Alcohol

Question 1

BAC intoxication level in most states

Answer 1

80

Question 2

Name the BAC level:

• Sedation, subjective “high,” slower reaction times
• Impaired motor function, slurred speech, ataxia
• Emesis, stupor
• Coma
• Respiratory depression, death

Answer 2

50-100 - Sedation, subjective “high,” slower reaction times
100-200 - Impaired motor function, slurred speech, ataxia
200-300 - Emesis, stupor
300-400 - Coma
>500 - Respiratory depression, death

Question 3

The two CNS ion channels that ethanol targets.

Answer 3

• NMDA subtype of glutamate receptors

- GABA

Question 4

What are NMDA and GABA receptor functions in the CNS?

Answer 4

NMDA is the primary EXCITATORY NT.

GABA is the primary INHIBITORY NT .

Question 5

Alcohol inhibition of NDMA and GABA results in loss of what normal functions of each?

Answer 5

NMDA - normally implicated in learning/memory. Alcohol inhibits the ability of glutamate to open the cation channel of the NMDA receptor and leads to a depression of the CNS.

GABA is normally implicated in depression of CNS. Alcohol enhances GABA effects.

Tolerance and dependence have opposite effects on NMDA and GABA than alcohol (making you drink more to get same effect).

Question 6

Symptoms of ____ include:

• hyperexcitability/palpitations, tremors, anxiety, insomnia, N/V, in mild cases
• seizures, toxic psychosis, and delirium tremens in severe cases

Answer 6

withdrawal syndrome

Question 7

What is characterized by delirium, hallucinations, fever, and tachycardia? How long after alcohol discontinuation does this begin?

Answer 7

Delerium tremens

48-72 hours

Question 8

Associated with thiamine deficiency, symptoms show: Paralysis of the external eye muscles, ataxia, and a confused state that can progress to coma and death.

Treatment of this

Answer 8

Wernicke-Korsakoff

Thiamine to improve ocular problems, ataxia, confusion.

Question 9

Peripheral nerve injury, gait and ataxia, dementia, painless blurring vision. all indicate?

Answer 9

Neurotoxicity from alcohol

Question 10

Ethanol increases levels of ___ enzyme, leading to what drug-drug interaction?

Answer 10

CYP450, leading to acetaminophen-induced hepatotoxicity

Question 11

Drugs for treatment of acute alcohol withdrawl

Answer 11

diazepam (long acting benzos), lorazepam and oxazepam (short acting benzos, good for people with iver dz), and thiamine

Question 12

Drugs for prevention of alcohol abuse/dependence

Answer 12

acamprosate, disulfram, naltrexone

Question 13

Drugs for treatment of acute methanol or ethylene glycol poisoning

Answer 13

ethanol and fomepizole

Question 14

Management of acute alcohol intoxication

Answer 14

glucose, thiamine, potassium (if severe vomiting)

Question 15

MOA of___: µ opioid receptor antagonist (long-acting). reduces craving for alcohol. Used to reduce cravings and relapse. For tx of alcohol and opiate dependence.

Contraindicated in patients with what two conditions

Answer 15

naltrexone

CI in hepatitis and liver failure

Question 16

MOA of ___: weak NMDA-receptor antagonist and GABAA receptor agonist (also affects serotonergic, noradrenergic, and dopaminergic systems). Used to reduce relapse (long+short term).

Contraindicated in what disease?

Answer 16

Acamprosate

CI in renal disease

Question 17

MOA of ___: irreversibly inhibits aldehyde dehydrogenase and causes extreme discomfort in
patients who drink alcoholic beverages (flushing, throbbing headache, nausea, vomiting, sweating, hypotension, confusion due to the accumulation of aldehyde).

Answer 17

Disulfiram

Question 18

Four part treatment of ___ poisoning - when a person comes in with blurred vision “like being in a snowstorm”.

Answer 18

Methanol poisoning
Treatment:
(1) Respiratory support
(2) Suppression of metabolism by ADH (ethanol and fomepizole)
(3) Hemodialysis to enhance methanol removal
(4) Alkalinization to counteract metabolic acidosis (bicarbonate)
ETHANOL has a higher affinity than methanol for ADH and is often.
Fomepizole inhibits ADH and also used for tx.

Question 19

A pet/child ingests antifreeze or an industrial solvent with ethylne glycol. Treatment?

Answer 19

Hemodialysis, ethanol infusion, fomepizole

Question 20

Inhibits alcohol dehydrogenase.

Answer 20

fomepizole

Question 21

Inhibits aldehyde dehydrogenase

Answer 21

disulfiram

Question 22

Ethanol undergoes extensive first-pass metabolism by gastric and liver ___

Answer 22

alcohol dehydrogenase (ADH)

Question 23

Withdrawal symptoms:
First 2 days
48-72 hrs
Months

Answer 23

The signs and symptoms that manifest

• earliest are anxiety, insomnia, tremor, palpitations, nausea, and anorexia as well as (in severe syndromes) hallucinations and seizures.
• 48-72 hours Delirium tremens typically develops after alcohol discontinuation. The earliest symptoms (anxiety, insomnia, etc) can persist, in a milder form, for several months after alcohol discontinuation.