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MM Test 2 > B6.041 Prework 3: Alcohol Use Disorder > Flashcards

B6.041 Prework 3: Alcohol Use Disorder Flashcards

1
Q

standard drink

A

14-15 g of EtOH

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2
Q

alcoholic content of common beverages

A

beer 3-6%
wine 8-14%
fortified wine 20%
liquor 40-90%

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3
Q

absorption of alcohol

A

rapidly absorbed
primarily absorbed in duodenum
rate is extremely variable

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4
Q

factors that influence BAC

A

amt and alcohol concentration of beverage
rate of drinking
food consumption and composition
gastric emptying and gastric metabolism
patient’s use of meds w interaction effects

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5
Q

major pathway of ethanol metabolism

A

ethanol> acetaldehyde> acetate> acetyl CoA > CO2 + H2O + energy (7 kcal/gm)

  1. alcohol dehydrogenase
  2. aldehyde dehydrogenase
  3. TCA cycle
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6
Q

location of metabolism of alcohol

A

90-98% in liver

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7
Q

kinetics of alcohol metabolism

A

alcohol dehydrogenase saturates at low to moderate BACs
0 order kinetics @ moderate BACs
-7 g per hour elimination
-15 mg% per hour disappearance

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8
Q

accumulation of acetaldehyde

A

aldehyde dehydrogenase usually not rate limiting
symptoms: headache, gastritis, nausea, dizziness (hangover)
can be caused by inhibition of aldehyde dehydrogenase

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9
Q

CNS effects of alcohol

A

CNS depressant
apparent stimulatory effects result from depression of inhibitory control mechanisms in the brain
characteristic response: euphoria, impaired thought processes, decreased psychomotor efficiency

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10
Q

what is a reinforcer

A

substance whose pharmacological effects drive the user to continue to use it

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11
Q

positive reinforcing effects of alcohol

A

euphoria
altered consciousness
relief of anxiety and other negative emotions
relief of withdrawal symptoms

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12
Q

what neural system is implicated in alcohol reinforcement

A

mesocorticolimbic system

  • prefrontal cortex
  • nucleus accumbens
  • VTA
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13
Q

animal models of alcohol reinforcement

A

animals can be selectively bred to self administer alcohol in preference to other usually reinforcing liquids

  • intra cranial injections into VTA
  • different neurotransmitter levels in mesocorticolimbic system compared to non-alcohol preferring animals
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14
Q

neurotransmitter effects of alcohol

A

increases dopamine in mesocorticolimbic system
activated opioid peptide system
facilitates GABA transmission
blocks NMDA receptors

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15
Q

euphoria/pleasure

A

increased dopamine

increased opioids

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16
Q

anxiolysis/ataxia

A

increased GABA

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17
Q

sedation/ amnesia

A

increased GABA

decreased NMDA

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18
Q

withdrawal symptoms (neurotransmitters)

A

decreased GABA

increased NMDA

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19
Q

craving

A

decreased opioids

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20
Q

effects of alcohol on GI tract

A 
increased incidence of cancer (esophagus, stomach, liver)
gastritis
malabsorption
pancreatitis
liver disease
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21
Q

clinical symptoms of acute alcoholic gastritis

A

anorexia
epigastric pain
vomiting (w or w/o hematemesis)

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22
Q

effects of ethanol on small intestine

A 
decreased absorption (folate, thiamine, B12)
increased absorption (iron)
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23
Q

symptoms of acute alcoholic pancreatitis

A

constant epigastric pain
pain worse after eating
low grade fever
epigastric tenderness

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24
Q

complications of pancreatitis

A 
acute, recurrent, or chronic
abscess or pseudocyst formation
exocrine insufficiency
endocrine insufficiency
hemorrhagic pancreatitis
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25
Q

manifestations of alcohol liver disease

A

fatty liver
hepatitis
cirrhosis

26
Q

alcoholic fatty liver

A

liver tender and may be enlarged 2-3x normal
GGTP, AST, and ALT usually elevated moderately
reversible in several weeks with abstinence

27
Q

alcoholic hepatitis

A

jaundice
low grade fever
enlarged tender liver
persistently elevated AST, ALT, alk phos

28
Q

alcoholic cirrhosis

A 
jaundice: elevated AST, ALT, bilirubin
ascites, peripheral edema
decreased albumin
gynecomastia, testicular atrophy
hard, nodular liver; enlarged spleen
easily bruised, elevated PT, decreased platelets
spider angiomata
29
Q

major complications of cirrhosis

A 
portal HTN
-esophageal varices and bleeding
-bleeding hemorrhoids
-encephalopathy
hepatoma
30
Q

causes of anemia in alcoholism

A 
blood loss
-gastritis, varices
-decreased platelets
-elevated PT
hypersplenism
decreased folate absorption
decreased EPO
31
Q

effects of alc on cardiovascular system

A

cardiomyopathy
HTN
stroke

32
Q

acute CNS effects of alc

A

intoxication
blackouts
coma

33
Q

alcohol intoxication symptoms

A 
euphoria
assertiveness
irritability
loss of behavioral inhibitions
dysarthria
ataxia
34
Q

alcoholic blackout

A

intoxicated, alert
new learning (memories) not recorded
retrograde amnesia for period of blackout
duration usually several hours
related to rate of increase in BAC, not in absolute level

35
Q

alcoholic coma

A

leads to death by respiratory depression
lethal BAC 500-700%
literally tolerance to lethal BAC
lethal synergism with other sedative hypnotics
hyperosmolarity becomes a problem with these levels

36
Q

chronic CNS effects of alc

A 
depression
polyneuropathy
W-K syndrome
tolerance
withdrawal
alcohol dementia
central pontine myelinosis
marchiafava-bignami syndrome
37
Q

pscyh illness correlations with alcoholism

A 
antisocial personality
-20% of male alcs
-5% of female alcs
affective disorder
-20% of female alcs
-5% male alcs
38
Q

alcohol induced depression

A

symptoms identical to major depressive disorder
occurs after several weeks to months of heavy drinking
resolves 2-21 days after cessation of alcohol

39
Q

wernicke’s encephalopathy

A 
clinical features:
-6th nerve paralysis/palsies
-truncal ataxia
-confusion
due to thiamine deficiency
give high dose of thiamine
cerebellar degeneration often prominent and may occur as isolated finding
40
Q

Korsakoff’s syndrome

A 
often occurs w Wernicke's
inability to retain new information
usually irreversible
-50% perm disables
-25% partial recovery w abstinence
41
Q

alcoholic dementia

A

memory impairment
cognitive dysfunction
cerebral atrophy common

42
Q

what % of patients in general medical practice are drinking at a hazardous level

A

20%

43
Q

at risk drinking

A

directly harmful or correlated w greater risk of health problems

44
Q

at risk drinking- men

A

> 14 per week

4 or more per occasion

45
Q

at risk drinking - women

A

> 7 per week

4 or more per occasion

46
Q

BAC in diagnosing alcoholism

A

> 300% anytime
150% in patient not obviously intoxicated
100% in patient during routine exam

47
Q

MCV

A

elevated in 40-95% of actively drinking alcs
associated w folate def in 1/3 of alcoholics
more marked in alcs who smoke
returns to normal with 2-4 months of abstinence

48
Q

GGTP

A

elevated in 75% of alcs with evidence of liver disease

49
Q

AST

A

elevated in 30-75% of alcs

50
Q

ALT

A

elevated in 50% of alcs

51
Q

AST/ALT

A

> 1

AST + ALT < 300 identifies 90% of patients w alcohol liver disease and 77% of patients with nonalcohol liver disease

52
Q

CDT

A

> 20 indicated heavy use for several months

53
Q

CXR in alcs

A

30% have old or new rib or vertebral fractures compared to 1% of controls

54
Q

treatment of minor withdrawal

A

benzos

GABA agonists

55
Q

treatment of major withdrawal (DTs)

A 
supportive
GABA agonists
antipsychotics
phenobarbital
gabapentin
a2 agonists
56
Q

pharm options for ttx of alcoholics

A

disulfram (Antabuse)
naltrexone (revia)
Acamprosate (campral)

57
Q

disulfram

A

inhibits metabolism of acetaldehyde

58
Q

naltrexone

A

opioid antagonist

perhaps better for attenuating relapse than maintaining abstinence

59
Q

Acamprosate

A

? GABA agonist and glutamate receptor antagonist

perhaps better for abstinence than relapse

60
Q

other treatments for alcohol use disorder

A 
AA
education groups
cognitive therapy
MET (motivational enhancement therapy)
psychodynamic therapy
marital and fam therapy
pharm

MM Test 2 (23 decks)

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