Alcohol and Disorders of Nicotine - Berges

Question 1

ethyl alcohol

Answer 1

in meds
cough syrups
aerosols
topicals

Question 2

alcoholic beverages

Answer 2

water and ethyl alcohol

Question 3

fermentation

Answer 3

stops at 12-13%

so no more than this concentration in wines

Question 4

50% of all alcohols

Answer 4

consumed by 10% all drinkers

Question 5

typical drink

Answer 5

10-14 grams of ETOH

Question 6

BAC 0.25g/dL

Answer 6

0.025

1-2 alcohol drinks

Question 7

alcohol metabolism

Answer 7

ADH
ALDH

ADH - 1 oz per hour

to acetic acid (vinegar)
acetic acid - then CO2 and H2O

Question 8

ADH

Answer 8

in liver

alcohol to acetaldehyde

Question 9

ALDH

Answer 9

acetaldehyde to acetic acid

Question 10

alcohol PK

Answer 10

oral rapid absorbed

peak BAC 30min - slower with food

absorption - small intestine

Question 11

BAC in female

Answer 11

higher compared to males

Question 12

BAC 50-100

Answer 12

sedation
high
rxn time slow

2-4 drinks

0.08 - legally drunk in many states

Question 13

BAC 100-200

Answer 13

impaired speech - slur, repeat

impaired motor fxn

clumsy walk - ataxia

can’t tandem walk - heel-toe

increasingly disinhibited

Question 14

blackout

Answer 14

anterograde amnesia

disruption sleep pattern - primary reduction in REM

relax muscles of pharynx - increased snoring and sleep apnea

Question 15

reduction in REM

Answer 15

with blackout in alcohol use

Question 16

BAC 200-300

Answer 16

emesis stupor

Question 17

BAC 300-400

Answer 17

coma

Question 18

BAC >500

Answer 18

resp depression
death

alcohol poisoning

Question 19

alcohol intox tx

Answer 19

thiamine
monitor labs
prevent aspiration
tx resp depression

Question 20

chronic alcoholism

Answer 20

multi-system disease common

do vitals

monitor labs

cover pt with vitamines, thiamine, benzo (withdrawal sx)

Question 21

long acting benzos

Answer 21

clorazepate dipotassium
diazepam

for withdrawal sx of alcohol

Question 22

liver in chronic alcoholic

Answer 22

cirrhosis

women - more susceptible to men

if hep C present - liver effects more severe

Question 23

GI chronic alcoholic

Answer 23

pancreatitis

3x more common alcoholics

chronic gastritia dn diarrhea

vit deficiency - malabsorption

weight loss

Question 24

chronic alcoholic in CNS

Answer 24

peripheral neuropathy- distal

cerebellar degeneration - gait and balance deterioration

wernicke - thiamine deficiency
korsakoff - memory problems

Question 25

cancer with alclhol

Answer 25

rate 10x nondrinkers

Question 26

HTN in males

Answer 26

alcohol use

Question 27

early alcohol withdrawal

Answer 27

early withdrawal - the shakes 12-18 hours after peak 24-48 hours subside 5-7 days

Question 28

late alcohol withdrawal

Answer 28

seizures 7-48 hours after peak 36 hours status epilepticus rare

Question 29

alcoholic hallucinations

Answer 29

begin within 48 hours of cessation of drinking may last 7 days

Question 30

alcohol withdrawal delirium

Answer 30

2-3 days after cessation peak 4-5 days mortality 15%

Question 31

tx alcoholic withdarwal

Answer 31

long acting benzo - diazepam, chlordiazepoxide, clorazepate dipotassium severe liver disease - short acting benzo - lorazepam / oxazepam also - thiamine haloperidol - if psychosis

Question 32

CAGE test

Answer 32

tried to CUT DOWN? ANNOYED about ppl asking you? felt GUILTY about drinking? ever needed EYE OPENER?

Question 33

antabuse

Answer 33

disulfiram inhibit ALDH - accumulation of acetaldehyde nausea, vomiting, hypotension, palpitations

Question 34

naltrexone

Answer 34

mu opioid antagonist reduce pleasure and craving

Question 35

campral

Answer 35

acmprosate glutamate receptor modulation reduced craving

Question 36

american public

Answer 36

25% smokes down from 32% in 1989

Question 37

nicotine

Answer 37

highly addictive and stimulating half life 2 hours - unpleasant withdrawal effecdts

Question 38

nicotine effects

Answer 38

``` HR increase increased BP increased RR dizzy, lightheaded tremor nausea ```

Question 39

nicotine withdrawal

Answer 39

``` craving for nicotine irritable, anger, frustrated anxiety diff concentrating decreased HR HA sleep disturbance weight gain ```

Question 40

tx nicotine dependence

Answer 40

``` transdermal patch gum lozenges inhaler E-cigs ```

Question 41

other tx of nicotine dependence

Answer 41

acupuncture hyponosis bupropion - 30% effective alone varenicline - 44% effective combo therapy best

Question 42

health issues of nicotine dependence

Answer 42

``` COPD, asthma, cancer CV disease - MI, peripheral vasc disease, stroke stroke HA impotence in males ```