Alcohol Abuse- Pharm Flashcards
(25 cards)
What is alcohol abuse
Compulsive use of alcohol
What is alcohol dependence
Alcohol abuse, physical dependence, tolerance, and s/s upon withdrawal
Alcohol withdrawal syndrome
Insomnia, tremor, agitation, seizure, autonomic instability
Delirium tremens
Severe alcohol withdrawal w/ sweating, tremor, confusion, and hallucinations
Fetal Alcohol Syndrome
Craniofacial dsymorphia, heart defects, mental retardation
Wernicke-Korsakoff syndrome
Ataxia, confusion, extraocular paralysis due to chronic alcoholism and thiamine deficiency
Explain ADH metabolism
-what inhibits ADH? What is a use of one of the inhibitors
Ethanol is converted to acetaldehyde via ADH which also converts NAD to NADH (accumulation of NADH contributes to metabolic disorders, lactic acidosis, and hypoglycemia)
ADH is inhibited by aspirin and FOMEPIZOLE which is used to treat acute methanol/ethylene poisoning
Explain ALDH metabolism
-what inhibits ALDH and what is its use
ALDH converts acetaldehyde to acetic acid which is then metabolized to CO2 and water; NAD is converted to NADH
Disulfiram inhibits ALDH and is used to treat alcohol abuse and dependence
Explain polymorphisms in ALDH
- who does it commonly affect
- what is the result
- what does it protect against and what does it inc risk of
ALDH polymorphisms are common in Asians resulting in flushing, light headedness, palpitations, and hangover symptoms
Helps protect against alcohol dependence and abuse; alcoholics w/ this polymorphisms are at inc risk of liver disease
Explain the MEOS system of metabolism; what does it lead to
If NAD is depleted MEOS (cyp450) use NADPH as cofactor in metabolism of ethanol; MEOS system activity inc toxins, free radicals, and hydrogen peroxide
Explain effects of acute ethanol consumption w/ regards to:
- CNS
- NMDA and GAGA
- Heart
- Smooth M
CNS- alcohol causes sedation and relieves anxiety but inc [ ] leads to slurred speech, ataxia, impaired judgement/behavior
NMDA- alcohol inhibits ability of glutamate to open NMDA-R; depress CNS and memory loss
GABA- alcohol inc effects of GABA at R which depresses CNS
Heart- depress myocardial contractility
Smooth m- vasodilate and hypothermia
Explain effects of chronic alcohol consumption w/ regards to:
- esophagus
- stomach
- intestines
- pancreas
- liver
Esophagus- esophageal dysfunction, reflux, barretts, esophageal cancer
Stomach- acute/chronic gastritis and epigastric pain
Intestines- chronic diarrhea, nutritional malabsorption, and vit deficiency
Pancreas- #1 cause pancreatitis; Ca stones
Liver- #1 cause cirrhosis and need for transplant; fatty liver, hepatitis, cirrhosis, LF
Explain chronic alcohol abuse w/ regards to:
- peripheral n
- Wernicke-Korsakoff
- Korsakoff psychosis
- vision
Peripheral n- symmetric peripheral n injury causing distal parathesias, gait abnml, and ataxia
WK- extraocular paralysis, ataxia, confusion due to thiamine deficiency
KP- chronic disabling memory disorder post-WK syndrome
Vision- optic n degen and blurred vision
Explain effects of chronic alcohol abuse w/ regards to CV system and relationship between alcohol and CAD
Inc risk of dilated cardiomyopathy, ventricular hypertrophy, cardiac fibrosis, arrhythmias, HTN, folate deficient anemia, and stroke
Mod alcohol- dec risk of CAD by inc HDL and inhibiting inflammatory processes of atheroslcerosis
Explain effects of chronic alcohol abuse on endocrine system
Gynecomastia, testicular atrophy, hypoglycemia, ketosis, and abnml K levels
Relationship between alcohol and diuresis
Alcohol inhibits vasopressin leading to diuresis; during withdrawal vasopressin inc leading to water retention and hyponatremia
Explain goals and mgmt of acute alcohol intoxication
Goals- prevent resp depression and aspiration
Glucose for metabolic disturbances
Thiamine to prevent wernicke-korsakoff
K if pt is vomiting severely
Explain goals and mgmt of alcohol withdrawal syndrome; class of drug used (compare interdrug classes pros and cons)
Goals- prevent seizure, delirium, and arrhythmias and correct electrolytes and thiamine levels
Substitute LA sedative for alcohol and taper LA benzodiazepine (clor and diazepam-have built in tappering but CI w/ liver dysfunction) Short acting benzodiazepine (l/o-zepam- can use in pt w/ liver dysfunction)
Explain mgmt of alcohol dependence
- primary treatment
- list the 3 drugs
Alcohol dependence
- psychosocial therapy #1
- drugs- naltrexone, acamprosate, disulfiram
Naltrexone
- use
- MOA
- effects
- metabolism
- what must pt be free of; why?
- AE and CI
Naltrexone
- used for alcohol dependence
- MOA- LA mu-antagonist
- effects- reduce cravings and relapse
- extensive 1st pass effect
- pt must be opioid free or will lead to acute withdrawal syndrome
- AE-hepatocellular injury
- CI- acute hepatitis or liver failure
Acamprosate
- MOA
- effects
- caution in what pt
Acamprosate
- MOA- NMDA antagonist and GABAa agonist
- effects- reduce relapse
- caution in pt w/ kidney disease
Disulfiram
- MOA
- who is it used in
- who is it never used in
Disulfiram
MOA- irreversibly inhibitors ALDH and causes extreme discomfort in pt who drink alcohol
Used in pt who are highly motivated and have supportive therapy
Never use in pt who are drunk
What are earliest signs of alcohol withdrawal syndrome? When do they first appear and how long can they last? When does delirium tremens develop?
Earliest signs- anxiety, tremor, insomnia, palpitations, anorexia, seizure, hallucinations w/ in 24 hr
Delirium tremens develops between 48-72 hrs since alcohol discontinuation
Methanol
- who does methanol poisoning effect
- what does it lead to
- how do you treat
Methanol
- poisoning due to accidental ingestion or in alcoholics using it as substitute
- causes very blurry vision
- treat- resp support, hemodialysis, alkalinization w/ bicarb, and inhibit its metabolism by ADH w/ ethanol (higher affinity) and fomepizole (inhibits ADH)
