E1- Alcoholism

Question 1

Alcohol is metabolized by ___ into ___.

Why is alcohol metabolism slower in women?

Answer 1

Alcohol dehydrogenase (ADH) into acetaldehyde

Women have lower levels of Alcohol dehydrogenase

Question 2

Acetaldehyde is oxidized by ___ into ___.

What does this reaction require?

Answer 2

Aldehyde dehydrogenase (ALDH) into acetate

NAD+

Question 3

What type of kinetics is alcohol metabolism?

Answer 3

ZERO order kinetics

rate is independent of c oncetration

Question 4

How does chronic alcoholism lead to pharmacokinetic tolerance?

Answer 4

Ethanol induces CYP2E1 to increase metabolism

Question 5

How does chronic alcoholism lead to pharmacodynamic tolerance?

Answer 5

Down-regulation of GABA receptors and up-regulation of NMDA receptors

Question 6

What occur in people with a ALDH deficiency?

Answer 6

Acetaldehyde (toxic alcohol metabolite) accumulates

-Common in those of Asian descent

Question 7

What is the MOA of alcohol? (2)

Answer 7

1. Binds to GABA receptor to increase Cl- influx and enhance inhibitory GABA transmission
2. Increases DA in mesolimbic pathway

Question 8

What is the CNS effect of alcohol at low concentrations?

Answer 8

Disinhibitory, decreased anxiety, mild euphoria, confidence increases

Question 9

What is the CNS effect of alcohol at high concentrations?

Answer 9

Impaired motor function/judgement speech slurs, depressant/sedative, anterograde amnesia (due to blockade of NMDA receptors)

Question 10

What are the effects of alcohol?

Answer 10

CNS
Vasodilator (hypothermia)
Depress myocardial contractility
Decreases antidiuretic hormone

Question 11

What can be used to treat alcohol induced seizures?

Answer 11

Lorazepam (BZ)

Phenytoin (anticonvulsant)

Question 12

What is paralysis of eye muscles, ataxia, confusion, coma, and death due to thiamine deficiency?chronic disabling memory loss

Answer 12

Wernicke-Korsakoff syndrome

Question 13

What is chronic disabling memory loss that can occur from chronic alcohol abuse?

Answer 13

Korsakoff’s psychosis:

Question 14

What are some effects of chronic alcohol abuse?

Answer 14

Gastritis, pancreatitis, liver disease, liver cancer 
Wernicke-Korsakoff syndrome
Korsakoff’s psychosis
Peripheral neuropathy
Cardiomyopathy
Arrhythmias
HTN
Folate and thiamine deficiency

Question 15

What are some effects of fetal alcohol syndrome?

Answer 15

Microcephaly
Mental retardation
Poor coordination
Flattened face
Joint abnormalities
Heart defects
Impaired immune system

Question 16

What are alcohol and drug interactions?

Answer 16

Acetaminophen 
Phenytoin
Hypoglycemics 
Benzodiazepines
Barbiturates
Phenothiazines
TCAs

Question 17

What drugs can be used to treat alcoholism? (4)

Answer 17

Naltrexone
Acamprosate
Disulfiram
Topiramate

Question 18

What is the MOA of Naltrexone?

Answer 18

Opioid receptor antagonist; blocks the ability of alcohol to stimulate the reward pathway

Question 19

What is a contraindication of Naltrexone?

Answer 19

Liver damage

Question 20

What is the MOA of Acamprosate?

Answer 20

Structural analogue of GABA; restores the normal balance of GABA and glutamate

Question 21

What drug (in the treatment of alcoholism) is excreted by the kidneys? AKA has no liver toxicity

Answer 21

Acamprosate

Question 22

What is the MOA of Disulfiram?

Answer 22

Inhibits ALDH –> acetaldehyde builds up

effects can be severe, not recommended

Question 23

What is the MOA of o Topiramate?

Answer 23

Anticonvulsant drug

Question 24

What drugs can be used to help alcohol withdrawal? (4)

Answer 24

Lorazepam (BZ)
Phenytoin (anticonvulsant)
Diazepam (Valium) Chlordiazepoxide