Alcohol Abuse Flashcards
Intoxicating ingredient found in wine, bear, and distilled spirits?
Ethyl alcohol
Structure of ethyl alcohol
CH3CH2OH - 2 Carbon w/ a single OH
How is ethyl alcohol produced?
fermentation of carbohydrate by microorganisms (yeast)
solubility of ethanol?
fully water soluble and somewhat lipid soluble
How does ethanol cross membranes?
diffusion
What is the rate of alcohol absorption influenced by?
presence of food or water, absorbed faster on a empty stomach
That which is not absorbed from the stomach is absorbed where?
in the upper small intestine
How is ethanol excreted?
5% in urine, expired in air and lost in sweat
95% oxidized to acetaldehyde by the liver
T/F Ethanol oxidation by the liver is obligatory?
True
If ethanol is taken with a high fat meal what gets precedence in the liver for breakdown?
alcohol
Where is ethanol largely absorbed?
stomach
ethanol to acetaldehyde is what type of reaction?
rate limiting step (slow)
What two major pathways are involved in ethanol metabolism?
Alcohol dehydrogenase system (ADH)
Microsomal Ethanol Oxidizing system (MEOS)
What can be used to measure the amount of ingested alcohol?
Breathaloizer
Ethanol oxidation by the liver is ….???
obligatory
What is the problem with a fatty liver?
can’t clear out other molecules which causes them to get deposited in tissues
What does ethanol do to other drugs clearance?
speeds up their clearance rate, so have to use higher doses
Where does ADH occur?
in cytosol
Where does MEOS occur?
in microsomes
MOA of ADH enzyme?
oxidizes ethanol to acetalydehyde
When is ADH active?
at low ethanol concentrations
T/F MEOS is inducible?
True
When does MEOS come out to play?
@ blood alcohol concentration >10mg/dl
If you DON’T consume alot of alcohol what pathway are you likely to use?
Alcohol dehydrogenase system (ADH)
If you consume alot of alcohol what pathway are you likely to use?
Microsomal Ethanol Oxidizing System (MEOS)
Ethanol metabolized by MEOS can do what to other drugs?
alter the rate of drug clearance, which increases the chances for over and underdosing
When is MEOS active?
high alcohol levels
Tolerance can occur in what pathway?
MEOS
What is MEOS?
Microsomal Ethanol Oxidizing System
What is responsible for the metabolism of all drugs?
MEOS
How does a alcoholic build up tolerance?
because the MEOS is constantly be induced
What disruptions are seen in the liver
decreased rate of beta oxidation
decrease in protein synthesis
increased synthesis of fatty acids from acetyl CoA
Increased rate of synthesis of alpha glycerol phosphate and formation of triglycerides
What causes the initial accumulation of fatty acids?
decreased beta oxidation
What further causes a accumulation of fatty acids?
acetyl CoA
What is considered early stage of liver degeneration
fatty liver
What can fatty streaking progress too
alcohol hepatitis and cirrhosis
Moderate alcohol intake does what to appetite?
stimulates it (increased food intake)
Why isn’t alcohol a nutrient?
added energy 7 kal/gram, contributes to body fat stores
What contributes to obesity
moderate alcohol consumption
What is one thing we can eliminate from the diet?
alcohol
What is a major cause of alcohol abuse?
chronic ETOH abuse
What are the 3 reasons for malnutrient due to alcohol?
- excessive consumption suppresses appetite
- alcohol interferes w/ the body’s ability to absorb and utilize nutrients
- nutrient content of the diet is often poor
Proportional to anorexia
degree of alcohol abuse
The faster you drink alcohol
the higher the blood concentrations go
since alcohol depresses appetite it can cause..
anorexia
What abnormalities is seen in mucosal cells?
- decreased production of mucosal enzymes
- impaired transport of nutrients (facilitated diffusion, active transport)
What is the toxic effect and DANGEROUS problem of alcohol
can cause fatty liver
What vitamins and minerals are effected by ethanol?
folate thaimin B12 Ca Mg Vitamins A,D,E,K
ETOH effect on pancreas
decreases protein synthesis, reduces production of pancreatic enzymes (risk for pancreatitis)
ETOH effect on muscle
inhibits glucose uptake and glycogen synthesis (DM)
What leads to hematologic problems?
folate deficiency
What deficiency is common
folate
What general symptoms may be linked to nutrient deficiencies seen in alcohol
immune suppression
cardiac myopathies
respiratory disorders
What 4 neurological problems are seen
- Wernickes encephalopahty
- Korsakoff psychosis
- Peripheral neuropathy
- Pellagrous psychosis
Severe form of thiamin deficiency
Wernicke encephalopathy
Txt for Wernicke?
withdrawal, thiamin therapy and general nutrition
Symptoms of Wernicke
visual disorder short term memory issue confusion ataxia coma
Chronic degenerative problem arising from Wernicke
Korsakoff psychosis
Korsaoff psychosis causes what
very poor short term memory or recollection
Degeneration of peripheral nerve function due to thiamin or vitamin B6 deficiency
peripheral neuropathy
What causes peripheral neuropathy
deficiency of thiamin and vitamin B6
Chronic niacin deficiency
pellagrous psychosis
Three forms of alcoholic liver disease
- fatty liver (steatosis)
- Alcoholic hepatitis
- Cirrhosis
Steatosis
fatty liver
Seen in 80% of all cases of chronic alcohol abuse
steatosis
one night of heavy drinking can cause what?
fatty streaks
5 symptoms of fatty liver:
Malaise Anorexia Vomiting Weakness Enlarged and tender liver
In severe steatosis what 3 things are seen?
portal hypertension
fluid retention
bleeding varices
What is the txt for fatty liver?
bed rest, alcohol withdrawal and proper nutrition
what is seen on labs in steatosis
increased serum globulin and transaminases
decreased albumin
Why is binge drinking so bad?
one day can take days to weeks to reverse these changes
T/F alcoholic hepatitis is less common than fatty liver
TRUE
Occurs in 30% of all cases of chronic alcohol abuse
alcoholic hepatitis
Occurs independent from fatty liver after a bout of heavy drinking
alcoholic hepatits
Symptoms of alcoholic hepatitis
fatigue
weakness
fever
hepatomegaly
What happens to hepatocytes during inflammation and hyaline degeneration
necrosis
What does laboratory test show in alcoholic hepatitis
increased transaminases, glutamate dehydrogenase, PT
FATAL disease
alcoholic hepatitis
progress to chronic liver disease and alcoholic cirrhosis
alcoholic hepatitis
end stage liver disease that results in hepatocyte destruction
Cirrhosis
What are some other causes of cirrhosis besides ETOH?
Viral hepatitis ( Hep C)
Metabolic disease
Vascular disorders
Destruction of hepatocytes resulting from chronic abuse of alcohol?
cirrhosis
10% of alcohol abusers who consume 160 g per day for 10 years or more
cirrhosis
results in fibrosis and formation of hepatocyte nodules within the liver
cirrhosis
what percent of pts will develop hepatoma
10%
In 1988 alcohol was declared a…
CARCINOGENIC
There is a causal dose dependent relationship between alcohol and ….
head and neck cancers
There is a SIGNIFICANT link between alcohol….
and pancreatic cancer
T/F light drinking is associated with increased risk for head, neck, and breast cancer
TRUE
What provides a synergistic and increased risk of head and neck cancers
smoking, drinking, bad diet (fruits and veges)
What is the safest level of alcohol consumption?
NONE
consumption of what amount might be CARDIOPROTECTIVE
< 1 drink per day
T/F “If you choose to drink do so in moderation”
TRUE
How many drinks should a woman consume?
1 a day
How many drinks should a man consume?
up to 2 a day
T/F higher the proof value the less it takes to consume
TRUE
What is binge drinking
> 5 drinks (men) or >4 (women) on one occasion
What is heavy drinking
> 15 more per wk (men) or >8 (women)
Which age group has the greatest amount of binge drinkers?
25-34 yr ( 18-24)
Where is binge drinking mostly seen on the map?
above the Manson Dixon line (north central region)
What states have the highest or lowest intensity of binge drinking?
West Virginia- highest
D.C.- lowest
