Alcohol (Exam #1)

Question 1

What type of metabolism/kinetics does alcohol follow, and what does this mean?

Answer 1

ZERO order kinetics

- Rate is independent of concentration

Question 2

What three enzymes metabolize alcohol?

Answer 2

• ADH
• MEOS
• CYP2E1

Question 3

What drug inhibits ALDH?

What enzyme does alcohol induce, and what does this mean?

Answer 3

• Disulfiram inhibits ALDH

- Ethanol induces CYP2E1 = increased tolerance

Question 4

MOA of alcohol?

Answer 4

CNS depressant

- Binds GABAa receptor → increase Cl influx → increased GABA transmission/activity

Question 5

How does long-term alcohol use effect GABA and NMDA receptors?

Answer 5

• DOWN regulate GABA receptors

- UP regulate NMDA receptors

Question 6

What four effects of alcohol are seen (think smooth muscle, heart, kidney)?

Answer 6

• Vasodilation Hypothermia
• Decreased contractility
• Diuretic

Question 7

What two medications can be used to TREAT alcohol-induced seizures, and which is preferred?

Answer 7

Lorazepam (Ativan) = benzo (PREFERRED)

- Phenytoin = anticonvulsant

Question 8

What effect is seen with low concentrations vs. high concentrations of alcohol? What is another word for “blackouts” and what does this mean for receptors?

Answer 8

• Low conc.: disinhibition, low anxiety, more confidence
• High conc.: impaired motor function and judgement

Blackout = anterograde amnesia: block NMDA receptors

Question 9

What is the most common medical complication associated with chronic alcohol use, and what five specific conditions associated with this complication? What other two conditions may be seen?

Answer 9

Liver disease = most common

• Fatty liver → Fibrosis → Cirrhosis
• Alcohol hepatitis
• Liver CA

Also, Gastritis and Pancreatitis

Question 10

What two vitamins may be deficient with chronic alcohol use, and what two CNS conditions can this result in?

Answer 10

Folate and Thiamine

• Wernicke-Korsakoff Syndrome
• Korsakoff psychosis

Question 11

What three CV conditions are associated with chronic alcohol use?

Answer 11

• Cardiomyopathy
• Arrhythmias
• HTN

Question 12

What medication is associated with possible liver damage when combined with alcohol?

Answer 12

Acetaminophen

- Increases Acetaminophen metabolites

Question 13

What four medications can be used to treat alcoholism?

Which does NOT decrease cravings? Which is considered dangerous and is not really recommended for use? Which can decrease cravings AND decrease rate of relapse?

Answer 13

• Naltrexone = decrease cravings AND decrease rate of relapse
• Acamprosate
• Disulfiram = does NOT decrease cravings; dangerous, not recommended
• Topiramate

Question 14

What condition is Naltrexone used to treat, and what is the MOA? What is the CI of this medication?

Answer 14

Alcoholism

• MOA: opioid receptor antagonist = blocks ability of alcohol to stimulate reward pathway
• CI: liver failure

Question 15

What condition is Acamprosate used to treat, and what is the MOA? What can this be used as an alternative to, and why?

Answer 15

Alcoholism

• MOA: structural analogue of GABA = restores balance of GABA and glutamate
• Alternative to Naltrexone because NO liver toxicity

Question 16

What condition is Disulfiram used to treat, and what is the MOA? Why is it rarely used?

Answer 16

Alcoholism

• MOA: inhibits ALDH → acetyldehyde builds up
• SEVERE effects (V, sweating, CP, hypotension)

Question 17

What two medications can be used to PREVENT alcohol-induced seizures, and which is preferred?

Answer 17

• Diazepam (Valium)

- Chlordiazepoxide (Librium)