Alcohol Disorders & Nicotine

Question 1

main component in alcohol

Answer 1

ethyl alcohol

Question 2

fermentation stops at what percent alcohol

Answer 2

12-13%

Question 3

50% of all alcohol consumed by

Answer 3

10% of all drinkers

Question 4

how many gr of ETOH per drink

Answer 4

10-14 grams
1.5 oz whiskey
12 oz beer
4 oz wine

Question 5

how is blood alcohol concentration BAC measured

Answer 5

g/dL or mg/dL

1-2 drinks is 0.25g/dL or 0.25%

Question 6

enzymes for alcohol metabolism

Answer 6

alcohol dehydrogenase

aldehyde dehydrogenase

Question 7

where is alcohol dehydrogenase ADH found

Answer 7

liver

Question 8

what does AldDH do

Answer 8

acetaldehyde to acetic acid

Question 9

acetic acid in normal metabolic pathway becomes

Answer 9

carbon dioxide and water

Question 10

peak BAC occurs how

Answer 10

30 minutes when alcohol taken orally

longer if taken with food

Question 11

primary site alcohol absorption

Answer 11

small intestine

Question 12

why is BAC higher in females than males

Answer 12

smaller total body water distribution due to fat stores

Question 13

effects of BAC 50-100 mg/dL

Answer 13

sedation
subjective sensation of high
reaction slowed
80mg/dL legally drunk

Question 14

how many drinks to cause 50-100 BAC in nontolerant

Answer 14

2-4 drinks in short period of time

Question 15

BAC 100-200 mg/dL signs

Answer 15

impaired speech
impaired motor function
gait disturbance, clumsiness, ataxia
increasingly disinhibited
blackouts, anterograde amnesia
disruption in REM sleep
snoring and sleep apnea

Question 16

BAC 200-300 mg/dL signs

Answer 16

emesis and stupor

Question 17

BAC 300-400 mg/dL signs

Answer 17

coma

Question 18

BAC 500+ mg/dL

Answer 18

respiratory depression and death

Question 19

management of acute alcohol intoxication

Answer 19

treat and prevent respiratory depression
monitor/prevent aspiration
give thiamine oral or IM
monitor labs for electrolytes, glucose, thiamine etc

Question 20

use of thiamine in acute alcohol intoxication

Answer 20

reduce risk of Wernickes encephalopathy from lactic acidosis

Question 21

management of chronic alcoholism

Answer 21

vital signs
monitor labs like BAC, CBC, LFT, CMP
vitamins thiamine benzo if withdrawal
vital signs again to monitor for deterioation

Question 22

what benzo best for withdrawal of alcohol

Answer 22

long acting like clorazepate dipotassium or diazepam

Question 23

chronic effects of alcohol on liver

Answer 23

cirrhosis in 25%
women>M
concurrent Hep C, liver effects more severe

Question 24

chronic alcohol effects on GI

Answer 24

pancreatitis 3x likely
chronic gastritis and diarrhea
vit deficiency from malabsorption
weight loss

Question 25

CNS effects chronic alcohol

Answer 25

peripheral neuropathy cerebellar degeneration- gait and balance wernickes encephalopathy- confusion korsakoffs psychosis- memory problems and chronic confabulation

Question 26

CV effects chronic alcohol

Answer 26

HTN in M>W 50% HTN 3-4 drinks a day 100% HTN 6-7 drinks.day

Question 27

neoplastic risks of chronic alcohol

Answer 27

cancer 10x risk

Question 28

uncomplicated alcohol withdrawal

Answer 28

shakes 12-18 hours after peak 24-48 hr no Tx subsides in 5-7 days

Question 29

alcohol withdrawal seizures

Answer 29

7-48 hrs post peak 24-48 hrs status epilepticus rare

Question 30

alcoholic hallucinosis

Answer 30

auditory visual or tactile hallucinations 48 hrs post may last up to 7 days

Question 31

delerium tremens

Answer 31

2-3 days post Sx peak 4-5 days last 3-5 days to weeks mortality rates 15%

Question 32

mangement alcohol withdrawal syndromes

Answer 32

long acting benzos short acting benzos if liver disease (lorazepam of oxazepam) thiamine oral or IM once folic acid 1 mg daily haloperidol or risperidone for hallucinosis

Question 33

CAGE test

Answer 33

- tried to Cut down? - felt Annoyed by questions? - felt Guilty about drinking? - needed Eye opener in morning?

Question 34

Tx options for alcohol disorders

Answer 34

``` AAA structured detox inpatient alcohol Tx physician support family support and interventions ```

Question 35

Antabuse

Answer 35

disulfiram | inhibits AldDH causeing accumulation acetaldehyde causing nausea, vomiting, hypotension and palpitations

Question 36

Naltrexone

Answer 36

mu opioid antagonist | reduce pleasurable effects and craving for alcohol

Question 37

campral (acmprosate)

Answer 37

reduce craving for alcohol via glutamate R modulation | reduces physical and emotional discomfort in alcohol cessation

Question 38

what % of Americans public smoke

Answer 38

25%

Question 39

major psychoactive substance in tobacco

Answer 39

nicotine

Question 40

half life nicotine

Answer 40

2 hours

Question 41

effects nicotine

Answer 41

inc HR, BP , RR dizziness, lightheadedness tremor nausea

Question 42

nicotine withdrawal effects

Answer 42

``` craving nicotine irritability, anger, frustration anxiety difficulty concentrating restlessness dec HR increased appetite/weight gain HA sleep disturbance ```

Question 43

Nicotine replacement Tx

Answer 43

``` transdermal patches nicotine gum nicotine lozenges nicotine inhaler electronic cigarette ```

Question 44

tx options for nicotine dependence

Answer 44

``` acupuncture hypnosis bupropion varenicline (chantix) combination therapy!!! ```

Question 45

health issues with smoking

Answer 45

lung disease like COPD asthma and cancer CV: MI PVD stroke HA impotence in males!!