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Case 13: FASD > Pharmacology: Alcohol > Flashcards

Pharmacology: Alcohol Flashcards

1
Q

What level of alcohol consumption is safe in pregnancy

A

Levels has not be established therefor abstinence

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2
Q

What is 3 consequences of chronic alcohol used at the liver & GIT level

A

Alcoholic fatty liver to alcoholic hepatitis to cirrhosis
Gastritis
Pancreatitis

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3
Q

What is 6 consequences of chronic alcohol used at the CNS level

A

Tolerance
Physical dependence
Psychological dependence
Peripheral neuropathy
Ataxia
Dementia

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4
Q

What is 3 consequences of chronic alcohol used at the CVS level

A

Dilated cardiomyopathy
Arrhythmia (binge & withdrawal)
Hypertension

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5
Q

What is the consequence of chronic alcohol used at the blood level

A

Anemia due to gastritis & folic acid deficiency

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6
Q

What is 3 consequences of chronic alcohol used at the malnutrition & vitamin deficiency level

A

Dietary deficiency
Malabsorption
Glutathione depletion

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7
Q

What is 6 general consequences of chronic alcoholism

A

Cancer
Pneumonia
TB
Accidents & suicide
Impact on relationship
Poor treatment adherence

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8
Q

What is the 5 management strategies with alcoholism

A
  1. Psychosocial intervention
  2. Detoxification
  3. Treat associated psychiatric problems (depression & anxiety)
  4. Naltrexone
  5. Disulfiram
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9
Q

What is Naltrexone

A

Inhibitor of opioid receptor

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10
Q

What is Disulfiram

A

Inhibits aldehyde dehydrogenase (irreversible inactivation) & accumulation of acetaldehyde

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11
Q

What 8 symptoms does Disulfiram cause

A

Flushing, throbbing headache, N, V, sweating, hypotension & confusion

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12
Q

What is the wanted outcome with Disulfiram use

A

Symptoms function as negative feedback to discourage alcohol intake

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13
Q

What is 3 problem associated with Disulfiram use

A
  1. Efficacy: long term therapy of chronic alcoholism not established
  2. Compliance is a problem
  3. Safety in pregnancy not established
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14
Q

What is the effect of acute intoxication on drug metabolism (pharmacokinetics)

A

Inhibition of CYP2EI
Reach toxic concentrations quicker/at normal dose

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15
Q

What is the effect of chronic intoxication on drug metabolism (pharmacokinetics)

A

CYP2EI is induced/more active
Medication rapidly metabolized & sub-optimal dose

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16
Q

What is the 6 pharmacodynamic effect of drug interaction with alcohol

A

CNS depressant
Vasodilators
Hypoglycemics
Hepatotoxins
Gastritis/peptic ulcers disease
Depletes glutathione (paracetamol poisoning)

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17
Q

What metabolise paracetamol in normal circumstances

A

Glutathione

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18
Q

What is the effect of alcohol on paracetamol metabolism

A

Depleted glutathione & reactive intermediate NAPQI accumulates & lead to hepatic cell death

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19
Q

When is drug use recommended in pregnancy

A

Potential benefit outweighs the risk

20
Q

What is the 5 pharmacodynamic effect of drugs during pregnancy

A
  1. Embryonic death
  2. Congenital malformation
  3. Psychomotor abnormalities
  4. Intellectual abnormalities
  5. Behavioral abnormalities
21
Q

What is Thalidomide

A

1st trimester treatment of anxiety

22
Q

What birth defect did Thalidomide cause

A

Anatomic defects

23
Q

What was diethyl-stilbestrol used for

A

Initially prevent miscarriages

24
Q

What birth defect did DES cause

A

In-utero exposure associated with rare adenocarcinoma of vagina

25
Q

What is the 4 effects of pregnancy in drugs

A
  1. Increased plasma volume increase volume of distribution
  2. Decrease in serum proteins changes in drug binding
  3. Alteration in GIT function change drug absorption
  4. Increased renal elimination & variable changes in hepatic metabolism & elimination
26
Q

When is the fetus at high risk for teratogenic drug effect

A

Week 4 to 14 of gestation

27
Q

What is 4 modifying influences of drug use & pregnancy

A
  1. Gestational period drug is taken
  2. Dose & duration of therapy
  3. Degree of drug transfer across placenta
  4. Genetic predisposition
28
Q

What is the effect of behavioural teratogens

A

CNS-active drugs are potential risks for intellectual, functional & social development

29
Q

In what 3 teratogens are withdrawal seen in neonates

A

Alcohol, benzodiazepines & opiates

30
Q

What is the 2 effect of aspirin in pregnancy

A

Prolonged labor & increased bleeding

31
Q

What is the 2 effect of NSAIDS in pregnancy

A

Premature closure of patent ductus arteriosus & primary pulmonary hypertension

32
Q

What is the effect of Warfarin in pregnancy

A

Fatal cerebral hemorrhage in neonates (3rd trimester use)

33
Q

What is the 3 effects of sedatives in pregnancy

A

Apnea, hypotonia & hypothermia

34
Q

What is the effect of cocaine in pregnancy

A

Cerebral ischemia in newborns

35
Q

What is the 4 challenges of prescribing in pregnancy

A
  1. Unplanned pregnancy: unknown exposure to teratogens in 1st trimester
  2. Limited information on majority of drugs: absence of harm evidence does not mean it is safe
  3. Poor understanding of background risk: spontaneous abortions, genetic congenital malformations, risk from disease & other exposures (alcohol & smoking)
  4. Adequate counsel patients without causing disproportionate concern
36
Q

What is the FDA classification system

A

A, B, C, D & X

37
Q

What does the A in FDA classification indicate

A

Adequate, well-controlled study failed to demonstrate risk to fetus

38
Q

What does the B in FDA classification indicate

A

Animal studies failed to demonstrate risk to fetus & no adequate & well controlled studies on pregnant women OR
Animal studies have shown a risk that was not confirmed in controlled studies in pregnant women in first trimester

39
Q

What does the C in FDA classification indicate

A

Animal studies have shown adverse effect
No human studies
Potential benefits may warrant despite risk

40
Q

What does the D in FDA classification indicate

A

+ evidence of human fetal risk based on adverse reaction data
Poetenital benefits may warrant use

41
Q

What does the X in FDA classification indicate

A

Studies in human/animals show fetal abnormalities &/ + evidence of risk from adverse reaction
Risk outweighs benefit

42
Q

What is the 5 general principles when prescribing drug during pregnancy

A
  1. Risk benefit assessment
  2. Choose drug with relatively more safe data
  3. Monitoring therapeutic drug
  4. Counsel on adherence of essential drugs
  5. Warnings about teratogenic drugs & substances
43
Q

What drugs get into breastmilk

A

All drugs (except insulin & heparin)
& can even influence milk production

44
Q

What is 3 considerations when prescribing while breastfeeding

A
  1. Dose received in breast milk (feed prior dose)
  2. Pharmacokinetics in infant (lower drug clearance)
  3. Effect on infant
45
Q

What is 5 considerations when prescribing in lactation

A
  1. Essential drugs only
  2. Absolute CI, avoided or monitored drugs
  3. Careful timing of frugs ingestion & breastfeeding
  4. ADR
  5. Drugs affecting breastfeeding

Case 13: FASD (9 decks)

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