ALCOHOL PREVENTION

Question 1

How is alcohol metabolised?

Answer 1

Metabolised in your liver cells by an enzyme called alcohol dehydrogenase (ADH).
- broken down into acetaldehyde
- then another enzyme ALDH breaks acetaldehyde into acetate
- acetate broken into CO2 and water

Question 2

How is alcohol absorbed?

Answer 2

• slowly absorbed from the stomach
• more rapidly absorbed in the small intestine

Question 3

When is alcohol absorption quicker?

Answer 3

when drinking on an empty stomach

Question 4

what type of alcohol beverages get into the system more quickly?

Answer 4

aerated alcohol (champagne/prosecco)

Question 5

where is alcohol metabolised in the body?

Answer 5

• 90% metabolised in the liver
• 2-5% excreted in sweat, urine or breath

Question 6

how does blood alcohol concentration vary between individuals?

Answer 6

Varies according to:
- age
- sex
- body build
- previous alcohol exposure
- type of drink
- empty/full stomach

Question 7

what drug can have a delaying effect on blood alcohol concentration?

Answer 7

Cimetidine will delay gastric emptying and reduce absorption

Question 8

what drugs can increased the rate of alcohol absorption into the blood?

Answer 8

antihistamines

Question 9

when does blood alcohol concentration peak?

Answer 9

1 hour after drinking on an empty stomach

Question 10

at what rate is alcohol removed from the blood?

Answer 10

15mg/100ml/hr

Question 11

what are the aspects of intoxication via alcohol?

Answer 11

• mild sedative
• mild anaesthetic
• stimulates dopamine & serotonin
• sense of wellbeing relaxation & dis-inhibition

Question 12

at what blood concentration of intoxication does alcohol become fatal?

Answer 12

> 400mg/100ml

Question 13

who’s more at risk of developing alcohol drinking problems?

Answer 13

• 4x increased risk of alcoholism in relatives
• more common in monozygotic twin siblings
• adopted away children of alcoholics 4x increased risk

Question 14

what is the max safe weekly alcohol limit for men & women?

Answer 14

no more than 14 units a week

Question 15

what GI medical problems are associated with chronic heavy drinking?

Answer 15

• acute gastritis
• liver problems
• GI bleeding
• oral cancer
• pancreatic disease

Question 16

what heart medical problems are associated with chronic heavy drinking?

Answer 16

• cardiomyopathy
• cardiac arrhythmias
• hypertension

Question 17

what musculoskeletal medical problems are associated with chronic heavy drinking?

Answer 17

• acute or chronic myopathy
• osteoporosis
• osteomalacia

Question 18

what blood medical problems are associated with chronic heavy drinking?

Answer 18

• macrocytosis
• thrombocytopenia
• leucopoenia

Question 19

what other medical problems are associated with chronic heavy drinking?

Answer 19

• bleeding
• poor wound healing
• drug interactions/metabolism
• mental health decrease

Question 20

what oral problems are prevalent in chronic heavy drinkers?

Answer 20

• oral cancer (usually concurrent tobacco use)
• oral ulceration
• dental neglect/trauma/lost dentures
• xerostomia
• poor wound healing
• dental erosion
• salivary gland enlargement
• immune system suppression

Question 21

what are co-morbidity factors that increase a patients chance of developing liver damage?

Answer 21

• age
• sex
• viruses
• drugs
• poor nutrition

Question 22

what are the different stages of alcoholic liver disease?

Answer 22

normal —> steatosis —> steato-hepatitis —> cirrhosis

Question 23

what is steatosis?

Answer 23

fatty liver

Question 24

what can cirrhosis of the liver cause?

Answer 24

• jaundice
• ascites
• bleeding
• cachexia
• infections
• encephalopathy

Question 25

why is liver disease a problem for dentists?

Answer 25

• reduced synthesis of clotting factors in damaged liver
• prolonged bleeding will occur

Question 26

how are drugs affected in patients with liver damage?

Answer 26

• reduced drug metabolism

Question 27

what drugs (as a dentist) may be affected by liver damage?

Answer 27

• local anaesthetic
• analgesia
• sedatives
• antibiotics

Question 28

what is the reaction between disulfiram and alcohol within the body?

Answer 28

• disulfiram inhibits alcohol dehydrogenase (which normally converts acetaldehyde —> acetate)
• acetaldehyde builds up & nausea/vomiting occurs if alcohol taken

Question 29

what drug is used in alcohol treatment?

Answer 29

Disulfiram

Question 30

what occurs if a patient who is taking Disulfiram has a large alcohol intake?

Answer 30

cardia arrhythmias & hypotensive collapse can occur

Question 31

what type of hepatitis induces cirrhosis of the liver?

Answer 31

Hep C (25% of patients with this disease will develop cirrhosis)
- should abstain from alcohol completely

Question 32

What occurs if alcohol is taken alongside cannabis?

Answer 32

increased sensation of confusion & disorientation (making accidents more likely)

Question 33

What occurs if alcohol is taken alongside amphetamines?

Answer 33

increased impairment of judgement

Question 34

What occurs if alcohol is taken alongside ecstasy?

Answer 34

increased intoxication BUT reduces the potentially fatal fluid retention effect of ecstasy

Question 35

roughly how many calories are in 6 pints of beer?

Answer 35

500kcals

Question 36

why are alcoholics generally malnourished?

Answer 36

• general neglect
• substitution of food with alcohol
• folic acid (macrocytosis)
• vitamin C scurvy

Question 37

what cardiac disease is a well-established complication of chronic alcohol abuse?

Answer 37

cardiomyopathy

Question 38

if a patient has 5 or more drinks a day, how much is their stroke likelihood increased by?

Answer 38

250-450%

Question 39

how can alcohol have a protective affect in the body?

Answer 39

• reduced risk of coronary heart disease
• reduced incidence of gallstones
• reduced macular degeneration

Question 40

how does alcohol increase the incidence of oral cancer?

Answer 40

• acetaldehyde promotes tobacco initiated tumour
• alcohol facilitates absorption of carcinogenic substances across oral mucosa

Question 41

what trauma may be as a result of alcohol consumption?

Answer 41

• broken teeth
• lost teeth
• damage to soft tissues
• lost dentures

Question 42

how can alcohol increase the incidence of NCTSL?

Answer 42

• alcohol is very acidic
• GORD = acid in alcohol directly relaxes the oesophageal sphincter
• alcohol can cause vomiting