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PMHP > Alcohol: Medical and Dental Issues > Flashcards

Alcohol: Medical and Dental Issues Flashcards

1
Q

Alcohol is distributed throughout what in the body?

A

Throughout body water Note: very little alcohol enters the body fat

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2
Q

Where in the body is alcohol conc. the highest and why?

A

Concentration of alcohol is greatest in the liver because the blood comes directly to the liver from the stomach and small intestines via the portal vein

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3
Q

Alcohol is absorbed from where and at what speed?

A

From the stomach slowly and more rapidly absorbed from the small intestines

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4
Q

The rate of alcohol is quicker when what?

A

when drinking on an empty stomach and when drinking alcohols of 20-30% Note: food retards the absorption of alcohol

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5
Q

What kinds of alcoholic drinks are absorbed more slowly and quickly?

A

Slowly = spirits (40% Quicker = aerated drinks

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6
Q

Where is alcohol metabolised?

A

90% of alcohol is metabolised in the liver and 2-5% is excreted in sweat, urine or breath.

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7
Q

What are the stages in the metabolism of alcohol?

A

alcohol-acealdehyde-acetate-Co2 and water

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8
Q

What is the pattern for blood alcohol concentration when drinking?

A

-peaks 1 hr after drinking on empty stomach -declines over the next 4 hrs -removed at a rate of 15mg/100ml/hr

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9
Q

What are some variables that affect blood alcohol levels?

A

o Age, sex, size and body build o Previous exposure o Type of drink and whether food has been taken o Drugs like cimetidine will delay gastric emptying and reduce absorption o Antihistamines increase absorption

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10
Q

Why is does alcohol have more of an effect in women more quickly than in men?

A

o They have smaller blood volume than men o Have lower lovers of alcohol dehydrogenase in the stomach so more alcohol is absorbed before it is metabolised

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11
Q

Why cant you drink during pregnancy?

A

alcohol crosses the placenta quickly

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12
Q

What happens to the tolerance in heavy drinkers?

A

The normal metabolism increases in heavy drinkers and the microsomal ethanol oxidising system comes into play i.e., enzyme induction occurs

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13
Q

How are genetics linked to alcohol problems?

A

There is a genetic predisposition (4x more likely in primary realatives)

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14
Q

Describe the effects of intoxication.

A

• Acts as a mild sedative • Acts as a mild anaesthetic • Stimulates dopamine and serotonin • Gives sense of wellbeing relaxation and disinhibition

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15
Q

What are the stages of intoxication?

A

100mg/100ml of blood = people become elated and aggressive 200mg/100ml = slurred speech and unsteadiness, many accidents occur at this time >400mg/10ml = commonly fatal due to atrial fibrillation, respiratory failure and inhalation of vomit

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16
Q

What is the legal driving limit in the UK and Scotland?

A

UK = 80mg/100ml blood Scotland = 50mg/100ml Note: at 50mg/100 risk of road accidents are doubled hence the lower Scottish limit

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17
Q

What is the recommended weekly intake for alcohol in men and women and how should it be spread out?

A

14 units spread evenly over 3 or more days

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18
Q

What are some oral problems that can occur as a result of heavy drinking?

A

• Oral ulceration • Glossitis • Angular cheilitis • Gingivitis – nutritional deficiency • Dental neglect • Dental trauma-chaotic lifestyle (involved in arguments etc) • Lost dentures • Salivary gland enlargement (sialosis) • Xerostomia • Poor wound healing and osteomyelitis • Suppression of immune system by alcohol • Dental erosion and bruxism

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19
Q

What are some medial probs associated with heacy drinking?

A

-liver disease -blood problems -traumatic injuries -Drugs interactions -poor wound healing -poor mental health -heart problems -GI problems

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20
Q

What percentage of heavy drinkers will go on to develop alcoholic liver disease?

A

approx 20%

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21
Q

Describe the spectrum of alcoholic liver disease.

A

Steatosis is the first stage and is reversible if you stop drinking. However, if you continue to be a heavy drinker it will progress into steatohepatitis which is more serious and less reversible. Steatohepatitis can then progress into cirrhosis which is not reversible

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22
Q

What is cirrhosis?

A

when the liver essentially becomes scared and the tissue is changed to fibrous tissue

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23
Q

Describe the survival rates for people with cirrhosis.

A

tend to develop liver cancer and die within 10 years

There is a 90% 5-year survival rate for people with cirrhosis if they stop drinking and a 60% 5-year survival rate if they don’t stop drinking.

24
Q

What is a big problem for dentists caused by liver disease?

A

Prolonged bleeding

Drug metabolism

25
Q

Why might someone with liver disease have prolonged bleeding?

A
  • Reduce synthesis of clotting factors in damaged liver
  • Reduced absorption of Vitamin K
  • Thrombocytopenia (less platelets)
  • Platelet aggregation is reduced
  • Megakaryocyte maturation is also reduced also leading to fewer platelets
26
Q

Describe how drinkng alcohol heavily in a normal patient can affect drug metabolism.

A

in patients without liver damage, heavy drinking induces liver enzymes which may increase the metabolism of some drugs which leads to more rapid destruction of the drug so reduced plasma concentration and lack of effect

27
Q

How is drug metabolism affected in patients with liver disease/damage? Why do we need to be aware of this?

A

the drug metabolism is reduced

need to be aware of this for drugs such as LA, analgesia, sedatives and antibiotics.

28
Q

What are some outcomes of interactions between alcohol and some drugs? (prescribed)

A
  • decreased metabolism
  • synergistic effect (enhanced effect)
  • sedative effect
29
Q

What can happen to paracetamol in heavy drinkers?

A
  • paracetamol can be converted to an intermediate metabolite which is very hepatotoxic
30
Q

What is disulfiram used for and what effect does it have?

A

-used to treat alcholol probs

It inhibits alcohol dehydrogenase which normally converts acetaldehyde to acetate. The acetaldehyde builds up and nausea and vomiting occurs if alcohol is taken

If large amounts of alcohol tajen then cardiac arrythmias and hypotensive collapse can occur

NOTE: some other drugs can cause this too

31
Q

What drugs might cause GI bleeding in patients with liver disease?

A
  • NSAIDS
  • Aspirin
  • Alcohol

(they irritate the gastric mucosa and as clotting may be deranged, due to liver damage, this exacerbates the problem.)

32
Q

Desribe the relationship between people with hep C and alcohol. Why do they need to do this?

A

People with hep C should abstain from alcohol completely.

25% of patients with Hep C will go onto develop cirrhosis and alcohol in any amount leads to more rapid development of severe liver disease

33
Q

Describe the effect of taking heroin and alcohol together.

A

Sedative effect

34
Q

Describe the effect of taking cocaine and alcohol together.

A
  • If both taken at the same time then new chemical is produces which prolongs the effects of cocaine (some people do it for this effect)
  • Can lead to heart problems
35
Q

Describe the effect of taking amphetamines and alcohol together.

A
36
Q

Describe the effect of taking ecstasy and alcohol together.

A
  • Alcohol increases intoxication but will reduce the potentially fatal fluid retention effect of ecstasy (alcohol makes you lose fluid)
37
Q

Describe the effect of taking cannabis and alcohol together.

A
  • Absorption of alcohol reduced but combination will increase sensation of confusion and disorientation making accidents more likely
38
Q

Describe the nutritional problems associated with heavy alcohol use.

A
  • Alcohol is very calorific
  • Alcoholics are generally malnourished
    • General neglect
    • Substitution of food with alcohol
    • Tend to see deficiencies of
      • Folic acid
      • Vit C
39
Q

What is cardiomyopathy?

A
  • Is a degenerative heart disease with no coronary artery disease (various aetiologies)
40
Q

How is cardiomyopathy and alcohol linked?

A
  • Is a well-established complication of chronic alcohol abuse
41
Q

What can cardiomyopathy lead to ?

A

arrhythmias, cardiomegaly and congestive heart failure

Note: these patients should abstain from alcohol

42
Q

What are some potential cardiac problems that can develop from drinking?

A
  • cardiomyopathy
  • Cardiac arrthymias
  • storkes
  • hypertension
43
Q

What types of cardiac arrhythmias can develop from heavy drinking?

A
  • Get ECG changes
    • Atrial fibrillation
    • Prolonged Q-T interval
    • Inverted T waves
    • Heart block
    • Ventricular arrhythmias
44
Q

What is ‘holiday heart syndrome’?

A
  • This is where people who don’t normally drink much go on holiday etc and drink lots and lots and this causes probs in terms of heart arrhythmias and can cause sudden death
45
Q

What is the link between strokes and alcohol?

A
  • Light to moderate alcohol consumption decreases risk of ischaemic stroke
    • 1-2 drinks a week
  • Consumption of 5 or more drinks a day increases risk of stroke by 250-450%
46
Q

Describe the link between alcohol and hypertension.

A
  • Is generally low grade hypertension
  • Risk factor for strokes
  • Chronic intake of 30g/day or more of alcohol
  • Hypertension reverses within 2-3 weeks of alcohol cessation in heavy drinkers
  • Portal hypertension
47
Q

What are the possible caridio-protective effects of alcohol?

A

Moderate alcohol intake is associated with decreased risks of coronary artery disease (CAD).

  • Alcohol decreases the atherogenic plaques both in humans and experimental animals.
  • Alcohol consumption increases HDL cholesterol (good cholesterol)
  • Moderate alcohol consumption in the year prior to acute myocardial infarction (MI) is associated with reduced mortality following infarction.

Note: Alcohol will also reduce the incidence of gallstones and macular degeneration.

48
Q

What are the 2 main maxillofacial and dental problems related to heavy drinking?

A
  • Oral cancer
  • Trauma
49
Q

What are the risks associated with drinking and oral cancer?

A
  • 75-80% of oral cancer patients drink
  • smoking and alcohol act synergistically
  • Heavy smokig and drinkinh increase risk by 38x
50
Q

What is the 5-year survival rate for oral cancer? Why is it this figure?

A

45-55%

Poor survival rate as often detected later (people don’t go for regular check-ups)

51
Q

Why can oral cancer lead to a viscous cycle with regards to drinkin?

A

Can become a viscous cycle with oral cancer as the cancer often need major surgery which can result in permanent facial disfigurement and problems with speech, eating, drinking and socialising. This can lead to depression and people use alcohol as a coping mechanism.

52
Q

What is the thought behind the link between alcohol, smoking and oral cancer?

A

The though process is that the ethanol metabolite acetaldehyde promotes tobacco-initiated tumours. Alcohol also facilitates the absorption of carcinogenic substances across the oral mucosa. The DNA becomes damages and alters oncogene production. It is partly due to the thinning of oral mucosa due to deficiency.

53
Q

What are some examples of dental trauma from alcohol-related injuries?

A
  • Broken teeth
  • Lost teeth
  • Damage to soft tissues
  • Lost dentures
54
Q

Why are there so many traumas to head and neck when alcohol is consumed?

A

alcohol and violence is associated

55
Q

Why can facial injuries from alcohol related injuries be viscous cycle?

A

Facial injuries can have long-lasting physical and psychological effects which can result in psychiatric morbidity including PTSD and alcohol problems (viscous cycle).

56
Q

Apart from trauma, what other dental/medical problems are associated with alcohol?

A

Alcohol is very acidic and other dental problems associated with alcohol are:

  • GORD
    • The acid in alcohol directly relaxes oesophageal sphincter
  • Vomiting
  • Multifactorial bruxism (acid and bruxism together) – shown in pic
    • Restoration of this is difficult until the alcohol problem is solved

PMHP (6 decks)

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