AAD Flashcards
(46 cards)
ALcoholism
chronic disease that when active, results in compulsive, out of control use of alcohol and neg. consequences
DSM 5
in the last yr have you
1. more than once tried to cut down drinking or tried and couldnt
2. spent a lot of time drinking or sick w after effects
3. wanted to drink so badly you couldnt think of anythign else
4. drinking interferes w taking care of home, family, job school
5. continued to drink even though in interfered w fam or friends
6. cut back on activities once important to you
7. more than once got into situation while drinking that inc chances of injury
8. continued to drink even though it was affecting mental health
9. have to drink more and more to get desired effect
10. withdrawal sx
2+ of these sx in past yr–> dx
DSM 5 and AUD severity
2-3 sx mild
4-5 mod
6+ severe
type I alcoholism
develops gradually over lifespan
equally prevalent in men and women
generally less severe health consequences
type II alcoholism
early onset
much more prevalent in men
more severe health consequences
AUD labs for dx
inc MCV
inc GGT
inc AST ALT (ALT x2 = AST)
inc uric acid, TG
ethyl glucuronide and ethyl sulfate
AAD most prevalent in which age group and sex
18-29 males
alcohol inhibits/simulates GABA-DA(inhibitory) and NMDA-glutamate(stimulatory) pathways?
stimulates GABA and inhibits NMDA
with time GABA down regulates and NMDA upregulates which precipitates withdrawal sx
“downreg the inhibitory and upreg the excitatory _ w/drawal = BAD”
alcohol and dopamine system
inc DA in mesolimbic system –> reinforcing and rewarding effects
alcohol and opioid peptide system
activates it
reinforcing and rewarding effects (mu)
craving
alcohol acutelystimulating gaba system causes what
sedative and anxiolytic effects
w drawal
alcohol inhibiting glutamate system causes
neuroadaptation and w drawal
alcohol results in an increase/decrease of DA release in the nucleus accumbens
inc
ethanol pk
lipid sol
non ppb
2 carbon moiety
1st order abs!!
metabolism is ) order (mikhaelis menten, capacity limited/fixed amt drug metab per unit time)
VERY low kM (conc where 50% of metabolism is saturated)
vMax (max amt cleared per hr) unrelated to how much drank
ethanol pk
begins w in 5 min of ingestion
lipids and proteins delay abs
75% abs in small int, 25% stomach
rapid gastric emptying and alcohol graphs
inc rate of gastric emptying–> more to small int–. more abs–> inc peak conc, inc curve sharpness, inc AUC
6 things that slow abs rate
- food in stomach
- carbs and amino acids
- cigarettes
- anticholinergics propantheline (delay gastric emptying)
- trauma, shock, massive blood loss
6 things that inc rate of absorption
- drinking in am after overnight fast
- drinks w higher % etOH
- carbonated drinkfs
- metoclopramide, erythromycin, cisapride (inc gastric emptying)
- low BG
- gut surgery (gastric bypass, gastrectomy)
rank Vd of alcohol, and why
male female obese
obese–> female–> male (highest)
alcohol distributes into TBW and lean, not fat. obese patients have dec TBW, females have more fat than males and a lower Vd compared to a male
who would get the highest BAC on the same beverage, all weigh 160lb
1. obese male who has not eaten all day
2. male who works out regularly and had light lunch
3. male drinking in the morning after no breakfast and going to the gym like he does 5x/week
1
male vs female alcohol dehydrogenase
women have less efficient pre-hepatic alcohol dehydrogenase –> greater bioavailability
inc Vd _______ BAC
(inc fat –> dec TBW) dec Vd –> inc BAC
CNS and chronic AUD effects
addiction
wernicke-korsakoff syndrome (wernicke’s encephalopathy)
cortical atrophy/dementia
hepatic and pancreatic effects of AUD chronic
steatosis, fatty liver
alcohol hepatitis
cirrhosis
pancreatitis
