Pharmacology and Pharmacotherapy of Alcohol Use/Abuse Flashcards
PHARMACOKINETICS OF ALCOHOL
Absorption
10% from stomach, remainder from intestine
Peak 30-90 minutes
Limited by gastric emptying - Slowed by food
Alcohol increases acid release - Induce ulcers/GERD
Distribution
Distributed in total body water - (58% men, 48% women); Men dilute ethanol more
ALCOHOL ELIMINATION FOLLOWS ZERO ORDER KINETICS
Blood concentration profile
Elimination is zero order at or above 10-20 mg/dl - ADH rate limiting step
body eliminates drug at a predictable rate, regardless of plasma concentration
ALCOHOL IS METABOLIZED IN TWO IMPORTANT STEPS
Metabolism:
90% in liver
Alcohol dehydrogenase (ADH)
Microsomal Ethanol Oxidizing System (MEOS) - Only at high alcohol concentration; Involves CYP2E1; LOW affinity for alcohol
Aldehyde dehydrogenase (ALDH) Glucuronidation (0.5%-EtG test):
Test used to monitor alcohol
consumption – Too sensitive
Ethyl glucuronide has very long
T1/2
1) ALCOHOL IS METABOLIZED BY ALCOHOL DEHYDROGENASE
Enzyme is found in liver, brain and stomach
Men express higher levels of gastric ADH
Fomepizole (Antizol): ADH inhibitor - Alcohol can be used as well; Ethylene glycol, MeOH
poisoning; Slow formation of
formaldehyde and toxic metabolites; Liver has more time to further metabolize toxic metabolites
2) ACETALDEHYDE IS METABOLIZED BY ALDEHYDE DEHYDROGENASE
ALDH1B1 and ALDH2 isozymes are important for alcohol metabolism - 50% Asians only have ALDH2
SNP in ALDH2 reduces activity - ALDH22
Heterozygous ALDH22: Reduced metabolic activity; Flushing and increase skin temp; Can still consume ethanol
Homozygous ALDH2*2: Deficient in the ability to metabolize acetaldehyde; neurotoxic; Strong ”hangover”; Also alcoholic neuropathy
Disulfiram (Antabuse): Irreversible inhibitor; Effects persist up to 14day
ALCOHOL HAS MANY TARGETS AND ACTIONS
Ligand-gated ion channels: GABAA-receptors (allosteric activator of inhibitory neurotransmitters); NMDA receptor (inhibitor); Alpha7 nicotinic receptors
Neurotransmitter release: Opioids (enkephalins) - Dopamine; Serotonin, norepinephrine; Acetylcholine; Increases CNS and blood ACTH levels
BLOOD ALCOHOL LEVEL CAN BE DEPICTED IN DIFFERENT WAYS
0.10% is equal to 100 mg/dl or 22 mmol/l of blood alcohol
Mg%: Milligrams of ethyl alcohol in 100 millilitres (1dl) of blood: 0.1% = 100 mg/dl = (100mg%); USA, 80mg% = legal driving limit; Independent of behavioral tolerance
PHARMACOLOGICAL ACTIONS OF LOW LEVELS OF ALCOHOL
Euphoria, disinhibition (30- 60 mg/dl), talkative
Analgesia (60-90 mg/dl)
PHARMACOLOGICAL ACTIONS OF INTERMEDIATE LEVELS OF ALCOHOL
CNS stimulation (80-120 mg/dl): Mood swings, aggression
CNS depression (100-200 mg/dl): Slurred speech, ataxia, sedation, loss of motor control, irrational behavior.
PHARMACOLOGICAL ACTIONS OF HIGH/FATAL LEVELS OF ALCOHOL
Coma-Death (300-500 mg/dl): Respiratory paralysis; People have survived (1000-1500 mg/dl)
CARDIOVASCULAR EFFECTS INDUCED BY ALCOHOL - acute
Vasodilation: Warm, flush; Reduced blood pressure; Increase heart rate - Decrease at high dose
CARDIOVASCULAR EFFECTS INDUCED BY ALCOHOL - moderate use
Reduced risk of coronary disease - HDL ↑
CARDIOVASCULAR EFFECTS INDUCED BY ALCOHOL - heavy/chronic use
Affects heart
Cardiomyopathy
Arrhythmias (binge drinking)
Hypertension (5% of all cases)
Hemostasis
PHYSIOLOGICAL EFFECTS OF ALCOHOL CONSUMPTION - thermoregulation
Hypothermia: Moderate in man; Possible lethal with cold temp and large dose
PHYSIOLOGICAL EFFECTS OF ALCOHOL CONSUMPTION - gastro-intestinal
EtOH is a secretagogue - increases HCl secretion; Chronic gastritis in alcoholics
Appetite stimulant (low dose)
Appetite depressant (high dose)