Alcohol

Question 1

Alcohol metab

Answer 1

ADH - 0.1%>

MEOS Microsomal ethanol oxizing system = 0.1%

Question 2

Acetominaphen poisoning in chronic alchy

Tx

Answer 2

N-acetylcysteine

ABUSERS SUSCEPTIBLE

Question 3

Diazepam

Answer 3

• withdrawal syndrome to seizures (DON’T USE ACAMPROSATE/TOPIRAMATE)
• increase GABA affinity to GABAa receptor
• Decrease affinity of glutamate
• INCREASE SYNAPSE CONCENTRATION of DA + Endogenous opioids (addiction)
• taper over weeks

Question 4

Clonidine, Propranolol

Answer 4

• mild ETOH withdrawal (anxiety, insomnia, tremors, muscle aches, sweating, cramping, arrythmias)
• clonidine = a2 activation CNS
• Propranolol = Beta blockade CNS (DOWN sympathetic)

Question 5

Disulfiram

Answer 5

• alcohol aversion, prevent relapse
• BLOCK ALDH, Acetaldehyde accumulates (N/V, HypoTN)
• HEPATOTOXIC (high dose); Respiratory depression, cardio collapse, seizure

Question 6

Naltrexone

Answer 6

• anti-craving tx, stop relapse
• CHECK opioid abuse w/ narcan test, if not can withdraw
• BLOCK Mu opioid receptors = ventral tegmental area (VTA)
• HEPATOTOXIC = high dose
• don’t combine with disulfiram (hepatic, no effect) = use acamprosate

Question 7

ETOH tolerance

Answer 7

• metabolic = MEOS enzymes

* Functional tolerance = (down reg GABAa, up reg NMDA+Ca2+

Question 8

Fetal development and ETOH effects

Answer 8

• Brain = 1st + 3rd trimester

* Physical = 2nd trimester

Question 9

Acute ETOH intoxication

Tx

Answer 9

• maintain vitals
• prevent vomit aspiration
• IV dextrose (+ thiamine if W-K)

Question 10

Naxalone

Answer 10

• narcan challenge prior to narcan tx, suspect opioid abuse

* BLOCK mu opioid receptors, SHORT ACTING ANTAG

Question 11

Acaprosate, Topiramate

Answer 11

• ETOH anti craving, anti-epileptic
• increase Gaba-A activity, DOWN glutamate receptors
• combo acamprosate + disulfiram better
• not for withdrawal

Question 12

Fomepizole, ETOH

Answer 12

• Tx methanol/ethelyne glycol poisoning; IV w/ HD (remove poisons, bicarb, acidosis)
• Binds to ADH, no metab of methanol/ethylene glycol to toxic metabs

Question 13

Withdrawal?

Answer 13

Clonidine, perpheral propranolol

Question 14

Healthy drinking?

Answer 14

Red>white>beer

• over 65
• resveratrol

Question 15

Methanol/Ethelyne glycol tx

Answer 15

• ethanol (IV)
• fomepizole

Saturates ADH