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BDS3 PMHP > Alcohol > Flashcards

Alcohol Flashcards

1
Q

How is alcohol distributed

A

via body water

very little alcohol enters body fat

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2
Q

Why is the concentration of alcohol in the liver highest

A

because blood comes directly to it from the stomach and small intestine via the portal vein

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3
Q

How is alcohol absorbed

A

its water soluble
slowly absorbed from the stomach
more rapid absorption from the SI
rate of absorption quicker on an empty stomach

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4
Q

What are the effects of spirit vs aerated alcohol on absorption

A

they delay gastric emptying and are absorbed more slowly

aerated alcohol gets into the system more quickly

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5
Q

Where is alcohol metabolized

A

90% in liver

2-5% excreted in sweat, urine or breath

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6
Q

What is alcohol metabolized into

A

alcohol –> acetaldehyde –> acetate –> Co2 and water

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7
Q

How does the blood alcohol concentration vary

A

varies according to age, sex, size and body build, previous exposure, type of drink and whether food is taken

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8
Q

What is the effect of drugs on alcohol absorption

A

some drugs like cimetidine (acid reflux) will delay emptying and reduce absorption

some drugs like antihistamines have the opposite effect

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9
Q

Why is alcohol metabolism a bit different for women

A

smaller blood volume than mean

lower levels of alcohol dehydrogenase in the stomach so more alcohol is absorbed before it has been metabolised

alcohol crosses placenta easily

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10
Q

Describe how the blood alcohol concentration changes after drinking alcohol

A

peaks 1 hour after drinking on an empty stomach

declines over next 4 hours

removed at rate of 15mg/100ml/hr

detectable levels still present for several hours

after 3 pints of beer blood alcohol will be detectable in the morning

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11
Q

Why is there tolerance in heavy drinkers

A

normal metabolism increases
microsomal ethanol oxidising system comes into play i.e enzyme induction occurs, this system can also be induced by drugs
in heavy drinkers with liver damage, enzyme production decreases as there is more fibrous tissue so not producing enzymes

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12
Q

What is the effect of intoxication

A 
mild sedative
mild anaesthetic
stimulates dopamine and serotonin 
sense of wellbeing relaxation and disinhibition 
1
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13
Q

What is the effect of intoxication of 100mg/100ml

A

ppl become elated and aggressive

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14
Q

What is the effect of intoxication of 200 mg/100ml

A

slurred speech and unsteadiness

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15
Q

What is the effect of >400mg/100ml intoxication

A

commonly fatal due to AF
respiratory failure
inhalation of vomit

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16
Q

What is the genetic factor for alcohol problems

A

there is a genetic predisposition in development of alcohol problems

4x increased risk in relatives

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17
Q

What is the safe weekly alcohol limit

A

14 units a week on a regular basis

spread over 3 or more days

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18
Q

How is the risk of health problems related to alcohol

A

it increases the more you drink on a regular basis

pregnant women should have no alcohol

can also cause issues with conception

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19
Q

What is medical problems associated with heavy drinking on the GI tract

A

acute gastritis
liver problems
GI bleeding
oral, esophageal, stomach and bowel cancer
pancreatic disease
obesity and malnutrition
vitamin deficiency-folic acid , vit B1, B2, B6, E, B1 and D

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20
Q

What is the medical problems associated with heavy drinking on the heart

A

cardiomyopathy
cardiac arrhythmias
hypertension
increased triglycerides and LDL cholesterol

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21
Q

What are medical problems associated with heavy drinking

A 
GI
CV
traumatic injuries 
skin, muscle, nerves and bones
blood
chest
gynaecological problems
obstetric problems 
bleeding
poor wound healing 
drugs
patients with hepatitis C
hormones and metabolism
immune system
mental health
nervous sytem
renal
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22
Q

What are medical problems to do with skin muscles nerves and bones caused by heavy drinking

A

acute or chronic myopathy
osteoporosis
osteomalacia

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23
Q

What are medical problems to do with blood caused by heavy drinking

A

macrocytosis
thrombocytopenia
leucopenia

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24
Q

What are medical problems to do with drugs caused by heavy drinking

A

drug metabolism
drug interactions
non compliance
interactions with illicit drugs

25
Q

What are medical problems to do with the nervous system caused by heavy drinking

A

epilepsy
wernicke korsakoff syndrome
cerebral atrophy

26
Q

What are the oral problems seen in chronic heavy drinking

A

oral cancer in those who have concurrent tobacco use

oral ulceration, glossitis, angular cheilitis, gingivitis - nutritional deficiency

dental neglect

dental trauma due to chaotic lifestyle

lost dentures

salivary gland enlargement - dialysis

xerostomia

poor wound healing and ostemyelitis

suppression of immune system by alcohol

dental erosion

bruxism

27
Q

What percentage of those who drink heavily will develop alcohol related liver injury

A

20%

28
Q

Why does the liver damage occur

A

due to alcohol and metabolized but also comobrbity factors such as age, sex, viruses, drugs and nutrition

29
Q

What is the spectrum of alcohol lever disease

A

the liver can go between normal and steatosis (fatty liver) which is reversible

then it can go between steatosis and steato-hepatitis which is reversible but less so

then it becomes cirrhosis which is not reversible

30
Q

What is the most common cause of cirrhosis in the west

A

alcohol

31
Q

What are the symptoms of cirrhosis

A 
jaundice
ascites
bleeding
cachexia
infections
encephalopathy
32
Q

What is the problem with liver disease for dentist

A

reduced synthesis of clotting factors in damaged liver

combined with reduced absorption of vitamin K so reduced factor II, VII, IX, X

thrombocytopenia due to splenomegaly associated with portal hypertension (less platelets)

megakaryocytic maturation is also reduced leading to fewer platelets

platelet aggregation is reduced

both will lead to prolonged bleeding

33
Q

What is the effect of alcohol on drugs in patients without liver damage

A 
heavy drinking induces liver enzymes
may increase metabolism of some drugs
more rapid destruction 
reduced plasma concentration
lack of effects
34
Q

What is the effect of alcohol on drugs in patients with liver damage

A

reduced drug metabolism

LA, analgesia, sedatives, antibiotics

35
Q

What is the effect of alcohol on warfarin

A

metabolism will be enhanced by regular consumptionof more than 3 units a day

36
Q

How do drugs act with alcohol

A

some drugs will interact with drugs producing a sedative effect on the nervous system and increase or prolong the effect

alcohol will interact with drugs producing a sedative effect on the nervous system and increase or prolong its effect

37
Q

How does alcohol and paracetamol act in heavy drinkers

A

in heavy drinkers, paracetamol can be converted to an intermediate metabolite which is hepatotoxic

38
Q

What is the disulfiram reaction

A

it inhibits alcohol dehydrogenase which normally converts acetaldehyde to acetate

acetaldehyde builds up and nausea and vomiting occur if alcohol is taken

39
Q

What is disulfiram used for

A

alcohol treatment

other drugs cause this reaction e.g metronidazole, cephalosporins, ketoconazoole

40
Q

What is the effect of alcohol on the stomach

A

gastric irritant

clotting may be deranged due to liver disease which exacerbates the issue

41
Q

What is the effect on alcohol on hep C

A

alcohol in any amounts leads to more rapid development of severe liver disease

px with hep c should abstain from alcohol completely

42
Q

What is the effect of alcohol on cocaine

A

if taken at the same time, a chemical similar to cocaine is produced so alcohol prolongs the effect of cocaine

can cause arrhythmia’s together

43
Q

What is the effect of cannabis on alcohol

A

absorbtion of alcohol is reduced

combo will increase sense of confusion and disorientation making accidents more likely

44
Q

What is the effect of amphetamines on alcohol

A

will increase impairment of judgement

45
Q

What is the effect of ecstasy on alcohol

A

increases intoxication but will reduce the potentially fatal fluid retention effect of ecstasy

46
Q

What are nutritional problems linked to alcohol

A

alcohol is v calorific

alcoholics generally malnourished due to general neglect, substation of food, deficiencies

47
Q

What are the CV issues linked to alcohol

A 
cardiomyopathy 
cardiac arrhythmias 
hypertension
stroke
protective effects
48
Q

What is cardiomyopathy

A

degenerative heart disease with no coronary artery disease

well established complication of chronic alcohol abuse

most cases asymptomatic

can lead to arrhythmias, cardiomegaly and congestive heart failure (dyspnea and peripheral edema)

49
Q

What is the tx for cardiomyopathy

A

treatment is largely supportive

need to abstain from alcohol

may be due to the accumulation of fatty acids thy esters in mitochondria

50
Q

What is the cardiac function in women like

A

women can develop cardiac problems with less alcohol and lower duration of consumption

higher risk

51
Q

what are the ECG changes that can be marked with alcohol

A 
ecg changes:
atrial fibrillation
prolonged QT interval
inverted T waves
heart block
ventricular arythmias
52
Q

How is the risk of stroke altered by alcohol

A

light to moderate consumption decreases risk

consumption of 5 or more drinks per day increases risk by a lot

53
Q

What is the link between hypertension and alcohol

A

generally a low grade hypretension

risk factor for stroke

chronic intake of 30g/day or more fo alcohol

hypertension reverses after cessation

those with liver disease may have portal hypertension - can have esophageal varies and can be fatal

54
Q

What are the cardio protective effects of alcohol

A

moderate intake decreases risk of coronary artery disease

1-2 units of alcohol 2-3 times a week

benefit is particularly in older men and post menopausal women

alcohol decreases atherogenic plaques

alcohol consumption increases HDL cholesterol

will also reduce incidence of gall stones and macular degeneration

55
Q

How is alcohol linked to oral cancer

A

risk when smoking and alcohol are taken together

56
Q

Describe how alcohol and smoking lead to oral cancer

A

ethanol metabolite acetaldehyde promotes tobacco initiated tumors

damages DNA and alters oncogene production

alcohol facilitates absorption of carcinogenic substances across the oral mucosa

partly due to thinning of oral mucosa due to nutritional deficiency

57
Q

What is the link between alcohol, violence and facial injury

A

violence linked to alcohol
facial injury have long lasting physical and pscyhological effect

can result in PTSD, alcohol problems and a vicious circle

58
Q

What is the dental trauma often seen with alcohol

A 
broken teeth
lost teeth
damage to soft tissue
lost dentures
interpersonal violence
falls
59
Q

What is the non carious tooth surface loss seen with alcohol

A

alcohol is very acidic
GORD in alcohol directly relaxes the oseophageal sphincter
vomiting brings up acid
multifactorial bruxism
restoration is difficult until problem is controlled

BDS3 PMHP (10 decks)

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