Themed Evening Alcohol

Question 1

What does %ABV indicate?

Answer 1

This equates to the number of units per litre

Question 2

Where is the majority of alcohol absorbed?

Answer 2

Duodenum and jejunum (over 80%)

Question 3

What are some of the factors the define alcohol dependence?

Answer 3

3 out of 7 of:
Tolerance
Withdrawal Symptoms
Ingestion in larger amounts
Persistent desire
Expenditure of increasing time drinking/recovering
Abandoning work/social activities
Continued ingestion despite problems

Question 4

What is the process that causes alcohol absorption?

Answer 4

Simple diffusion

Question 5

How does alcohol distribute in the body?

Answer 5

Alcohol is water and fat soluble, it easily crosses plasma membranes and the blood brain barrier. Therefore, alcohol distributes in total body water which is around 0.6l/kg

Question 6

Describe the stages of alcohol metabolism

Answer 6

Ethanol—> Acetaldehyde –> Acetate

Question 7

What is the limiting factor in alcohol metabolism?

Answer 7

Conversion of NAD to NADH, as levels of NAD are depleted

Question 8

What enzyme is induced with excess alcohol intake? What are the consequences of this?

Answer 8

CYP2E1

Cause production of free radical which are damaging

Question 9

How is alcohol eliminated from the body?

Answer 9

First order kinetics, cleared at a rate of around 6 grams per hour (1 unit per hour)
Some is excreted unchanged which is used for detection

Question 10

How does alcohol bring about it’s neurological effects?

Answer 10

GABA- A potentiation causes increased inhibitory activity
NMDA Antagonist- Reduces excitatory signalling from glutamate
Opioid, serotonin and dopamine signalling leads to reward and euphoria

Question 11

What effects can alcohol have when combined with CNS drugs?

Answer 11

Increased sedation and drowsiness

Drugs includes benzodiazepine, SSRIs, TCAs, Anti-histamines

Question 12

What effects can alcohol have when combined with anti-hypertensive drugs?

Answer 12

Increased anti-hypertensive effect

Question 13

How might alcohol interact with warfarin?

Answer 13

With large consumption of alcohol the anti-coagulant role may be interrupted. Warfarin inhibits the activity of vitamin K

Question 14

For which antibiotic should alcohol be avoided?

Answer 14

Metronidazole

This causes a disulfiram like reaction due to increased levels of acetaldehyde (much more toxic than ethanol)

Question 15

What is a common cause of death in acute alcohol intoxication?

Answer 15

Aspiration of vomit

Question 16

What questions are included in CAGE?

Answer 16

Cut down alcohol plans
Anger when confronted over drinking
Guilty feelings after drinking
Eye opener in the morning

Question 17

Describe some features of alcohol withdrawal

Answer 17

Anxiety, insomnia, headache, GI upset, hallucinations, seizures, delirium tremens (48 to 72 hours)

Question 18

What can be used to treat the symptoms of alcohol withdrawal?

Answer 18

Treat the anxiety and restlessness with benzodiazepines

Treat the seizures

Question 19

What is used to prevent/treat encephalopathy?

Answer 19

Alcoholics are often deficient in thiamine which can cause neurological issues
Treatment is with thiamine replacement
Give pabrinex- Vitamin B complex with vitamin C. 2-3 ampules every 8 hours followed by oral thiamine (200-300mg)

Question 20

How does acamprosate work?

Answer 20

Stabilises GABA and glutamate transmission to reduce alcohol cravings and anxiety

Question 21

How does naltrexone work?

Answer 21

Opioid antagonist reduces the rate of relapse

Question 22

How does nalmefene work?

Answer 22

Opioid receptor modulator that is taken 1-2 hours before drinking and reduces the associated pleasure

Question 23

How does disulfiram work?

Answer 23

Also called antabuse
Inhibits acetaldehyde dehydrogenase causes levels of the highly toxic acetaldehyde to increase. This causes nausea, sweating and flushing