SECRETS Neurology - Alcohol & Drugs

Question 1

why give thiamine to hypoglycemic alcoholic before administer glucose?

Answer 1

thiamine is cofactor for pyruvate dehydrogenase (pyruvate –> acetyl CoA)

without, pyruvate –> lactic acid = lactic acidosis

Question 2

Wernicke encephalopathy

Answer 2

thiamine deficiency

acute CNS sx =
reversible ataxia, confusion, nystagmus, ophthalmoplegia

Question 3

Korsakoff’s psychosis

Answer 3

thiamine deficiency

chronic CNS sx =
retrograde/anterograde memory impairment, confabulation

Question 4

Brain regions affected in Wernicke-Korsakoff

Answer 4

petechial hemorrhage and infarction
mamillary bodies, thalamus, periaqueductal gray matter
limbic system (Korsakoff)

Question 5

alcohol withdrawal

Answer 5

delirium tremens

agitated, anxiety, muscle cramps, tremors, delusions, hallucinations

Question 6

alcohol withdrawal tx and why

Answer 6

benzos
barbiturates
LONG ACTING

activate same receptor type as alcohol GABA-A
opens Cl channel –> hyperpolarization –> reduce neuronal excitability

Question 7

alcohol withdrawal pathophys

Answer 7

reduced neuronal excitability (via GABA-A overuse & hyperpolarization)

if taken away suddenly –> hyperexcitability of CNS

Question 8

dosage of benzos & barbiturates for alcoholics

Answer 8

HIGHER

cross tolerance to other GABA-A agonists

Question 9

benzos/barbiturates + alcohol

Answer 9

respiratory depression, respiratory failure