Alcohol pharm DSA

Question 1

bDrugs for tx of acute alcohol withdrawal syndrome

Answer 1

• diazepam, lorazepam, oxazepam

- thiamine (vit B1)

Question 2

drugs for prevention of alcohol abuse

Answer 2

• acamprosate
• disulfiram
• naltrexone

Question 3

drugs for tx of acute methanol or ethylene glycol poisoning

Answer 3

• ethanol

- fomepizole

Question 4

acute withdrawal syndrome

Answer 4

-insomnia, tremor, agitation, seizures, autonomin instability

Question 5

DTs

Answer 5

• severe form of alcohol withdrawal

- sweating, tremor, confusion, hallucinations

Question 6

fetal alcohol syndrome

Answer 6

• craniofacial dysmorphia, heart defects, mental retardation
• IUGR
• microcephaly
• minor joint abnormalities

Question 7

Wernicke-Korsakoff syndrome

Answer 7

• ataxia, confusion, paralysis of extraocular m’s- assoc w chronic alcoholism and thiamine def
• most pts left w Korsakoff’s psychosis (chronic disabling memory disorder)

Question 8

alcohol metabolism

Answer 8

• ethanol–Alcohol dehydrogenase–> acetaldehyde
• aspirin inhibits gastric ADH
• fomepizole inhibits ADH

Question 9

Acetaldehyde metabolism

Answer 9

• NAD+ is required to convert acetaldeyde to acetic acid

- ALDH (acetaldehyde dehydrogenase) is inhibited by disulfiram

Question 10

genetic polymorphism of ALDH

Answer 10

• Asian descent- low activity level of mitochondrial ALDH

- hangover sx’s

Question 11

Microsomal ethanol oxidizing system (MEOS)

Answer 11

• mixed fxn oxidases (cytochrome P450s) use NADPH as a cofactor in the metabolism of ethanol to acetaldehyde
• chronic alcohol consumption induces MEOS activity- enhanced act of toxins, free radicals, hydrogen peroxide

Question 12

chronic alcohol consumption- esophagus, stomach, intestines

Answer 12

• esophageal dysfxn, esophageal reflux, BE, rupture of esophagus, Mallory-Weiss tears, esophageal cancer
• acute and chronic gastritis (disrupts gastric mucosal barrier)
• chronic diarrhea (malabs of nutrients in small intestine)
• def in thiamine

Question 13

chronic alcohol consumption- pancreas, liver

Answer 13

• most common cause of acute and chronic pancreatitis
• leading cause of liver cirrhosis
• liver dz- most common medical complication of alcohol abuse

Question 14

chronic alcohol consumption- neurotoxicity

Answer 14

• generalized symmetric peripheral n injury
• gait disturbances and ataxia
• dementia and demyelinating dz
• Wernicke-Korsakoff syndrome

Question 15

chronic alcohol consumption- CV

Answer 15

• dilated cardiomyopathy w ventricular hypertrophy and fibrosis
• arrhythmias
• HTN
• CHD
• stroke

Question 16

alcohol-drug interactions

Answer 16

• inc levels of CYP450s (esp 2E1)
• acetaminophen-induced hepatotoxicity
• additive CNS depression w other CNS depressants

Question 17

acute alcohol intoxication- tx

Answer 17

• prevent severe resp depression and aspiration of vomit
• glucose- hypoglycemia, ketosis
• thiamine- protect against Wernicke-Korsakoff syndrome
• K if severe vomiting

Question 18

alcohol withdrawal syndrome- tx

Answer 18

(tremor, anxiety, insomnia)

• prevent seizures, delirium, arrhythmias, electrolyte rebalancing, thiamine
• benzodiazepines

Question 19

methanol poisoning- sx

Answer 19

-most common sx- blurred vision (“like being in a snowstorm”

Question 20

methanol poisoning- tx

Answer 20

• resp support
• suppression of metabolism by ADH (ethanol, fomepizole)
• hemodialysis- enhance methanol removal
• alkalinization- counteract metabolic acidosis
• ethanol- IV
• fomepizole- inhibits ADH

Question 21

ethylene glycol- tx

Answer 21

(antifreeze)

• hemodialysis
• ethanol infusion
• fomepizole