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CLASP Y2 JC > Alcohol > Flashcards

Alcohol Flashcards

1
Q

What is the treatment for methanol poisoning?

A

Give regular alcohol and dialysis as it is a competitive inhibitor working on alcohol dehydrogenase to avoid making formic acid.

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2
Q

What is the weekly recommended limit for alcohol

A

14 units

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3
Q

What is the main absorption site for alcohol? Why?

A

Small bowel due to alcohol dehydrogenase present in high quantities

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4
Q

What are some of the ways to delay the effects of alcohol? Why?

A

Eating food, as it delays gastric emptying into the bowel

Drinking shots as it irritates the gastric mucosa so delays emptying

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5
Q

What are some of the ways to increase alcohol absorption/ get drunk quickest

A

Antihistamines/metaclopramide increse gastric emptying
Champagne, sherries, mixing so less irritating to gastric mucosa
Drinking on empty stomach
20-30% alcohol best absorption

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6
Q

Name the two enzymes that catalyse the reaction of

alcohol (1)->acetaldehyde (2)-> acetate +co2 + H20

A

1- alcohol dehydrogenase

2- aldehyde dehydrogenase

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7
Q

What metabolite of alcohol metabolism causes hangovers effects?

A

Acetaldehyde

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8
Q

Where is acetaldehyde mainly metabolised? And at what rate is it eliminated

A

Liver main
Pancreas little

Generally 1 unit an hour

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9
Q

By what mechanisms is tolerance increased for alcohol?

A

Induction of CP450 pathway (electron transport chain)

Microsomal enzyme oxidase system (MEOS) that upregulates alcohol dehydrogenase

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10
Q

What are some of the consequences of the MEOS system?

A

Inhibits the krebs cycle so low energy and build up of H+ ions causing lactic acid build up
Inhibits hepatic gluconeogenesis
Fatty acid oxidation impaired so increased ketogenesis, lipid synthesis

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11
Q

Treatments for alcohol abusers?how work?

A

Antabuse medication- inhibits aldehyde dehydrogenase so acetaldehyde accumulates making hangovers horrendous and effects worse. Works as a deterrent

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12
Q

Name some of the structures in the CNS that are affected by alcohol

A 
Reticular formation
Cerebellum 
Limbic system 
Lower brain stem 
Cortex
Pituitary gland producing ADH
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13
Q

Effects of alcohol on the function of the cortex in the CNS?

A

Disinhibition (lack of restraint for social conventions)
Talkativenesss
Anxiolytic (reducing anxiety)

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14
Q

Effects of alcohol on the function of the limbic system in the CNS?

A

Memory loss, confusion, disorientation

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15
Q

Describe the events how alcohol makes you pee more

A

Inhibits ADH that causes water reabsorption in the kidneys and so concentrates urine

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16
Q

What is holiday heart syndrome

A

Supraventricular tachycardia due to excess alcohol/ food

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17
Q

What is veisalgia cephalgia?

A

Headaches

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18
Q

What would the results of LFTs in alcoholic steatosis(hepatitis)

A

Increase in ALT, AST and GGT
NOT ALP
Decrease in albumin

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19
Q

What are some common risk factors for chronic pancreatitis?

A

Alcohol
Idiopathic
Gallstones

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20
Q

Child presents with neurological symptoms, keiser flesher rings and there is copper deposits in his pancreas. Diagnosis?

A

Wilsons disease

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21
Q

Man presents with fatigue, weight loss, erectile dysfunction, joint pain. Blood tests taken and pearl stain is positive. Diagnosis? Treatment>

A

Haemochromatosis

Venosection

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22
Q

Name some common signs of chronic alcoholism on general exam

A 
Palmar erythema (due to increased oestrogen from liver cirrhosis)
Duputrens contracture
Caput medusae (from portal hypertension from liver cirrhosis)
Spider naevi (same as above)
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23
Q

What is the cause of dupuytrens contracture? What other conditions is it indicitive of?

A

Fibrosis of the palmar fascia

Anti-epileptic meds, diabetics

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24
Q

What are some of the consequences of thiamine deficiency ?

A

Maintains peripheral and autonomic nerves SO can get

  • lost sensation in arms/legs
  • wernicke-korsakoffs syndrome (confusion, shaky gait, odd eye movements, disorientation)
  • wet beri beri syndrome (leading to cardiomyopathy)
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25
Q

What is wenicke-korsakoffs syndrome?

A

Due to lack of thiamine there is a shaky gait, ophthalmoplegia (paralysed muscles of eye), confusion, disorientation, memory loss

Lack of thiamine due to poor nutrition in alcoholics

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26
Q

Man presents with aspiration pneumonia, what most likely lobe would be affected

A

Inferior right lobe due to branch bring vertical

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27
Q

What is wet beri beri syndrome?

A

Affects the cardiovascular system due to lack of thiamine, causing heart failure, weakened capillary walls

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28
Q

Man presents with chronic alcoholism, breathlessness, peripheral oedema, and on examination high HR and JVP. Diagnosis?

A

Dilated cardiomyopathy secondary to wet beriberi from low thiamine

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29
Q

What are the mechanisms causing fatty liver disease

A

More free fatty acids taken to the liver
NAD converted to NADG by alcohol allowing lipid synthesis
Mitochondrial oxidation of the fatty acids reduced
Reduced cell tubulin so decreased fat transport out of hepatocytes

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30
Q

Man presents with fever, yellowing, pain in RUQ. He also says he has been on a bender for the last month. Likely Diagnosis?

A

Alcoholic staetohepatitis

Occuring after excessive alcoholism from 3-4 weeks.

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31
Q

Diabetic becomes hypoglycaemic in the night after a night of drinking. Why?

A

Alcohol inhibits glucose production from glycogen in the liver

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32
Q

What would you expect to find on examination with someone suffering chronic alcoholism?

A 
Signs of portal hypertension (caput medusae, spidernaevi, splenomegaly)
Dupuytrens contracture
Palmar erythema
Signs of memory loss
Foot/wrist drop (thiamine deficiency)
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33
Q

What is boerhaave syndrome

A

Transmural perforation of the oesophagus mainly after a vomiting episode/ sudden increase in intraoesophageal pressure. Different from mallory-weiss tear which is non-transmural

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34
Q

Man presents with LUQ pain, floating stools, nausea/vomiting, weight loss and fatigue. He is a chronic drinker. Likely diagnosis?

A

Chronic pancreatitis

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35
Q

Man presents with fine tremor, sweating, anxiety, fever, retching. He is a mild chronic alcoholic how long ago was his last drink aprox?

A

12-36 hours

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36
Q

What are some of the symptoms of a moderate dependency alcoholic 12-5 days without alcohol?

A 
SEIZURES
Coarse tremor
Shaking agitation
Confusion
Disorientation
Paranoia
Hallucinations
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37
Q

What are some of the symptoms of a severe dependecy alcoholic with withrawl 12-7days ?

A 
Severe agitation
Anxiety 
High risk of delerium tremens (DTs)
Confusion
Hallucinations
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38
Q

What is the treatment for the withdrawl of alcohol symptoms?

A

Diazepam

From 2mg if scoring 2+ on alcohol withdrawl protocol

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39
Q

After night of binging, a man wakes with reduced function of his arm. What is this condition known as? How does it occur

A

Compression neuropathy due to radial nerve compression from the humeral head

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40
Q

How much alcohol does someone have to consume to be likely to get alcoholic cardiomyopathy ?

A

8-9 units a day for 5+years

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41
Q

Alcohol contributes to breast cancer T/F

A

True

42
Q

Alcohol contributers to oral, pharyngeal and laryngeal cancers T/F?

A

True

43
Q

Alcohol contributes to colorectal T/F?

A

True

44
Q

Alcohol contributes to kidney cancer T/F?

A

False

45
Q

Name some drugs used to treat hepatic encephalopathy

A

Lactulose

Ridaximin

46
Q

Name some drugs used to reduce craving for alcohol by blocking receptors in the brain

A

Acamprostate
Naltrexone
Nalmefene

47
Q

Name some drugs used to create an acute response to alcohol. How do they work

A

Disulfiram (antabuse)

By inhibiting the aldehyde dehydrogenase to create a crazy hangover

48
Q

What are some of the symptoms of a moderate dependency alcoholic 12-5 days without alcohol?

A 
SEIZURES
Coarse tremor
Shaking agitation
Confusion
Disorientation
Paranoia
Hallucinations
49
Q

What are some of the symptoms of a severe dependecy alcoholic with withrawl 12-7days ?

A 
Severe agitation
Anxiety 
High risk of delerium tremens (DTs)
Confusion
Hallucinations
50
Q

What is the treatment for the withdrawl of alcohol symptoms?

A

Diazepam

From 2mg if scoring 2+ on alcohol withdrawl protocol

51
Q

After night of binging, a man wakes with reduced function of his arm. What is this condition known as? How does it occur

A

Compression neuropathy due to radial nerve compression from the humeral head

52
Q

How much alcohol does someone have to consume to be likely to get alcoholic cardiomyopathy ?

A

8-9 units a day for 5+years

53
Q

Alcohol contributes to breast cancer T/F

A

True

54
Q

Alcohol contributers to oral, pharyngeal and laryngeal cancers T/F?

A

True

55
Q

Alcohol contributes to colorectal T/F?

A

True

56
Q

Alcohol contributes to kidney cancer T/F?

A

False

57
Q

Name some drugs used to treat hepatic encephalopathy

A

Lactulose

Ridaximin

58
Q

Name some drugs used to reduce craving for alcohol by blocking receptors in the brain

A

Acamprostate
Naltrexone
Nalmefene

59
Q

Name some drugs used to create an acute response to alcohol. How do they work

A

Disulfiram (antabuse)

By inhibiting the aldehyde dehydrogenase to create a crazy hangover

60
Q

What properties of ethanol make it able to communicate with so many receptors

A

Small molecule

Diffusion between lipid and water is high

61
Q

How many grams of ethanol in 1 unit

A

8

62
Q

What is the mechanism by which GABA receptors/ glycine receptors inhibit neurotransmission

A

By allowing chloride ions intracellularly to cause hyperpolarisation to prevent cells reaching the threshold for action potential

63
Q

What is the function of GABA receptors?

A

To produce GABA molecule which is an inhibitory molecule on receptors in the CNS

64
Q

What is the difference between extrasynaptic and synaptic receptors on membrane potential?

A

Synpatic receptors are those in the neurone synapse and create a trasient effect
Extrasynaptic are outwith the synapse and create a tonic effect (long lasting) on membrane potential

65
Q

What is the function of glutamate receptors?

A

Produce glutamate neurotransmitter that excites pathways in the CNS.

66
Q

What is the effect acute alcohol has on GABA and glutamate receptors. To what end?

A

Enhances GABA inhibitory NT
Suppresses glutamate excitatory NT

Causes CNS depression aka reduced anxiety, sedation, impaired motor coordination

67
Q

What pathway is involved with triggering dependency of alcohol?

A

The mesolimbic dopaminergic pathway

68
Q

Describe the mesolimbic dopaminergic pathway and how it creates a response

A

Ventral tegmental area (VTA) releases dopamine through the medial forebrain bundle

Dopamine acts on GPCR dopamine receptors in the nucleus accumbens (Nac)

The neurone then fires signals to the hippocampus, amygdala, prefrontal cortex to cause happiness

69
Q

What percentage of alcohol is excreted through the lungs?

A

5%

70
Q

How many kcal in 1g of alcohol (8g in 1 25ml vodka shot)

A

7kcal

71
Q

What is the chronic effects of alcohol on GABA and glutamate receptors? What is the significance?

A

GABA downregulation
Glutamate upregulation

Withdrawl from alcohol causes a mismatch between these usually balanced mechanisms causing anxiety, seizures etc. As CNS is confused

72
Q

What is the role of thiamine in the body?

A

Important for ATP production
Normal nerve conduction
Maintenance of neural membranes

73
Q

Baby presents with small eye opening, smooth philitrum and a thin upper lip. Mom drank while pregnant, diagnosis?

A

Foetal alcohol spectrum disorder

74
Q

Can mother drink and breast feed? Why?

A

No as alcohol will transfer from blood stream into the milk, causing drowsiness, weakness, abnormal weight gain

75
Q

Man presents with confusion, inability to coordinate voluntary movement and eye abnormalities. He is a chronic drinker. Diagnosis

A

Wernickes encephalopathy

76
Q

Man presents with amnesia and con(fab)ulation. He is a chronic drinker. Diagnosis?

A

Korsakoff syndrome

77
Q

What are the 4Ds of pellagra? How does it occur?

A

Inability to absorb niacin (vit b3)

Diarrhoea, dementia, photosensitive dermatitis, death

78
Q

What are the three alcohol misuse disorders

A

Harmful use
Dependence syndrome
Withdrawl state with delerium

79
Q

What are some of the features an alcoholic needs to express to be classed as having dependence syndrome

A 
Strong desire/compulsion f/alcohol
Difficulty controlling use
Persistent use despite clear harm
Preoccupation with substance abuse
Increased tolerance
Psychological withdrawal state
80
Q

What is the AUDIT/ FAST score determine?

A

The risk someone has due to drinking alcohol, can be used to see risk of having a seizure

81
Q

Man admits to hospital and has an audit score of 15-19, what are the next steps?

A

(Harmful drinking)

Deliver a brief intervention
Deliver 4 motivational enhancement therapy
Consider prescribing options like naltrexone

82
Q

What are the stepwise drugs to treat alcohol dependence? E.g first line/ second line

A

1) acamprostate and naltrexone

2) disulfiram

83
Q

Man has been having withdrawl seizures for the last 5 minutes, what do you do?

A

Administer diazepam injection

84
Q

Man presents with autonomic hyperactivity (Sweating, tachycardia, pyrexia), hallucinations. It has been 3 days since his last drink. Diagnosis?

A

Delirium tremens “(DTs)

85
Q

What is the treatment for delerium tremens?

A

1) Give oral lorazepam (bezodiazepine)

2) paraenteral lorazepam or haloperidol

86
Q

What time period after drinking can alcoholic hallucinosis persistent until?

A

6 months

87
Q

What is the medication used for medically assisted alcohol withdrawl?

A

Chlorodiazepodixde

88
Q

Man presents with what you expect is chronic alcoholism, what tests can you run to confirm this? Results if positive?

A

Gamma GT (increases 3x)
MCV (increases
Triglycerides (increases

89
Q

Very low bicarbonate in the blood could be indicative of poisoning from what?

A

Methanol
Ethylene glycol
As it mops up excess H+ ions to prevent acidic blood

90
Q

What is the osmolal gap and why may it vary from estimations in alcoholics?

A

Its the difference between the estimated serum osmolarity from sodium and the actual tested result.

Can be due to alcohol present in the blood

91
Q

GGT and ALP are both raised in someone with RUQ pain. What does this suggest?

A

Bile duct obstruction

92
Q

You suspect pyloric stenosis due to chronic vomiting, what tests could you run in order to determine if it is? Why?

A

Acid base test, as will have metabolic alkalosis due to loosing acid from stomach and it not being neutralised by the duodenal contents

93
Q

You suspect haematemesis is due to mallory weiss tear. What LAB tests could you do to determine this? Why?

A

Test the lactate to see if there has been anaerobic respiration from lack of blood supply

94
Q

What is methanol metabolised to form in the body?

A

Formaldehyde then formic acid

95
Q

What cell type are responsible for cirrhosis of the liver?

A

The stellate cells as they lay down collagen

96
Q

What is baretts oesophagus?

A

Change in lower oesophagus from normal mucosa to columar to cope with acid reflux

97
Q

How many calories per unit of alcohol?

A

56 kcal as every 1g of alcohol has 7kcal and 8g of pure ethanol= 1 unit

98
Q

How can malnutrition arise from alcoholism?

A

Decreases pancreatic enzyme/ bile excretion so cant break down food

Damages lining of cells in stomach and small intestine

Dont eat thiamine rich foods so cant metabolise alcohol

99
Q

What cancers can arise from alcohol consumption?

A

Breast, bowel, liver, mouth and throat, oesophageal, stomach

100
Q

What is the treatment for delerium tremens?

A

Benzodiazepine- to prevent seizures
Rehydration
Glucose

101
Q

What would you expect to find on routine bloods if you suspect methanol poisoning?

A

Extrememly low bicarbonate

102
Q

Where is GGT and ALT released from?

A

GGT from bile ducts

ALT from liver hepatocytes

CLASP Y2 JC (2 decks)

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