Alcohol and Disorders of Nicotine - Berges Flashcards
ethyl alcohol
in meds
cough syrups
aerosols
topicals
alcoholic beverages
water and ethyl alcohol
fermentation
stops at 12-13%
so no more than this concentration in wines
50% of all alcohols
consumed by 10% all drinkers
typical drink
10-14 grams of ETOH
BAC 0.25g/dL
0.025
1-2 alcohol drinks
alcohol metabolism
ADH
ALDH
ADH - 1 oz per hour
to acetic acid (vinegar)
acetic acid - then CO2 and H2O
ADH
in liver
alcohol to acetaldehyde
ALDH
acetaldehyde to acetic acid
alcohol PK
oral rapid absorbed
peak BAC 30min - slower with food
absorption - small intestine
BAC in female
higher compared to males
BAC 50-100
sedation
high
rxn time slow
2-4 drinks
0.08 - legally drunk in many states
BAC 100-200
impaired speech - slur, repeat
impaired motor fxn
clumsy walk - ataxia
can’t tandem walk - heel-toe
increasingly disinhibited
blackout
anterograde amnesia
disruption sleep pattern - primary reduction in REM
relax muscles of pharynx - increased snoring and sleep apnea
reduction in REM
with blackout in alcohol use
BAC 200-300
emesis stupor
BAC 300-400
coma
BAC >500
resp depression
death
alcohol poisoning
alcohol intox tx
thiamine
monitor labs
prevent aspiration
tx resp depression
chronic alcoholism
multi-system disease common
do vitals
monitor labs
cover pt with vitamines, thiamine, benzo (withdrawal sx)
long acting benzos
clorazepate dipotassium
diazepam
for withdrawal sx of alcohol
liver in chronic alcoholic
cirrhosis
women - more susceptible to men
if hep C present - liver effects more severe
GI chronic alcoholic
pancreatitis
3x more common alcoholics
chronic gastritia dn diarrhea
vit deficiency - malabsorption
weight loss
chronic alcoholic in CNS
peripheral neuropathy- distal
cerebellar degeneration - gait and balance deterioration
wernicke - thiamine deficiency
korsakoff - memory problems
cancer with alclhol
rate 10x nondrinkers
HTN in males
alcohol use
early alcohol withdrawal
early withdrawal - the shakes
12-18 hours after
peak 24-48 hours
subside 5-7 days
late alcohol withdrawal
seizures
7-48 hours after
peak 36 hours
status epilepticus rare
alcoholic hallucinations
begin within 48 hours of cessation of drinking
may last 7 days
alcohol withdrawal delirium
2-3 days after cessation
peak 4-5 days
mortality 15%
tx alcoholic withdarwal
long acting benzo - diazepam, chlordiazepoxide, clorazepate dipotassium
severe liver disease - short acting benzo - lorazepam / oxazepam
also - thiamine
haloperidol - if psychosis
CAGE test
tried to CUT DOWN?
ANNOYED about ppl asking you?
felt GUILTY about drinking?
ever needed EYE OPENER?
antabuse
disulfiram
inhibit ALDH - accumulation of acetaldehyde
nausea, vomiting, hypotension, palpitations
naltrexone
mu opioid antagonist
reduce pleasure and craving
campral
acmprosate
glutamate receptor modulation
reduced craving
american public
25% smokes
down from 32% in 1989
nicotine
highly addictive and stimulating
half life 2 hours - unpleasant withdrawal effecdts
nicotine effects
HR increase increased BP increased RR dizzy, lightheaded tremor nausea
nicotine withdrawal
craving for nicotine irritable, anger, frustrated anxiety diff concentrating decreased HR HA sleep disturbance weight gain
tx nicotine dependence
transdermal patch gum lozenges inhaler E-cigs
other tx of nicotine dependence
acupuncture
hyponosis
bupropion - 30% effective alone
varenicline - 44% effective
combo therapy best
health issues of nicotine dependence
COPD, asthma, cancer CV disease - MI, peripheral vasc disease, stroke stroke HA impotence in males
