kruse booze

Question 1

Acomprostate

Answer 1

for EtOh withdrawal- used in combination with naltrexone or disulfiram

MOA:

a. NMDAr antagonist (weakly)
b. GABAa agonist
c. interferes with SET, NET, DAT
contraindication: kidney diz/injury

Question 2

EtOh withdrawal characterization

Answer 2

tremors, anxiety, insomnia (delerium tremans)

Question 3

major pharamacological objective in management of of EtOh withdrawal syndrome

Answer 3

prevent arrhythmias, seizures, delirium and restore electrolytes + thiamine therapy

Question 4

drug detox tx for alcoholics

1. drugs with less dosing and built in tapering- drugs and their disadvantages
2. drugs that are rapidly converted into inactive metabolites

Answer 4

1. chlordiazepoxide, clorazepate, diazepam
   
   1. pharmacologically active metabolites may accumulate, especially in patients with compromised livers
2. lorazepam, oxazepam
   
   1. useful in patients with liver disease

Question 5

naltrexone

Answer 5

1. approved for treating Etoh and opioid dependency
2. MOA: mu-opioid receptor antagonist
   
   1. short acting
3. used for 12 wks
4. contraindicated in pts with hepatic cirrhosis or liver injury/disease
   
   1. first pass metabolism extensive
5. pt must be off opiods first or it will precipitate opioid withdrawal
6. dose related hepatocellular injury

Question 6

disulfiram

Answer 6

for EtOh dependency tx

MOA: irreversibly inhibits aldehyde dehydrogenase

AE: causes extreme discomfort for pt when they drink

Onset: absorbed from GI in 3-12 hrs, persist for up to 14 days

hepatotoxic

inhibits metabolism of

anticoagulants, phenytoin, caffeine, isoniazid, barbituates

notes: can only be used in pts who are highly motivated to quit. seldom used, research not validating. cooley said it combined with an NO moiety to produce an endorphine, so patients get high off it while drinking.

Question 7

fomepizole

Answer 7

1. inhibits ADH (alcohol dehydrogenase): note- make a mental note this is for methanol poisoning, not EtOh withdrawal. prevents production of formaldehyde.
2. can also be used to stop the metabolism of ethylene glycol

Question 8

treating methanol poisoning

Answer 8

1. hemodialysis
2. fomepizole
3. respiratory support
4. alkaliniazation to counteract metabolic acidosis

Question 9

treatment for ethlyene glycol

Answer 9

1. ethanol infusion
2. formepizole
3. hemodialysis