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Pharm > Alcohol > Flashcards

Alcohol Flashcards

1
Q

Ethylene Glycol

A
  • Ethylene glycol used as heat exchangers, in antifreeze formulations, and as industrial solvents.
  • Young children are sometimes attracted by the sweet taste of ethylene glycol
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2
Q

physical dependence symptoms

A
  • insomnia
  • tremor
  • seizure
  • nausea/vomiting
  • diarrhea
  • arrhythmia
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3
Q

Medical applications of ethanol

A
  1. 10-15g/day increases serum HDL levels

2. delays onset of labor

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4
Q

Drug that inhibits ADH

A

Fomepizole

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5
Q

what does ADH do?

A

converts ethanol to acetaldehyde

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6
Q

What enzyme converts acetaldehyde to acetate?

A

aldehyde dehydrogenase

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7
Q

drug that inhibits aldehyde dehydrogenase

A

disulfiram

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8
Q

ethanol facilitates action at which receptors?

A

GABA-A

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9
Q

Ethanol inhibits

A

the ability of glutamate to activate NMDA receptors

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10
Q

acute effects of alcohol

A
  • sedation
  • loss of inhibition
  • impaired judgment
  • slurred speech and ataxia
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11
Q

what does aldehyde dehydrogenase do?

A

converts acetaldehyde to acetate

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12
Q

Effects of alcohol on liver

A

a) reduced gluconeogenesis –> hypoglycemia

b) progresses on to fatty liver, hepatitis, cirrhosis and liver failure

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13
Q

fomepizole

A

inhibits ADH

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14
Q

disulfiram

A

inhibits Aldehyde dehydrogenase

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15
Q

effects of ethanol on the GIT

A

a) inflammation, scarring, and bleeding of the gut wall

b) increased risk of pancreatitis

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16
Q

effects of ethanol on the CNS

A

a) peripheral neuropathies

b) thiamine deficiency can occur (Wernicke-Korsakoff)

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17
Q

Effects of ethanol on the endocrine system

A

a) gynecomastia

b) testicular atrophy

18
Q

Effects of ethanol on the cardiovascular system

A
  1. increased incidence of:
    a) HTN
    b) anemia
    c) dilated cardiomyopathy
  2. ingestion of moderate quantities (10-15g/day) raises serum levels of HDL
19
Q

Wernicke-Korsakoff Syndrome

A
  • uncommon
  • Characterized by:
    a) paralysis of the external eye muscles
    b) ataxia
    c) confused state
  • can progress to coma and death
  • associated with thiamine deficiency
  • patients suspected of having W-K syndrome should receive thiamine therapy
  • ocular symptoms, ataxia, and confusion often improve with thiamine administration
  • most patients are left with a chronic disabling MEMORY disorder known as Korsakoff’s psychosis
20
Q

Fetal Alcoholic Syndrome (FAS)

A 
➢	Intrauterine growth retardation
➢	Microcephaly
➢	Poor motor coordination
➢	Underdevelopment of the mid-facial region (appearing as a flattened face)
➢	Minor joint anomalities
21
Q

Treatment of Acute Alcohol Intoxication

A

➢ Supportive Measure:
• Prevent respiratory depression & aspiration pneumonia
• Give fluids and electrolytes

➢ Pharmacological measure:
• Give glucose to treat hypoglycemia and ketosis
• Thiamin (100 mg) is given to protect against Wernike-Korsakoff syndrome
• Prevent seizures, delirium, & arrhythmia
• Restore K, Mg, & Phosphate ions

22
Q

Long-term consequences of Wernicke-Korsakoff syndrome

A

most patients are left with a chronic disabling MEMORY disorder known as Korsakoff’s psychosis

23
Q

Patient presents with: Insomnia, tremor, anxiety, life threatening seizures, visual hallucinations, delirium tremens

A

symptoms of alcohol withdrawal

24
Q

Patient presents with paralysis of the external eye muscles, ataxia and confused state. History of drinking

A

Wernicke-Korsakoff syndrome

25
Q

Management of alcohol withdrawal symptoms

A

a) thiamine
b) restoration of fluid electrolyte balance
c) long-acting sedative-hypnotic drug i.e. BZD (diazepam, chlordiazepoxide)
d) in patients with liver disease Lorazepam or oxazepam are preferred because they don’t require hepatic oxidation
e) Intensity of withdrawal effects reduced by clonidine or propranolol

26
Q

Drugs approved to treat alcoholism

A

a) disulfiram
b) naltrexone
c) acamprosate

27
Q

Ethylene Glycol metabolism

A

ethylene glycol –(ADH)–> Glycoldehyde –(Aldehyde dehydrogenase)–> Glycol acid–> oxalic acid

28
Q

MOA of the drug used in management of alcohol withdrawal syndrome

A

Clonidine = alpha 1 blocker

29
Q

Toxic effects of Ethylene Glycol toxicity

A
  • Excitation followed by central nervous system depression.
  • After a delay of 4–12 hours, severe metabolic acidosis develops from accumulation of acid metabolites and lactate.
  • Finally, delayed renal insufficiency follows deposition of oxalate in renal tubules
30
Q

Drug of choice for management of alcoholic withdrawal in patients with liver disease

A

Lorazepam or oxazepam

preferred because they don’t require hepatic oxidation

31
Q

disulfiram

A

approved to treat alcoholism
➢ Aldehyde dehydrogenase inhibitor
➢ If a patient on disulfiram consumes ethanol then acetaldehyde accumulates
➢ This leads to nausea,vomiting, headache, flushing & hypotension

32
Q

Other drugs with disulfiram-like effects

A
  • Metronidazole
  • Cephalosporins (not all)
  • Sulfonylurea hypoglycemic drugs
  • Griseofulvin
33
Q

How is methanol metabolized?

A

methanol– (ADH)–> formaldehyde –(aldehyde dehydrogenase)–> formic acid

34
Q

used to manage profound metabolic acidosis

A

bicarbonate

35
Q

naltrexone

A

opioid antagonist approved to treat alcoholism

36
Q

patient comes in with respiratory failure, a severe anion gap with metabolic acidosis and ocular damage

A

suspect methanol poisoning

37
Q

Methanol

A

➢ Constituent of windshield cleaners & “canned heat”
➢ Intoxication includes:
• visual dysfunction, GI distress, Shortness of breath & loss of consciousness
➢ Methanol metabolized to formic acid, which may cause:
• severe acidosis and retinal damage/blindness

38
Q

acamprosate

A

NMDA antagonist approved to treat alcoholism

39
Q

treatment of methanol poisoning

A

➢ Gastric lavage
➢ Ethanol is given I.V as it is a preferred substrate for alcohol dehydrogenase
• So methanol is not metabolized to formaldehyde
➢ Fomepizole is given, which is an inhibitor of alcohol dehydrogenase
➢ Rx with bicarbonate (to manage profound metabolic acidosis)
➢ Hemodialysis done in high alcohol levels

40
Q

Symptoms of Methanol intoxication

A
  • visual dysfunction
  • GI distress
  • Shortness of breath
  • loss of consciousness
41
Q

Treatment of Ethylene Glycol Toxicity

A
  • Ethanol
  • Fomepizole
  • Supportive measures
42
Q

Physiological dependence

A

deprivation of the drug results in severe anxiety

Pharm (32 decks)

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