Neuro 3

Question 1

inability to control consumption of etoh, obtaining and consuming etoh is primary purpose, will have s/sx of withdrawal without it is defined as _______________

Answer 1

dependence

Question 2

T/F: alcohol is a CYP450 inducer if consumed regularly

Answer 2

TRUE

Question 3

______________ is a small water soluble molecule that is absorbed rapidly from the GI tract

Answer 3

ethanol

Question 4

peak concentrations of ethanol are reached within _____________

Answer 4

30 min

Question 5

why do women etoh concentrations peak before mens even with equal consumption

Answer 5

d/t lower total body water in females & differences in first pass metabolism

Question 6

___________% of ethanol is oxidized in the liver

Answer 6

90

Question 7

the remaining 10% of ethanol that is NOT oxidized in the liver is excreted through ________________ and ______________

Answer 7

lungs, urine

Question 8

primary metabolism of etoh involves what enzyme?

Answer 8

alcohol dehydrognease

Question 9

abuse of etoh typically leads to issues with what organs?

Answer 9

liver and pancreas (pancreatitis)

Question 10

what is the primary pathway of ETOH metabolism?

Answer 10

Ethanol is converted to acetylaldehyde via oxidation reaction utilizing alcohol dehydrognease

Question 11

what is the ethanol metabolism pathway chronic alcoholics

Answer 11

ethanol + NADPH + O2 –> microsomal ethanol oxidizing system (MEOS) –> acetaldehyde + NADP + H20

Question 12

what is the second step in ethanol metabolism

Answer 12

Acetaldehyde dehydrogenase converts acetaldehyde to acetate.

Question 13

if someone is allergic to alcohol they are lacking what enzyme

Answer 13

aldehyde dehydrogenase

Question 14

what meds are used to tx alcoholism

Answer 14

1. disulfuram 2. naltrexone

Question 15

MOA of disulfram

Answer 15

inhibits aldehyde dehydrogenase (i.e. inhibits the conversion of acetaldehyde to acetate)

Question 16

disulfram has been known to inhibit the metabolism of other drugs, such as:

Answer 16

1. phenytoin 2. oral anti-coagulants 3. isoniazid

Question 17

_______________ should not be given with other drugs medications that contain alcohol

Answer 17

disulfram

Question 18

absorption of disulfram is _________________, and elimination is ________________

Answer 18

fast; slow (thus actions may persist for several days)

Question 19

s/e of disulfram

Answer 19

1. extreme discomfort in those who drink etoh 2. flushing 3. throbbing headache 4. N/V 5. sweating 6. hypotension 7. confusion

Question 20

what is the MOA of naltrexone

Answer 20

1. opioid receptor antagonist, blocks effects at mu opioid receptors 2. prevents the self administration of alcohol

Question 21

how is naltrexone administered

Answer 21

PO or IM

Question 22

what is the drug of choice in the tx of etoh-ism

Answer 22

naltrexone

Question 23

DO NOT administer naltrexone in what situations?

Answer 23

1. with disulfram 2. to pts with opioid dependance

Question 24

in the treatment of etohism, __________________ will cause small increases in LFTs, and ______________________ will cause dose dependent hepatotoxicity

Answer 24

disulfram; naltrexone

Question 25

meds that are not FDA approved that reduce cravings in chronic alcoholism

Answer 25

1. ondansetron (zofran) 2. topiramate (topamax) 3. baclofen

Question 26

which med has proven favorable for the relapse prevention and the tx of etoh dependence, esp when paired with psychological counseling

Answer 26

naltrexone

Question 27

s/sx 6-8 hours into etoh withdrawal

Answer 27

1. increased BP 2. tremor 3. anxiety 4. insomnia s/sx decrease after 1-2 days

Question 28

etoh withdrawal has a large risk of seizures and hallucinations between days ______________

Answer 28

1-5

Question 29

DT's begin ______________ hours after last drink, and can last _________________ days

Answer 29

48-72; 5-10

Question 30

s/sx of DT's

Answer 30

1. delirium 2. agitation 3. ANS instability 4. low grade fever 5. diaphoresis

Question 31

goals of drug therapy with etoh withdrawal

Answer 31

1. prevention of seizures 2. prevention of delirium 3. prevention of arrhythmias

Question 32

drug therapy with alcohol withdrawal

Answer 32

1. electrolyte imbalances need to be restored: K, Mg, phos (banana bag) 2. long acting sedative-hypnotic (Bz: librium, valium)

Question 33

what is the sedative hypnotic of choice in tx of alcohol withdrawal

Answer 33

benzodiazepines: 1. chlordizepoxide (librium) 2. diazepam (valium)

Question 34

if a pt comes in with liver dz, and etoh withdrawal, you should use ___________________ benzos, such as ______________ or _______________

Answer 34

shorter-acting; lorazepam (Ativan); Oxazepam (Serax)

Question 35

what would molecularly explain why acute consumption of alcohol can cause "blackouts"

Answer 35

alcohol blocks glutamate action on the NMDA receptor

Question 36

acute consumption of alcohol enhances the action of ______________ receptors

Answer 36

GABA-a

Question 37

CNS effects of acute consumption of alcohol

Answer 37

1. sedation 2. relief of anxiety 3. slurred speech 4. ataxia 5. impaired judgement 6. disinhibited behavior 7. intoxication

Question 38

chronic effects of alcohol consumption on the CNS

Answer 38

1. tolerance + physical/psychological dependence 2. dementia 3. wernicke-korsakoff syndrome 4. bilateral impaired visual acuity + blurred vision --> optic nerve degeneration

Question 39

what is wernicke korsakoff syndrome caused by

Answer 39

thiamine deficiency secondary to chronic alcholism

Question 40

what is wernicke korsakoff syndrome

Answer 40

rare degenerative brain d/o caused by chronic alcohol consumption

Question 41

s/sx of wernicke korsakoff syndrome

Answer 41

1. paralysis of external eye muscles 2. ataxia 3. confusion 4. coma 5. death

Question 42

alcohol tolerance develops from ______________________ of neural pathway

Answer 42

up regulation

Question 43

alcohol dependence results from over activity of the same neural pathway as _________________, after ethanol dissipates

Answer 43

tolerance

Question 44

chronic consumption of etoh effects on PNS

Answer 44

1. generalized symmetrical peripheral nerve injury 2. distal paresthesia of hands and feet 3. degenerative changes resulting in gait disturbances and ataxia

Question 45

there is significant depression of myocardial contractility at BAC > _____________ mg/dl

Answer 45

100

Question 46

CV effects of acute etoh consumption

Answer 46

1. signifcant depression of myocardial contractility at BAC < 100 mg/dl 2. vasodilation secondary to CNS effects (even in cold environments)

Question 47

CV effects of chronic etoh consumption

Answer 47

1. dilated cardiomyopathy 2. ventricular hypertrophy 3. fibrosis 4. atrial and ventricular arrhythmias 5. HTN 6. raises HDL (thus prev CAD)

Question 48

chronic etoh consumption interferes the therapeutic effects of what cardiac drug class?

Answer 48

beta blockers

Question 49

T/F: ethanol previously was used IV to suppress premature labor

Answer 49

TRUE

Question 50

acute consumption of etoh reproductive effects

Answer 50

releaxes the uterus