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Flashcards in Alcohol Deck (42):
1

Ethylene Glycol

• Ethylene glycol used as heat exchangers, in antifreeze formulations, and as industrial solvents.
• Young children are sometimes attracted by the sweet taste of ethylene glycol

2

physical dependence symptoms

-insomnia
-tremor
-seizure
-nausea/vomiting
-diarrhea
-arrhythmia

3

Medical applications of ethanol

1. 10-15g/day increases serum HDL levels
2. delays onset of labor

4

Drug that inhibits ADH

Fomepizole

5

what does ADH do?

converts ethanol to acetaldehyde

6

What enzyme converts acetaldehyde to acetate?

aldehyde dehydrogenase

7

drug that inhibits aldehyde dehydrogenase

disulfiram

8

ethanol facilitates action at which receptors?

GABA-A

9

Ethanol inhibits

the ability of glutamate to activate NMDA receptors

10

acute effects of alcohol

-sedation
-loss of inhibition
-impaired judgment
-slurred speech and ataxia

11

what does aldehyde dehydrogenase do?

converts acetaldehyde to acetate

12

Effects of alcohol on liver

a) reduced gluconeogenesis --> hypoglycemia
b) progresses on to fatty liver, hepatitis, cirrhosis and liver failure

13

fomepizole

inhibits ADH

14

disulfiram

inhibits Aldehyde dehydrogenase

15

effects of ethanol on the GIT

a) inflammation, scarring, and bleeding of the gut wall
b) increased risk of pancreatitis

16

effects of ethanol on the CNS

a) peripheral neuropathies
b) thiamine deficiency can occur (Wernicke-Korsakoff)

17

Effects of ethanol on the endocrine system

a) gynecomastia
b) testicular atrophy

18

Effects of ethanol on the cardiovascular system

1. increased incidence of:
a) HTN
b) anemia
c) dilated cardiomyopathy
2. ingestion of moderate quantities (10-15g/day) raises serum levels of HDL

19

Wernicke-Korsakoff Syndrome

- uncommon
- Characterized by:
a) paralysis of the external eye muscles
b) ataxia
c) confused state

- can progress to coma and death

- associated with thiamine deficiency

- patients suspected of having W-K syndrome should receive thiamine therapy

- ocular symptoms, ataxia, and confusion often improve with thiamine administration

- most patients are left with a chronic disabling MEMORY disorder known as Korsakoff's psychosis

20

Fetal Alcoholic Syndrome (FAS)

➢ Intrauterine growth retardation
➢ Microcephaly
➢ Poor motor coordination
➢ Underdevelopment of the mid-facial region (appearing as a flattened face)
➢ Minor joint anomalities

21

Treatment of Acute Alcohol Intoxication

➢ Supportive Measure:
• Prevent respiratory depression & aspiration pneumonia
• Give fluids and electrolytes

➢ Pharmacological measure:
• Give glucose to treat hypoglycemia and ketosis
• Thiamin (100 mg) is given to protect against Wernike-Korsakoff syndrome
• Prevent seizures, delirium, & arrhythmia
• Restore K, Mg, & Phosphate ions

22

Long-term consequences of Wernicke-Korsakoff syndrome

most patients are left with a chronic disabling MEMORY disorder known as Korsakoff's psychosis

23

Patient presents with: Insomnia, tremor, anxiety, life threatening seizures, visual hallucinations, delirium tremens

symptoms of alcohol withdrawal

24

Patient presents with paralysis of the external eye muscles, ataxia and confused state. History of drinking

Wernicke-Korsakoff syndrome

25

Management of alcohol withdrawal symptoms

a) thiamine
b) restoration of fluid electrolyte balance
c) long-acting sedative-hypnotic drug i.e. BZD (diazepam, chlordiazepoxide)
d) in patients with liver disease Lorazepam or oxazepam are preferred because they don't require hepatic oxidation
e) Intensity of withdrawal effects reduced by clonidine or propranolol

26

Drugs approved to treat alcoholism

a) disulfiram
b) naltrexone
c) acamprosate

27

Ethylene Glycol metabolism

ethylene glycol --(ADH)--> Glycoldehyde --(Aldehyde dehydrogenase)--> Glycol acid--> oxalic acid

28

MOA of the drug used in management of alcohol withdrawal syndrome

Clonidine = alpha 1 blocker

29

Toxic effects of Ethylene Glycol toxicity

• Excitation followed by central nervous system depression.
• After a delay of 4–12 hours, severe metabolic acidosis develops from accumulation of acid metabolites and lactate.
• Finally, delayed renal insufficiency follows deposition of oxalate in renal tubules

30

Drug of choice for management of alcoholic withdrawal in patients with liver disease

Lorazepam or oxazepam

preferred because they don't require hepatic oxidation

31

disulfiram

approved to treat alcoholism
➢ Aldehyde dehydrogenase inhibitor
➢ If a patient on disulfiram consumes ethanol then acetaldehyde accumulates
➢ This leads to nausea,vomiting, headache, flushing & hypotension

32

Other drugs with disulfiram-like effects

• Metronidazole
• Cephalosporins (not all)
• Sulfonylurea hypoglycemic drugs
• Griseofulvin

33

How is methanol metabolized?

methanol-- (ADH)--> formaldehyde --(aldehyde dehydrogenase)--> formic acid

34

used to manage profound metabolic acidosis

bicarbonate

35

naltrexone

opioid antagonist approved to treat alcoholism

36

patient comes in with respiratory failure, a severe anion gap with metabolic acidosis and ocular damage

suspect methanol poisoning

37

Methanol

➢ Constituent of windshield cleaners & “canned heat”
➢ Intoxication includes:
• visual dysfunction, GI distress, Shortness of breath & loss of consciousness
➢ Methanol metabolized to formic acid, which may cause:
• severe acidosis and retinal damage/blindness

38

acamprosate

NMDA antagonist approved to treat alcoholism

39

treatment of methanol poisoning

➢ Gastric lavage
➢ Ethanol is given I.V as it is a preferred substrate for alcohol dehydrogenase
• So methanol is not metabolized to formaldehyde
➢ Fomepizole is given, which is an inhibitor of alcohol dehydrogenase
➢ Rx with bicarbonate (to manage profound metabolic acidosis)
➢ Hemodialysis done in high alcohol levels

40

Symptoms of Methanol intoxication

- visual dysfunction
- GI distress
- Shortness of breath
- loss of consciousness

41

Treatment of Ethylene Glycol Toxicity

• Ethanol
• Fomepizole
• Supportive measures

42

Physiological dependence

deprivation of the drug results in severe anxiety