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PSYCH > Alcohol: use and abuse > Flashcards

Alcohol: use and abuse Flashcards

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1
Q

alcohol dehydrogenase is inhibited by which drug?

A

fomepizole (drug that is used in the treatment of acute ethanol or ethylene glycol intoxication)

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2
Q

disulfiram MOA

A

inhibits aldehyde dehydrogenase leading to the buildup of acetaldehyde which quickly gives rise to a feeling of nausea and vomiting

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3
Q

explain how some alcoholics find acetaldehyde pleasurable

A

appears to provide dual action

  • unpleasant in the periphery
  • pleasure in the VTA where it promotes DA release
  • condenses w/ DA to make salsolinol (strongly reinforcing agent)
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4
Q

asians with what heterozygosity experience significantly more positive feelings after alcohol intoxication?

A

ALDH21/22

  • Allele assoc. w/ lower prev. of abuse & alcoholism
  • acetaldehyde may explain alcoholism prevalence among Native americans
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5
Q

which CYP enzyme is induced with extensive alcohol abuse?

A

CYP2E1

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6
Q

with alcoholisms CYP2E1 is induced which leads to the accumulation of what highly toxic metabolic intermediate of acetaminophen metabolism?

A

NAPQI

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7
Q

what molecule is needed to converted NAPQI into Cysteine & mercapturic acid conjugates?

A

GSH

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8
Q

what are the physiologic effects of a pt who has a BAL of 15-400 mg/dL?

A

N/V, ataxia, amnesia, dysarthria

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9
Q

what effect does alcohol have on GABA-A?

A

increased GABA release, increased receptor density

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10
Q

what effect does alcohol have on NMDA?

A

inhibition of postsynaptic NMDA receptors; w/ chronic use, up-regulation

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11
Q

what effect does alcohol have on dopamine?

A

increases synaptic DA, increased effects on ventral tegmentum (VTA) & nucleus accumbens (NA) reward

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12
Q

what effects do alchol have on ACTH?

A

increase CNS & blood levels of ACTH

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13
Q

what effects do alcohol have on opioids?

A

release of beta-endorphins, activation of mu receptors

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14
Q

what effect does alcohol have on 5-HT?

A

increased 5-HT in the synaptic space

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15
Q

what effects do alcohol have on cannabinoid?

A

increased CB1 activity–> changes in DA, GABA, glutamate activity

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16
Q

what are the effects of alcohol on CV, smooth muscle and uterine smooth muscle?

A

CV depressant
Relaxes smooth muscle (vasodilation, increased gastric bloodflow)
Relaxes uterine smooth muscle

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17
Q

which gender has a higher BAL typically?

A

women

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18
Q

why do women typically have a higher BAL than men?

A

increased absorption
lower weight
more body fat

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19
Q

what is the relationship b/w BMI and BAL?

A

higher BMI = more body fat = small Vd = higher BAL

20
Q

what is the most significant component to adaptation with alcohol?

A

behavioral and neural adaptation

21
Q

what are the chronic effects of ethanol on the liver?

A 
decreases gluconeogenesis (hypoglycemia)
fatty liver-hepatitis, cirrhosis & failure
22
Q

explain how chronic alcohol use can cause hypoglycemia

A

alcohol increases the NADH/NAD ratio in the liver, which (via normal ethanol metabolism), causing pyruvate —>lactate and OAA–>malate; therefore this inhibits gluconeogensis

23
Q

explain how chronic alcohol use can cause fatty liver?

A

alcohol use depletes OAA which shuts down the TCA cycle and this causes acetyl-coA to get shunted into ketone production.

Breakdown of excess malate increases NADPH and thus this increases fatty acid synthesis

24
Q

what are the chronic effects of alcohol on the GI system?

A

bleeding, scarring causing/exacerbating nutritional deficiencies

25
Q

what are the chronic effects of alcohol on the CNS?

A 
peripheral neuropathy (MC)
Wernicke-korsakoff syndrome (ataxia, confusion, ocular muscle paralysis, treat with thiamine)
26
Q

what is the Wernicke-Korsakoff syndrome classic triad?

A

ataxia
confusion
opthalmoplegia

Treat with thiamine

27
Q

what are the chronic effects of alcohol on the endocrine system?

A

gynecomastia & testicular atrophy secondary to steroid insufficiency

28
Q

what are some of the reasons why alcoholics have a thiamine deficiency?

A

decreased thiamine in diet
decreased thiamine absorption in GI tract
decreased thiamine storage in liver
decreased biosynthesis

29
Q

what are the chronic effects of alcohol on the CV system?

A

HTN, anemia, dilated cardiomyopathy
arrhythmias w/ binge drinking
Modest alcohol intake increases HDL & may protect against CHD

30
Q

what are the chronic effects of alcohol in regards to cancer?

A

higher incidence of GI cancer (e.g. esophageal squamous cell carcinoma=upper esophagus)

31
Q

what are the effects of chronic alcohol use on the immune system?

A

extra inflammation in liver & pancreas, but reduced immune response in other tissues
-chronic alcoholics susceptible to infectious pneumonia

32
Q

what are some of the features of fetal alcohol syndrome?

A 
IUGR
microcephaly
poor coordination
flattened face
minor joint anomalies
33
Q

the fetal alcohol levels reflect the ________

A

maternal alcohol levels

34
Q

how do you treat a pt intoxicated w/ alcohol in the ER ?

A

ABCs
Thiamine
Dextrose
Correct electrolytes

35
Q

what are the features of alcohol withdrawal?

A

insomnia, tremor, anxiety

DTs, and rarely seizures

36
Q

how do you treat alcohol withdrawal?

A

BNZ sedative
thiamine
correct electrolytes

37
Q

if an alcoholic pt who is withdrawing also has hepatic dysfunction, which BNZ can you give him?

A

lorazepam (b/c it’s only processed by glucuronidation-phase II)

38
Q

name all the drugs you can think of that have disulfiram-like effects?

A

sulfonylureas
cefotetan
ketoconazole
procarbazine

39
Q

how is naltrexone used in alcoholism?

A

mu (OP-3) Opioid antagonist; decreases the high you get with drinking

40
Q

how is acamprosate used in alcoholism?

A

weak NMDA antagonist, activates GABA-A receptors; may decreased mild protracted abstinence syndromes with decreased feeling of need for alcohol

41
Q

alcohol indirectly activates which pathway in the brain?

A

corticomesolimbic dopaminergic pathway, which goes from VTA to the NA (important in the rewarding effects of many drugs)

42
Q

which enzyme metabolize both ethylene glycol and methanol to other toxic metabolites?

A

alcohol dehyrogenase

43
Q

how do you treat ethylene glycol/methanol intoxication?

A
  1. treat with fomepizole (inhibits Alcohol DH) and allows renal elimination
  2. treat with ethanol and keep at 100 mg/dL to ensure enzyme saturation
44
Q

what is the result of ethylene glycol poisoning?

A

acidosis, nephrotoxicity

45
Q

what is the result of methanol poisoning?

A

severe acidosis, retinal damage

46
Q

how is fomepizole administered?

A

IV infusion

47
Q

ethanol is an _______sedative-hypnotic

A

addictive

PSYCH (8 decks)

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