Alcohol

Question 1

Alcoholic pt comes into ER with withdrawal. What to give?

Answer 1

Thiamine and Benzos (Lorazepam).. And dextrose if they’re in a coma (after thiamine of course)

Question 2

What drugs do you give for alcohol dependence?

Answer 2

Disulfiram, Naltrexone, or Acamprosate (modify alcohol metabolism or VTA/NA reward response)

Question 3

What order kinetics is the metabolism of alcohol in the liver?

Answer 3

Zero order (PEA: Phenytoin, Ethanol, Aspirin).. Means that it is metabolized at a constant rate despite the amount in ur system

Question 4

Steps of alcohol metabolism?

Answer 4

EtOH –> acetaldehyde (via alcohol dehydrogenase or MEOS.. both require NAD/NADP) –> acetate (via aldehyde dehydrogenase)

Question 5

Chronic alcoholism induces what?

Answer 5

CYPs

Question 6

What intermediate metabolite of alcohol makes you “feel like shit”.. N/V & skin flushing

Answer 6

Acetaldehyde (aldehyde dehydrogenase gets overwhelmed when you drink too much)

Question 7

What group of ppl have SNPs in aldehyde dehydrogenase?

Answer 7

Asians –> Asian flush

Question 8

Some alcoholics find acetaldehyde build up pleasurable due to?

Answer 8

SNPs (AlDH21/22)

Question 9

This drug blocks acetaldehyde dehydrogenase –> accumulation of acetaldehyde

Answer 9

Disulfuram

Question 10

What drugs have disulfiram effects?

Answer 10

Sulfonylureas, cefotetan, ketoconazole, procarbazine, metronidazole

Question 11

This drug is a mu antagonist –> decreases reward feeling & craving

Answer 11

Naltrexone

Question 12

This drug is a GABAa agonist & weak NMDA antagonist

Answer 12

Acamprosate

Question 13

Why is acetaminophen so toxic for alcoholics?

Answer 13

Alcoholics induce CYP2E1 –> increase NAPQI pathway –> NAPQI is toxic and is eliminated by Mercaptopuric acid (MA) conjugation

• MA gets overwhelmed –> BOOM hepatotoxic
• Give N-acetylcystine (replinishes glutathione by donating sulfhydryl groups)

Question 14

BAL < 50 does what?

Answer 14

Limited muscular coordination

Question 15

BAL 50-100 does what?

Answer 15

Pronounced incoordination

Question 16

BAL 100-150 does what?

Answer 16

Mood & personality changes; intoxication over legal limit

Question 17

BAL 150-400 does what?

Answer 17

N/V, ataxia, amnesia, dysarthria

Question 18

BAL >400 does what?

Answer 18

Coma, respiratory insufficiency, death

Question 19

Other effects not listed?

Answer 19

CV depression, relaxes vascular and uterine smooth muscle (can be used to prevent premie birth)

Question 20

What are the factors affecting BAL?

Answer 20

1. Vd (high weight = low BAL)
2. BMI (high fat = high BAL)
3. Female (high BMI, low Vd, high absorption)
4. EtOH doesn’t go to adipose so more body water = low BAL

Question 21

What are the EtOH receptors?

Answer 21

1. GABA (increased release & receptor density)
2. NMDA (receptors upreg in alcoholics)
3. DA (increased VTA/NA reward)
4. ACTH (increased)
5. Opioid (increased Bendorphin, activate mu)
6. 5HT (increased)
7. Cannabinoid (increased –> modulates DA/GABA/Glutamate)

Question 22

Additive EtOH AEs?

Answer 22

CNS depression, acetominophen toxicity, bleeding w/ NSAIDs, anti-coags, teratogen

Question 23

Liver AEs?

Answer 23

1. Decreased gluconeogenesis
2. Fatty liver
3. Cirrhosis
4. Liver failure
5. HCC

Question 24

GI AEs?

Answer 24

1. Bleeding from portal HTN or retching

2. Nutrient deficiencies

Question 25

CNS AEs?

Answer 25

1. Peripheral neuropathy | 2. Wernicke-Korsakoff (thiamine def --> ataxia, confusion, opthalmoplegia).. mammillary bodies

Question 26

Endocrine AEs?

Answer 26

1. Gynecomastia | 2. Testicular atrophy from decreased steroidogenesis

Question 27

CV AEs?

Answer 27

1. HTN 2. Folate deficiency anemia 3. Dilated cardiomyopathy 4. Arrhythmia (binge drinking) 5. Modest use can increase HDL

Question 28

Immune AEs?

Answer 28

1. Increase inflammation in liver & pancreas 2. Decrease inflammation everywhere else 3. Increased risk of pneumonia

Question 29

Describe the complications of FAS

Answer 29

Alcohol crosses placenta --> increased neuronal apoptosis --> growth retardation, microcephaly, ataxic, flat face, joint anomalies, VSD/ASD

Question 30

Toxicity of ethylene glycol (antifreeze)

Answer 30

Acidosis & nephrotoxicity

Question 31

Toxicity of methanol?

Answer 31

Acidosis & retinal damage

Question 32

Ethylene glycol & methanol are metabolized by?

Answer 32

Alcohol dehydrogenase

Question 33

Tx of ethylene glycol/methanol poisoning?

Answer 33

1. Fomepizole: blocks alcohol dehydrogenase --> allows the ethylene/methanol to be excreted unmetabolized 2. EtOH: competes with the other alcohols