ALCOHOL

Question 1

T OR F

calories from alcohol are empty of
nutrients such as proteins and vitamins and cannot be used
in the repair of damaged tissue.

Answer 1

T

Question 2

Alcohol metabolism pathways

1. reduction of nicotinic acid dehydrogenase (NAD) to nicotinamide adenine dinucleotide (NADH)
2. involves______ which is located in the peroxisomes and mitochondria
3. “___________, located
   mainly in the microsomes of the endoplasmic reticulum.

Answer 2

catalase,

microsomal ethanol oxidizing system” (MEOS)

Question 3

Persons who flush easily after ingestion of alcohol (Chinese, Japanese, and other Asians)
differ from “nonflushers” with respect to the metabolism
of _______ rather than to the metabolism of alcohol

Answer 3

acetaldehyde

Question 4

At a blood alcohol level of
 30 mg/ dL, a\_\_\_\_\_\_\_\_was detectable, and at
 50 mg/ dL, \_\_\_\_\_\_\_\_\_. 
100 mg/ dL, ataxia was obvious; at 
200 mg/ dL, there was\_\_\_\_\_\_ and a reduced level of mental activity; at
 300 mg/ dL, the subjects were \_\_\_\_\_; 
and a level of 400 mg/dLaccompanied
by deep anesthesia-was potentially fatal

Answer 4

mild euphoria
mild incoordination

confusion

stuporous

Question 5

once the absorption of
alcohol has ended and equilibrium has been established
with the tissues, ethanol is oxidized at a _______ rate,
independent of its concentration in the blood

Answer 5

constant

Question 6

_____ drug acts by raising the tissue concentration necessary for
the metabolism of a certain amount of acetaldehyde
per unit of time

Answer 6

disulfiram (Antabuse),

Question 7

The patient taking both disulfiram
and alcohol will accumulate an inordinate amount
of acetaldehyde, resulting in_______, _______, ________

Answer 7

nausea, vomiting, and

hypotension

Question 8

other drugs-notably the_________, _________,__________–have effects like those
of disulfiram but are less potent

Answer 8

sulfonylureas,

metronidazole, and furazolidone

Question 9

One likely site that relates to the acute intoxicating effects of alcohol is a receptor for the inhibitory neurotransmitter _________ and its associated chloride ion channel.

Answer 9

garnmaarninobutyric acid (GABA)

Question 10

Like the GABA-chloride channel, the___________, which transduce signals
carried by glutamate (the major excitatory transmitter in
the brain), are sensitive to extremely low concentrations
of alcohol.

Answer 10

N-methyl-oaspartate

(NMDA) receptors

Question 11

There is also evidence that alcohol selectively
potentiates ______ receptor-ion currents, and the
activity of this receptor has been implicated in alcoholand
drug-seeking behavior and addiction.

Answer 11

serotonin

Question 12

alcohol has an exclusively excitatory rather than a sedative effect. This reaction has been referred to in the past as pathologic, or complicated, intoxication and as _________

Answer 12

acute alcoholic paranoid state

Question 13

Pathologic intoxication may require the use of restraints
and the parenteral administration of _______ or _________, repeated once after 30 to
40 min if necessary

Answer 13

diazepam (5 to 10

mg) or haloperidol (2 to 5 mg)

Question 14

refers to an interval of time, during a period of severe intoxication, for which the patient later has no memory-even though the state of consciousness, as observed by others, was not grossly altered during that interval.

Answer 14

A l co h o l i c “ B l a cko uts “

Question 15

type of memory affected in alcohol black out

Answer 15

short term/ retentive

Question 16

In alcohol intoxication,

The use of ______ should be
considered in comatose patients with extremely high
blood alcohol concentrations (>500 mg/dL), particularly
if accompanied by acidosis, and in those who have concurrently ingested methanol or ethylene glycol or some other dialyzable drug

Answer 16

hemodialysis

Question 17

The characteristic features of
this intoxication, however, are damage to retinal ganglion
cells-giving rise to scotomata and varying degrees of
blindness, dilated unreactive pupils, and retinal edemaand
bilateral degeneration of the putamens, readily visible
on CT scans.

Answer 17

methyl alcohol intoxication

Question 18

In Methyl alcohol intoxication,

The most important aspect of treatment
is the intravenous administration of large amounts of
______

Answer 18

sodium bicarbonate to reverse acidosis

Question 19

Hemodialysis and ______(see later) may be useful adjuncts because of the slow rate of oxidation of methanol.

Answer 19

4-methylpyrazole

Question 20

The treatment o f ethylene glycol poisoning has, until relatively
recently, consisted of hemodialysis and the intravenous
infusion of sodium bicarbonate and _____ the
latter serving as a competitive substrate for alcohol dehydrogenase.

Answer 20

ethanol,

Question 21

Generally; for either methanol
of ethylene glycol, a plasma level of the alcohol above
20 mg/ dL, or above 10 mg/ dL when combined with an
__________ is considered appropriate to institute
the drug.

Answer 21

osmolal gap over 10

Question 22

This i s the well-known symptom complex o f tremulousness,
hallucinations, seizures, confusion, and psychomotor
and autonomic overactivity associated with alcoholism

Answer 22

The Alcohol Abstinence, o r Withd rawa l,

Syn d ro me

Question 23

The most common single manifestation of the abstinence
syndrome is ________ often referred to as “the
shakes” or “the jitters,” combined with general irritability
and gastrointestinal symptoms, particularly nausea
and vomiting

Answer 23

tremulousness,

Question 24

In alcohol withdrawal, The symptoms
then become augmented, reaching their peak intensity
_____ h after the complete cessation of drinking

Answer 24

24 to 36

Question 25

In withdrawal syndrome,

More than 90 percent of withdrawal seizures occur during the 7- to 48-h period following the cessation of drinking, with a peak incidence between ______

Answer 25

13 and 24 h.

Question 26

In withdrawal syndrome,

During the period of seizure activity
and for days afterwards, the patient is unusually sensitive
to stroboscopic stimulation; almost half the patients
respond with _______ or _________

Answer 26

generalized myoclonus or a convulsive

seizure (photoparoxysmal response).

Question 27

Twenty-eight percent
of Victor ‘s patients with generalized withdrawal seizures
went on to develop ________ (the percentage has
been less in other series);

Answer 27

delirium tremens

Question 28

T or F

Most patients during withdrawal do not require antiepileptic
drugs, as the entire episode of seizure activitywhether
a single seizure or a brief flurry of seizuresmay
have terminated before the patient is brought
to medical attention

Answer 28

T

Question 29

The parenteral administration of
________ or __________ early in the withdrawal
period does, however, prevent withdrawal fits in
patients with a previous history of this disorder, as well
as in those who might be expected to develop seizures on withdrawal of alcohol

Answer 29

diazepam

sodium phenobarbital

Question 30

It is characterized by profound confusion,
delusions, vivid hallucinations, tremor, agitation,
and sleeplessness, as well as by the signs of increased
autonomic nervous system activity-i.e., dilated pupils,
fever, tachycardia, and profuse perspiration

Answer 30

DT

Question 31

T or F

when delirium
tremens occurs as a single episode, the duration is 72 h or more in more than 80 percent of cases.

Answer 31

F

less

Question 32

the most important and
the one obligate factor in the genesis of delirium tremens
and related disorders is the __________

Answer 32

withdrawal of alcohol

following a period of sustained chronic intoxication

Question 33

In
all but the mildest cases, the early phase of alcohol
withdrawal is attended by a drop in serum _________
concentration and a rise in_________-the latter on the
basis of respiratory alkalosis

Answer 33

magnesium

arterial pH

Question 34

Lab findings in DT

___________
with normal blood glucose is another infrequent finding

Answer 34

Ketoacidosis

Question 35

The treatment of delirium tremens begins with a_______

Answer 35

search
for associated injuries (particularly head injury with
cerebral lacerations or subdural hematoma), infections
(pneumonia or meningitis), pancreatitis, and liver
disease

Question 36

In the Tx of DT,

An additional important element in treatment
is the correction of fluid and electrolyte imbalance,
particularly ______ and severe ______

Answer 36

hypokalemia

hypomagnesemia

Question 37

In the Tx of DT,
T or F

Severe degrees of agitation and perspiration may require
the administration of up to 5 L of fluid daily, of which
at least 1,500 to 2,000 mL should be normal saline

Answer 37

T

Question 38

In pts with DT,

special danger attends the use of glucose solutions in alcoholic patients .

The administration of intravenous glucose may
serve to consume the last available reserves of thiamine
and precipitate _____

Answer 38

Wernicke disease

Question 39

it is good practice to add B vitamins, specifically _________(which may also be supplemented by intramuscular injection), in all cases requiring parenterally administered glucoseeven though the alcoholic disorder under treatment, e.g., delirium tremens, is

Answer 39

thiamine

Question 40

In pts with DT,

A wide variety of drugs are effective in controlling
withdrawal symptoms. The more popular ones have
been _____, _______
and the ancillary medications, ______, _______

Answer 40

chlordiazepoxide (Librium), diazepam (Valium),

Question 41

In pts with DT,

________may reduce the requirement for sedative drugs.

Answer 41

Gabapentin

Question 42

In pts with DT,

In general, _______
drugs should be avoided because they may reduce the
threshold to seizures.

Answer 42

phenothiazine

Question 43

In pts with DT,

If parenteral medication is necessary, we still
prefer _______ or chlordiazepoxide given
intravenously and repeated once or twice at 20- to
30-min intervals until the patient is calm but awake; we
also favor ________ in closely controlled circumstances
when hyperactivity and hallucinosis are extreme

Answer 43

10 mg of diazepam

midazolam

Question 44

In pts with DT,

Beta-adrenergic-blocking agents, such as _______________, are helpful in reducing heart
rate, blood pressure, and the tremor to some extent.

Answer 44

propranolol,

labetalol, and atenolol

Question 45

In pts with DT,

_______, an alpha2-agonist that blocks autonomic
outflow centrally, and clonidine are similarly effective
in reducing the severity of most of the withdrawal
symptoms,

Answer 45

Lofexidine

Question 46

_________ have no place in the
treatment of the withdrawal syndrome and more potent
agents such as propofol are usually not necessary.

Answer 46

Corticosteroids

Question 47

The term________ i s used widely and often indiscriminately to designate a presumably distinctive form of dementia that is attributable to the chronic, direct effects of alcohol on the brain

Answer 47

alcoholic dementia

Question 48

patients with a fairly pure disorder of memory of
acute onset and that patients with more global symptoms
of intellectual deterioration, of gradual evolution, be
considered to have alcoholic dementia

Answer 48

Korsakoff psychosis

Question 49

young alcoholics with and some without symptoms
of cerebral disease were often found to have enlarged
cerebral ventricles and widened sulci, mainly of the
frontal lobes

Answer 49

Alcoholic cerebral atrophy