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Q4 Pharm psych > Alcohol (lec 1) > Flashcards

Alcohol (lec 1) Flashcards

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1
Q

Alcohol abuse vs Alcoholism?

A

Abuse = social life impaired ≥ 1 mo

Ism = tolerance/dependence resulting from long-term use

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2
Q

Genetic factors for alcoholism?

A

↑↑ β-endorphins in DA-reward pathway

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3
Q

Alcohol absorbed where?

Distributes?

A

stomach, small intest

evenly thru body and across BBB and placenta

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4
Q

Peak blood alcohol content (BAC) occurs when?

A

30 - 90 min post drinking

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5
Q

Alcohol metabolized how?

Uses what co-factor?

A

alcohol dehydrogenase -> acetaldehyde -> aldehyde DH -> acetate

NAD+ (saturation occurs at low levels of alcohol),
byproduct is NADH

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6
Q

NAD+ use by alcohol results in?

A

inability of other enzymes to use NAD+ ->
accumulation of lactate/acetyl-CoA ->
FA synth/lactic acidosis

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7
Q

Alcohol metabolism rate?

A

Zero-order, rate independent of concentration

~10g/hr

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8
Q

Women less tolerant of alcohol, why?

A

fewer alcohol dehydro in GI tract ->

metabo more slowly than men

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9
Q

Microsomal-ethanol oxidizing system (MEOS) is?

Result of?

A

Alternate metabo of alcohol to acetaldehyde,
Uses NADPH, byproduct is NADP+

chronic alcohol consumption

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10
Q

Alcohol affects other drugs how?

A

competes for metabolism

induces CYP2E1

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11
Q

Alcohol ↑ metabolism of what type of drugs?

A

CYP450-metabolized drugs
e.g. phenytoin (seizures),
hypoglycemics

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12
Q

Alcohol-induction of CYP2E1 has what effect on acetaminophen?

A

↑↑ hepatotoxicity

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13
Q

Alcohol inhibits breakdown of what drugs?

A

pheonthiazine
benzodiazepine
barbiturate
TCA

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14
Q

Aldehyde DH deficiency results in?

Esp common in what group?

A

acetaldehyde accumulates -> flushing, HA, N

Asians

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15
Q

Pharmacokinetic Alcohol Tolerance from?

A

ETOH-induced CYP2E1/MEOS ->

metabolism ↑ in chronic users

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16
Q

Pharmacodynamic Alcohol Tolerance from?

A

Down-reg GABA receptors and
Up-reg NMDA receptors

**withdrawal is result of pharmacodynamics

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17
Q

Cross tolerance is?

A

↑ tolerance to ETOH causes ↑ tolerance to benzodiaz/barbitu

18
Q

Alcohol action on GABA?

A 
CNS depressant:
binds GABAa recep -> 
↑ Cl- influx ->
inhibits GABA transmission ->
↓ DA in mesolimbic path, 
down reg of GABA recept
19
Q

Alcohol action on NMDA?

A

inhibits glutamine effect on NMDA recept ->
upreg of NMDA recept

NMDA involved w/ learning/memory, seizures

20
Q

Alcohol effects: low [ ]?

higher [ ]?

A

disinhibition

depressant/sedation of mood, motor, etc

21
Q

Anterograde amnesia is?

A

blackout from NMDA recpt blockade

22
Q

ETOH effects: smooth mm?

A

vasodilator
hypothermia
relax uterus

23
Q

ETOH effects: heart?

kidney?

A

↓ myocard contractility

↓ ADH = diuretic

24
Q

Acute ETOH toxicity results in?

A

V, stupor, coma, resp depression

metabolic/e- ∆s
hypothermia
↓ BP/CO

25
Q

Acute ETOH toxicity-induced seizure tx?

A

benzos, anticonvulsants

26
Q

Chronic ETOH abuse effects on liver/GI?

Nutrition?

A

Lowers [glutathione] = ox stress tissue damage,
FA prdxn = fibrosis

folate/thiamine deficiency

27
Q

Chronic ETOH abuse effects on CNS?

A

Wernicke-Korsakoff Synd (thiamine deficiency),
Korsakoff’s Psychosis,
Peripheral neuropathy

28
Q

Wernicke-Korsakoff Synd presentation?

A

eye mm paralysis,
ataxia,
confusion,
coma/death

29
Q

Korsakoff’s Psychosis presentation?

A

chronic memory loss

30
Q

Chronic ETOH abuse effects on CV?

A

Cardiomyopathy (direct toxicity of acetaldehyde),
Arrhy
HTN
↑ CV dz

31
Q

Chronic ETOH abuse effects on tobacco?

A

↑ carcinogenicity of tobacco

32
Q

Naltrexone (ReVia) action?

Used for?

S/E?

A

opoid recpt antagonist:
blocks etoh from stim reward path

↓ craving for eoth

liver damage

33
Q

Acamprosate (Campral EC) action?

Used for?

A

GABA analogue:
normalizes balance of GABA/Glutamine

eoth cessation support
NOT liver toxic (kidney metab)

34
Q

Disulfiram (Antabuse) action?

A

aldehyde DH inhibitor:

actealdehyde build-up = severe toxic s/e

35
Q

ETOH w/drawal presentation:

Mild?

Severe?

A

anxiety, irritab, N, tachy

hallucination, delirium/tremors, seiz, arrhy, hypoTN

36
Q

ETOH w/drawal tx?

A

Diazepam/Chlordiaz: prevent DTs, seizures

Lorazepam: stop seiz

Phenytoin: 2nd line stop seiz

37
Q

Methanol Poisoning presentation?

A

Visual disturb (snowstorm)
Formaldehyde breath
Bradycard, coma

38
Q

Methanol Poisoning action?

A

methanol metab to toxic aldehydes/oxalates ->
transient CNS stim ->
severe metabolic acidosis

39
Q

Methanol Poisoning tx?

A

resp support
lavage
alkalization
Fomepizole

40
Q

Fomepizole (Antizol) action?

A

alcohol DH inhibitor

Q4 Pharm psych (20 decks)

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