Alcohol and substance abuse

Question 1

What order of kinetics is being used by alcohol?

Answer 1

Michaelis–Menten zero-order kinetics

Question 2

How much % of alcohol is excreted unchanged in the breath and urine?

Answer 2

5 to 10%

Question 3

The leading cause of death in chronic users of alcohol is?

Answer 3

Cardiac dysfunction

Question 4

How much consumption of alcohol per month may induce alcohol-induced hypertension?

Answer 4

60 oz of ethanol per month

8 pints of whiskey or 55 cans of beer

Question 5

An intake ___ oz per month over a 10-year period may result in congestive cardiomyopathy.

Answer 5

> 90

Question 6

Acute/chronic alcohol use may cause esophagitis, gastritis, and pancreatitis. Acute/chronic alcohol use leads to delayed gastric emptying and relaxation of the lower esophageal sphincter, increasing the risk of
aspiration.

Answer 6

Acute

Chronic

Question 7

Which nutritional deficiencies are seen in chronic alcohol users?

Answer 7

Thiamine and folic acid

Question 8

What are the effects of alcohol on inhalational anesthetics?

In acutely intoxicated, nonhabituated patients, the minimal alveolar concentration (MAC) of
inhalational agents is?

Answer 8

Reduced

Question 9

For chronic users of alcohol the MAC for inhalational agents is?

Answer 9

Increased

Question 10

What is the best inhalational anesthetic for sober chronic alcohol users?

Answer 10

Isoflurane

Question 11

Start of alcohol withdrawal?

Answer 11

10 to 30 hours after abstinence, and the symptoms may last for 40 to 50 hours.

Question 12

Alcohol withdrawal treatment?

Answer 12

The treatment is administration of benzodiazepines or intravenous infusion of ethanol.

Question 13

This condition implies “a state of adaptation that is manifested by a drug class–specific withdrawal syndrome that can be produced by abrupt cessation, rapid dose reduction, decreasing blood level of the drug, and/or administration of an antagonist.”

Answer 13

Dependence

Question 14

Is “a state of adaptation in which exposure to a drug induces changes that result in a diminution of one or more of the drug’s effects over time.”

Answer 14

Opioid tolerance

Question 15

Is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. It is
characterized by behaviors that include one or more of the following: impaired control over drug use, compulsive use, continued use despite harm, and craving.

Answer 15

Addiction

Question 16

Refers to an iatrogenic state in which the patient displays addiction-type behaviors, but the cause is inadequate treatment of a painful condition.

Answer 16

Pseudoaddiction

Question 17

How is cocaine metabolized and excreted?

Answer 17

Peak plasma concentration: 15 to 60 mins (intranasal)
Half life: 45 to 90 mins
Hydrolyzed by: plasma pseudocholinesterase & liver esterase
Clearance: Urine (14 to 60 hours)

Question 18

Physiologic effects of cocaine mostly because of?

Answer 18

NE

Question 19

What is the most life-threatening toxic side effect of cocaine?

Answer 19

MI (vasoconstriction)

Question 20

The MAC of inhalational anesthetic agents is ____ in the setting of acute cocaine intoxication.

Answer 20

Increased

Avoid ketamineand pancuronium

Question 21

Use of this drug is common among homosexual males, and there is a strong relationship between its use and having the human immunodeficiency virus. Use of this drug produces a rapid pleasurable rush followed by euphoria, heightened attention, and increased energy.

Answer 21

Methamphetamine (inc norepinephrine)

Question 22

An unusual sign seen in chronic methamphetamine users is?

Answer 22

Dental decay, known as meth mouth.

Question 23

Is a synthetic, psychoactive drug similar to

the stimulant methamphetamine and the hallucinogen mescaline.

Answer 23

Ecstasy, or 3,4-methylenedioxymethamphetamine

Its effects last 3 to 6 hours

Question 24

Is a cyclohexylamine that was developed in the 1950s as an anesthetic but was subsequently taken off the market because of its tendency to produce hallucinations. The precise mechanism of action of PCP is unknown, but it is thought to depress cortical and
thalamic function while stimulating the limbic system.

Answer 24

Phencyclidine (PCP)

Question 25

This drug produces a dissociative state or out-of-body experience. Dissociation may resemble schizophrenia.

Answer 25

Phencyclidine (PCP)

Question 26

What anesthetic management is preferred for drug abusers?

Answer 26

General anesthesia

Question 27

How do you increase clearance of phencyclidine?

Answer 27

Clearance is increased by acidification of the urine and nasogastric suction.