Alcohol

Question 1

Ethanol: Behavior Effects

Answer 1

Sedative Hypnotic/CNS Depressant

Question 2

Ethanol: Absorption

Answer 2

Rapid and distributes to all tissues (placental included). Slowed by previous food intake

Question 3

Explain the Metabolism of Ethanol

Answer 3

Alcohol is metabolized by alcohol dehydrogenase (ADH) at levels <0.1%
Microsomal Ethanol Oxidizing System metabolizes at blood ethanol levels above 0.1%

Question 4

What BAC level is considered the “danger zone”?

Answer 4

100-200 mg/dL
This is the level of social dysfunction (Excitement, decreased inhibitions, impaired motor function, slurred speech, ataxia)

Question 5

EtOH Major Actions in CNS

Answer 5

Sedative effects

1. Enhances the affinity for GABA at its receptor. Remember GABA is inhibitory
2. Inhibit glutamate activation of glutamatergic NMDA receptors.

Question 6

Additional EtOH effects in the CNS

Answer 6

1. Chronic uses increases the synaptic concentrations of dopamine, serotonin, and endogenous opioids in nucleus accumbens and the VTA
2. Enhances calcium-activated, voltage gated BK potassium channels

Question 7

Treatment for Acute Intoxication

Answer 7

Maintain VS and prevent aspiration

Give “Banana Bag” and IV dextrose if Wernicke-Korsakoff is suspected

Question 8

The Mechanism of Disulfiram

Answer 8

Inhibits acetaldehyde dehydrogenase, causing a buildup of acetaldehyde.
Acetaldehyde leasd to nausea, vomiting, headache, and hypotension.

Question 9

Mechanism of Clonidine, Propanolol

Answer 9

1. Clonidine activates alpha2 adrenergic receptors in CNS to decrease sympathetic outflow
2. Propanolol blocks beta adrenergic receptors in CNS to decrease sympathetic outflow

Question 10

Therapeutic Use of Clonidine, Propanolol

Answer 10

Used to treat mild alcohol withdrawal symptoms (anxiety, insomnia, tremors, muscle aches, sweating, cramping, arrhythmias)

Question 11

Clinical Use of Diazepam

Answer 11

Severe alcohol withdrawal syndrome leading to convulsion

Question 12

Mechanism of Action of Diazepam

Answer 12

Activates GABA-A receptors in CNS. Benzos act by increasing affinity of endogenous GABA to GABA-A receptor

Question 13

Naltrexone: MOA

Answer 13

Inhibits mu opioid receptors in the VTA

This is anti-craving therapy used to prevent relapse in recovering alcoholics

Question 14

Topiramate: MOA and Indication

Answer 14

MOA: enhances GABA-A receptor activity and inhibits excitatory glutamatergic receptor activity
Indication: anti-craving medication NOT for withdrawal symptoms

Question 15

Fomepizole: Indication

Answer 15

Used for methanol and ethylene glycol poisioning

Question 16

Fomepizole: MOA

Answer 16

Binds with ADH to prevent to metabolism of methanol and ethylene glycol to toxic metabolites

Question 17

N-acetylcysteine (NAC)

Answer 17

Used to treat chronic alcoholics suspected of acetaminophen poisoning

Question 18

Clinical Use of Naloxone

Answer 18

Suspect recovering alcoholic is abusing opioids; perform Narcan challenge test prior to treatment with naltrexone

Question 19

Naloxone: MOA

Answer 19

Inhibits mu opiod receptors in VTA

Question 20

Two Kinds of Tolerance

Answer 20

1. Metabolic tolerance (pharmacokinetic)- induction of MEOS enzymes
2. Functional tolerance (pharmacodynamic)- reduction of CNS sensitivity to ethanol due to adaptive changes in neurons

Question 21

What BAC level is associated with respiratory depression and death?

Answer 21

> 500 mg/dL

Question 22

How long does it take for ADH to metabolize a single drink (15 g ethanol)

Answer 22

1.5-2 hours

Question 23

Liver Effects of Ethanol

Answer 23

Decreased gluconeogenesis, hypoglycemia, NAD depletion, fatty accumulation in the liver. Eventual hepatitis and cirrhosis

Question 24

GI Effects of Ethanol

Answer 24

Inflammation, bleeding, scarring –> eventual absorption deficits

Question 25

Endocrine Effects of Ethanol

Answer 25

Altered steroid metabolism (gynecomastia, testicular atrophy, salt retention)

Question 26

Cardiovascular Effects of Ethanol

Answer 26

Anemia, Hypertension, Ventricular hypertrophy (increased risk for MI)

Question 27

Neoplasia and Ethanol

Answer 27

Increased incidence of esophageal, mouth, breast, ovarian and colorectal cancer

Question 28

Nervous System Effects of Ethanol

Answer 28

Peripheral Neuropathy

Question 29

Wernicke-Korsakoff Syndrome

Answer 29

Associated with thiamine deficiency resulting in encephalopathy Symptoms: ataxia, confusion, paralysis of extraocular muscles, memory loss; can progress to coma and death

Question 30

Fetal Alcohol Syndrome

Answer 30

Intellectual disability, growth deficiencies, microcephaly, underdevelopment of the mid-face region

Question 31

Alcohol Withdrawal Syndrome

Answer 31

Mild: anxiety, insomnia, tremors, agitation, muscle aches, sweating, cramping, N/V/D, arrhythmias Severe: hallucinations, DTs, and seizures