Alcohol (lec 1)

Question 1

Alcohol abuse vs Alcoholism?

Answer 1

Abuse = social life impaired ≥ 1 mo

Ism = tolerance/dependence resulting from long-term use

Question 2

Genetic factors for alcoholism?

Answer 2

↑↑ β-endorphins in DA-reward pathway

Question 3

Alcohol absorbed where?

Distributes?

Answer 3

stomach, small intest

evenly thru body and across BBB and placenta

Question 4

Peak blood alcohol content (BAC) occurs when?

Answer 4

30 - 90 min post drinking

Question 5

Alcohol metabolized how?

Uses what co-factor?

Answer 5

alcohol dehydrogenase -> acetaldehyde -> aldehyde DH -> acetate

NAD+ (saturation occurs at low levels of alcohol),
byproduct is NADH

Question 6

NAD+ use by alcohol results in?

Answer 6

inability of other enzymes to use NAD+ ->
accumulation of lactate/acetyl-CoA ->
FA synth/lactic acidosis

Question 7

Alcohol metabolism rate?

Answer 7

Zero-order, rate independent of concentration

~10g/hr

Question 8

Women less tolerant of alcohol, why?

Answer 8

fewer alcohol dehydro in GI tract ->

metabo more slowly than men

Question 9

Microsomal-ethanol oxidizing system (MEOS) is?

Result of?

Answer 9

Alternate metabo of alcohol to acetaldehyde,
Uses NADPH, byproduct is NADP+

chronic alcohol consumption

Question 10

Alcohol affects other drugs how?

Answer 10

competes for metabolism

induces CYP2E1

Question 11

Alcohol ↑ metabolism of what type of drugs?

Answer 11

CYP450-metabolized drugs
e.g. phenytoin (seizures),
hypoglycemics

Question 12

Alcohol-induction of CYP2E1 has what effect on acetaminophen?

Answer 12

↑↑ hepatotoxicity

Question 13

Alcohol inhibits breakdown of what drugs?

Answer 13

pheonthiazine
benzodiazepine
barbiturate
TCA

Question 14

Aldehyde DH deficiency results in?

Esp common in what group?

Answer 14

acetaldehyde accumulates -> flushing, HA, N

Asians

Question 15

Pharmacokinetic Alcohol Tolerance from?

Answer 15

ETOH-induced CYP2E1/MEOS ->

metabolism ↑ in chronic users

Question 16

Pharmacodynamic Alcohol Tolerance from?

Answer 16

Down-reg GABA receptors and
Up-reg NMDA receptors

**withdrawal is result of pharmacodynamics

Question 17

Cross tolerance is?

Answer 17

↑ tolerance to ETOH causes ↑ tolerance to benzodiaz/barbitu

Question 18

Alcohol action on GABA?

Answer 18

CNS depressant:
binds GABAa recep -> 
↑ Cl- influx ->
inhibits GABA transmission ->
↓ DA in mesolimbic path, 
down reg of GABA recept

Question 19

Alcohol action on NMDA?

Answer 19

inhibits glutamine effect on NMDA recept ->
upreg of NMDA recept

NMDA involved w/ learning/memory, seizures

Question 20

Alcohol effects: low [ ]?

higher [ ]?

Answer 20

disinhibition

depressant/sedation of mood, motor, etc

Question 21

Anterograde amnesia is?

Answer 21

blackout from NMDA recpt blockade

Question 22

ETOH effects: smooth mm?

Answer 22

vasodilator
hypothermia
relax uterus

Question 23

ETOH effects: heart?

kidney?

Answer 23

↓ myocard contractility

↓ ADH = diuretic

Question 24

Acute ETOH toxicity results in?

Answer 24

V, stupor, coma, resp depression

metabolic/e- ∆s
hypothermia
↓ BP/CO

Question 25

Acute ETOH toxicity-induced seizure tx?

Answer 25

benzos, anticonvulsants

Question 26

Chronic ETOH abuse effects on liver/GI? Nutrition?

Answer 26

Lowers [glutathione] = ox stress tissue damage, FA prdxn = fibrosis folate/thiamine deficiency

Question 27

Chronic ETOH abuse effects on CNS?

Answer 27

Wernicke-Korsakoff Synd (thiamine deficiency), Korsakoff's Psychosis, Peripheral neuropathy

Question 28

Wernicke-Korsakoff Synd presentation?

Answer 28

eye mm paralysis, ataxia, confusion, coma/death

Question 29

Korsakoff's Psychosis presentation?

Answer 29

chronic memory loss

Question 30

Chronic ETOH abuse effects on CV?

Answer 30

Cardiomyopathy (direct toxicity of acetaldehyde), Arrhy HTN ↑ CV dz

Question 31

Chronic ETOH abuse effects on tobacco?

Answer 31

↑ carcinogenicity of tobacco

Question 32

Naltrexone (ReVia) action? Used for? S/E?

Answer 32

opoid recpt antagonist: blocks etoh from stim reward path ↓ craving for eoth liver damage

Question 33

Acamprosate (Campral EC) action? Used for?

Answer 33

GABA analogue: normalizes balance of GABA/Glutamine eoth cessation support NOT liver toxic (kidney metab)

Question 34

Disulfiram (Antabuse) action?

Answer 34

aldehyde DH inhibitor: | actealdehyde build-up = severe toxic s/e

Question 35

ETOH w/drawal presentation: Mild? Severe?

Answer 35

anxiety, irritab, N, tachy hallucination, delirium/tremors, seiz, arrhy, hypoTN

Question 36

ETOH w/drawal tx?

Answer 36

Diazepam/Chlordiaz: prevent DTs, seizures Lorazepam: stop seiz Phenytoin: 2nd line stop seiz

Question 37

Methanol Poisoning presentation?

Answer 37

Visual disturb (snowstorm) Formaldehyde breath Bradycard, coma

Question 38

Methanol Poisoning action?

Answer 38

methanol metab to toxic aldehydes/oxalates -> transient CNS stim -> severe metabolic acidosis

Question 39

Methanol Poisoning tx?

Answer 39

resp support lavage alkalization Fomepizole

Question 40

Fomepizole (Antizol) action?

Answer 40

alcohol DH inhibitor