Chapter 33: Substance Abuse Disorders II

Question 1

alc

Answer 1

Most commonly used and abused psychoactive agent in the United States​

Some therapeutic use​

Primarily used for nonmedical purposes​
Moderate consumption: Prolongs life, reduces risk of dementia and cardiovascular disorders​
Excessive consumption: Diminishes quality and quantity of life​

Question 2

basic pharm of alc: cns effects

Answer 2

Acute effects​:
General depression of CNS function​
Enhances GABA-mediated inhibition​
Dose-dependent​

Activation of the reward circuit​:
Binds with 5-HT3 receptors​

Question 3

basic pharm of alc: chronic effects, Two neuropsychiatric syndromes

Answer 3

Wernicke encephalopathy: Confusion, nystagmus, and abnormal ocular movements; readily reversible with thiamin​

Korsakoff psychosis: Polyneuropathy, inability to convert short-term memory into long-term memory, and confabulation (unconscious filling of gaps in memory with fabricated facts and experiences); not reversible​

Question 4

basic pharm of alc: chronic effects, Impact on cognitive function​

Answer 4

Low to mod ​

May have positive effect on dementia

Question 5

basic pharm of alc: chronic effects, effects on sleep

Answer 5

Decreases total sleep time ​

Increased snoring ​

Increased deep sleep ​

Increased sleep apnea

Question 6

basic pharm of alc: other pharm effects

Answer 6

Cardiovascular system: Abuse of alcohol results in direct damage to the myocardium, increasing the risk of heart failure and elevation of blood pressure​

Glucose metabolism: Increase insulin sensitivity ​

Bone health​: Increase bone mineral and density ​

Respiration: Alcohol depresses respirations​

Liver: Nonviral hepatitis​

Fatty liver ​

Major cause of fetal cirrhosis ​

Stomach: Erosive gastritis​

Kidney: Alcohol is a diuretic​

Pancreas: Pancreatitis

Cancer: Breast and colorectal cancer​

Pregnancy and lactation: Fetal alcohol spectrum disorder and fetal alcohol syndrome​

Impact on longevity​:
Dose dependent
Heavy is neg ​
Moderate drinking if pt exercises did enter than non drinkers ​

Question 7

alc pharmacokinetics: absorption

Answer 7

20 % in stomach ​

80% in sm int

Question 8

alc pharmacokinetics: distributions

Answer 8

Well ​

Women have lower total body water ​-When women drink it is diluted in smaller amt f water -> more alc found in tissue and fluids

Question 9

alc pharmacokinetics: metabolism

Answer 9

liver and stomach
To not have drug accumulation, no more than 1 rink/hr ​

People who drink more often in lg amount can metabolize drug faster

Question 10

alc pharmacokinetics: blood levels

Answer 10

In United States, 0.08% defines intoxication​

Earliest effects at 0.05%​

When blood alcohol level exceeds 0.4%, substantial risk of respiratory depression, peripheral collapse, and death

Question 11

alc drug interactions

Answer 11

CNS depressants​

Nonsteroidal antiinflammatory drugs-Risk for GI bleed ​

Acetaminophen​- Liver injry​

Disulfiram​ -Severe Rxn, Take for abstention ​

Antihypertensive drugs-Alc counteracts effects ​

Question 12

alc acute OD

Answer 12

Vomiting, coma, and pronounced hypotension and respiratory depression​

Aspiration​

Alcohol-induced hypotension: Direct effect on peripheral blood vessels​

Hypotension cannot be corrected with vasoconstrictors (e.g., epinephrine)​

Hypotension can lead to renal failure and cardiovascular shock​

Alcohol poisoning is treated like poisoning with all other general CNS depressants

Question 13

alc precautions and contrindications

Answer 13

Peptic ulcer disease​

Liver disease​

Pregnancy ​

Epilepsy​

Dose-related increase in the risk of breast cancer​

Increases the risk of cancer of the liver, rectum, and aerodigestive tract​

Serious adverse effects if combined with CNS depressants, nonsteroidal anti-inflammatory drugs, acetaminophen, vasodilators, and disulfiram​

Question 14

alc therapeutic uses

Answer 14

Topical​

Oral​

Local injection​
Nerve block

Question 15

alc use disorder

Answer 15

Relapsing disorder​

Impaired control over drinking​

Preoccupation with alcohol consumption​

Use of alcohol despite awareness of adverse consequences​

Distortions in thinking​

Influenced by genetics as well as psychosocial and environmental factors

Question 16

drugs for AUD

Answer 16

Drugs used to facilitate withdrawal​

Drugs used to maintain abstinence​

Other drugs used for the treatment of alcohol abuse

Question 17

drugs used to facilitate withdrawal

Answer 17

Benzodiazepines​
Chlordiazepoxide [Librium, others]​
Clorazepate [Tranxene]​
Oxazepam [Serax]​
Lorazepam [Ativan]​

Adjuncts to benzodiazepines​
Carbamazepine (antiepileptic drug)​
Clonidine (alpha-adrenergic blocker)​
Atenolol and propranolol (beta-adrenergic blockers)​

Question 18

drugs used to maintain abstinence: disulfiram

Answer 18

Disulfiram aversion therapy​:

Refrain from drinking​

Causes irreversible inhibition of aldehyde dehydrogenase​

Effects caused by alcohol plus disulfiram are referred to as acetaldehyde syndrome -sweating, palpitations, tachycardia, life-threatening reaction​

Patients must be carefully chosen​

Patients must be thoroughly informed to avoid all forms of alcohol, including the following:​

Sauces​

Cough syrups​

Alcohol applied to the skin (e.g., lotions, colognes, mouthwashes, liniments)​

Question 19

Drugs Used to Maintain Abstinence: Naltrexone [Revia]

Answer 19

Pure opioid antagonist​

Decreases craving for alcohol​

Blocks reinforcing effects of alcohol​

Mechanism unclear​

Adverse effects​
Nausea​
Headache​

Question 20

Drugs Used to Maintain Abstinence: Acamprosate [Campral]

Answer 20

Reduces unpleasant feelings brought on by abstinence​

Devoid of direct anxiolytic, anticonvulsant, and antidepressant activity​

Does not cause alcohol aversion​

Administered orally​

Excreted unchanged in the urine​

Adverse effects and drug interactions​
Diarrhea​
Avoid during pregnancy

Question 21

Nutritional Support, Fluid Replacement, and Antibiotics

Answer 21

B vitamins​
Thiamine​
Folic acid​
Cyanocobalamin​

Vitamin supplements​

Fluid replacement therapy​

Antibiotics