ALCOHOL Flashcards
T OR F
calories from alcohol are empty of
nutrients such as proteins and vitamins and cannot be used
in the repair of damaged tissue.
T
Alcohol metabolism pathways
- reduction of nicotinic acid dehydrogenase (NAD) to nicotinamide adenine dinucleotide (NADH)
- involves______ which is located in the peroxisomes and mitochondria
- “___________, located
mainly in the microsomes of the endoplasmic reticulum.
catalase,
microsomal ethanol oxidizing system” (MEOS)
Persons who flush easily after ingestion of alcohol (Chinese, Japanese, and other Asians)
differ from “nonflushers” with respect to the metabolism
of _______ rather than to the metabolism of alcohol
acetaldehyde
At a blood alcohol level of 30 mg/ dL, a\_\_\_\_\_\_\_\_was detectable, and at 50 mg/ dL, \_\_\_\_\_\_\_\_\_. 100 mg/ dL, ataxia was obvious; at 200 mg/ dL, there was\_\_\_\_\_\_ and a reduced level of mental activity; at 300 mg/ dL, the subjects were \_\_\_\_\_; and a level of 400 mg/dLaccompanied by deep anesthesia-was potentially fatal
mild euphoria
mild incoordination
confusion
stuporous
once the absorption of
alcohol has ended and equilibrium has been established
with the tissues, ethanol is oxidized at a _______ rate,
independent of its concentration in the blood
constant
_____ drug acts by raising the tissue concentration necessary for
the metabolism of a certain amount of acetaldehyde
per unit of time
disulfiram (Antabuse),
The patient taking both disulfiram
and alcohol will accumulate an inordinate amount
of acetaldehyde, resulting in_______, _______, ________
nausea, vomiting, and
hypotension
other drugs-notably the_________, _________,__________–have effects like those
of disulfiram but are less potent
sulfonylureas,
metronidazole, and furazolidone
One likely site that relates to the acute intoxicating effects of alcohol is a receptor for the inhibitory neurotransmitter _________ and its associated chloride ion channel.
garnmaarninobutyric acid (GABA)
Like the GABA-chloride channel, the___________, which transduce signals
carried by glutamate (the major excitatory transmitter in
the brain), are sensitive to extremely low concentrations
of alcohol.
N-methyl-oaspartate
(NMDA) receptors
There is also evidence that alcohol selectively
potentiates ______ receptor-ion currents, and the
activity of this receptor has been implicated in alcoholand
drug-seeking behavior and addiction.
serotonin
alcohol has an exclusively excitatory rather than a sedative effect. This reaction has been referred to in the past as pathologic, or complicated, intoxication and as _________
acute alcoholic paranoid state
Pathologic intoxication may require the use of restraints
and the parenteral administration of _______ or _________, repeated once after 30 to
40 min if necessary
diazepam (5 to 10
mg) or haloperidol (2 to 5 mg)
refers to an interval of time, during a period of severe intoxication, for which the patient later has no memory-even though the state of consciousness, as observed by others, was not grossly altered during that interval.
A l co h o l i c “ B l a cko uts “
type of memory affected in alcohol black out
short term/ retentive
In alcohol intoxication,
The use of ______ should be
considered in comatose patients with extremely high
blood alcohol concentrations (>500 mg/dL), particularly
if accompanied by acidosis, and in those who have concurrently ingested methanol or ethylene glycol or some other dialyzable drug
hemodialysis
The characteristic features of
this intoxication, however, are damage to retinal ganglion
cells-giving rise to scotomata and varying degrees of
blindness, dilated unreactive pupils, and retinal edemaand
bilateral degeneration of the putamens, readily visible
on CT scans.
methyl alcohol intoxication
In Methyl alcohol intoxication,
The most important aspect of treatment
is the intravenous administration of large amounts of
______
sodium bicarbonate to reverse acidosis
Hemodialysis and ______(see later) may be useful adjuncts because of the slow rate of oxidation of methanol.
4-methylpyrazole
The treatment o f ethylene glycol poisoning has, until relatively
recently, consisted of hemodialysis and the intravenous
infusion of sodium bicarbonate and _____ the
latter serving as a competitive substrate for alcohol dehydrogenase.
ethanol,
Generally; for either methanol
of ethylene glycol, a plasma level of the alcohol above
20 mg/ dL, or above 10 mg/ dL when combined with an
__________ is considered appropriate to institute
the drug.
osmolal gap over 10
This i s the well-known symptom complex o f tremulousness,
hallucinations, seizures, confusion, and psychomotor
and autonomic overactivity associated with alcoholism
The Alcohol Abstinence, o r Withd rawa l,
Syn d ro me
The most common single manifestation of the abstinence
syndrome is ________ often referred to as “the
shakes” or “the jitters,” combined with general irritability
and gastrointestinal symptoms, particularly nausea
and vomiting
tremulousness,
In alcohol withdrawal, The symptoms
then become augmented, reaching their peak intensity
_____ h after the complete cessation of drinking
24 to 36
In withdrawal syndrome,
More than 90 percent of withdrawal seizures occur during the 7- to 48-h period following the cessation of drinking, with a peak incidence between ______
13 and 24 h.
In withdrawal syndrome,
During the period of seizure activity
and for days afterwards, the patient is unusually sensitive
to stroboscopic stimulation; almost half the patients
respond with _______ or _________
generalized myoclonus or a convulsive
seizure (photoparoxysmal response).
Twenty-eight percent
of Victor ‘s patients with generalized withdrawal seizures
went on to develop ________ (the percentage has
been less in other series);
delirium tremens
T or F
Most patients during withdrawal do not require antiepileptic
drugs, as the entire episode of seizure activitywhether
a single seizure or a brief flurry of seizuresmay
have terminated before the patient is brought
to medical attention
T
The parenteral administration of
________ or __________ early in the withdrawal
period does, however, prevent withdrawal fits in
patients with a previous history of this disorder, as well
as in those who might be expected to develop seizures on withdrawal of alcohol
diazepam
sodium phenobarbital
It is characterized by profound confusion,
delusions, vivid hallucinations, tremor, agitation,
and sleeplessness, as well as by the signs of increased
autonomic nervous system activity-i.e., dilated pupils,
fever, tachycardia, and profuse perspiration
DT
T or F
when delirium
tremens occurs as a single episode, the duration is 72 h or more in more than 80 percent of cases.
F
less
the most important and
the one obligate factor in the genesis of delirium tremens
and related disorders is the __________
withdrawal of alcohol
following a period of sustained chronic intoxication
In
all but the mildest cases, the early phase of alcohol
withdrawal is attended by a drop in serum _________
concentration and a rise in_________-the latter on the
basis of respiratory alkalosis
magnesium
arterial pH
Lab findings in DT
___________
with normal blood glucose is another infrequent finding
Ketoacidosis
The treatment of delirium tremens begins with a_______
search
for associated injuries (particularly head injury with
cerebral lacerations or subdural hematoma), infections
(pneumonia or meningitis), pancreatitis, and liver
disease
In the Tx of DT,
An additional important element in treatment
is the correction of fluid and electrolyte imbalance,
particularly ______ and severe ______
hypokalemia
hypomagnesemia
In the Tx of DT,
T or F
Severe degrees of agitation and perspiration may require
the administration of up to 5 L of fluid daily, of which
at least 1,500 to 2,000 mL should be normal saline
T
In pts with DT,
special danger attends the use of glucose solutions in alcoholic patients .
The administration of intravenous glucose may
serve to consume the last available reserves of thiamine
and precipitate _____
Wernicke disease
it is good practice to add B vitamins, specifically _________(which may also be supplemented by intramuscular injection), in all cases requiring parenterally administered glucoseeven though the alcoholic disorder under treatment, e.g., delirium tremens, is
thiamine
In pts with DT,
A wide variety of drugs are effective in controlling
withdrawal symptoms. The more popular ones have
been _____, _______
and the ancillary medications, ______, _______
chlordiazepoxide (Librium), diazepam (Valium),
In pts with DT,
________may reduce the requirement for sedative drugs.
Gabapentin
In pts with DT,
In general, _______
drugs should be avoided because they may reduce the
threshold to seizures.
phenothiazine
In pts with DT,
If parenteral medication is necessary, we still
prefer _______ or chlordiazepoxide given
intravenously and repeated once or twice at 20- to
30-min intervals until the patient is calm but awake; we
also favor ________ in closely controlled circumstances
when hyperactivity and hallucinosis are extreme
10 mg of diazepam
midazolam
In pts with DT,
Beta-adrenergic-blocking agents, such as _______________, are helpful in reducing heart
rate, blood pressure, and the tremor to some extent.
propranolol,
labetalol, and atenolol
In pts with DT,
_______, an alpha2-agonist that blocks autonomic
outflow centrally, and clonidine are similarly effective
in reducing the severity of most of the withdrawal
symptoms,
Lofexidine
_________ have no place in the
treatment of the withdrawal syndrome and more potent
agents such as propofol are usually not necessary.
Corticosteroids
The term________ i s used widely and often indiscriminately to designate a presumably distinctive form of dementia that is attributable to the chronic, direct effects of alcohol on the brain
alcoholic dementia
patients with a fairly pure disorder of memory of
acute onset and that patients with more global symptoms
of intellectual deterioration, of gradual evolution, be
considered to have alcoholic dementia
Korsakoff psychosis
young alcoholics with and some without symptoms
of cerebral disease were often found to have enlarged
cerebral ventricles and widened sulci, mainly of the
frontal lobes
Alcoholic cerebral atrophy
