Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

People and Illness > Alcohol and Addiction > Flashcards

Alcohol and Addiction Flashcards

You may prefer our related Brainscape-certified flashcards:
People You Should Know flashcards
1
Q

Define dependence.

A

The physical and/or psychological effects produced by the habitual taking of certain drugs, characterised by a compulsion to continue taking the drug

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Define physical dependence.

A

Dependence in which withdrawal of the drug causes specific symptoms, such as sweating, vomiting or tremors, that are reversed by further doses

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Define psychological dependence.

A

Dependence in which repeated use of a drug induces reliance on it for a state of wellbeing and contentment, but there are no physical withdrawal symptoms if use of the drug is stopped

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Define addiction.

A

A state of dependence produced either by the habitual taking of drugs or by regularly engaging in certain activities (e.g. gambling)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Define tolerance.

A

The reduction or loss of the normal response to a drug or other substance that usually provokes a reaction in the body

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

List the criteria needed to diagnose dependence/addiction.

A
  1. Strong desire/compulsion to take the drug
  2. Loss of control over substance-taking behaviour (e.g. onset, termination, levels of use)
  3. Physiological withdrawal state
  4. Tolerance
  5. Progressive neglect of other pleasures/interests
  6. Persistent use despite awareness of overt harmful effects
  7. Narrowing of repertoire
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the causes of dependence/addiction to alcohol.

A
  1. Excessive/long term use of drug
  2. Genetics
    a. If parents are alcoholics, child has x4 increased risk
    b. Heritability of alcoholism: 0.3-0.6
  3. Environmental factors
    a. Socioeconomic status
    b. Culture/customs relating to alcohol use
    c. Peer behaviour
    d. Religion
    e. Employment status
    f. Parental influence
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the signs and symptoms of dependence/addiction.

A
  1. Not meeting obligations/responsibilities
  2. Ceasing social/recreational activities
  3. Increased criminality
  4. Increased risk taking
  5. Problems at school/work
  6. Neglected appearance
  7. Behavioural changes
  8. Somatic problems, e.g.
    a. Lack of energy
    b. Lack of motivation
  9. Drug specific signs and symptoms
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the features of withdrawal.

A
  1. May be substance specific
  2. Psychological disturbances, e.g.
    a. Anxiety
    b. Depression
    c. Sleep disorders
  3. Physical symptoms, e.g.
    a. Tremor
    b. Convulsions
    c. Sweating
  4. Symptoms are relieved by further substance use
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What is the underlying mechanism of all types of addiction?

A

Neurophysiological reinforcement (reward) involving the mesolimbic pathway

Location: ventral tegmental area –> forebrain (especially nucleus accumbens)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

How do stimulant drugs cause addiction?

Give 3 specific examples of the mechanisms by which this occurs.

A

Increased activation of the mesolimbic reward pathway

COCAINE

  1. Inhibits monoamine reuptake
  2. Therefore there is more dopamine in the synapse, so the reward pathway is constantly stimulated
  3. Chronic use alters receptor sensitivity, making them less sensitive – this causes tolerance

AMPHETAMINE

  1. Stimulates release of dopamine and NA
  2. Blocks reuptake of dopamine and NA
  3. Therefore there is more dopamine in the synapse, so the reward pathway is constantly stimulated

NICOTINE

  1. Binds and activates nicotinic acetylcholine receptors in reward pathway neurons
  2. This causes opening of Na+ channels, which causes depolarisation
  3. Therefore the reward pathway is stimulated
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

How do depressant drugs cause addiction?

Name one specific example.

A

Depressant drugs cause decreased activation of this pathway, BUT this causes:

  1. Upregulation of excitatory (glutamate) receptors in the pathway
    a. This means there is increased stimulation in absence of the drug (which then causes withdrawal symptoms)
  2. Downregulation of inhibitory (GABA) receptors in the pathway
    a. This means there is less inhibition, and the pathway is activated more

ALCOHOL

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

How does alcohol cause addiction?

A
  1. Stimulates release of dopamine from the ventral tegmental area – this activates the reward pathway
  2. Acute alcohol use inhibits glutamate receptors, and stimulates GABA receptors, causing an overall inhibitory effect
    a. Alcohol acts on the GABA alpha receptor, which causes Ca2+ channels to open
    b. This causes hyperpolarisation of neurons in the reward pathway
    c. Therefore the pathway is not activated
  3. Chronic alcohol use causes neuroplasticity
    a. Upregulation of glutamate receptors increases the excitability of neurons
    i. Therefore more glutamate receptors are stimulated and the pathway is activated
    b. Downregulation of GABA receptors decreases the inhibition of neurons
    i. Therefore neurons are no longer inhibited as much, and the pathway is activated
    ii. NOTE: this causes tolerance
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

List the drugs which might be used to manage alcohol addiction.

Briefly describe the mechanism of action.

A
  1. Disulfiram
    a. Mechanism of action: blocks metabolism of alcohol by inhibiting the conversion of acetaldehyde into acetate (this leads to the build-up of acetaldehyde, which is toxic)
    b. This results in many systemic effects, e.g.
    - –Vomiting
    - –Flushing
    - –Nausea
    - –Diarrhoea
    - –Tachycardia
    - –Hypotension
  2. Naltrexone
    Mechanism of action: opioid antagonist (inhibits the reward pathway)
    b. Can be started in patients who are still drinking
  3. Nalmefene
    a. Mechanism of action:
    - –Opioid antagonist (inhibits the reward pathway)
    - –Competitive antagonist at the mu opioid receptor (inhibits the reward pathway)
    b. Should be administered on days where the patient thinks they are likely to consume alcohol
  4. Acamprosate
    a. Mechanism of action: stabilises glutamate and GABA systems
  5. Benzodiazepines
    a. Improve withdrawal effects
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

List recommended drinking levels for:

a) Men
b) Women
c) Pregnant women
d) Driving

A

Men: 14 units/week (3-4 units per day)

Women: 14 units/week (2-3 units per day)

Pregnant women: no safe amount - should avoid alcohol altogether

Legal driving limit: 50mg alcohol per 100ml blood (NOTE: in England/Wales, it’s 80mg)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the definition of 1 unit of alcohol?

A

10ml of absolute alcohol OR 8g of absolute alcohol

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How is the alcohol content of a drink calculated?

A

Alcohol content = % ABV x 0.78

18
Q

How is the absolute alcohol content of a drink calculated?

A

Absolute alcohol = (% ABV x volume (ml)) / 1000

19
Q

List the 3 pathways of alcohol metabolism.

A
  1. Alcohol dehydrogenase (ADH) pathway
    a. Location: cytosol
    b. Function of ADH: catalyses the conversion of ethanol to acetaldehyde
    c. There may also be some ADH in gastric mucosa (but the importance of this is debated)
  2. Microsomal ethanol oxidising system (MEOS)
    a. Location: smooth endoplasmic reticulum
    b. Function of MEOS pathway: catalyses the conversion of ethanol to acetaldehyde via the action of CYP3E1
    c. Small role when there are only low ethanol concentrations
    d. Increased role in chronic alcohol abuse (up to 10%)
  3. Catalase pathway
    a. Location: peroxisomes
20
Q

Describe the metabolism of alcohol.

A
  1. Ethanol is converted to acetaldehyde via ADH
    a. Aided by CYP2E1
  2. Acetaldehyde is converted to acetate via ALDH (acetaldehyde dehydrogenase)
    a. There are 2 isoforms of ALDH – mitochondrial ALDH2 is the most important
  3. Acetate is converted to CO2 and H2O via the Krebs cycle etc., which is then excreted
21
Q

What is the rate limiting step of alcohol oxidation?

A

Dissociation of the NADH-NAD enzyme complex (needed for ADH to oxidise ethanol)

22
Q

What is the rate of alcohol elimination in the urine/breath?

A

7-10g/hour

23
Q

Describe the social effects of alcohol.

A
  1. Increased crime and antisocial behaviour
  2. Single biggest risk factor for suicide
  3. Breakdown of families
  4. Loss of work
  5. Health inequalities
  6. Impaired interpersonal relationships
  7. Domestic violence
24
Q

When is the foetus most vulnerable to alcohol?

A

4-10 weeks

25
Q

What are the risks of alcohol during pregnancy?

A
  1. Spontaneous abortion

2. Foetal alcohol syndrome

26
Q

Describe the features of foetal alcohol syndrome.

A
  1. Pre- and post-natal growth retardation
  2. CNS abnormalities
    a. Microcephaly
    b. Agenesis of corpus callosum
    c. Cerebellar hypoplasia
    d. Mental retardation
    e. Irritability
    f. Hypotonia
    g. Incoordination
    h. Hyperactivity
  3. Craniofacial abnormalities
    a. Short palpebral fissures
    b. Epicanthic folds
    c. Smooth philtrum
    d. Thin upper lip
    e. Mid-facial hypoplasia
    f. Lower jaw hypoplasia
    g. Short upturned nose
    h. Minor ear abnormalities
    i. Ptosis
  4. Associated abnormalities, including congenital defects of:
    a. Cardiovascular system
    b. Skeletal system
    c. Genitourinary tract
    d. Ocular tract
    e. Auditory system
27
Q

Describe the effects of acute alcohol use on the body.

A
  1. Social effects:
    a. Elation
    b. More talkative
    c. Loss of social inhibition
  2. Functional impairment:
    a. Slurred speech
    b. Unsteadiness
    c. Drowsiness
    d. Reduced motor function
  3. Autonomic effects:
    a. Flushing of skin
    b. Pupil dilation
    c. Tachycardia
  4. Cognitive impairment:
    a. Decreased reasoning
    b. Impaired memory
    c. Reduced perception
    d. Easily distracted
  5. Psychological effects:
    a. Feelings of enhanced ability
    b. Loss of emotional restraint – i.e. become more emotional
28
Q

List some acute physical consequences of alcoholism.

A
  1. Accidents
  2. Aspiration pneumonia
  3. Oesophagitis
  4. Gastritis
  5. Pancreatitis
  6. Arrhythmias
  7. Cerebrovascular accidents
29
Q

List some chronic physical consequences of alcoholism.

A
  1. Systemic:
    a. Accidents
    b. Systemic hypertension
  2. GI system:
    a. Malabsorption
    b. Malnutrition
    c. Pancreatitis
  3. Liver:
    a. Fatty liver
    b. Hepatitis
    c. Cirrhosis
  4. Cardiovascular system:
    a. Systemic hypertension
    b. Cardiomyopathy
    c. Coronary heart disease
  5. Brain damage
    a. Dementia
    b. Wernicke-Korsakoff syndrome
    c. Cerebellar atrophy
    d. Central pontine myelinolysis
  6. Musculoskeletal system:
    a. Osteoporosis
  7. Nerves:
    a. Peripheral neuropathy
  8. GU system:
    a. Infertility
    b. Sexual dysfunction
30
Q

Briefly list the factors contributing to the pathophysiology of alcoholic liver disease.

A
  1. Acetaldehyde production
  2. Acetate production
  3. Increased NADH/NAD ratio
  4. Non-oxidative metabolism
  5. Reactive oxygen species (ROS) production
  6. Increased intestinal permeability
  7. Production of IL-8 by hepatocytes
31
Q

Describe the pathophysiology of alcoholic liver disease (12 marks).

A
  1. Acetaldehyde production
    a. Toxic
    b. Immunogenic (stimulates T cells)
    c. Stimulates collagen production by Stellate cells (causes fibrosis)
  2. Acetate production
    a. Acetate forms acetyl coA levels
    b. Increased acetyl CoA causes acetylation of histones
    c. This causes DNA to stimulate pro-inflammatory cytokine production
  3. Increased NADH/NAD ratio
    a. This causes increased fatty acid synthesis
    b. This also causes reduced fatty acid oxidation
    c. These factors cause steatosis
  4. Non-oxidative metabolism
    a. This causes fatty acid ethyl ester production
    b. This causes steatosis
  5. Reactive oxygen species (ROS) production
    a. Caused by increased usage of the MEOS (CYP2E1)/catalase pathways
    b. Increased levels of ROS causes production of hydrogen peroxide and superoxide ions
    c. This causes activation of redox-sensitive transcription factors such as NF-kB
    d. Redox-sensitive transcription factors cause:
    i. Increased lipid peroxidation
    ii. Inflammation
    iii. Damage to mitochondrial membranes
    iv. Increased TNF alpha production
    e. TNF alpha causes apoptosis, necrosis, activation of stellate cells (produce collagen, cause fibrosis)
  6. Increased intestinal permeability
    a. Caused by: alcohol
    b. This causes portal circulation endotoxaemia (i.e. the presence of endotoxins from intestinal microflora in the portal circulation)
    c. This promotes activation of Kupffer cells in the liver, which then produce pro-inflammatory factors such as ROS, TNF alpha
  7. Production of IL-8 by hepatocytes
    a. This is stimulated by redox-sensitive transcription factors
    b. This causes further pro-inflammatory response, in particular:
    i. IL-8 causes neutrophil activation
    ii. Neutrophil activation leads to increased production of ROS in hepatocytes
    iii. ROS contributes to oxidative stress and apoptosis
32
Q

Draw a diagram to show how portal hypertension contributes to ALD.

A

(See flowchart)

33
Q

Define Wernicke’s encephalopathy.

A

Mental confusion or delirium occurring in combination with paralysis of the eye muscles, nystagmus, and an unsteady gait, caused by vitamin B1 deficiency

34
Q

Define Korsakoff’s psychosis.

A

An organic disorder affecting the brain that results in a memory defect in which new information fails to be learnt, although events from the past are still recalled; disorientation in time and place; and a tendency to unintentionally invent material to fill memory blanks (confabulation)

35
Q

Describe the problems that alcoholism can cause in the brain.

A
  1. Mental health problems:
    a. Depression
    b. Anxiety
    c. Attempted suicide/Suicide
    d. Changes in personality
  2. Other problems:
    a. Insomnia
    b. Delirium tremens
    c. Alcoholic hallucinosis
    d. Association with other addictions
  3. Alcohol related brain damage:
    a. Peripheral neuropathies
    b. Cerebellar degeneration
    c. Dementia (partially reversible when caused by alcohol)
    d. Wernicke’s encephalopathy
    e. Korsakoff/amnestic syndrome
36
Q

Describe the symptoms of Wernicke’s encephalopathy.

A
  1. Eye symptoms
    a. Gaze paralysis (ophthalmoplegia)
    b. Nystagmus
  2. Confusion
  3. Gait ataxia
37
Q

Describe the pathophysiology of Wernicke’s encephalopathy.

A
  1. Neuropathological lesions
    a. Along neural axis
    b. Especially along walls of 3rd ventricle
38
Q

Describe the symptoms of Korsakoff’s psychosis/amnestic syndrome.

A
  1. Prominent loss of recent memory
  2. Retrograde amnesia
  3. Anterograde amnesia
  4. Confabulation
  5. Long term memory is intact
  6. Disorientation in time/space
39
Q

Describe the pathophysiology of Korsakoff’s psychosis/amnestic syndrome.

A
  1. Lesions along mammillary bodies and thalamic nuclei
  2. May also affect neighbouring regions, e.g. the hippocampus
  3. Haemorrhage into the thalamus
  4. Mammillary bodies shrink
40
Q

Describe the symptoms of alcoholic dementia.

A
  1. Decline in cognitive function
  2. Memory loss PLUS:
    a. Agnosia
    b. Aphasia
    c. Apraxia
  3. Loss of executive function
    a. Poor planning
    b. Poor organisation
    c. Poor adaptability
    d. Inability to cope with changes in surroundings/circumstances
41
Q

Outline the 7 different categories of drugs and give at least one example of each.

A
  1. Stimulants (e.g. cocaine)
  2. Empathogens (e.g. ecstasy)
  3. Psychodelics (e.g. LSD)
  4. Dissociatives (e.g. NO, ketamine)
  5. Cannabinoids (e.g. cannabis)
  6. Depressants/benzodiazepines (e.g. valium, diazepam)
  7. Opioids (e.g. heroin)

People and Illness (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions