E1: Alcohol

Question 1

What is the difference between alcohol abuse and alcoholism?

Answer 1

Alcohol abuse is when the social life of an individual is impaired for at least 1 month as a results of alcohol, and alcoholism is the occurrence of tolerance and dependence as a result of prolonged abuse

Question 2

What happens physiologically when you drink that may cause alcohol dependence?

Answer 2

Marked increase in the release of B endorphins in the dopamine reward pathway

Question 3

At what rate is alcohol metabolized?

Answer 3

Alcohol follows zero order kinetics and the rate is independent of concentration

Question 4

What enzyme metabolizes alcohol? What is it converted to?

Answer 4

Alcohol is metabolized by alcohol dehydrogenase to acetaldehyde. Acetaldehyde is then converted to acetate via aldehyde dehydrogenase

Question 5

What two metabolism pathways are active with chronic alcohol consumption?

Answer 5

• Microsomal-ethanol oxidizing system (MEOS

- CYP2E1

Question 6

What are the pharmacokinetics behind alcohol tolerance?

Answer 6

-Ethanol induces CYP2E1, so chronic users tend to have increased metabolism of alcohol

Question 7

What are the pharmacodynamics behind alcohol tolerance?

Answer 7

• Down regulation of GABA, and upregulation of NMDA receptors.
• Severe withdrawal can occur due to pharmacodynamic tolerance

Question 8

If you are tolerance to alcohol, what drugs are you probably tolerance to as well?

Answer 8

Benzodiazepines and barbiturates

Question 9

What is the MOA of alcohol?

Answer 9

• A CNS depressant that binds to GABAa receptor to increase Cl influx and enhance inhibitor GABA transmission
• Increases DA in mesolimbic pathway

Question 10

How does alcohol affect NMDA receptors?

Answer 10

It inhibits the effect of glutamate on the NMDA receptor and long term use causes up regulation of NMDA receptors

Question 11

What is the major excitatory NT?

Answer 11

Glutamate

Question 12

What is the major inhibitor neurotransmitter?

Answer 12

GABA

Question 13

What causes anterograde amnesia when drinking too much alcohol?

Answer 13

Blockade of the NMDA receptors

Question 14

What are the effects of alcohol on smooth muscle?

Answer 14

• Ethanol is a vasodilator
• may lead to hypothermia
• relaxes the uterus and has been used to prevent premature labor

Question 15

What is the effect of alcohol on the kidneys?

Answer 15

-Deceases ADH thus produces a diuretic effect

Question 16

What are the symptoms of acute alcohol toxicity?

Answer 16

• Emesis, stupor, coma, respiratory depression
• Metabolic and electrolyte disturbances
• Hypothermia
• Blood pressure and CO may be decreased

Question 17

What causes hangovers?

Answer 17

Buildup of acetaldehyde, dehydration, and the beginning of withdrawal

Question 18

If seizures occur with alcohol withdrawal, what should you treat with?

Answer 18

Lorazepam (Ativan)-Benzo
OR
Phenytoin- anticonvulsant

Question 19

What are the long term effects of chronic alcohol abuse on the GI system?

Answer 19

• Gastritis and pancreatitis
• liver disease is most common (cirrhosis, alcoholic hepatitis, liver cancer)
• malnutrition

Question 20

What is Wernicke-Korsakoff syndrome?

Answer 20

-paralysis of the eye muscles, ataxia, confusion, coma, and death due to thiamine deficiency in chronic alcohol abuse

Question 21

What are the cardiovascular effects of long term alcohol abuse?

Answer 21

• Cardiomyopathy
• Arrhythmias
• HTN

Question 22

What is the most effective modality for treating alcoholism?

Answer 22

A combination of pharmacological and psychosocial treatments

Question 23

What kind of drug is Naltrexone?

Answer 23

Opioid receptor antagonist

Question 24

What is the MOA of Naltrexone?

Answer 24

• Blocks the ability of alcohol to stimulate the reward pathway
• reduces cravings

Question 25

What are the side effects of Naltrexone?

Answer 25

Large doses may cause liver damage, dont use in patients with liver damage

Question 26

What kind of drug is Acamprosate?

Answer 26

Structural analog of GABA

Question 27

What is the MOA of Acamprosate?

Answer 27

• Restores the normal balance of GABA and glutamate

- reduces cravings and likelihood of relapse

Question 28

What is beneficial about Acamprosate when compared to Naltrexone?

Answer 28

Acamprosate is eliminated by the kidneys so it does not have liver toxicity

Question 29

What is the MOA of Disulfiram (Antabuse)?

Answer 29

Inhibits aldehyde dehydrogenase so acetaldehyde builds up. This causes flushing, headache, nausea, confusion
-makes drinking unpleasant

Question 30

What kind of drug is Topiramate?

Answer 30

Anticonvulsant

Question 31

How does Topiramate help treat alcoholism?

Answer 31

-Decreases cravings and increase abstinence in recovering alcoholics, though mechanism is not understood

Question 32

What are the symptoms of mild alcohol withdrawal?

Answer 32

-Anxiety, irritability, insomnia, nausea, tachycardia

Question 33

What are the symptoms of severe alcohol withdrawal?

Answer 33

-Hallucinations, Delirium and tremors, seizures, arrhythmias, and hypotension

Question 34

What are the pharmacologic treatment options of alcohol withdrawal?

Answer 34

1) diazepam or Chlordiazepoxide: prevents seizures and DTS, tapers symptoms
2) Lorazepam: treat seizures
3) Phentoin: secondary drug to treat seizures