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Spring Pharm Exam 1 > Alcohol > Flashcards

Flashcards in Alcohol Deck (21)
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1
Q

Ethanol metabolism

A
ADH = <10%, in liver and gut, 7-10g/hr
MEOS = >10%, CYP/p450
2
Q

What is acetylaldehyde?

A

ADH/MEOS breaks ethanol down into it

Build up leads to N/V, headache and hypotension

3
Q

Acute ethanol drug intxns

A

ALDH inhibit by hypoglycemics and Flagyl

Competition at p450 with TCA, H1 antihistamines, narcotics, and benzos leads to CNS depression

4
Q

Chronic alcohol interactions

A

Induction of CYPs increases likelihood of secondary drug metab
Acetaminophen hepatotoxicity even at low dose

5
Q

How do you treat acetaminophen hepatotoxicity?

A

N-acetylcysteine

Neutralizes reactive intermediates

6
Q

How much alcohol is 1% BAC

A

1 g/dL

7
Q

How much alcohol is in a typical drink?

A

15 g ethanol
12 oz beer
4 oz wine
1.5 oz shot

8
Q

Volume of distribution of alcohol

A
Men = 0.7 L/kg
women = 0.63 L/kg
9
Q

Mechanisms of CNS effects

A

Enhance GABA
Inhibit glutamate at NMDA
Chronic: inc synaptic dopamine and endogenous opioids in NA and VTA

10
Q

Metabolic tolerance to alcohol

A

Pharmacokinetic

Induction of MEOS/CYPs leads to more rapid break down of alcohol

11
Q

Functional tolerance to alcohol

A

Pharmacodynamic
Reduction in CNS sensitivity to ethanol d/t changes in neurons
Downreg of GABA, upreg of NMDA

12
Q

Tx of acute intoxication

A

Maintain vitals
Prevent vomit aspiration
IV dextrose
Thiamine

13
Q

Treatment of mild w/d

A
Central clonidine (a2 agonist)
Peripheral propanolol (B antagonist) 
Decrease sympathetic outflow
14
Q

Tx of severe w/d

A

Diazepam and thiamine

15
Q

Disulfiram

A

Alcohol aversion therapy
Inhibits ALDH leading to acetylaldehyde build up upon alcohol consumption
AE: hepatotoxic, resp depression/CV collapse/convulsion if alcohol consumed binge

16
Q

Naltrexone

A

Anti-craving therapy
MOA: inhibits mu opioid receptors in VTA to reduce rewarding effects
AE: hepatotoxic at high dose
WILL CAUSE SEVERE W/D IN OPIOID USERS

17
Q

Acamprosate/topiramate

A

Anti-craving
Inc GABA, inhib glutamate
Combined with disulfiram is more effective

18
Q

Why should you do the nalaxone challenge before admin naltrexone?

A

Nalaxone is a short acting antagonist - will cause w/d effects that are less severe than if you give naltrexone to an opioid abuser

19
Q

Toxic effects of methanol

A

Acidosis

Retinal damage

20
Q

Toxic effects of ethylene glycol

A

Acidosis

Nephrotoxicity –> oxalate crystals

21
Q

Tx for methanol or ethylene glycol poisoning

A

Ethanol or fomepizole
Bind to ADH which prevents metab of toxics
Bicarb, hemodialysis