ch 33 Flashcards
2 effects of alcohol on the brain
depression of CNS
activation of reward circuit
Three target proteins that alcohol interacts with
GABA
Glutamate
5HT3
rewarding effects of alcohol
result from binding with 5HT3 receptors in the brains reward circuit. when these receptors are activated, they promote release of dopamine, the major transmitter of the reward system. When alcohol binds with the receptors, it enhances serotonin-mediated release of dopamine and intensifies the reward process.
what is the major reward neurotransmitter
dopamine
characterized by confusion, nystagmus, abnormal ocular movements
Wernicke encephalopathy
characterized by polyneuropathy, inability to convert short-term memory into long term memory and confabulation (unconscious filling of gaps in memory with fabricated facts and experiences)
Korsakoff psychosis
which neuropsychiatric syndrome is not reversible
Korsakoff psychosis
Neuropsychiatric syndromes are caused by what deficiency
thiamin from poor diet and alcohol induced suppression of thiamin absorption
cerebral effect excessive alcohol
enlargement of cerebral ventricles in response to atrophy of the cerebrum itself. - may reverse in some individuals with cessation
alcohol consumption to preserve cognitive function
low to moderate in older people may protect against the development of dementia.
red wine only - Resveratrol is responsible
alcohol effect on sleep
disruptive
Alcohol acute for cardiac
dilation of cutaneous blood vessels increasing blood flow to skin
alcohol abuse and heart affects
direct damage to myocardium -> increased r/o heart failure
major cause of cardiomyopathy
dose dependent elevation of blood pressure
moderate drinking women
1 drink a day or less
moderate drinking men
2 or less a day
moderate drinking is associated with
less ischemic stroke
CAD
MI
heart failure
heavy drinking is defined as
5 or more a day
heavy drinking and cardiac
increases risk of heart disease and stroke
moderate drinking protects against heart disease by
raising levels of HDL
what type of cholesterol protects against CAD
HDL
what type of cholesterol promotes CAD
LDL
Of all of the agents that can raise HDL, what is the most effective
alcohol
How does alcohol offer heart protection
decreases platelet aggregation
decreases levels of fibrinogen
increases levels of tissue plasminogen
suppresses inflammatory component of atherosclerosis
cardiac protection is determined primarily by
amount of alcohol consumed
and the pattern of drinking
NOT what you drink
protection is greater for people who drink
moderately - 3-4 days a week as opposed to 1-2.
cardioprotection is greater for those with an ____ lifestyle
unhealthy - up to 50% reduction in risk
for those who eat fruits, vegetables, do not smoke - alcohol has little or no effect on incidence of coronary events
alcohol metabolizes at what rate
constant rate no matter how you drink
15 mL per hour (0.5 oz)
1 drink per hour (practical)
enzyme that metabolizes alcohol is
alcohol dehydrongenase
alcohol ____ BP
raises
low to moderate may help
heavy drinking will cause HTN
Alcohol overdose symptoms
vomiting
coma
hypotension
resp depression
vomiting plus unconsciousness can cause aspiration -> pulmonary obstruction and pneumonia
alcohol induced hypotension results from a direct on the peripheral blood vessels and cannot be corrected with vasoconstrictors (epi)
hypotension -> renal failure -> cardiovascular shock -> death
do not give stimulants such as caffeine -> seizures
a chronic, relapsing disorder characterized by impaired control over drinking, preoccupation with alcohol consumption, use of alcohol despite awareness of adverse consequences and distortions in thinking
alcohol use disorder
the development of alcohol use disorder is influenced by what factors
genetic
psychosocial
environmental
aging ____ body’s tolerance for alcohol
lowers
what drug does not have a cross dependence for alcohol
opioids
benzodiazepines used most often for alcohol withdrawal
chlordiazepoxide clorazepate (Tranxene) oxazepam Lorazepam Diazepam
fixed schedule or PRN can be effective
adjuncts to benzodiazepines for alcohol withdrawal
carbamazepine (antiepileptic)
clonidine (Alpha adrenergic agonist)
atenolol and propranolol (b blockers)
drugs used to maintain alcohol abstinence
Naltrexone (Vivitrol) - blocks reward circuit
Acamprosate - helps with anxiety and tension during abstinence
Disulfiram (Antabuse) - makes deathly ill
Naltrexone (Vivitrol) adverse effect
cannot be dependent! will precipitate withdrawal!
nausea
headache
anxiety
sedation
Disulfiram (antabuse) side effects
nausea copious vomiting flushing palpitations headache sweating thirst chest pain weakness blurred vision hypotension -> shock-> death
cardiac dysrhythmias resp depression cardiovascular collapse Congestive heart failure death
Disulfiram effects can last from
30 min to several hours
Cross tolerance to alcohol is associated with
general anesthetics and other CNS depressants but not opioids
Abstinence syndrome occurs how long after last drink
12 - 72 hours
What OTC med is contraindicated in chronic alcohol abusers
Tylenol - Liver
