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CLASP Y2 JC > Alcohol > Flashcards

Alcohol Flashcards

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1
Q

What is the treatment for methanol poisoning?

A

Give regular alcohol and dialysis as it is a competitive inhibitor working on alcohol dehydrogenase to avoid making formic acid.

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2
Q

What is the weekly recommended limit for alcohol

A

14 units

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3
Q

What is the main absorption site for alcohol? Why?

A

Small bowel due to alcohol dehydrogenase present in high quantities

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4
Q

What are some of the ways to delay the effects of alcohol? Why?

A

Eating food, as it delays gastric emptying into the bowel

Drinking shots as it irritates the gastric mucosa so delays emptying

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5
Q

What are some of the ways to increase alcohol absorption/ get drunk quickest

A

Antihistamines/metaclopramide increse gastric emptying
Champagne, sherries, mixing so less irritating to gastric mucosa
Drinking on empty stomach
20-30% alcohol best absorption

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6
Q

Name the two enzymes that catalyse the reaction of

alcohol (1)->acetaldehyde (2)-> acetate +co2 + H20

A

1- alcohol dehydrogenase

2- aldehyde dehydrogenase

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7
Q

What metabolite of alcohol metabolism causes hangovers effects?

A

Acetaldehyde

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8
Q

Where is acetaldehyde mainly metabolised? And at what rate is it eliminated

A

Liver main
Pancreas little

Generally 1 unit an hour

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9
Q

By what mechanisms is tolerance increased for alcohol?

A

Induction of CP450 pathway (electron transport chain)

Microsomal enzyme oxidase system (MEOS) that upregulates alcohol dehydrogenase

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10
Q

What are some of the consequences of the MEOS system?

A

Inhibits the krebs cycle so low energy and build up of H+ ions causing lactic acid build up
Inhibits hepatic gluconeogenesis
Fatty acid oxidation impaired so increased ketogenesis, lipid synthesis

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11
Q

Treatments for alcohol abusers?how work?

A

Antabuse medication- inhibits aldehyde dehydrogenase so acetaldehyde accumulates making hangovers horrendous and effects worse. Works as a deterrent

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12
Q

Name some of the structures in the CNS that are affected by alcohol

A 
Reticular formation
Cerebellum 
Limbic system 
Lower brain stem 
Cortex
Pituitary gland producing ADH
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13
Q

Effects of alcohol on the function of the cortex in the CNS?

A

Disinhibition (lack of restraint for social conventions)
Talkativenesss
Anxiolytic (reducing anxiety)

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14
Q

Effects of alcohol on the function of the limbic system in the CNS?

A

Memory loss, confusion, disorientation

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15
Q

Describe the events how alcohol makes you pee more

A

Inhibits ADH that causes water reabsorption in the kidneys and so concentrates urine

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16
Q

What is holiday heart syndrome

A

Supraventricular tachycardia due to excess alcohol/ food

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17
Q

What is veisalgia cephalgia?

A

Headaches

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18
Q

What would the results of LFTs in alcoholic steatosis(hepatitis)

A

Increase in ALT, AST and GGT
NOT ALP
Decrease in albumin

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19
Q

What are some common risk factors for chronic pancreatitis?

A

Alcohol
Idiopathic
Gallstones

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20
Q

Child presents with neurological symptoms, keiser flesher rings and there is copper deposits in his pancreas. Diagnosis?

A

Wilsons disease

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21
Q

Man presents with fatigue, weight loss, erectile dysfunction, joint pain. Blood tests taken and pearl stain is positive. Diagnosis? Treatment>

A

Haemochromatosis

Venosection

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22
Q

Name some common signs of chronic alcoholism on general exam

A 
Palmar erythema (due to increased oestrogen from liver cirrhosis)
Duputrens contracture
Caput medusae (from portal hypertension from liver cirrhosis)
Spider naevi (same as above)
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23
Q

What is the cause of dupuytrens contracture? What other conditions is it indicitive of?

A

Fibrosis of the palmar fascia

Anti-epileptic meds, diabetics

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24
Q

What are some of the consequences of thiamine deficiency ?

A

Maintains peripheral and autonomic nerves SO can get

  • lost sensation in arms/legs
  • wernicke-korsakoffs syndrome (confusion, shaky gait, odd eye movements, disorientation)
  • wet beri beri syndrome (leading to cardiomyopathy)
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25
What is wenicke-korsakoffs syndrome?
Due to lack of thiamine there is a shaky gait, ophthalmoplegia (paralysed muscles of eye), confusion, disorientation, memory loss Lack of thiamine due to poor nutrition in alcoholics
26
Man presents with aspiration pneumonia, what most likely lobe would be affected
Inferior right lobe due to branch bring vertical
27
What is wet beri beri syndrome?
Affects the cardiovascular system due to lack of thiamine, causing heart failure, weakened capillary walls
28
Man presents with chronic alcoholism, breathlessness, peripheral oedema, and on examination high HR and JVP. Diagnosis?
Dilated cardiomyopathy secondary to wet beriberi from low thiamine
29
What are the mechanisms causing fatty liver disease
More free fatty acids taken to the liver NAD converted to NADG by alcohol allowing lipid synthesis Mitochondrial oxidation of the fatty acids reduced Reduced cell tubulin so decreased fat transport out of hepatocytes
30
Man presents with fever, yellowing, pain in RUQ. He also says he has been on a bender for the last month. Likely Diagnosis?
Alcoholic staetohepatitis Occuring after excessive alcoholism from 3-4 weeks.
31
Diabetic becomes hypoglycaemic in the night after a night of drinking. Why?
Alcohol inhibits glucose production from glycogen in the liver
32
What would you expect to find on examination with someone suffering chronic alcoholism?
``` Signs of portal hypertension (caput medusae, spidernaevi, splenomegaly) Dupuytrens contracture Palmar erythema Signs of memory loss Foot/wrist drop (thiamine deficiency) ```
33
What is boerhaave syndrome
Transmural perforation of the oesophagus mainly after a vomiting episode/ sudden increase in intraoesophageal pressure. Different from mallory-weiss tear which is non-transmural
34
Man presents with LUQ pain, floating stools, nausea/vomiting, weight loss and fatigue. He is a chronic drinker. Likely diagnosis?
Chronic pancreatitis
35
Man presents with fine tremor, sweating, anxiety, fever, retching. He is a mild chronic alcoholic how long ago was his last drink aprox?
12-36 hours
36
What are some of the symptoms of a moderate dependency alcoholic 12-5 days without alcohol?
``` SEIZURES Coarse tremor Shaking agitation Confusion Disorientation Paranoia Hallucinations ```
37
What are some of the symptoms of a severe dependecy alcoholic with withrawl 12-7days ?
``` Severe agitation Anxiety High risk of delerium tremens (DTs) Confusion Hallucinations ```
38
What is the treatment for the withdrawl of alcohol symptoms?
Diazepam From 2mg if scoring 2+ on alcohol withdrawl protocol
39
After night of binging, a man wakes with reduced function of his arm. What is this condition known as? How does it occur
Compression neuropathy due to radial nerve compression from the humeral head
40
How much alcohol does someone have to consume to be likely to get alcoholic cardiomyopathy ?
8-9 units a day for 5+years
41
Alcohol contributes to breast cancer T/F
True
42
Alcohol contributers to oral, pharyngeal and laryngeal cancers T/F?
True
43
Alcohol contributes to colorectal T/F?
True
44
Alcohol contributes to kidney cancer T/F?
False
45
Name some drugs used to treat hepatic encephalopathy
Lactulose | Ridaximin
46
Name some drugs used to reduce craving for alcohol by blocking receptors in the brain
Acamprostate Naltrexone Nalmefene
47
Name some drugs used to create an acute response to alcohol. How do they work
Disulfiram (antabuse) By inhibiting the aldehyde dehydrogenase to create a crazy hangover
48
What are some of the symptoms of a moderate dependency alcoholic 12-5 days without alcohol?
``` SEIZURES Coarse tremor Shaking agitation Confusion Disorientation Paranoia Hallucinations ```
49
What are some of the symptoms of a severe dependecy alcoholic with withrawl 12-7days ?
``` Severe agitation Anxiety High risk of delerium tremens (DTs) Confusion Hallucinations ```
50
What is the treatment for the withdrawl of alcohol symptoms?
Diazepam From 2mg if scoring 2+ on alcohol withdrawl protocol
51
After night of binging, a man wakes with reduced function of his arm. What is this condition known as? How does it occur
Compression neuropathy due to radial nerve compression from the humeral head
52
How much alcohol does someone have to consume to be likely to get alcoholic cardiomyopathy ?
8-9 units a day for 5+years
53
Alcohol contributes to breast cancer T/F
True
54
Alcohol contributers to oral, pharyngeal and laryngeal cancers T/F?
True
55
Alcohol contributes to colorectal T/F?
True
56
Alcohol contributes to kidney cancer T/F?
False
57
Name some drugs used to treat hepatic encephalopathy
Lactulose | Ridaximin
58
Name some drugs used to reduce craving for alcohol by blocking receptors in the brain
Acamprostate Naltrexone Nalmefene
59
Name some drugs used to create an acute response to alcohol. How do they work
Disulfiram (antabuse) By inhibiting the aldehyde dehydrogenase to create a crazy hangover
60
What properties of ethanol make it able to communicate with so many receptors
Small molecule | Diffusion between lipid and water is high
61
How many grams of ethanol in 1 unit
8
62
What is the mechanism by which GABA receptors/ glycine receptors inhibit neurotransmission
By allowing chloride ions intracellularly to cause hyperpolarisation to prevent cells reaching the threshold for action potential
63
What is the function of GABA receptors?
To produce GABA molecule which is an inhibitory molecule on receptors in the CNS
64
What is the difference between extrasynaptic and synaptic receptors on membrane potential?
Synpatic receptors are those in the neurone synapse and create a trasient effect Extrasynaptic are outwith the synapse and create a tonic effect (long lasting) on membrane potential
65
What is the function of glutamate receptors?
Produce glutamate neurotransmitter that excites pathways in the CNS.
66
What is the effect acute alcohol has on GABA and glutamate receptors. To what end?
Enhances GABA inhibitory NT Suppresses glutamate excitatory NT Causes CNS depression aka reduced anxiety, sedation, impaired motor coordination
67
What pathway is involved with triggering dependency of alcohol?
The mesolimbic dopaminergic pathway
68
Describe the mesolimbic dopaminergic pathway and how it creates a response
Ventral tegmental area (VTA) releases dopamine through the medial forebrain bundle Dopamine acts on GPCR dopamine receptors in the nucleus accumbens (Nac) The neurone then fires signals to the hippocampus, amygdala, prefrontal cortex to cause happiness
69
What percentage of alcohol is excreted through the lungs?
5%
70
How many kcal in 1g of alcohol (8g in 1 25ml vodka shot)
7kcal
71
What is the chronic effects of alcohol on GABA and glutamate receptors? What is the significance?
GABA downregulation Glutamate upregulation Withdrawl from alcohol causes a mismatch between these usually balanced mechanisms causing anxiety, seizures etc. As CNS is confused
72
What is the role of thiamine in the body?
Important for ATP production Normal nerve conduction Maintenance of neural membranes
73
Baby presents with small eye opening, smooth philitrum and a thin upper lip. Mom drank while pregnant, diagnosis?
Foetal alcohol spectrum disorder
74
Can mother drink and breast feed? Why?
No as alcohol will transfer from blood stream into the milk, causing drowsiness, weakness, abnormal weight gain
75
Man presents with confusion, inability to coordinate voluntary movement and eye abnormalities. He is a chronic drinker. Diagnosis
Wernickes encephalopathy
76
Man presents with amnesia and con(fab)ulation. He is a chronic drinker. Diagnosis?
Korsakoff syndrome
77
What are the 4Ds of pellagra? How does it occur?
Inability to absorb niacin (vit b3) Diarrhoea, dementia, photosensitive dermatitis, death
78
What are the three alcohol misuse disorders
Harmful use Dependence syndrome Withdrawl state with delerium
79
What are some of the features an alcoholic needs to express to be classed as having dependence syndrome
``` Strong desire/compulsion f/alcohol Difficulty controlling use Persistent use despite clear harm Preoccupation with substance abuse Increased tolerance Psychological withdrawal state ```
80
What is the AUDIT/ FAST score determine?
The risk someone has due to drinking alcohol, can be used to see risk of having a seizure
81
Man admits to hospital and has an audit score of 15-19, what are the next steps?
(Harmful drinking) Deliver a brief intervention Deliver 4 motivational enhancement therapy Consider prescribing options like naltrexone
82
What are the stepwise drugs to treat alcohol dependence? E.g first line/ second line
1) acamprostate and naltrexone | 2) disulfiram
83
Man has been having withdrawl seizures for the last 5 minutes, what do you do?
Administer diazepam injection
84
Man presents with autonomic hyperactivity (Sweating, tachycardia, pyrexia), hallucinations. It has been 3 days since his last drink. Diagnosis?
Delirium tremens “(DTs)
85
What is the treatment for delerium tremens?
1) Give oral lorazepam (bezodiazepine) | 2) paraenteral lorazepam or haloperidol
86
What time period after drinking can alcoholic hallucinosis persistent until?
6 months
87
What is the medication used for medically assisted alcohol withdrawl?
Chlorodiazepodixde
88
Man presents with what you expect is chronic alcoholism, what tests can you run to confirm this? Results if positive?
Gamma GT (increases 3x) MCV (increases Triglycerides (increases
89
Very low bicarbonate in the blood could be indicative of poisoning from what?
Methanol Ethylene glycol As it mops up excess H+ ions to prevent acidic blood
90
What is the osmolal gap and why may it vary from estimations in alcoholics?
Its the difference between the estimated serum osmolarity from sodium and the actual tested result. Can be due to alcohol present in the blood
91
GGT and ALP are both raised in someone with RUQ pain. What does this suggest?
Bile duct obstruction
92
You suspect pyloric stenosis due to chronic vomiting, what tests could you run in order to determine if it is? Why?
Acid base test, as will have metabolic alkalosis due to loosing acid from stomach and it not being neutralised by the duodenal contents
93
You suspect haematemesis is due to mallory weiss tear. What LAB tests could you do to determine this? Why?
Test the lactate to see if there has been anaerobic respiration from lack of blood supply
94
What is methanol metabolised to form in the body?
Formaldehyde then formic acid
95
What cell type are responsible for cirrhosis of the liver?
The stellate cells as they lay down collagen
96
What is baretts oesophagus?
Change in lower oesophagus from normal mucosa to columar to cope with acid reflux
97
How many calories per unit of alcohol?
56 kcal as every 1g of alcohol has 7kcal and 8g of pure ethanol= 1 unit
98
How can malnutrition arise from alcoholism?
Decreases pancreatic enzyme/ bile excretion so cant break down food Damages lining of cells in stomach and small intestine Dont eat thiamine rich foods so cant metabolise alcohol
99
What cancers can arise from alcohol consumption?
Breast, bowel, liver, mouth and throat, oesophageal, stomach
100
What is the treatment for delerium tremens?
Benzodiazepine- to prevent seizures Rehydration Glucose
101
What would you expect to find on routine bloods if you suspect methanol poisoning?
Extrememly low bicarbonate
102
Where is GGT and ALT released from?
GGT from bile ducts | ALT from liver hepatocytes

CLASP Y2 JC (2 decks)

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