Pharmacotherapy of Drug Addiction and Alcoholism

Question 1

What is Addiction? Does Treatment work How does it affect the body?

Answer 1

Addiction: a brain disease but with biological, psychological and social components
Yes, treatment works; it is cost-effective in the long run
Addiction is a complex disease (CD)
The entire organ system is affected by addiction

Question 2

Explain why Addiction is a Developmental disease.

Answer 2

Addiction is a DEVELOPMENTAL Disease: as it starts early
- The Sooner a child or adolescent starts binging on medication, the higher the percent of susceptibility to mental disorders, psychiatric disorders and also Addiction, and multi drug use
Studies show 67% of people who use Marijuana for first time was a Teen (12-17 years old)
26% had first marijuana as a Young Adult (age 18-25)
(coffee also a psychostimulant that can cause seizure or sleep deprivation in epileptic patients; )

Question 3

What are the three C’s of Addiction and what does it include? What factors strictly define a Complex disease (like Addiction)

Answer 3

Three C’s of Addiction
1. Control
-early social and recreational use (of drugs) leads to eventual Loss of emotional and behavioral control
-Cognitive distortions (denial and minimization)
-Tolerance & Withdrawal = Strictly define CD (complex disease)
2. Compulsion
-Drug seeking activities and Craving leads to Addiction
-Continued use despite adverse consequences
3. Chronicity
-Natural history of multiple relapses preceding recovery
-Possible relapse after years of sobriety
(some people more susceptible to three C’s; others are not)

Question 4

What factors do Addicts try and seek?

Answer 4

Addicts seek SELF-CONTROL, NOT Abstinence

Question 5

What are the risk factors for Addiction ?

Answer 5

Addiction Risk Factors
-genetics
-Earlier Age of onset
-Childhood Trauma (violent, sexual)
-Learning Disorders and ADD/ADHD
-Mental Illness Predating Use
-Depression
-Bipolar Disorder
-Psychosis
-ADHD

Question 6

What kind of disease is Addiction ? What are its effects?

Answer 6

Addiction is a BRAIN disease
-prolong use of drugs or substances cause many changes in the brain
ex: Healthy brain, normal function
Cocaine Addict Brain- causes hypo metabolism (persistent changes in brain, as there is a higher amount of glucose in the cortical area of brain.

Question 7

What happens to brain after 10 days or 100 days after Cocaine use?

Answer 7

After 10 days, the brain will start o have recovery of metabolism. It will slowly start to return back to normal appearance of brain.
After 100 days, metabolism will also to go back to normal, however there will NOT be a complete recovery

Question 8

Explain what happen with DAT (Dopamine Transporter) with one month after Methamphetamine abuse, compared to 24 month abstinence ? Where is the DAT located?

Answer 8

-Normally Dopamine transporter is active and has normal function
-Individuals who use abuse Methamphetamine will cause Dopamine transporter to not work properly, lead to hypometabolism and causing an influx of Dopamine in brain.
-After 1 month of detoxification of Meth, the Dopamine transporter will still not function normally
**After 24 month of abstinence: the Dopamine transporter will have NORMAL function again, and brain can recover from abuse.
-dopamine transporter is active and seen in Nucleus Accumbens of brain
-

Question 9

Explain the mechanisms of different kinds go medications used to treat drug abuse addicts or one who experiences stress

Answer 9

-Opiate agonists stabilize brain function in heroin addicts —> Agonist Therapy:
Use Methadone: which is Agonist/Antagonist that binds to dopamine receptor and compete with other drug; however this will cause patients to have continuing dependency on opiates (will need cognitive/ behavioral therapy)
-Beprenorphine: against that will reduce anxiety
- CB1 KO (cannabinoid Knock out) mice have decreased responses to multiple drugs of abuse
-Less susceptibility to self- administrating drugs
Smokers who are poor nicotine metabolizers smoke less: people who cannot metabolize Nicotine well will be have less suscepibility to being dependent.
treatment: inhibit metabolism of nicotine (using inhibitors of metabolizing enzymes) to induce same response ??
-Stress triggers relapse in animal models of addiction and CRF antagonists interfere with the response to stress:
-use CRF (corticotropin releasing factor) antagonists
REVIEW

Question 10

How do drugs and alcohol work with the body? What are the results of using drugs and alcohol?

Answer 10

How drugs and Alcohol works:
-They interact with nerve circuits, centers and chemical messengers
Results:
-I Feel Good- Euphoria and Reward
- I feel “Better”- reduce negative feelings
-This Feels “Normal”
-I’m craving it, tolerating its effects, withdrawing and feeling sick

Question 11

What is Dopamine?

Answer 11

Dopamine–> REWARD
(dopamine is a neurotransmitter or chemical released from the brain that creates feeling of reward or feeling good)

Question 12

What are sources of Natural Rewards?

Answer 12

Natural Rewards
-Food
-Sex
-Excitement
-Comfort

Question 13

What areas of the brain are brain reward pathways located?

Answer 13

Brain reward pathways
-prefrontal cortex
-nucleus accumbens
-VTA (Ventral Tegmental Area)

Question 14

Explain how addictive drugs leads to activation of reward pathway in the brain

Answer 14

Activation of reward pathway by addictive drugs
-Heroin acts at Ventral Tegmental Area (VTA)
-Cocaine, heroin and nicotine all affect the regulation of Dopamine in nucleus accumbent
-alcohol has a more generalized effect in nucleus accumbens and throughout rest of the brain

Question 15

Explain how behavior pathways works? what does rewarding behavior lead to?

Answer 15

Behavior Pathways
-A rewarding behavior becomes routine which leads to–> “subconscious” control of the behavior. This then leads to It being hard to extinguish the behavior: I’m NOT Always aware when it starts. Then the person resists change –> leading to it being a Habit
(hence conditioning leads to a habit)

Question 16

Explain how Addiction can be interprets a like a Dog with a Bone

Answer 16

Addiction = Dog with a Bone
-It never wants to let go
-It bugs you until it get what it wants
-it never forgets when and where it is used to getting its bone
-It thinks it’s going to get a bone anytime you do anything that reminds it of the bone

Question 17

Compare and contrast the effects of cocaine use on the brain vs a normal brain. What part of the brain is largely impacted and how?

Answer 17

With normal brain, the Amygdala is not lit up, and people have normal function of brain
-With brain of Cocaine user, the Amygdala is activated. This causes a lack of control, and can lead to paraphernalia. Person has a tendency to relapse to drug use.
REVIEW

Question 18

What are cognitive Deficits seen with Drugs and Addiction?

Answer 18

Cognitive Deficits and Drug and Addiction
-Memory problems- short-term loss
-Impaired Abstraction
-Perseveration and using FAILED Problem-solving strategies
-Loss of IMPULSE control
-These deficits are SIMILAR to those with brain damage

Question 19

What are commonly abused drugs?

Answer 19

Commonly Abused Drugs
-Alcohol
-Marijuana
-Cocaine/crack
-Methamphetamine
-Heroin
-New Drugs (prescription drugs)
(Abuse: describes taking drug MORE Than recommended)

Question 20

What kind class of drugs is Alcohol?Describe the related issues that occur with this abuse of drugs

Answer 20

Alcohol
Class of Drug: Sedatives-Hypnotics
Related Issues:
-Detoxification
-Fetal Alcohol Syndrome (FAS)
-Loss of Judgement
-Suicide/Homicide
-DWI/DUI Concerns
-Poly-drug Use
-Legality issues

Question 21

Which class of drugs is Marijuana?Describe the related issues that occur with this abuse of drugs

Answer 21

Marijuana
Class of Drug: Hallucinogens
Related issues
-Lack of Motivation
-Arrested Development
-Memory and Learning problems
-Long Detection Time
-Legalization Issues
-Medical Use Issues
-Health Issues

Question 22

Explain which class of drugs Cocaine/Crack is? Describe the related issues that occur with this abuse of drugs

Answer 22

Cocaine/Crack
Class of Drug: Stimulants
Related Issues:
-High-relapse potential
-High Reward
-A cycle: Euphoria–> Agitation_> paranoia–>”Crash” –> Sleeping–> Euthymia (stable mood)–> Craving
-Obsessive Rituals
-Risk of permanent Paranoia
-No medications currently available

Question 23

Which class of drugs Methamphetamine is? Describe the related issues that occur with this abuse of drugs

Answer 23

Methamphetamine:
Class of Drug: STIMULANTS
Related Issues:
-High Energy Level
-Repetitive Behavior patterns
-Incoherent Thoughts and confusion
-Auditory Hallucinations and Paranoia
-Binge Behavior
-Long-acting (up to 12 hours)

Question 24

What class of drug is Heroin? What are related issues that occur with this abuse of drugs?

Answer 24

Heroin:
Class of Drug: OPIATES
Related issues
-Detoxification
-Medications Available
-Euphoria
-Craving
-Intense Withdrawal
-Physical Pain

Question 25

Which type of drugs are considered “New Drugs” ? What are significant Health Risks and what are some characteristics with these drugs?

Answer 25

New Drugs
are Club Drugs: Prescription Drugs
-Popular with Youth and Young Adults
-Significant Health Risks: Neuron Destruction with Ecstasy
-Users believe they know how to reduce the risks-WRONG!
-Use increasing for Oxycontin, Decreasing for Ecstasy

Question 26

What are common characteristics of people who are addicted?

Answer 26

Common characteristics of people who are addicted?
-Unemployed or employed
-Multiple or no criminal justice contacts
-Difficulty coping with stress or anger
-Highly influenced by social peer group or a loner
-difficulty handling high-risk relapse situations or craves excitement
-emotional and psychological immaturity
-Difficulty relating to family
-Difficulty sustaining long-term relationships
-Educational and vocational deficits

Question 27

How can drug use lead to violence?

Answer 27

Violence
-Alcohol disinhibits aggressively
-stimulants produce dose-dependent paranoia
-Opiate-seeking, but NOT opiates, produces violence

Question 28

What are the risks of becoming addicted?

Answer 28

-Genetic predisposition
-a younger age for beginnning use
-Childhood trauma (violent, sexual)
-Learning disorders & or ADD/ADHD
-Mental Illness
-Depression
-Bipolar Disorder
-Psychosis
-Personality disorder

Question 29

What occurs with Co-Occuring Disorders?

Answer 29

Co-Occuring Disorders
-Each disorder affects the other and changes the outcome of treatment

Question 30

What are the different forms of Multiaxial Diagnoses?

Answer 30

Multiaxial Diagnoses
Axis I: Clinical Disorders
Axis II: Personality Disorders and Mental Retardation
Axis III: Medical Conditions
Axis IV: Psychosocial Factors
Axis V: Global Assessment of Functioning (GAF)

Question 31

If teens abuse specific substances, what’s their risk of having mental problems?

Answer 31

Teens have the highest risk of having problems after using Alcohol and Marijuana (High risk: 11-22 problems)
-Meanwhile teens have the lowest risk of having mental health problems with Alcohol abuse (low risk: 0-4 problems)

Question 32

Explain why we need to do MORE to help people with Co-Occurring Disorders?

Answer 32

because…
- MORE treatment failures and cost
-More relapse
-More re-hospitalization
-more ER visits
-More vulnerability: violence, suicide, homelessness, arrests
-More illness and earlier deaths
-More resistance to treatment

Question 33

Describe the different Co-occuring disorders that people may have.

Answer 33

Co-Occuring Disorders=COD
-Mood Disorder + : 24-40% have a co-occurring substance abuse disorder
-Alcoholism+: 65% of females and 44% of male alcoholics have co-occuring mental health disorders;
-THE MAJOR ONE= DEPRESSION
-19% females alcoholics, 4x the rate for men
-Addiction+ : 30-59% of women in treatment have PTSD, 2-3 times the rate for men
-Prescriptions: 1:7 women >64 years old take medication for a mental health disorder.
Don’t Forget physical effects:
Body/brain breakdown

Question 34

How can we enable recovery? (describe different ways)

Answer 34

-Education
-Curiosity
-Setting reasonable and legal limits
-Patience
-Humility
-Organizing a system of care
-Avoid scapegoating and stigmatization

Question 35

Describe the integrated Recovery Model. What are its components ?

Answer 35

Integrated Recovery Model
-Addiction–> Stages of recovery that can lead back to Relapse–> Addiction
also, during stages of recovery, one can have a recovery barrier/relapse trigger due to negative affects, interpersonal conflict, social pressure or conditioned craving. All of these factors can lead to relapse trigger

Question 36

What are two major conditions that occur in integrated recovery model. Describe the factors involved to improve these conditions.

Answer 36

Integrated Recovery Model
-Addiction: the steps made to cut down/stop use of substance or drug, then one gets comfortable and is able to establish life balance
-Mental illness: finding how to establish safety/reduce symptoms by having illness acceptance and functional improvement; which can lead to life balance, personal growth and development

Question 37

What occurs during the recovery process? What do you Discover?

Answer 37

During Recovery:
-a process of growing
-Accepting the illness
-Making healthy choices about treatment and living in the world
-Being motivated and hopeful

Question 38

What kind of factors are recovered in recovery?

Answer 38

-Abstinence
-sense of responsibility
-Range of Emotions
-Intimacy

Question 39

What are the Phases of Recovery?

Answer 39

Phases of Recovery
-Crisis
-Stability and Structure
-Consistency and Balance

Question 40

What are different factors that complicates Recovery?

Answer 40

-Socio-economic status
-Single parent
-Ethnic
-Matriarch/Patriarch
-Gender
-Religion
-Treatment method
-Co-dependency
-Employment
-Domestic violence
-Living situation
-Extended family

Question 41

What are some of the skills learned and taught during counseling and other behavioral therapies?

Answer 41

Counseling and other Behavioral Therapies:
-Replacing Drug using activities
-Drug resisting skills
-Motivational Enhancement counseling
-Problem solving skills
-Building interpersonal relationships

Question 42

What is the purpose of medical detoxificaiton? Is it a cure?

Answer 42

Medical Detoxification: only the FIRST stage of addiction treatment
-by itself, it does little to change long-term drug and alcohol use
-There are high post-detoxification relapse rates
-Detoxification is NOT a cure
-It prepares the person for further care
(cure can be gaining abstinence from drug)

Question 43

What medications are used for the different types of drugs?

Answer 43

Medications are an important element when combined with counseling and other behavioral therapies:
-Alcohol: Naltrexone (oral and injectable) (only used when opiate is controlled), Disulfiram, Acamprosate
-Opiates: Naltrexone, Methadone, Buprenorphine
-Suboxon: Naltrexone & Buprenorphine
-Nicotine: Nicotine replacement (gum, patches, spray, inhaler), Bupropion, Varenicline
-Stimulants (NONE to date) ; NO medications

Question 44

Why are medications recommended ?

Answer 44

Why Recommend a Medication?
- reduced drinking leads to abstinence
-helps the motivated person stay abstinent when severe consequences for relapse
-Allows for time to:
-Learn coping skills
-Build a social network
-re-establish intimate relationships

Question 45

Discuss the history of how Alcohol was made and who discovered it.

Answer 45

Alcohol:
-Alcohol is a product of fermentation of sugars in fruits by yeast or bacteria. Man discovered this process in 10,000 B.C.
- in ancient Egypt, Osiris, the god of wine, was worshiped throughout the entire country
-900 A.D. - The Persian physician and scientist Rhazes discovered techniques of distillation

Question 46

compares the amount of alcohol consumed in Europe and U.S. which countries had highest rates?

Answer 46

Comparison of Alcohol Consumption among European and U.S.
- France had the highest rates of Alcohol consumption among European countries and America as well (for years 1970, 1980, 1990)
-Germany had the second highest consumption rates
-Japan had the lowest alcohol consumption rates in all three years.
(U.S. had around same consumption rates as Canada; UK rates were a little less )

Question 47

Discuss the graph describing people who used alcohol at least once in High School

Answer 47

• about 70 percents of students in 12th grade have used alcohol at least once throughout the years (1991-1997)
  -Meanwhile around 50% students in 10th and 30% of students in 8th have consumed alcohol at least once

Question 48

What is the rate of consumption for high school students who have consumed more than 5 drinks in last 30 days?

Answer 48

30 % of Students in 12th grade, have consumed more than f drinks in last 30 days. Meanwhile, around 24% students in 10th and 12% of students in 8th grade have consumed more than 5 drinks in last 30 days

Question 49

Discuss the prevalence of lifetime alcohol dependence based on age of first use . Which age is more likely to have alcohol dependence?

Answer 49

16% of Lifetime alcohol dependence (HIGHEST RATE) occurs in people who had first alcohol use before age 12.
Meanwhile the lowest rate for alcohol dependence were people had first use of alcohol during or after age 21.
Hence, the earlier your age was during first use of alcohol, the higher chance of having alcohol dependence

Question 50

What is the age of onset, of one being alcohol dependent?

Answer 50

Age of onset:
- Two thirds of dependent individuals become alcohol dependent before age of 25.
-Only 20% of dependent individuals have onset after age 30

Question 51

What occurs in the Digestion of Alcohol. Who gets drunk more rapidly, men or women? why?

Answer 51

Digestion of Alcohol:
-Absorption
-Elimination
-Proof,
-Blood Alcohol level
-WOMEN are more susceptible to get drunk quickly, since their metabolism is delayed by enzymes, and is slow at breaking down. Also, women have more adipose tissue .
(since it takes while to break down alcohol, more alcohol will be in woman’s bloodstream, raising BAC (blood alcohol count)

Question 52

Discuss the impact of Alcohol in the U.S. how does it affect the human population?

Answer 52

Alcohol’s Impact
-More than 700,000 receive treatment on any given day
-Accounts for the loss of 100,000 lives per year
-30% of all traffic fatalities
-in 2002, 15.9 million were heavy drinkers
-Approximately 10% become alcohol dependent
-14 million adults abused alcohol or were dependent on it in 1992
-Ten percent of those who drink consume fifty percent of the alcohol used in the Unites States

Question 53

Discuss whether Alcoholism is a disease and explain why or why not.

Answer 53

Is Alcoholism as Disease?
-YES., Alcoholism is a disease. The craving that an alcoholic feels for alcohol can be strong as the need for the water. An alcoholic will continue to drink despite serious family, health, or legal problems
-Like many other diseases, alcoholism is CHRONIC, meaning that it lasts a person’s lifetime. It usually follows a predictable course; and has its symptoms. The risk for developing alcohol is influenced both by a person’s genes and by his or her lifestyle.

Question 54

What is the impact of treatment for alcohol abuse ?

Answer 54

Impact of treatment
-40-70% of patients return to drinking within the year following treatment (relapse)

Question 55

According to DSM IV:TR, what is the criteria for alcohol dependence?

REVIEW

Answer 55

DSM IV TR: Criteria for Alcohol Dependence
-At least THREE of the following has occured in the same 12-month period
1) Tolerance
2) Withdrawal
3) Taken in larger amounts than was intended
4) Unsuccessful efforts to cut down
5) Time is spent trying to obtain alcohol
6) Activities given up because of alcohol
7) Continued despite physical or psychological problems
A h/o tolerance or withdrawal predicts a more SEVERE course
(tolerance: after repeatedly using drugs, body gets used to it and requires higher dose, to feel same effect)

Question 56

According to DSM IV TR, what is the criteria for Alcohol Abuse?

Answer 56

DSM IV TR: Alcohol Abuse
-At least one of the following has occurred in the same 12-months:
-Role impairment (ex: failed work or home obligations)
-Hazardous use (ex: driving while intoxicated)
-legal problems related to alcohol use
-Social or interpersonal problems due to alcohol

Question 57

Discuss the rates of Alcohol Abuse and Dependence amongst Americans, females and males and major races.

Answer 57

Rates of Alcohol Abuse and Dependence
-17.6 million American adults (about 1 in 12) abuse or are dependent on alcohol; alcohol problems are highest among YOUNG ADULTS ages 18-29 and lowest among adults ages 65 and older
-Alcohol abuse- 4.65% of Americans (9.7 million people, males 6.93%, females 2.55%) (whites 5.1%, Hispanics 3.97%, African Americans 3.29%) The highest rate of abuse is among white males ages 18 to 29 (10%)
-Alcohol dependence - 3.81% of Americans (7.9 million people, whites 3.83%, Native Americans 6.35%)
-A little more than twice as many men as women are dependent on alcohol

Question 58

What are risk factors of Alcohol abuse and dependence in children

Answer 58

Risk factors in Children
-Adolescents who are diagnosed with ADHD, Depression, Anxiety or Conduct-Disorder all face a HIGHER risk of alcohol abuse and dependence as adults.

Question 59

Discuss the different effects of alcohol. Also occurs what happens to body during Alcohol intoxication. What is Delirium Tremens?

Answer 59

-Effects of alcohol vary according to the level of consumption: low does promote mild euphoria and uninhibited behavior, while hight doses trigger irrational thinking, problematic behavior, psychomotor difficulties, and in rare cases, coma
-First identify predisposing factors including high blood alcohol levels, history of withdrawal or seizure, concurrent use of sedating agents, and co-occurrence of acute or chronic medical problems
-Most persons with alcohol dependence experience mild withdrawal 24 hours after the last drink including restless, anxiety, tremors, tachycardia, GI Discomfort, and insomnia. Symptoms last 24 hours.
A mild withdrawal state may develop into 1) an episode of generalized seizure, typically within 24 to 72 hours or 2) delirium tremens, usually within 5 days of the last drink.
Delirium tremens is characterized by a magnification of the symptoms of withdrawal and by the development of disorientation, visual hallucinations, high blood pressure, and in some cases, fever. Blackouts.
-Acute ethanol poisoning causes more than 1,000 deaths each year (Fraternity Drinking Games)

Question 60

Discuss genetics of alcoholism, and how it can impacts one’s use

Answer 60

genetics of alcoholism
-NO specific gene found
-Heritability rate, 50-60%
-Largely substance-specific
-phenotype and genotype show early and late onset subtypes
-A low response to alcohol (tolerance) is More common in the SONS of alcoholics than controls

Question 61

Discuss whether it is safe to drink during pregnancy?

Answer 61

Is it safe to Drink During Pregnancy:
NO, alcohol can Harm the baby. Although the highest risk is to babies whose mothers drink Heavily, it is not clear yet whether there is any complete safe level of alcohol during pregnancy. For this reason, the U.S. Surgeon General released advisories in 1981 and again in 2005 urging women who are pregnant to abstain from alcohol

Question 62

What are the possible effects of prenatal alcohol use?

Answer 62

The damage caused by prenatal alcohol includes physical, behavioral, and learning problems. Babies severely affected have what is called Fetal Alcohol Syndrome (FAS). These babies may have abnormal facial features and severe learning disabilities; some can be born with disabilities without facial changes; typical of FAS
Associated features of children with FAS;
-Small eye slits
-flat mid face
-Short nose
-Indistinct phiiltrim
-*Thin upper lip
-pointed chin
-Minor ear anomalies,
-Low nasal bridge
-Epicanthal folds

Question 63

Discuss the impairment seen at different blood alcohol concentration

Answer 63

BAC Level:
20-30 mg/dL
Impairment: Slowed motor performance and decreased thinking ability
30-80 mg/dL impairment: Increases in motor and cognitive problems
80-100 mg/dL impairment: Mildly
intoxication effect (legally intoxicated)
(80 mg/dL= 0.08 g/dL)
100-200 mg/dL Impairment: Increases in incoordination and judgement errors, mood lability, Deterioration in cognition
200-300 mg/dL impairment: Nystagmus (cortical damage) , marked slurring of speech; and alcoholic blackouts
>300 mg/dL: impaired vital signs and possible death
>600 mg/dL : LIKELY Death

Question 64

What chemicals are associated with the Reward Pathway? How does this affect the brain?

Answer 64

Reward Pathway
- chemicals like endogenic opoide peptides, Noradrenaline, GABA, Opoids, cocaine, Alcohol, Amphetamines, Benzodiazepines, Nicotine and THC all activate Mesolimbic Dopamine Pathway.
-This causes DOPAMINE to be related in the Nucleus accumbens (of brain)

Question 65

How does alcohol affect the immune system and potentially cause disease?

Answer 65

Alcohol and Disease Transmission
-Alcohol impairs immune responses leading to INCREASED susceptibility to liver disease
-Alcohol INHIBITS 3 important cytokines involved in immune cellular reproduction and hepatic cellular repair
-Alcohol inhibits polymorphonuclear neutrophils (PMNs)
-Alcohol impairs Hepatocyte growth factors, which delays the repair of liver damage.

Question 66

Discuss the correlation between alcoholic consumption and health problems

Answer 66

The HIGHER the number of alcohol drinks consumed per day, the greater the risk for Health problems
(for example: someone who consumes about 6 or more drinks per day has higher risk for health problems)

Question 67

How does Alcohol affect the different neurotransmitters like GABA and NMDA? What happens in Acute intoxication, and alcohol withdrawal with these neurotransmitters?

Answer 67

Alcohol on Neurotransmitter Systems
-Gamma Amionbutyric Acid (GABA) will INCREASE acute intoxication and Decrease Alcohol withdrawal
(GABA- inhibitory signal)
-N-methyl-d-aspartate (NMDA) Excitatory glutamate receptors will REDUCE Acute intoxication and INCREASE alcohol withdrawal

Question 68

Explain how alcohol affects the brain regions and other hormones and the effects of this

Answer 68

Alcohol acutely INCREASES dopamine levels, which will greatly impact ventral tegmentum and related brain regions, causing continued alcohol use, craving, and relapse
-Alcohol can also cause increases in stress hormones including Cortisol and Adrenocorticotropic hormone (ACTH)
-These alterations contribute to both feelings of reward during intoxication and depression

Question 69

How do all kinds of drugs and substances affect brain regions
REVEIW THIS

Answer 69

In Ventral tegmental area (VTA):
-Glutamate and Nicotine inputs activating dopamine
- Alcohol has an effect on GABA and Dopamone
Opiated inhibit GABA
-Nicotine and alcohol activate Opoid peptides
-Stimulants also activate Dopamine that goes to Nucleus accumbens
-Glutamate inputs will have an effect on nucleus accumbens (NAc) and alcohol will affect glutamate inputs
-Opiates will inhibit Nucleus accumbens
REVIEW

Question 70

Discuss the metabolism of alcohol and the enzymes and molecules involved. What does alcohol take away from the body? What drug can inhibit formation of acetate?

Answer 70

Metabolism of Alcohol:
-Ethanol (ch3-ch2OH)—–> Acetaldehyde (ch3–CHO) using enzyme Alcohol Dehydrogenase
-Acetlaldehyde will then produce Acetate (ch3–COO-) by Aldehyde Dehydrogenase
-Acetate will then be converted into Acetyl CoA (ch3-C-O-S-CoA)
(Acetyl CoA provides energy to Krebs cycle)
-Alcohol can depress nutrients and vitamins away from body
-Disilfiram drug can be used to inhibit conversion of acetaldehyde to Acetate
(it will block the enzyme aldehyde DH from breaking down acetaldehyde to Acetate)

Question 71

Does alcohol provide energy? Explain what it does in the body

Answer 71

Alcohol supplies CALORIES (a drink contains 70-100 kcal)
-Devoid of nutrients such as minerals, proteins and vitamins
-Interfere with absorption of vitamins in small intestine
-DECREASES their storage in the liver

Question 72

What kind of effects does GABA have relating to alcohol use ?

Answer 72

GABA
-Key INHIBITORY neurotransmitter
-Effects of low concentrations of alcohol
-GABAA-receptor
-Effects of high alcohol levels
-Effects of Continued use
-Cross tolerance with sedative-hypnotics
-Polymorphisms in the GABA system

Question 73

What effects does Glutamate have on Alcohol ?

Answer 73

Glutamate
-Major excitatory neurotransmitter in CNS
-alpha-amino-3-hydroxy-5-methylisoxazole–propanoic acid (AMPA)
-N-methyl-D-aspartate (NMDA) receptors
-Effects of low levels of alcohol
-Effects of continued use of alcohol
-Glutamate polymorphisms EAAT2

Question 74

Explain why some cultures have Low Alcohol Tolerance? What contributes to this?

Answer 74

Some cultures have Low Alcohol Tolerance due to ADH22 Allele
-A polymorphism on the ADH22 allele, has been shown to account for 20-30% of the variance in alcohol intake between light and heavy drinkers among Asian and Jewish populations
(mutation in gene leads to LESS alcohol consumption; causes slow metabolism and high levels of acetaldehyde)
REVEIW

Question 75

What occurs during Alcohol Withdrawal? What parts of the body are affected?

Answer 75

Alcohol Withdrawal:
-Develops within 24 to 96 hours after the last drink for 90% of people
-in approximately 16% of the cases, the withdrawal syndrome will result in alcohol related-seizures
-nervous-system excitation
-Dysphoric and negatively reinforcing
-GABAA and NMDA dysregulation
-CNS hyperactivity
-Locus coeruleus (activation)
REVIEW

Question 76

What is Delirium Tremens (DTs)? What are the symptoms and diagnostic criteria? how long does this last? What kind of treatment is used?

Answer 76

Delirium Tremens (or DTs)
-The MOST SERIOUS manifestation of alcohol withdrawal
-Diagnostic Criteria: disturbance of consciousness, change in cognition or perceptual disturbance, developing in a short period during or shortly after a withdrawal form heavy alcohol intake
-Often includes hyperpyrexia (body temperatures goes up to over 100 degrees due to changes in hypothalamus) , tachycardia, hypertension, and diaphoresis (excessive sweating)
-Incidence 5% alcohol dependent patients entering inpatient treatment for alcohol withdrawal
-Withdrawal can start within hours but delirium typically does not develop until 2 or 3 days after cessation of drinking
-lasts 48 to 72 hours, but some cases have much longer duration
-Initial studies found mortality to be as high as 15%, but with advances mortality of 0% to 1%
-Pharmacologic treatment involves the use of medications that are cross-tolerant with alcohol

Question 77

Discuss the treatment that is used for Delirium Tremens and how it improves symptoms?

Answer 77

Treatment of DT’s (Delirium Tremens)
-Benzodiazepines safe and effective in preventing seizures and delirium
-Diazepam (Valium) and chlordiazepoxide (Librium) are long-acting agents with good efficacy. Withdrawal is smoother, and rebound withdrawal symptoms are Less likely to occur.
-Lorazepam (Ativan) and oxazepam (Serax) are intermediate-acting medications
-Treatment with these agents may be preferable in patients who metabolize medications less effectively, particularly the elderly and those with liver failure.
-Lorazepam is the ONLY benzodiazepine with predictable IM (intramuscular) absorption
REVIEW

Question 78

What is the protocol for using BZD’s (Benzodiazepines) for DT’s?

Answer 78

Protocol in using BZD’s for DT’s (Delirium Tremens):
-Diazepam, 5 mg intravenously (2.5mg/min). If the initial dose is NOT effective, repeat the dose in 5 to 10 minutes. If the second dose of 5mg is NOT satisfactory, use 10 mg for the third and fourth doses every 5 to 10 minutes. Then use 5 to 10 mg every hour as needed to maintain light somnolence
-Lorazepam, 1 or 2 mg intravenously or IM every 5 to 15 minutes until calm, then every hour as needed to maintain light somnolence (sleepiness)

Question 79

What are other agents that have been used to treat patients with alcoholic withdrawal ? What must be given to patients before administering IV fluids of glucose?

Answer 79

Other agents
-Magnesium: low serum magnesium levels frequent in patients with AWD (alcoholic withdrawal). Its sue has NOT been evaluated in controlled trials
-Beta-adrenergic antagonists (ex: propranolol) in patients with AWD has NOT been well studied
-Patients with alcohol dependence are often THIAMINE Deficient, and thiamine 100 mg IM (intramuscularly) should be given to all patients in acute withdrawal
-Thiamine should be given before administration of IV fluids containing glucose, as the IV administration of glucose may precipitate acute thiamine deficiency
Carbamazepine, other anti epileptic agents and clonidine have been tried and done well in some small, uncontrolled case series

Question 80

What is the Naltrexone? What kind of drug is it? What are possible side effects of this drug?

Answer 80

Naltrexone (Revia, Vivitrex)
-Naltrexone is an opioid receptor antagonist. It reduces heavy drinking by reducing the rewarding effect of alcohol. It has been approved by FDA sine 1994.
-70% of 27 clinical trials that measured reductions in “heavy or excessive drinking” demonstrated an advantage for prescribing naltrexone over placebo, whereas only 9 (36%) of 25 clinical trials found an advantage for placebo
-However, adherence to daily oral pharmacotherapy can be problematic, and clinical acceptance and utility of oral naltrexone have been limited. Vivitrex (approved 2006) is a monthly injectable (380 mg IM) formulation of naltrexone
-Must avoid opioids; can impair liver function; can increase suicidal ideation. Attempts to overcome naltrexone-induced opioid blockade by using exogenous opioids may result in FATAL Overdose

Question 81

What is the dosage used for Disulfiram? What are its effects? How was it discovered?

Answer 81

Disulfiram (Antabuse)
-Dose 250-500 mgs
-Somatic reaction if one uses alcohol
-Serendipitously discovered (found by accident)
-This drug will block metabolism of alcohol, causing build up Acetaldehyde in body, and increasing discomfort for drinking alcohol (“makes you feel sick”)

Question 82

What is Acamprosate? What is its purpose? Describe its mechanism of action?

Answer 82

Acamprosate
-drug used in Europe for almost 20 years
-approved in the U.S. in 2004.
-Mechanism of action
(interacts through NMDA receptors and AMPA receptors)
-Efficacy studies
-Pharmacology- half life-renal excretion
(drug is excreted by renal system)
anticrave drug (used to reduce the desire to drink alcohol ??????)
REVIEW

Question 83

What occurs in Wernicke-Korsakoff Syndrome? What are its clinical features?

Answer 83

Wernicke-Korsakoff Syndrome (caused by inevitable changes in brain function due to alcoholism)
-Global confusional state that appears over days or weeks
-Abnormal eye movements include nystagmus (involuntary eye movement)
-Truncal ataxia (“drunken sailor’s gait”) or lack of muscle coordination)
-Korsakoff (alcohol Amnestic) syndrome
(memory disorder that results form Vitamin B deficiency (thiamine) due to alcoholism
-Histopathological lesions

Question 84

What are the ethanol-Drug interactions that occur? How does this affect the body?

Answer 84

Ethanol-Drug interactions
-Often occur in suicide attempts
-combined with hypnotics (mickey Finn) (lead to lethal effects)
-Ethanol and morphine
-Ethanol with some antibiotics (chloramphenicol, griseofulvin, isoniazid, metronidazole, and quinacrine hydrochloride)