Alcohol Flashcards
(203 cards)
1
Q
what is methanol metabolised into
A
formaldehyde then formic acid
2
Q
what can acidosis from methanol poisoning cause
A
blindness
3
Q
how do you treat methanol toxicity
A
alcohol +/- dialysis
4
Q
how does alcohol treat methanol toxicity
A
competitive inhibition- both metabolised by alcohol dehydrogenase
5
Q
how many units a week
A
14
6
Q
where is alcohol mostly absorbed and what is it soluble in
A
the small bowel, water
7
Q
what is ethanol metabolised by
A
alcohol dehydrogenase
8
Q
what can delay alcohol gastric emptying
A
eating, spirits irritate gastric mucosa and delay emptying
9
Q
what can speed up gastric emptying
A
antihistamines and metoclopramide
10
Q
what type of alcohol is absorbed faster
A
20-30% aerated
11
Q
what is a common sign of alcohol withdrawal
A
seeing spiders
12
Q
why do men have higher tolerances
A
as women have more adipose tissue, alcohol is distributed in fat free mass. women also have less alcohol dehydrogenase
13
Q
what is ethanol metabolised to
A
acetaldehyde and then aldehyde dehydrogenase then CO2 and h20
14
Q
what causes hangover
A
acetaldehyde
15
Q
where does alcohol metabolism occur
A
90% in the liver, small volume in the pancreas and brain
16
Q
at what rate is alcohol removed from the body
A
15mg/100ml/hour, one unit per hour, conc decreases linearly
17
Q
when is alcohol conc at its highest
A
60 mins after consumption
18
Q
why do some ethnic groups have lower tolerance
A
lower levels of dehydrogenase
19
Q
what is antabase
A
drug which makes drinking unpleasant, inhibits aldehyde dehydrogenase
20
Q
what is acetaldehyde metabolised
A
aldehyde dehydrogenase
21
Q
how do you increase your alcohol tolerance
A
increase alcohol dehydrogenase activity, analgous and alternative pathways activated: MEOS pathway, induction og CP450
22
Q
what are the consequences of activating alternative pathways in alcohol metabolism
A
MEOS pathway- increased production of hydrogen ions which are removed via the krebs cycle, switch to anaerobic metabolism which produces lactic acid faster, inhibits citric acid cycle and hepatic gluconeogenesis
23
Q
what happens to hepatic gluconeogenesis with alcohol
A
is inhibited, get hypoglyceamic, hungry
24
Q
what happens to fatty acid oxidation with alcohol
A
impaired- excess ketogenesis and lipid synthesis- makes you fat
25
what is alcoholic ketoacidosis
no gluconeogenesis, impaired fatty acid oxidation, makes ketones instead, excess NADH
26
compare diabetic and alcohol ketoacidosis
diabetic- hyperglycaemia, high ketones
alcoholic- hypoglycaemia, high ketones
27
how does alcohol act as a depressant
increases levels of GABBA- inhibitor of neurotransmitters
28
affects of alcohol via the cortex
dis-inhibition, talkative, anxiolytic
29
affects of alcohol via the limbic system
memory loss, confusion, disorientation
30
affects of alcohol via the cerebellum
loss of muscular coordination, slurred speech
31
affects of alcohol via the reticular formation (upper brain stem)
consciousness
32
affects of alcohol via the lower brain stem
breathing and blood pressure
33
what are signs of high alcohol blood content
stupor, difficult to rouse, loud snoring
34
what happens to ADH when drinking
inhibited
35
why do you get a heavy heartbeat when hungover
alcohol is a negative inotrope
36
describe holiday heart syndrome
binge drinking- healthy heart, supra-ventricular tachycardia, spontaneous resolution
37
why do you get a headache
dehydration and acetic acid
38
describe the symptoms of mild alcohol withdrawal and their onset
(12-13 hrs from last drink) fine tremor, sweating, anxiety, hyperactivity, increased HR and/or BP, fever, anorexia, nausea, retching
39
describe the symptoms of moderate alcohol withdrawal and their onset
(12 hrs - 5 days) coarse tremor, shaking, agitation, confusion, disorientation, paranoia, seizures (especially 24-48 hours), hallucination
40
describe the symptoms of severe alcohol withdrawal and their onset
(12 hrs to 5 days) severe agitation, confusion, delusions, hallucinations, circulatory collapse, death
41
how is alcohol withdrawal treated
diazepam
42
how is the dosage of diazepam decided
regular symptom assessment
43
what does alcohol cause the release of from the reward centres of the brain
dopamine and serotonin
44
what types of seizure are associated with alcohol consumption
alcohol withdrawal can cause seizures
can cause epileptic seizures in susceptible individuals
45
how does alcohol affect nerves and muscles long term
peripheral neuropathy, compression neuropathy, myopathy,
46
what does peripheral neuropathy feel like and how is it caused by alcohol
'glove and stocking' burning pain and weakness
direct damage to peripheral nerves, nutritional deficiencies (thiamine)
47
what is compression neuropathy and what causes it
temporary damage to myelin sheath- radial nerve compression at humeral head
48
describe acute myopathy after binges
myalgia, proximal weakness, swollen tender muscles, raised CK
49
how long does acute myopathy take to recover
weeks to months
50
describe chronic myopathy
develops over weeks to months, painless, proximal weakness and atrophy, normal CK, low K, PO4
51
define wernickes encephalopathy
thiamine deficiency and cytotoxic oedema in mamillary bodies
52
what are the symptoms of wernicke encephalopathy
ocular dysfunction, ataxic gait, acute confusion
53
how is WE syndrome treated
thiamine replacement
54
what happens if WE syndrome isn't resolved
develops into korsakoffs syndrome
55
define korsakoffs syndrome
cerebral atrophy resulting from WE
56
what are the symptoms of korsakoff syndrome
loss of shirt term memory, episodic memory, confabulation, lack insight
57
how is korsakoff syndrome treated
abstinence and nutrition, chances of recovery low
58
what other brain problems can alcohol cause
dementia, storke (haemorrhagic), depression, head injury, cerebellar disease
59
describe the relationship between alcohol and cardiovascular mortality
j shaped curve
60
how does excessive drinking over a long period cause cardiomyopathy
alcohol impairs ventricular function (calcium homeostasis), mitochondrial effects, signal transduction). prolonged exposure leads to chronic inflammation/ fibrosis of myofibrils muscle fibres)
61
what acute arrhythmias can be cause by alcohol
AF, SVT 'holiday heart'
62
what chronic arrhythmias can be caused by alcohol
long QT- electrolyte imbalance
atrial and ventricular arrhythmias due to dilated cardiomyopathy
63
how old are the majority of people who die from alcohol liver disease
<60
64
describe the simple pathological process of cirrhosis
regular heavy drinking- fat accumulation in hepatocytes- inflammation- fibrosis- cirrhosis
65
does alcohol related steatosis reverse with cessation
yes
66
what happens to hepatocytes in alcohol related steatosis
swell with triglycerides
67
is alcohol related hepatitis acute or chronic
acute
68
describe the pathology of alcohol related hepatitis
parenchymal inflammation and hepatocyte damage
69
what conditions are associated with alcohol related hepatitis
jaundice, coagulopathy, liver failure
70
what are people with alcohol related hepatitis at high risk of
renal failure, bleeding, infections (if severe mortality <50%)
71
how do you treat alcohol related hepatitis
abstinence, nutrition
72
what is associated with portal hypertension
variceal bleeding, ascites, spontaneous bacterial peritonitis, hepatic encephalopathy,
73
what is the process leading to hepatic encephalopathy
portosystemic shunting through collaterals, failure to clear toxins/ ammonia from blood, crosses blood brain barrier
74
what is the treatment for ecephalopathy
lactulose and rifampicin
75
treatments for alcohol related cirrhosis
abstinence, vitamins, nutritionm endoscopic, beta blockers, radiological (TIPPS), transplant
76
why does alcohol cause cancer
Alcohol -> acetaldehyde (carcinogenic) -> acetate
Most alcohol -> acetaldehyde by ADH in liver
As alcohol increases, less metabolised on first pass through liver, and circulating alcohol then metabolised by ADH at other sites eg oral mucosa. Acetaldehyde unable to be converted to acetate at these sites due to absence of AlDH
is a soovent, makes it easier for carcinogens to enter cells
deficiencies in essential nutrients
77
why (theory) does alcohol increase risk of breast cancer
as increases oestrogen levels (post- menopausal women)
78
what are the pharmacological interventions for alcohol missuse
acamprosate- reduces cravings
naltrexone- reduces desire for alcohol
disulfiram- aversion drug therapy
nalmefene- opioid antagonist
79
how is alcohol excreted
lungs, sweat and urine
80
where is the primary metabolism site of alcohol
liver
81
how is alcohol removed from the blood
oxidation process
82
eating slows absoption of alcohol, how does this decrease drunkness
as increases first pass metabolism in the liver, less reaches systemic circulation
83
how many calories in 1g of alcohol
7kcal
84
how does alcohol increase risks of deficiencies
replaces food/ alters appetite
decreases secretion of pancreatic enzymes and bile
damages cells lining stomach and intestines limiting absorption
ethanol metabolism relies of thiamine
decreased liver stores of vitamins
85
what is vitamin B1, describe it and where its found
thiamine- water soluble essential nutrient found in e.g cereals, beans, nuts, yeast and meat
86
what is thiamine important for
ATP production, normal nerve conduction and maintenance of neural membranes
87
why do thiamine levels get low in alcoholism
poor intake,
decreases phosphorylation in the gut to active co enzyme,
reduced storage in fatty liver,
inhibited intestinal absorption,
increased metabolic demand (needed for ethanol metabolism)
88
what are the three clinical thiamine deficiency signs
dry beriberi, wet beri beri, wernicke-korsakoff syndrome
89
describe dry beriberi
nervous system- polyneuropathy, weakness, numbness, paralysis- usually in lower limbs
90
what is wet beriberi
CV system- increased HR, SOB, high cardiac output failure
91
what is ataxia
inability to coordinate voluntary movements
92
what vitamin deficiencies are associated with alcoholism
thiamine (B1)
water soluble vits (B+C)= folate and B12, niacin
fat soluble vits (A,DE,K)- vit a
minerals- increased urinary excretion of Ca- osteoporosis
93
what does a folate and B12 deficiency result in
megaloblastic anaemia
94
what is niacin
pellagra- diarrhoea, dermatitis, dementia, and death
95
what vitamin deficiency causes night blindness
vit a
96
what cancers can be caused by alcohol
breast, bowel, liver, mouth/ throat, oesophageal and stomach
97
describe foetal alcohol syndrome
physical (abnormal appearance, stunting, low body weight and head size, poor coordination)
mental (low intelligence, learning difficulties)
sight and hearing problems
98
what type of bonds does alcohol form
hydrogen- low affinity as only one hydrogen donor/ acceptor
99
blood goes hypotonic when drinking alcohol, why don't red blood cells swell
as alcohol gets into the cytoplasm
100
how does alcohol act as a depressant on a cellular level
enhancement of inhibitory enhancement of inhibitory neurotransmission or depression of excitatory transmission
enhancement of neuronal membrane conductances leading to hyperpolarisaton
101
name the two important receptors that alcohol affects and whether they inhibit or excite neurotransmission
glycine and GABAa receptors (inhibitory)
subtypes of glutamate receptor (excitatory)
102
explain excitatory and inhibitory neurotransmitters and alcohol
alcohol potentiates inhibitory neurotransmission by GABA (y-aminobutyric acid) or glycine
and
inhibits excitatory neurotransmission by glutamate
103
what mediates fast excitatory and inhibitory neurotransmission in the CNS
ligand gated ion channels
104
what receptor family does glycine and GABAa belong to
cys-loop family
105
what is the main inhibitory neurotransmitter in the CNS
GABA
106
where does GABA and glutamate act
ionotropic receptors
G protein coupled receptors
107
which ionotropic glutamate receptor is sensitive to alcohol
NMDA
108
what is the main excitatory neurotransmitter in the CNS
glutamate
109
summaries alcohols affect on GABA and glutamate
simultaneous enhancement of GABAergic inhibitory neurotransmission and a suppression of excitatory glutamateric transmission leading to overall CNS depression
110
what is the reward system of the brain (activated by alcohol and most drugs)
mesolimbic dopaminergic pathway
111
how do drugs cause dependence via the reward system- which method does alcohol use
exciting ventral tegmental area neurones stimulating the release dopamine which inhibits neurones in the nucleaus accumbens
enhancing release of dopamine from the ventral tegmental area neurone terminals or preventing its reuptake
inhibiting nucleus accumbens neurones (how alcohol does it)
112
describe the neuroadaption that causes the symptoms of alcohol withdrawal
to compensate for CNS depression (after prolonged usage of alcohol) NMDA receptor expression is upregulated in the brain and GABAa receptors are down regulated
during alcohol withdrawal there is an imbalance between excitatory (upregulated) and inhibitory (downregulated) influences- anxiety, dysphoria, seizures
113
how long must a pattern of use that is causing damage physical or mental health persist for until it is classified harmful use
for a least 1 month or occurred repeatedly
114
name the criteria for dependence syndrome (3 or more= diagnosis)
strong desire or compulsions
difficulties in controlling use
persistent use despite clear evidence of harm
preoccupation with substance use
increased tolerance
psychological withdrawal state (many forms)
115
what are the components needed to treat alcohol dependence
medical treatment, psychology of change, social context
116
what supportive treatments should be gives for alcohol dependence
oral thiamine for low risk
IM/IV pabrinex for high risk
nutrition, hydration, anti emetics, anti- diarrhoeals
117
what are the complications of alcohol dependence
withdrawals (4-12hrs), withdrawal seizures (60%) *30-40% progress to status epilepticus), delirium tremens (3-10 days), wernicke-korsakoff syndrome
118
what is the main characteristic of korsakoff
confabulation
119
what drug to support after seizures
diazepam
120
what is delirium tremens
severe from of withdrawal that includes sudden and severe mental and/or nervous system changes A MEDICAL EMERGENCY
121
what are the symptoms of deririum tremens
confusion, hallucinations, autonomic hyperactivity, tachycardia, sweating, HTN, pyrexia, tremors, seizures
122
when does delirium tremens occur
72-96 hrs after last drink
123
how do you manage delirium tremens
inpatient detox, benzodiazepine (to prevent seizures), pabrinex (vitamin injection), anticonvulsants, antipsychotics, antiemetics, fluids
124
what are the triad of symptoms of wernickes encephalopathy
ophtalmoplegia (eye paralysis), ataxia (lack of voluntary coordination), confusion
125
what does alcohol and BZD cause
ataxia and nystagmus (involuntary eye movement)
126
what medications can be used to prevent relapsing
acamprosate and naltrexone (1st line)
disulfiram 2nd line
127
what does disulfiram do
makes patient suffer allergy like symptoms when they drink
128
what psychological programme is used to prevent relapsing
12 step programme AA, trauma focused therapies, brief interventions
129
what is the minimum pricing
50p per unit of alcohol
130
where does aspiration pneumonia typically occur
superior segment of the right lower lobe
131
which of these microscopic features is not present within a portal tract; artery, vein, hepatocyte, lymphocyte, bile ducts
hepatocyte
132
why does alcohol cause diuresis
decreased ADH levels
133
jaundice as a result of alcoholic hepatitis is caused by an accumulation of what
conjugated bilirubin
134
is hyperbilirubinaemia (resulting in clinical jaundice) associated with alcoholic liver disease
yes
135
facial flushing and a generl feeling on being unwell is caused by what
aldehyde
136
name a drug that increases the rate of alcohol absorption
domperidone (anti emetic)
137
what cell type mediates fibrosis cirrhosis of the liver
hepatic stellate cells / interstitial cells of ito
138
what is a patient with normal GGT, AST and ALT but raised Alk Phos most likely to have
bone disease
139
what syndrome is severe hepatitis associated with
hepatorenal syndrome
140
which of the following of signs is not associated with acute pancreatitis;
caput medusa, grey turners sign, cullens sign, renal failure, resp failure
renal failure
141
true or false; ethanol is sometimes used to treat patients with a raised osmolal gap
true
142
what causes dupuytrens contracture
scarring of the palmar fascia
143
what is portal hypertension associated with: splenomegaly, +ve courvoisier's sign, +ve murphys sign, hepatomegaly, cullens sign
splenomegaly
144
name a medication used for medically assisted alcohol withdrawal
chlordiazepoxide
145
what biochem test can be used to assess perfusion in a severe upper GI bleeding
lactate
146
what does alcohol do to the precipitation of uric acid
increases it
147
what embryological remnant forms the falciform ligament
umbilical vein
148
what is the timescale for delerium tremens
3-10 days
149
which clotting factor is not made in the liver
8
150
what borders hepatocytes
the spaces of disse
151
where is haemoglobin broken down
the liver and spleen
152
haemoglobin is broken down in to haem and globin, what is haem then broken down into
iron and biliverdin
153
what breaks down haem into iron and biliverdin
oxygenase
154
what then breaks down biliverdin into what
reductase
unconjugated bilirubin
155
how is unconjugated bilirubin transported to the liver
with albumin (not water soluble)
156
how and where is bilirubin conjugated
at the liver by glucuronyl transferase
157
what is bilirubin conjugated with
glucuronic acid
158
what does conjugated bilirubin do
goes into gall bladder to make bile salts
159
why is bile needed
excretion of; lipophilic toxins, bilirubin, cholesterol
immune function IgA
emulsify dietary fat
160
what enzyme do statins target
Hmg-CoA reductase
161
what does HmG-CoA reductase do
rate controlling enzyme for pathway controlling production of cholesterol
162
what happens to bile after it leaves gall bladder
converted to urobilinogen and stercobilinogen and finally stercobilin
10-15% reabsorbed by enterohepatic circulation
163
what does AST stand does
asparate transaminase (aminotransferase)
164
what is AST an imprtant part of
amino acid metabolism
165
what does ALT stand for
alanine aminotransferase
166
ALK raised in isolation would most likely be what
bone disease
167
what does raised ALP and GGT suggest
biliary disease- obstructive post hepatic jaundice
168
what does raised AST but not ALT suggest
liver damage
169
what does raised GGT and abnormal AST and ALT suggest
alcohol
170
what are biological markers of chronic alcohol consumption
Gamma GT
MCV (mean corpuscular volume)
triglycerides raised (increased synthesis in the liver)
171
what is the osmolal gap and how does it show if a patient had ingested alcohol
a difference between measured (inc. dissolved solutes in blood) and calculated serum (electrolytes) osmolarity
solutes contribute to osmolarity
172
what is ALT a marker of
liver damage
173
where is ALP found
liver, bone, small intestine, kidneys, placenta
174
where is gamma GT found
liver (cell membranes of bile ducts), kidneys, pancreas, prostate
175
what does albumin show in relation to alcohol
albumin falls in the systemic inflammatory response- capillary permeability associated with inflammation causes redistribution
176
what is better than albumin at showing liver synthesis
prothrombin ratio
177
what does prothrombin ratio show
clotting factors synthesised in the liver - liver synthesis and patients bleeding tendency
178
what are the differential diagnosis of abdominal pain in patient with alcohol issues
acute pancreatitis, alchoholic hepatitis, peptic ulceration +/- perforation, ascites +/- peritonitis
179
what investigations should be done for abdominal pain in patient with alcohol issues
amylase, liver function tests, ascitic fluid analysis
180
what are the differential diagnosis of vomiting in apatient with alcohol issues
acute gastritis, oesophageal stricture, pyloric stenosis
181
how do you check to severity of vomiting in a patient with alcohol issues
U&E, ABG, LFT, Amylase
182
does acid increase or decrease hydrogen ions in the gut
increases
183
does alcohol increase the hydrogen ion and CO2 concentration of the blood
increase CO2
| decrease H+
184
what are the differentials in a patient with haematemesis and alcohol issues
acute gastritis, mallory-weiss tear, peptic ulceration +/- perforation, oesophageal varices
185
what investigations should be done in a patient with haematemesis and alcohol issues
prothrombin ration, LFTs
186
what signs show acute drinker
osmolality/ osmolal gap
187
what tests should be done into a GI bleed
U&E, LFT, PTR, lactate
188
what in relation to alcohol activated GGT
The mechanism by which alcohol is converted to aldehyde by alcohol dehydrogenase induces GGT
189
does MCV increase or decrease with chronic drinking
decreases
190
what can be used to treat hyponutremia
aldosterone antagonst e.g. spironolactone
191
what ions will be low after excessive vomiting
sodium and potassium
192
which LFT can reflect enzyme induction
GGT (very sensitive)
193
how do triglycride levels change in the blood with chronic alcohol consumption
increase in the blood due to increased triglyceride synthesis in the liver
194
metabolic acidosis is harder to compensate in pateints with what
pyloric stenosis- hydrogen ions cannot re-enter stomach from small intestines
195
what does serum osmolarity measure
the amount of solutes in the fluid portion of the blood
196
what happens to lipid solubility and intoxicating potential as alcohol chain length increases
lipid solubility increases
intoxicating potential increases up to chain length of 6 then after 8 decreases
197
what are cys-loop receptors comprised of
a pentamer of subunits with 3 functional nodules; the extracellular, transmembrane and intracellular domains
198
which functional nodule of the cys loop receptor contains an allosteric binding site which can accomodate alcohol and general anaesthetics
transmembrane
199
what does the extracellular component of a cysloop do
provides a binding site for neurotransmitter and competitive antagonists
200
what does the intracellular component of the cysloop do
interacts with the cytoskeleton and harbours sites for channel regulation by phosphorylation
201
does alcohol mix best with water or organic solvents
mixes with both equally well
202
why are alcohols longer than 8 less intoxicating
as physically dont fit into sites
203
what type of receptors are GABBA A
ligand gated cys loop receptors
