelings of warmth but actually heat loss. At higher doses leads to HTN, cardiomyopathy, arrhythmias, and can be fatal
Inhibits ADH –> diuretic
moderate amounts improve lipid profile
Appetite- large amounts suppress apetite –> nutrient deficiencies ie Korsakoff and wernicke (thiamin and niacin)
Liver- dose dependent toxicity- fatty change leads to hepatitis, cirrhosis, and hepatic failure
pancreatitis can be fatal
Gout exacerbation
Hyperestrogenemia
Emesis and other GI issues
Fetal alcohol syndrome

Question 13

Alcohol and drug interactions- mechanism

Answer 13

in the beginning it is a CYP450 inducer dec drugs metabolized by this system.
As liver damage progresses that system slows down

Question 14

Signs of Fetal Alcohol syndrome

Answer 14

microcephaly
mental retardation
abnormal- face, joints, and heart

Question 15

Alcohol tolerance

Answer 15

pharmacokinetic tolerance= more efficiently metabolized
pharmacodynamic tolerance= less sensitive to the drug
Behavioral tolerance= learn how to not act drunk when you are

Question 16

What two issues are caused by B1 deficiency

Answer 16

Thiamine deficiency results in Wernikes and Korsakoff encephalopathy

Question 17

Wernikes encephalopathy

Answer 17

reversible

ataxia, opthalmoplegia, confusion

Question 18

Korsakoff encephalopahty

Answer 18

Irreversible

apathy, antero and retrograde amnesia, confabulations

Question 19

What are the signs of hyperestrogenemia

Answer 19

gynecomastia

Testicular shrinkage

Question 20

Emesis issues with alcohol

Answer 20

Mallor Weiss tear
Boerhaave syndrome
aspiration
GERD

Question 21

Withdrawal- alcohol

Answer 21

starts 6-24 hours after last drink
last 5 days
characterized by irritability, insomnia, tachycardia, palpitations, hallucinations, delirium, tremors, grand mal seizures, arrhythmias
seizures and arrhythmias can be deadly

Question 22

Alcohol withdrawal treatment

Answer 22

benzos- diazepam, lorazepam, oxazepam- work on same receptor. oxazepam and lorazepam are not dependent on hepatic metabolism (preferred bc alcoholics may have liver damage.
phenytoin- control seizures
betablockers, clonidine- control autonomic effects
vitamins and thiamine for nutrient deficiencies

Question 23

do you give antipsychotics in alcohol withdrawal

Answer 23

NO!, inc seizures

Question 24

Drugs to give after alcohol withdrawal has subsided and now patient is focused on kicking the addiction

Answer 24

Disulfram –> block acetaldehye dehydrogenase causing a buildup of acetaldehyde –> flushing, HA, N/V, hepatotoxicity
Naltrexone- long acting opiod agonist- reduces cravings, cause hepatotoxicity
Acamprosate- dec cravings to help maintain abstinence, may act on GABA receptors. Less potential for hepatotixicity.
Naltrexone + acamprosate work well together and are better than either one alone