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Week 3 Flashcards

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1
Q

What are the most important determinants of population alcohol consumption?

A

cost and availability

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2
Q

How is the relationship between alcohol and mental health problems complex?

A

the symptoms may be a direct consequence of substance misuse
the mental disorder may predate the substance abuse
the 2 disorders may exist coincidentally in the same individual

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3
Q

What are the psychological problems associated with acute intoxication with alcohol?

A 
insomnia
depression
anxiety
amnesia
attempted suicide
suicide
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4
Q

What are the psychological problems associated with regular heavy drinking?

A 
insomnia
depression
anxiety
attempted suicide / suicide
changes in personality
amnesia
delirium tremens 
alchohol hallucinosis
dementia
association with other addictions
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5
Q

What is associated with alcohol dependence?

A 
compulsion
control
tolerance 
withdrawal
persistance 
neglect
repertoire narrows 
reinstatement
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6
Q

What is the general rule of thumb for withdrawal effects?

A

opposite of intoxication symptoms and signs

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7
Q

What are typical withdrawal symptoms from alcohol?

A 
excitable
anxious
hypervigilant
high BP
high pulse
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8
Q

What are thought to be the causes of alcohol problems?

A

price and availability
biological factors
behavioural models
socio-economic differences

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9
Q

What are psychiatric associations with cannabis?

A

dependence
psychosis
amotivational syndrome
cognitive impairment?

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10
Q

What are psychiatric associations with opiate dependence?

A 
depression
attempted suicide / suicide
personality disorder
PTSD
no evidence for psychosis
polydrug dependence likely
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11
Q

what are the psychiatric problems associated with stimulant drugs?

A

anxiety
depression
antisocial behaviours
paranoid psychosis

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12
Q

What transmitters / receptors does alcohol act on?

A

dopamine, opioids

increased GABA

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13
Q

How do stimulants work?

A

enhance transmission at the catecholaminergic / dopaminergic. serotonergic synapses

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14
Q

What are the effects of stimulants?

A 
increased behavioural and motor activity
increase alertness / sleep disruption
euphoria
confidence
anxiety, insomnia and irritability
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15
Q

What is the stimulant toxidrome?

A 
tachycardia
hypertension
risk of arrythmia
sweaty
hallucination
agitation
dilated pupils
elevated temperature
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16
Q

What is the serotonin syndrome triad?

A

altered mental status
autonomic changes
neuromuscular effects

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17
Q

How does cocaine act?

A 
quick onset
peak levels in 30 minutes
rapid BBB penetration
short half life
Blocks Da, NE and 5HT reup-take
pleasure effect and readiness
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18
Q

How do amphetamines work?

A 
quick onset
peak levels in 30 minutes
BBB penetration
long half life 
enhance release of DA and NE from pre-synaptic terminals
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19
Q

What are the acute neurological problems with stimulants?

A

tremor, myoclonus, rhabdomyolysis, movement disorders
seizures
neuropsychiatric - restlessness, irritability, violence, psychosis
autonomic - hyperpyrexia

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20
Q

What are the chronic neurological problems with stimulants?

A 
anxiety
sleep deprivation
paranoia 
aggression
paranoid psychosis
cognitive dysfunction
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21
Q

How can stimulants cause vasospasm / sticky blood?

A

alpha adrenergic stimulation
platelet aggregation increased
accelerated atherosclerosis

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22
Q

Describe the opiate toxidrome?

A 
pinpoint pupils
respiratory depression
bradycardia
hypotension
hypothermia
pulmonary oedema
seizures
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23
Q

What is the sedative toxidrome?

A 
ataxia
blurred vision
coma
confusion
delirium
sedation
pupils likely to be normal
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24
Q

What are the acute neurological problems with sedatives?

A

coma
compressive nerve palsies
anoxic brain injury

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25
Q

What is the cholinergic toxidrome?

A 
defecation
urination
miosis
bronchoconstriction
emesis
lacrimation
salivation
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26
Q

WHat effects does MDMA have?

A 
stimulant toxidrome
perceptual effects 
thermoregulatory problems 
hallucinations
CV complications
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27
Q

What are the neurologic effects of hallucinogens?

A

rare reports of stroke
toxic psychosis
dangerous behaviour
Wernicke’s type syndrome - angel dust

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28
Q

What are the acute effects of organic solvents?

A

lightheadedness

hallucinations

29
Q

What are the consequences of prolonged use of organic solvents?

A

cognitive impairment
diplopia / ataxia. nystagmus
coma

30
Q

Describe the effects of cannabis

A

agonist at cannabanoid receptors - g protein linked receptors
alters mood
increases dopamine release
modulates opioid receptors

31
Q

What are NPS?

A

new psychoactive substances

32
Q

Describe legal highs

A

contain substances which produce similar psychoactive effects to traditional illegal drugs. There is no officially agreed list of substances that are categorised as legal highs

33
Q

What is the main risk factor for alcoholic liver disease?

A

the amount type and frequency of alcohol consumption

34
Q

What is the main pathway for alcohol metabolism for healthy people with safe alcohol consumption?

A

alchohol dehydrogenase enzyme which takes place in the cytosol

35
Q

What are the overflow pathways for alcohol metabolism ?

A

MEOS - microsomal ethanol oxidising system (CYP2E1)

and catalase in the peroxisomes

36
Q

What is one of the theories as to why some people are more susceptible to ALD than others?

A

genetic differences in ADH

37
Q

What are the consequences of alcohol metabolism?

A

acetaldehyde production
acetate production
Increased NADH/NAD ratio
non-oxidative metabolism

38
Q

What are the consequences of acetaldehyde production?

A

binds to proteins and DNA - immunogenic

Stimulates collagen production by stellate cells

39
Q

What are the consequences of acetate production?

A

increased acetyl CoA promotes inflammation by histone acetylation

40
Q

What is the consequence of an increased NADH/NAD ratio?

A

increased fatty acid synthesis, reduced fatty acid oxidation, promotes steatosis

41
Q

What is the consequence of non-oxidative metabolism?

A

fatty acid ether ester production which promotes steatosis

42
Q

Describe ROS production

A

largely through MEOS but catalase may also contribute
production of hydrogen peroxide and superoxide ions
activates redox sensitive transcription factors such as NF-KB which leads to increased TNF alpha production
Promotes lipid per oxidation which promotes inflammation and damages mitochondrial membranes leading to apoptosis

43
Q

Describe TNF alpha action in regards to ALD

A

promotes apoptosis and necrosis, and activates stellate cells to produce collagen leading to fibrosis

44
Q

What effect does alcohol have on intestinal permeability?

A

increases it
leads to portal circulation endotoxaemia
this promotes activation of Kupffer cells which in turn promote liver injury and TNF alpha release

45
Q

Describe the intrinsic apoptosis pathway

A

initiated by oxidative stress
leads to leakage of pro-apoptotic factors from the mitochondria (cytochrome C) regulated by Bcl2 proteins
Pro-apoptotic factors from mitochondria activate cascades leading to cell degredation

46
Q

Describe the extrinsic apoptotic pathway

A

initiated by TNF - alpha
binding to TNF receptors leads to Caspase activation via FADD (Fas-associated death domain) and TRADD (TNF receptor associated death domain) proteins

47
Q

Describe apoptosis

A

natural cell death
stimulated by cell signals
beneficial
produces cell fragments that are able to send signals that facilitate phagocytosis

48
Q

Describe necrosis

A

traumatic cell death
stimulated by factors external to the cells
fatal
cannot send signals, leads to build up of dead tissue and cell debris

49
Q

Describe mitochondrial susceptibility in ALD

A

mitochondria in patients with chronic alcohol excess are more susceptible to ROS
normally protected by mitochondrial survival factors (MnSOD, Blf1 BclXL) and anti-oxidants (glutathione)

50
Q

How can malnutrition make ALD more likely?

A

depletion of trace elements (zinc) may exacerbate ROS production and promote apoptosis
vitamine deficiency may lead to impaired metabolism of methionine and reduction into glutathione (normally protective against oxidative stress)

51
Q

Describe how obesity increases the risk of ALD

A

alcohol induces a lipodystrophy - reduction in peripheral fat and increase in visceral fat
induction of CTP2E1 by increased free FA, insulin resistance and alcohol
increased ROS and further insulin resistance
Metabolism of FFas to w hydroxylated farry acids
obesity induced pro-inflammatory state

52
Q

WHat is the main test that determines whether NAFLD orALD is more likely?

A

AST:ALT ratio is usually very elevated in ALD due to mitochondrial damage which raises ALT

53
Q

WHat is the main zones of the liver effected by fatty liver disease?

A

2 and 3

54
Q

How is a fibrotic liver assessed?

A

a fibroscan

replacing biopsies

55
Q

What are the signs of chronic liver disease?

A 
stigmata - spiders
foetor
encephalopathy 
prolonged PT
hypoalbuminaemia
56
Q

What are the signs of portal hypertension?

A

caput medusa
hypersplenism
thrombocytopenia

57
Q

WHat are the results of raised portal pressure?

A 
hypersplenism
oesophageal varices
encephalopathy 
hyperdynamic circulation
ascites 
hepato-renal syndrome
58
Q

What is the other name for Korsakoff syndrome?

A

amnestic syndrome

59
Q

What do 50% of alcoholic adults show problems in?

A

spatial skills
planning
learning and memory

60
Q

What are the different types of alcohol related brain damage?

A

neuropathies
cerebellar degeneration
dementia
wernicke-korsakoff syndrome

61
Q

What are the predisposing factors for neurotoxicity?

A 
genetic
quantity / frequency of alcohol use
severity of dependence 
frequent episodes of acute intoxication
withdrawal syndromes 
other drugs use
concurrent liver damage
62
Q

What are the predisposing factors for nutritional or thiamine deficiency ?

A

weight loss in past year
reduced BMI
high carb intake
recurrent episodes of vomiting

63
Q

What are the symptoms of wernicke-korsakoff syndrome?

A 
confusion
eye symptoms
gaze paralyis
nystagmus
gait ataxia
64
Q

What areas are affected in korsakoffs disease?

A

maxillary bodies and mediodorsal thalamic nucleus

65
Q

Describe korsakoffs disease

A

an amnesic syndrome with impaired recent memory and relatively intact intellectual function

66
Q

Describe the complexity of cognitive impairment with alcohol misuse which includes other factors

A 
intoxication
seizures 
alcohol neurotoxicity
vitamin deficiecny 
hypoglycaemia
head injury
cerebellar accidents 
withdrawal deltrium
hepatic encephalopathy 
hypoxia
non-alcholic related cerebral pathology in older people
67
Q

Describe alcohol and the physiology of aging

A

decreased lean body mass and total body water = increased blood alcohol conc
Age-related disease in gastric alcohol dehydrogenase increases BAC
liver oxidation decreases with age, increases BAC
sensitivity of brain to alcohol increases with age

68
Q

Describe foetal alcohol syndrome

A

a serious developmental disorder caused by prenatal alcohol exposure of the foetus and is characterised by =
prenatal/post natal growth retardation
central NS dysfunction
characteristic craniofacial abnormalities

People and illness (5 decks)

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