Alcohol and It's Effects Flashcards
What is alcohol
Any organic liquid with hydroxyl (-OH) group(s)
It can be considered a drug
Where is methanol found
In de-icer and other chemicals
May be produced in contaminated home brews and counterfeit alcohol
What are the effects of methanol
It has similar depressant properties to ethanol and people will appear drunk
It is highly toxic
Leads to acidosis and blindness
Causes methanol poisoning
How is methanol metabolised
Becomes formaldehyde and then formic acid
This causes the acidosis
How do you treat methanol poisoning
Give them ethanol (whiskey etc) as it competitively inhibits the alcohol dehydrogenase and reduces methanol metabolism
Also put on dialysis to clear the methanol
What is the recommended alcohol intake per week
No more than 14 units
What is the type of alcohol found in drinks
Ethanol
What are common signs of alcohol withdrawal
Aggression
Seeing spiders
Seen after surgery due to fasting etc
Where is alcohol mainly absorbed
The small bowel
Limited in the stomach
How is alcohol digested in the stomach
By alcohol dehydrogenase
This is limited
How does food help reduce alcohol absorption
Slows gastric emptying (time to digest) which gives alcohol slightly more time to be metabolised
This means less is absorbed in small bowel
What type of drink is absorbed fastest
Aerated drinks like champagne
Which drugs increase alcohol absorption
antihistamines and metaclopramide
Anything that increases rate of gastric emptying
How are spirits processed by the body
They delay emptying due to irritation of the gastric mucosa
Absorbed slower
Why do women have lower alcohol tolerance (usually)
On average they have lower circulating blood volumes which means less volume to dilute the alcohol
Also the have lower alcohol dehydrogenase levels
And less lean body mass
Where does alcohol metabolism occur
90% in the liver
Small amounts in the brain and pancreas
5% excreted in breath - basis for breathalyser
How is alcohol metabolised
Broken down by alcohol dehydrogenase to acetaldehyde
Then metabolised to acetate by acetate dehydrogenase
Further broken down into CO2 and H20
Which compound is responsible for hangovers
Acetaldehyde
At what rate is alcohol removed from the body
Roughly 1 unit per hour
15mg/100ml/hour
Which ethnic groups struggle to metabolise alcohol and why
Inuits, Eskimos and aborigines due to low alcohol dehydrogenase levels
50% of Japanese people lack it completely
Leads to more unpleasant side effects: flushing, nausea and headache
Is it possible to build tolerance for alcohol
Yes
It’s possible to up regulate alcohol dehydrogenase
In heavy drinkers other metabolism pathways can be activated such as CP450
How does alcohol affect the Krebs cycle
It inhibits it which switches to anaerobic metabolism
This produces lactic acid faster - sore muscles
What is hepatic gluconeogenesis
When blood glucose is low, the glycogen stores in the liver are converted into glucose to increase the levels
How does alcohol affect hepatic gluconeogenesis and what is the result
It inhibits the process so new glucose isn’t made
This is why you get hungry when drunk as the body is trying to get more sugar
How does alcohol affect fatty acid oxidation and what are the effects
It impairs oxidation
Causes excess ketogenesis - leads to alcoholic ketoacidosis
Increased lipid synthesis - lay down more fat
What is alcoholic ketoacidosis
Excess ketone production due to impaired fatty acid metabolism, excess NADH and often a fasting state
Low or normal blood sugar with high ketones
How does alcohol affect the brain
Increases levels of GABBA - CNS depressant
Affects: cortex - disinhibition, limbic system - memory loss,confusion, cerebellum - loss of coordination and slurring, reticular formation - consciousness and the lower brain stem - breathing and blood pressure
Why does alcohol make you pee more
We often drink more fluid when drinking alcohol than we would soft drinks
Inhibits ADH which reduces water reabsorption
Describe the effects of different alcohol levels (<100, 100-200, >200)
<100 - fun, disinhibited etc
100-200 - falling, slurred speech etc
>200 - dangerous, difficult to rouse
What effect does alcohol have on the heart
It’s a negative into rope - reduces force of contraction
Heart beats faster to compensate
Occasionally get Holiday Heart Syndrome after lots of binge drinking which is a supraventricular tachycardia caused by the alcohol, it often gets better itself
What is the proper name for a hangover headache and what causes it
Veisalgia Cephalgia
Mainly caused by dehydration
Other causes are the other substances in alcohol such as sulphites, phenols etc
Are there any health benefits from alcohol
No
Large study has found that even small amounts bring no benefits
Main risk factor for death in 15-49 y/o
What are the symptoms of mild alcohol withdrawal
Occurs 12-36 hrs from last drink
fine tremor, sweating, anxiety, hyperactivity, ^HR, ^BP, fever, anorexia, nausea, retching
What are the symptoms of moderate alcohol withdrawal
Occurs 12hrs to 5 days after last drink
coarse tremor, shaking agitation, confusion, disorientation, paranoia, seizures (especially 24-48hrs), hallucinations
What are the symptoms of severe alcohol withdrawal
Occurs 12hrs to 7+ days
more severe and prolonged, risk of DTs around 48 hrs – severe agitation, anxiety, confusion, delusions, hallucinations (tactile visual – crawling beesties). Circulatory collapse and death can occur
How do you manage alcohol withdrawal
Treat with diazepam
Regularly assess and alter dose
Provide supportive treatment
What are the CNS effects of mild alcohol consumption
sedative, mild anaesthetic
activates reward centre
sense of well being, disinhibition, euphoria
What are the CNS effects of alcohol intoxication
Increased risk of accidental injury
Elated, aggressive behaviours, drowsiness, slurred speech, unsteadiness
Loss of consciousness
How does alcohol consumption cause seizures
Sudden cessation of alcohol can cause TC seizures
May also trigger seizures in existing epileptics
How does alcohol affect the nerves and muscles
Can cause peripheral neuropathy - pain and weakness
Compression neuropathy - temporary damage to myelin sheath that usually resolves itself
Myopathy can occur acutely after binges or chronically - muscle pain and weakness
What causes Wernicke-Korsakoff SYndrome
Thiamine deficiency which is common in alcoholics
Leads to cytotoxic oedema
What are the symptoms of Wernicke-Korsakoff
Ocular dysfunction
Ataxic gait
Acute confusion
How do you treat Wernicke-Korsakoff
Thiamine replacement
Urgent!
What are the symptoms of Korsakoff syndrome
Anterograde amnesia - cant remember new info
Retrograde amnesia - episodic memory
Confabulation
How can you treat Korsakoff syndrome
Abstinence and nutrition
chances of recovery low
How is alcohol linked to dementia
50-70% of problem drinkers have global cognitive impairment
May kill some neurones
What effect does alcohol have on the heart
Can cause dilated cardiomyopathy - impairs ventricular function
Arrhythmias - AF or SVT that usually resolve
Chronic electrolyte imbalance may cause OT
What are the population trends of liver disease
5th most common cause of death in UK
Increasing hugely
One of the most common causes of premature mortality
Usually preventable
What is alcohol related steatosis
hepatocytes swell with triglycerides - fat build up
almost always seen in heavy drinkers
Commonly presents with odd LFT
reverses with cessation
Describe alcohol related hepatitis
Acute, life threatening manifestation
Cell damage & inflammation
Presents with jaundice, coagulopathy, liver failure
High risk of renal failure, bleeding, infections
high mortality
only hope is abstinence and nutrition
What can cirrhosis lead on to
portal hypertension
hepatocellular carcinoma
nutritional decline
What are some consequences of portal hypertension
variceal bleeding
ascites
spontaneous bacterial peritonitis
hepatic encephalopathy
What are potential treatments/ managements for cirrhosis
Abstinence Vitamins Nutrition Endoscopic Pharmacological – Bblockers, lactulose, Rifaximin Radiological – TIPPS Surgical - Transplant
What effect does alcohol have on cancer risk
Increases it
Oral, pharyngeal, laryngeal, oesophageal, colorectal, hepatocellular carcinoma, female breast cancer
This is due to carcinogenic metabolites and may be linked to increased oestrogen
Name 4 key drugs for alcohol abstinence treatment
Acamprosate – reduces cravings
Naltrexone – reduces desire for alcohol
Disulfiram – aversion therapy drug
Nalmefene – opioid antagonist
