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PHAR222 > L23 > Flashcards

L23 Flashcards

1
Q

Diagnostic criteria for alcohol use disorder

A
  1. Impaired control
  2. Social impairment
  3. Risky use
  4. Pharmacological criteria
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2
Q

Alcohol metabolism ethanol

A

Ethanol
↓ alc dehydrogenase (cyto)
Acetaldehyde (toxic and reactive)
↓ aldehy dehydrogenase 2
↓(mito)
Acetate

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3
Q

Enzymes involved in alcohol metabolism

A
  • Alcohol dehydrogenase
  • CYP2E1
  • catalase
  • aldehyde dehydrogenase2
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4
Q

Enzymes involved in alcohol metabolism
alcohol dehydrogenase

A
  • cytosol
  • class I ADH is most important
  • primarily found in the liver
  • zero-order kinetics - 7~10g/hour
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5
Q

Enzymes involved in alcohol metabolism
CYP2E1

A
  • microsome
  • minor but becomes important at elevated alcohol concentrations
  • induced in chronic heavy drinkers
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6
Q

Enzymes involved in alcohol metabolism
catalase

A
  • peroxisome
  • an important antioxidant enzyme - removes hydrogen peroxide
  • H2O2 + H2O2 → 2 H2O + O2
  • oxidise alcohol (e.g., in the brain)
  • CH3CH2OH + H2O2 → CH3CHO + 2H2O
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7
Q

Enzymes involved in alcohol metabolism
aldehyde dehydrogenase 2

A
  • mitochondria
  • converts acetaldehyde to acetate
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8
Q

thiamine (vitamin B1)

A
  • phosphorylated form (thiamine pyrophosphate, TPP) is a cofactor for enzymes involved in meta of carbohydrates (slide)
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9
Q

Alcohol, thiamine deficiency,

A
  • malnutrition from poor diet
  • ↓ absorption in the GI tract (thiamine transporter SLC19A2/3)
  • ↓ storage in the liver due to liver damage
  • ↓ uptake and impaired utilisation of thiamine in cells
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10
Q

Wernicke-Korsakoff Syndrome (WKS)

A
  • Wernicke’s encephalopathy (acute phase)
  • Korsakoff’s syndrome (chronic phase)
    – alcohol-induced neurocognitive disorder (DSM-5)
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11
Q
  • Korsakoff’s syndrome (chronic phase)
A

alcohol-induced neurocognitive disorder (DSM-5)

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12
Q

Effects of thiamine deficiency

A

–ataxia - affects gait and stance
–nystagmus - uncontrolled eye movement

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13
Q

Early age drinking associated with increased likelihood of lifetime alcohol dependence

A
  • early maturation of limbic regions, e.g.,NAc- critical for processing of rewarding stimuli
  • delayed maturation within PFC regions - critical in inhibitory control and other executive functions
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14
Q

Alcohol and dopaminergic transmission steps

A
  1. Alc stim the release of endogenous opioid peptides in VTA
  2. Alc enhances GABA(a) receptor activity
  3. Alc inhibit release of glutamine from nerve terminals -> (/)
  4. (1&2) -> inhib Gaba interneurons -> disinhib VTA DArigic neurons -> enhance DAergic transmission in NAc(/)
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15
Q

benzodiazepines outcome

A

relieve acute withdrawal symptoms

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16
Q

disulfiram outcome

A
  • maintain abstinence
17
Q

acamprosate outcome

A
  • maintain abstinence
18
Q

naltrexon outcome

A
  • block pleasure and reward
19
Q

Benzodiazepines

A
  • long-acting benzodiazepines are preferred
  • anticonvulsant/anxiolytic
  • short-term; gradual cessation of drugs as
    withdrawal effects are similar to alcohol
20
Q

Disulfiram info

A
  • metabolites of disulfiram irreversibly inhibit aldehyde dehydrogenase
  • prevent conversion of acetaldehyde to acetate
  • Increase in ace-hyde→ unpleasant symptoms, e.g., flushing, dizziness, nausea and headaches
  • used in motivated individuals after detoxification and under supervision (not act. drinkers and in conjuc iwth behavioural interventions)
21
Q

Acamprosate

A
  • oral calcium salt (Bio-11)
  • not hepatically meta, and excreted unchanged in urine and faeces
  • Mod GABA and glutamate (might be main one)
  • Dose adjusted for renally impaired
  • Diarrhoea common, nausea, vom, rash, abdo pain
22
Q

Naltrexone

A
  • an opioid receptor antagonist (binding affinity: µ > k > delta)
  • hepatically metabolized by dihydrodiol dehydrogenase: 6-β-naltrexol
  • Oral tablets
    • not suitable for current opioid users/on opioid maintenance bc of WD
  • nausea, headache, dizziness, fatigue, insomnia, vomiting, and anxiety
23
Q

thiamine deficiency distinct brain lesions

A

thalamus –> amnesia
mammillary bodies –> confabulation
hippocampus –>confusion
pons: ataxia - affects gait and stance
cerebellum: nystagmus - uncontrolled eye movement

PHAR222 (25 decks)

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