Alcohols

Question 1

cytosolic NAD+ -dependent enzyme
found mainly in liver and gut
zero-order kinetics: fixed capacity for ethanol of 7-10 g/h

Answer 1

alcohol dehydrogenase

Question 2

responsible for ethanol metabolism at blood levels higher than 100 mg/dL

Answer 2

microsomal ethanol oxidizing system (MEOS)

Question 3

blood alcohol concentration (BAC) effects at:
50-100 mg/dL
60-80 mg/dL
100-200 mg/dL
200-300 mg/dL
300-400 mg/dL
>500 mg/dL

Answer 3

50-100 mg/dL: sedation, subjective “high”, slower reaction times
60-80 mg/dL: impairment of driving ability (DUI)
100-200 mg/dL: impaired motor function, slurred speech, ataxia
200-300 mg/dL: emesis, stupor
300-400 mg/dL: coma
>500 mg/dL: respiratory depression, death

Question 4

chronic effects of ethanol

Answer 4

1. tolerance and dependence
2. liver disease = most common complication of chronic alcohol abuse
3. GI system: increased risk of pancreatitis
4. CNS: Wernicke-Korsakoff Syndrome (ataxia, confusion, paralysis of EOMs/ophthalmoplegia)
5. endocrine system
6. cardiovascular system: cardiomyopathy; ingestion of modest quantities of ethanol (10-15 g/day) raises HDL levels and may PROTECT against CAD
7. Fetal Alcohol Syndrome: mental retardation is most common
8. neoplasia
9. immune system
10. excessive CNS depression

Question 5

brain changes seen in Wernicke-Korsakoff Syndrome?

Answer 5

hemorrhagic necrosis of mamillary bodies (in thalamus)

Question 6

what constitutes delirium tremens?

Answer 6

HAD 48
hallucinations
autonomic instability = tachycardia, tachypnea, fever
delirium
48-72 hours post-discontinuation

Question 7

treatment of alcohol withdrawal symptoms

Answer 7

1. correction of electrolyte imbalance
2. administration of thiamine
3. administration of sedative-hypnotic (DOC is long-acting benzodiazepine)

Question 8

treatment of alcoholism

Answer 8

1. opioid receptor antagonists (naltrexone)

2. NMDA receptor antagonist (acamprosate)

Question 9

inhibits aldehyde dehydrogenase

acetaldehyde accumulation –> nausea, headache, flushing, hypotension

Answer 9

disulfiram

Question 10

drugs that can cause disulfiram reaction

Answer 10

chlorpropamide
cefoperazone
cefomandole
cefotetan
procarbazine
metronidazole

Question 11

treatment of methanol poisoning

Answer 11

1. ethanol: competes for oxidation by alcohol dehydrogenase

2. fomepizole: slows or prevents formation of oxalic acid