Alcohol Flashcards
How is alcohol distributed
via body water
very little alcohol enters body fat
Why is the concentration of alcohol in the liver highest
because blood comes directly to it from the stomach and small intestine via the portal vein
How is alcohol absorbed
its water soluble
slowly absorbed from the stomach
more rapid absorption from the SI
rate of absorption quicker on an empty stomach
What are the effects of spirit vs aerated alcohol on absorption
they delay gastric emptying and are absorbed more slowly
aerated alcohol gets into the system more quickly
Where is alcohol metabolized
90% in liver
2-5% excreted in sweat, urine or breath
What is alcohol metabolized into
alcohol –> acetaldehyde –> acetate –> Co2 and water
How does the blood alcohol concentration vary
varies according to age, sex, size and body build, previous exposure, type of drink and whether food is taken
What is the effect of drugs on alcohol absorption
some drugs like cimetidine (acid reflux) will delay emptying and reduce absorption
some drugs like antihistamines have the opposite effect
Why is alcohol metabolism a bit different for women
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
Describe how the blood alcohol concentration changes after drinking alcohol
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
Why is there tolerance in heavy drinkers
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
What is the effect of intoxication
mild sedative mild anaesthetic stimulates dopamine and serotonin sense of wellbeing relaxation and disinhibition 1
What is the effect of intoxication of 100mg/100ml
ppl become elated and aggressive
What is the effect of intoxication of 200 mg/100ml
slurred speech and unsteadiness
What is the effect of >400mg/100ml intoxication
commonly fatal due to AF
respiratory failure
inhalation of vomit
What is the genetic factor for alcohol problems
there is a genetic predisposition in development of alcohol problems
4x increased risk in relatives
What is the safe weekly alcohol limit
14 units a week on a regular basis
spread over 3 or more days
How is the risk of health problems related to alcohol
it increases the more you drink on a regular basis
pregnant women should have no alcohol
can also cause issues with conception
What is medical problems associated with heavy drinking on the GI tract
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
What is the medical problems associated with heavy drinking on the heart
cardiomyopathy
cardiac arrhythmias
hypertension
increased triglycerides and LDL cholesterol
What are medical problems associated with heavy drinking
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
What are medical problems to do with skin muscles nerves and bones caused by heavy drinking
acute or chronic myopathy
osteoporosis
osteomalacia
What are medical problems to do with blood caused by heavy drinking
macrocytosis
thrombocytopenia
leucopenia
What are medical problems to do with drugs caused by heavy drinking
drug metabolism
drug interactions
non compliance
interactions with illicit drugs
What are medical problems to do with the nervous system caused by heavy drinking
epilepsy
wernicke korsakoff syndrome
cerebral atrophy
What are the oral problems seen in chronic heavy drinking
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
What percentage of those who drink heavily will develop alcohol related liver injury
20%
Why does the liver damage occur
due to alcohol and metabolized but also comobrbity factors such as age, sex, viruses, drugs and nutrition
What is the spectrum of alcohol lever disease
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
What is the most common cause of cirrhosis in the west
alcohol
What are the symptoms of cirrhosis
jaundice ascites bleeding cachexia infections encephalopathy
What is the problem with liver disease for dentist
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
What is the effect of alcohol on drugs in patients without liver damage
heavy drinking induces liver enzymes may increase metabolism of some drugs more rapid destruction reduced plasma concentration lack of effects
What is the effect of alcohol on drugs in patients with liver damage
reduced drug metabolism
LA, analgesia, sedatives, antibiotics
What is the effect of alcohol on warfarin
metabolism will be enhanced by regular consumptionof more than 3 units a day
How do drugs act with alcohol
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
How does alcohol and paracetamol act in heavy drinkers
in heavy drinkers, paracetamol can be converted to an intermediate metabolite which is hepatotoxic
What is the disulfiram reaction
it inhibits alcohol dehydrogenase which normally converts acetaldehyde to acetate
acetaldehyde builds up and nausea and vomiting occur if alcohol is taken
What is disulfiram used for
alcohol treatment
other drugs cause this reaction e.g metronidazole, cephalosporins, ketoconazoole
What is the effect of alcohol on the stomach
gastric irritant
clotting may be deranged due to liver disease which exacerbates the issue
What is the effect on alcohol on hep C
alcohol in any amounts leads to more rapid development of severe liver disease
px with hep c should abstain from alcohol completely
What is the effect of alcohol on cocaine
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
What is the effect of cannabis on alcohol
absorbtion of alcohol is reduced
combo will increase sense of confusion and disorientation making accidents more likely
What is the effect of amphetamines on alcohol
will increase impairment of judgement
What is the effect of ecstasy on alcohol
increases intoxication but will reduce the potentially fatal fluid retention effect of ecstasy
What are nutritional problems linked to alcohol
alcohol is v calorific
alcoholics generally malnourished due to general neglect, substation of food, deficiencies
What are the CV issues linked to alcohol
cardiomyopathy cardiac arrhythmias hypertension stroke protective effects
What is cardiomyopathy
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)
What is the tx for cardiomyopathy
treatment is largely supportive
need to abstain from alcohol
may be due to the accumulation of fatty acids thy esters in mitochondria
What is the cardiac function in women like
women can develop cardiac problems with less alcohol and lower duration of consumption
higher risk
what are the ECG changes that can be marked with alcohol
ecg changes: atrial fibrillation prolonged QT interval inverted T waves heart block ventricular arythmias
How is the risk of stroke altered by alcohol
light to moderate consumption decreases risk
consumption of 5 or more drinks per day increases risk by a lot
What is the link between hypertension and alcohol
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
What are the cardio protective effects of alcohol
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
How is alcohol linked to oral cancer
risk when smoking and alcohol are taken together
Describe how alcohol and smoking lead to oral cancer
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
What is the link between alcohol, violence and facial injury
violence linked to alcohol
facial injury have long lasting physical and pscyhological effect
can result in PTSD, alcohol problems and a vicious circle
What is the dental trauma often seen with alcohol
broken teeth lost teeth damage to soft tissue lost dentures interpersonal violence falls
What is the non carious tooth surface loss seen with alcohol
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
