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Flashcards in Alcohol Deck (27)
1

What are the 3 drugs for alcohol maintenance and which one is usable for pts w/ liver damage? 

1) Disulfiram

2) Naltrexone

3) Calcium Acetylhomotaurinate - Acomprosate - No Liver Toxicity!!! 

2

What is Physiologic Depenedence? 

State of the body as a result of ongoing exposure to a substance

 

Definitely Present if person displays tolerance or withdrawal but NOT synonymous with addiction 

4

Definitions: 

Tolerance

Withdrawal

Sensitization

Tolerance: The need for increasing amounts of a substance for the same effects

Withdrawal: Problems (physical or psychological) that occur after the cessation of use of a substance were body has tolerance

 

Sensitization: Reverse Tolerance ...increased response to same amount of drug

6

What are the Intoxications you can die from? 

Nicotine, Cocaine, Amphetamine

Benzos, Alcohol, Barbituates

 

Opioids, PCP, Steroids

 

Inhalants and designer drugs 

8

What are the Withdrawals you can die from? 

The "B.A.B."s + O

Alcohol

Barbituates

Benzos 

 

 

Opioids (debiltated and infants) 

10

How is alcohol absorbed? What are factors that alter absorption? 

Rapidly absorbed in GI tract and sometimes even starting in the mouth

Passive Diffusion that is concentration dependent (Rapid at 20-30% and slower above that) 

Depends on stomach content!!!!!

 

Summary of Factors altering absorption:

  • Volume and character of beverage
  • food
  • fat content
  • time course of ingestion
  • individuals
  • H2 Blockers

12

How does alcohol distribute in the body? 

EtOH is highly water soluble and therefore distributes water to all tissues and accumulates in high blood flow organs (THE BRAIN!)

 

Enters Fetal circulation too!!!

 

Alcohol moves to organs w highest water content

14

Describe the metabolism of Ethanol: What are the major enzymes players? What are some factors that cause differences in metabolism? 

Metabolized in liver in 2 big steps controlled by 2 enzymes: 1) Alcohol Dehydrogenase to Acetaldehyde and Aldehyde Dehydrogenase 

 

Gender Differences matter 

- For any given amount, women have higher BAC and slower metabolism

Race and Ethnicity Matters: 

- ADH enzyme variants matter - especially asians!! 

 

SEE PICTURE

16

How is alcohol eliminated? aka what are the pharmacokinetcs? 

Most alcohol elimination is Zero Order elimination until at very low amounts (10mg/dl) where it is First Order 

18

What are the important BACs to know for Alcohol? 

0.02 - mood elevation and slight muscle relaxation; DUI if under 21

 

0.08 - DUI

 

0.5 Death 

 

[amounts are different in tolerant people]

20

What are effects of alcohol intoxication? 

 

What is treatment? 

BEING DRUNK!!! flushing, diuresis, warmth, nystagmus etc

 

Treatment supportive - protect airway, electrolytes, trauma (CHECK HEAD FOR TRAUMA), COFFEE DOESNT CUT IT! 

22

What are the GI effects of Alcohol Intoxication? 

stimulates gastric juices - high acid and low pepsin

Low amounts stimulate GI motility and high amounts depress it 

can cause N/V that is both central and peripheral 

GI IRRITANT 

24

How does taking ASA affect Alcohol absorpiton? 

MORE alcohol is absorbed when also using ASA 

 

ASA inhibits gastric ADH!!!!

 

Both are more likely to cause GI irritation and are local irritants! 

26

What are CV effects of Alcohol? 

Smaller amounts - transient increase in pulse, CO, BP and sub-cutaneous vasodilation

 

Then Hypotension

 

DANGER in cold weather!!!!

 

28

What's the more important factor in Alcohol withdrawal from chronic use? 

Absolute alcohol level is less important compared to the relative decreases in that level which are important bc tolerance changes dependence on BAC

30

What is the staging/symptoms of Chronic alcohol withdrawal? What is the final result and what can kill you? 

Stage 1 - (w/in 24 hours and ablates by 48) - Shakey/tremor, HTN, tachycardia, sweating, N, Hyperactive reflexes, Fever, anxiety, derealization, clowdy sensorium, insomnia, HA --- Hangover

Stage 2 - (w/in 48 hours) more severe Stage 1 symptoms + HALLUCINATIONS - people know that something is weird - mostly auditory and are non-life-threatening

Pts have non-threatening hallucinations but intact reality testing

Stage 3 - (w/in 72 hrs and can last 3-7 days or more!) = Delirium Tremens - Need to prevent it - MORE hallucinations that are visual/tactile/auditory/olfactory and Threatening!!!! 

OR have Seizures - tonic clonic (can be seen up to 1 week later) that are self-limited and can occur depsite normal vital signs 

 

Delirium tremens or Seizures can be lethal

32

What are some criteria that mandate in-patient detox?> 

History of DT or Seizures when stop drinking

dehydration, malnutrition, infection

CV collapse or arrhythmias

Hallucinatoins

Trauma

Hepatic Decompensation

Wernicke's Encephalopathy 

Fever, Tremor, Tachycardia

34

What can you use in the treatment of Alcohol withdrawal? 

Supportive measures

correct fluid imblances

 

Benzos!!! Diazepam for a smoother taper 

(Or barbituates) 

+ Beta-blocker or Anti-convulsants (carbamazepine) so you can use less BZD

36

What is Wernicke? Why is it dangerous? What are some signS? 

Less result of EtOH and more of nutrient deficiency in Thiamine

Can progress to Alcoholic-Induced Persisting Amnestic Disorder - Korsakoff which is irreversible

 

Nystagmus, Lateral Gaze Palsy, Ataxia, Confusion, Diplopia 

38

What are primary diseasesa from chronic alcohol use? 

 

What are secondary diseases from chronic alcohol use? 

Primary - Withdrawal

Cardiomyopathy!!!! Gastritis, Liver cirrhosis, neuropathy

 

Secondary

Cancer, DB, Pancreatitis, Pneumonia/influenza/TB, malnutrition, Respiratory disease 

40

What are some biological markers for chronic heavy drinking? 

LFTs - AST/ALT

GGT!!!!

 

CDT and MCV 

42

What are endocrine effects of chronic alcohol use 

Decreased testosterone in men - loss of secondary sex characteristics leading to impotence and sterility + testitcular atrophy and gynecomastia

Women - disruption of ovarian function

44

What do you see in FAS? 

microcephaly 

Prenatal Growth deficiency

Short, palpebral fissures

46

What are the 3 maintenance treatments for Alcoholism and how do each of them work? 

1) Disulfiram - Blocks Aldehyde Dehydrogenase so build up acid aldehyde ....N/Dizziness/HA/Flushing

2) Naltrexone - Mu Antagonist to decrease reinformcement you get when someone drinks 

3) Calcium Acetylhomotaurinate (Acomprosate/Campral) - NMDA glutamate Rec modulator - decreases cravings and triggers 

48

What are the pros and cons of disulfram?

Pros - makes you feel like shit if you drink on it = Adverse Conditioning

Cons - occasionally can cause heart problems and death if you drink on it

HAVE TO TAKE IT!!!!

 

Side Effects: Drowsiness, lethargy, HTN, peripheral neuropathy

Liver Toxicity!

50

What are the pros and cons of naltrexone? 

Pros - decreases reinforcement you get w/ drinking 

generally well tolerated

Can get long-acting injection! 

Cons - occasional N/ HA sedation or anziety 

 

Rarely - increase in LFT!

52

What are the pros and cons of Calcium Acetylhomotaurinate aka Acomprosate? 

Pros: Decreases cravings by normalizing glutamate levels to help w craving and trigger 

NO LIVER TOXICITY

Cons: FDA WARNING INCREASED SUICIDE AND VIOLENCE

Side Effects: Diarrea and nausea

3x/day dosing