Alcohol and substance abuse Flashcards
What order of kinetics is being used by alcohol?
Michaelis–Menten zero-order kinetics
How much % of alcohol is excreted unchanged in the breath and urine?
5 to 10%
The leading cause of death in chronic users of alcohol is?
Cardiac dysfunction
How much consumption of alcohol per month may induce alcohol-induced hypertension?
60 oz of ethanol per month
8 pints of whiskey or 55 cans of beer
An intake ___ oz per month over a 10-year period may result in congestive cardiomyopathy.
> 90
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.
Acute
Chronic
Which nutritional deficiencies are seen in chronic alcohol users?
Thiamine and folic acid
What are the effects of alcohol on inhalational anesthetics?
In acutely intoxicated, nonhabituated patients, the minimal alveolar concentration (MAC) of
inhalational agents is?
Reduced
For chronic users of alcohol the MAC for inhalational agents is?
Increased
What is the best inhalational anesthetic for sober chronic alcohol users?
Isoflurane
Start of alcohol withdrawal?
10 to 30 hours after abstinence, and the symptoms may last for 40 to 50 hours.
Alcohol withdrawal treatment?
The treatment is administration of benzodiazepines or intravenous infusion of ethanol.
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.”
Dependence
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.”
Opioid tolerance
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.
Addiction
Refers to an iatrogenic state in which the patient displays addiction-type behaviors, but the cause is inadequate treatment of a painful condition.
Pseudoaddiction
How is cocaine metabolized and excreted?
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)
Physiologic effects of cocaine mostly because of?
NE
What is the most life-threatening toxic side effect of cocaine?
MI (vasoconstriction)
The MAC of inhalational anesthetic agents is ____ in the setting of acute cocaine intoxication.
Increased
Avoid ketamineand pancuronium
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.
Methamphetamine (inc norepinephrine)
An unusual sign seen in chronic methamphetamine users is?
Dental decay, known as meth mouth.
Is a synthetic, psychoactive drug similar to
the stimulant methamphetamine and the hallucinogen mescaline.
Ecstasy, or 3,4-methylenedioxymethamphetamine
Its effects last 3 to 6 hours
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.
Phencyclidine (PCP)
This drug produces a dissociative state or out-of-body experience. Dissociation may resemble schizophrenia.
Phencyclidine (PCP)
What anesthetic management is preferred for drug abusers?
General anesthesia
How do you increase clearance of phencyclidine?
Clearance is increased by acidification of the urine and nasogastric suction.
