Exam 5 (final) - Watts AUD Flashcards
ADME: absorption
peak 30-90 minutes
-food slows absorption
alcohol increases acid release
-may induce ulcers/GERD
alcoholism affects _____% of population
10
ADME: distribution
alcohol is distributed throughout TBW
-men have more TBW (58%) than women (48%)
ADME: metabolism
90% in liver in 2 steps:
-by alcohol dehydrogenase —> acetaldehyde then by aldehyde dehydrogenase —> acetate
microsomal ethanol oxidizing system (MEOS)
-only at high alcohol conc., involves CYP2E1
ADME: elimination
follows zero order kinetics
-20 beers=20 hours before it is all eliminated
fomepizole (Antizol) use
-ADH inhibitor for alcohol OD
-slows formation of formaldehyde and toxic metabolites
-gives liver more time to further metabolize toxic metabolites
disulfiram (Antabuse) use
-used to treat alcohol abuse/dependance
-effects last up to 14 days
-not very effective bc patient must be very motivated to quit before starting, otherwise they just won’t take it
SNP in ALDH2 _______ activity (reduces or increases)
reduces
heterogygous ALDH2*2 can _____ consume alcohol (still or not)
still
homozygous ALDH2*2 can _____ consume alcohol (still or not)
not
what does alcohol do at GABA-A (chloride channels) receptors?
it is an allosteric activator of inhibitory neurotransmitters
what does alcohol do at NMDA receptors?
inhibitor
what does alcohol cause a release of?
opioids (enkephalins)
serotonin, NE, DA
Ach
low levels of alcohol cause what behaviors?
euphoria, disinhibition (talkative) at 30-60
analgesia at 60-90
intermediate levels of alcohol cause what behaviors?
CNS stimulation (mood swings, aggression) at 80-120
CNS depression (slurred speech, ataxia, sedation) at 100-200
high levels of alcohol cause what behaviors?
coma/death at 300-500
CV effects: acute
vasodilation
-flushing
-lowered BP
-increased HR
CV effects: moderate
reduced risk of coronary disease
CV effects: heavy/chronic use
cardiomyopathy
arrhythmias (binge drinking)
HTN
hemostatis
high doses of alcohol may cause ____thermia (hypo or hyper) especially in cold temp
hypo
alcohol is a __________, appetite _______ (at low doses) and appetite _______ (at high doses)
secretagogue, stimulant, suppressant
-increase HCl secretion
alcohol can cause what to happen to the liver?
fatty liver
cirrhotic liver
cancer (of liver or anywhere along site of ingestion)
edema
drug-drug interactions to watch for with alcohol
CNS depressants
aldehyde dehydrogenase inhibitors
acetaminophen (bc it increases amt of toxic metabolite NAPQI)
aspirin
alcohol toxicology acute management
prevent respiratory depression
prevent aspiration of vomit
alcohol toxicology taratogen
fetal alcohol syndrome
lower testosterone and sperm quality
alcohol withdrawal sx
anxiety
seizures/tonic clonic convulsions
delirium tremes
N/V
alcohol withdrawal tx
benzos
phenytoin for seizures
electrolytes
alpha 2 adrenergic partial agonists
-clonidine, gaunfacine
alcohol relapse is normally _____ triggered
cue
-seeing glass of alcohol, fav bar
-mood related
3 FDA approved drugs for alcoholism
disulfiram (Antabuse)
acamprosate (Campral)
naltrexone (Revia)
disulfiram (Antabuse) MOA
aldehyde dehydrogenase inhibitor
acamprosate (Campral) MOA
NMDA receptor antagonist/GABA agonist
naltrexone (Revia) MOA
opioid receptor antagonist
patients who have alanine118glycine mutation at mu receptor respond better to what drug for alcoholism
naltrexone
drugs used off label for alcoholism:MOA
topiramate (Topamax): inhibits glutamate signaling, enhances GABA signaling
baclofen: GABA-B receptors
varenicline (Chantix): nicotinic receptors
