Alcohol Use Disorders Flashcards by Kat Che

MOA of benzodiazepines

bind to BZ-GABA-A receptor-> positive allosteric-> more Cl ion channel open-> treat withdrawal

How well did you know this?

Not at all

Perfectly

Benzodiazepines decrease the duration and severity of symptoms and incidence of ___ and _______

seizures and delirium tremens

These can be experienced well past acute withdrawal

How well did you know this?

Not at all

Perfectly

Which benzodiazepine is best for treatment of EtOH withdrawal? Which are the most used?

all are equal

-chlordiazepoxide, diazepam, lorazepam

How well did you know this?

Not at all

Perfectly

Benzos should be dosed _______ for alcohol withdrawal than anxiety or insomnia

higher and more frequent

start high, taper slow

How well did you know this?

Not at all

Perfectly

The most used barbiturate for alcohol withdrawal is

phenobarbital (oral, IM, IV)

How well did you know this?

Not at all

Perfectly

Do barbiturates and benzodiazepines bind at the same place

How well did you know this?

Not at all

Perfectly

Where to barbiturates bind and how is that used for alcohol withdrawal

subunits on GABA-A receptor complex-> (+) allosteric modulation-> Cl- open longer-> treated

How well did you know this?

Not at all

Perfectly

Barbiturates suppresses _______ glutamate receptors and this _______

excitatory

decreases glutamate release

How well did you know this?

Not at all

Perfectly

Barbiturates are useful as ____ and ____ when compared to benzos for AUD

first line and withdrawal refractory

How well did you know this?

Not at all

Perfectly

Phenobarbital has a ___ onset of effect and a ____ half life

rapid, long

How well did you know this?

Not at all

Perfectly

Phenobarbital should be ____ based doing. There is a concern for ____ _____.

weight based

respiratory depression

How well did you know this?

Not at all

Perfectly

Phenobarbital should be used with caution in ___ and ____ disease. It is an enzyme ______

severe liver and renal disease

enzyme inducer

How well did you know this?

Not at all

Perfectly

In addition to medications, what other things should be given to someone experiencing alcohol withdrawal

multivitamin, thiamine, folic acid, fluids (banana bag)

Likely you need more thiamine than what is in the banana bag

How well did you know this?

Not at all

Perfectly

Giving thiamine to someone experiencing EtOH withdrawal can prevent ________. It needs to be given before or with ____.

Wenicke’s encephalopathy

D5W

How well did you know this?

Not at all

Perfectly

Thiamine is converted to thiamine pyrophosphate which is a cofactor in ____

carbohydrate metabolism

How well did you know this?

Not at all

Perfectly

Chronic drinking may present with alcoholic _____ and _____

ketacidosis and hypoglycemia

How well did you know this?

Not at all

Perfectly

Alcohol interferes with hepatic _____ becasue _______

glyconeogenesis becasue the energy needed for alcohol metabolism is diverted away

How well did you know this?

Not at all

Perfectly

Who is at greatest risk for alcoholic ketoacidosis and hypoglycemia

not eaten within 12-14 hours following last drink (N/V and loss of appetite)

How well did you know this?

Not at all

Perfectly

Lorazepam is a great drug to use AUD because

long half life
few drug interactions (gluconoronidation)
PK are consistent through liver function
many methods of deliver

How well did you know this?

Not at all

Perfectly

Alcohol withdrawal may present with___ and ____ which can lead to _______

HypoK and HypoMg

QT interval prolongation

How well did you know this?

Not at all

Perfectly

Diazepam has a __ half life. What is special about its PK

long

active metabolites

How well did you know this?

Not at all

Perfectly

Mg is a cofactor needed for converting ___ to ____

thiamine to thiamine pyrophosphate

How well did you know this?

Not at all

Perfectly

For alcohol withdrawal, you can use ______ and ______ to treat sympathetic symptoms (BP, HR, tremor, sweating, anxiety_

clonidine and dexmedetomidine (“clonidine on steroids”, ICU IV only)

How well did you know this?

Not at all

Perfectly

In the ED, the treatment is _______

symptom-triggered

How well did you know this?

Not at all

Perfectly

Should you use anti seizure medications for alcohol withdrawal?

no, seizures usually end before administration of medication/benzodiazepines

Antipsychotics can be used to treat ____ and ____ in alcohol withdrawal. But there is a risk of ___ and ____

agitation, hallucinations | QTc prolong, lowering seizure threshold

Do not send a patient out of the hospital while they are still on _____

benzodiazepines

Three FDA approved medications for AUD | Two not FDA approved meds for AUD

disulfiram (Antabuse), naltrexone (and long acting vivitrol), acamprosate Topiramate, gabapentin

_____ and _____ are first line for AUD treatment. if they do not respond to these two ______ is used

Naltrexone, acamprosate | Disulfiram

Disulfiram works as an alcohol ______ by _______ (MOA). There is ___ effect without alcohol

alcohol aversion medication irreversibly inhibits aldehyde dehydrogenase-> acetaldehyde levels 5-10x normal. no effect without alcohol, effect seen within 12-14 Horus of taking disulfiram

Alcohol + disulfiram = ?

palpitations, facial flushing, sweating, N/V, headache, tachycardia, chest pain, hypotension, dizziness, weakness

For disulfiram, caution when patients are also on/have:

metronidazole, cognitive disorder, unstable CVD, cirrhosis

Patients can be at risk for disulfiram reaction for ______ after stopping taking it

weeks | slow elimination and no aldehyde dehydrogenase needs to be synthsized

Disulfiram is pregnancy category __

Naltrexone is an antagonist at ____ which leads to a decrease in _____ in the reward pathway

mu-receptors, dopamine activity this will lesses reinforcing properties of EtOH, decrease cravings, lesses intoxication feeling, lessens euphoria (uncouples drinking and pleasure)

What are the short term and long term effect of naltrexone?

Short term: reduce relapse, cravings, returning to drinking | long term: unclear if there is a benefit in maintaining abstinence

Naltrexone AE? Contraindications?

AE: N/V, somnolence CI: opioids (7-10 days), child Pugh C liver dx, LFTs high (hepatotoxicity)

To prescribe naltrexone, need to order _____ and _____

urine too screen for opioids and LFTs (synthetic opioids will not show up)

Acamprosate modulates glutamate at _____ and is a _______ agonist.

NMDA, GABA-A receptor agonist thought to restore equilibrium of GABA and glutamate systems (toss up on if it actually works)

Acamprosate has a benefit in _______ and dosing is _____

maintenance of abstinence | weight based

Acamprosate AE? Contraindications?

AE: diarrhea CI: CrCl<30ml/min Use if worried about liver or pt on opioid or will continue to drink

For using acamprosate as a treatment for AUD, opioids, and liver dz: _______ are not a major concern. It is preg category ___.

drug drug | C

Treatment for AUD should continue for at least __ months

Clonidine and antipsychotics should be combined with ____ for alcohol withdrawal

benzodiazepine

What is considered heavy drinking

5 or more binge days a month (4 for female)

___ of EtOH is absorbed in the stomach, with the other amount absorbed in the small intestine

20%

If there is ______ there will be less EtOH absorbed

food in the stomach

Metabolism of EtOH | alcohol --alcohol dehydrogenase-> ______ --_______--> Acetic acid -> oxidation ->->-> energy (Krebs)

acetaldehyde | acetaldehyde dehydrogenase

Metabolism of EtOH | alcohol --alcohol dehydrogenase-> ______ --_______--> Acetic acid -> oxidation ->->-> energy

acetaldehyde | acetaldehyde dehydrogenase

EtOH elimination is ____ with time because of ___ saturation

linear, ADH saturation | you lose about 1 drink an hour

What are some reasons for the gender difference in alcohol disposition

women weight less, have more fat and less water, less gastric alcohol dehydrogenase (less first pass), eliminate slightly faster

What happens if you inhibit alcohol dehydrogenase or aldehyde dehydrogenase

You get nausea due to sympathetic NS activation-> bradykinin and His release-> nausea, flushing, hangover

Acetaldehyde dehydrogenase is an active ____ in the ____ of cells. There are mutations that cause it to have low affinity for ____ and as a result _______

tetramer in the mitochondria | low affinity for NAD, short half life with virtually no activity

EtOH inhibits toxic _____ ______ acutely due to inhibition of CYP2E1. However in chronic alcohol, there is CYP2E1 induction and if _____ is taken there will be:

acetominophen metabolism | acetaminophen, depletion of antioxidants and inactive conjugates leading to liver damage

What is the major MOA of EtOH in the brain

It is a GABA-A agonist and a glutamate (NMDA) antagonist

Typical sedating effects of EtOH

disinhibition, muscle relaxant, reinforcement, vasodilation, diuresis, sexual behavior

EtOH causes diuresis by _______

inhibition of ADH secretion

At what level of BAC will there be loss of motor coordination? What level is major impairment of mental and physical control? What level conscious but stupor? What level is lethal for 50%

0.08-0.10 0.14-0.16 0.3 .45

Consequences of regular binge drinking on major body organs

Brain-> memory, attention, exec function Liver-> fatty liver, fibrosis, cirrosis CV-> HTN, MI, stroke, atherosclerotic Kidney-> glomerulonephritis Cancer-> oral, pharynx, larynx, colorectal Other-> pancreas, FAS, depression, impaired fertility

Main mechanism for alcohol tolerance

Decrease in GABA receptor function (internalization) Increased NMDA function (minor is metabolism change in liver)

Which things of alcohol withdrawal can be life threatening and should be treated with benzos

CNS hyper excitability, ANS hyper excitability, tremor and motor abnormalities

When alcohol releases β endorphins, inhibits GABA what gets released

dopamine

With tolerance to alcohol, there is enhanced ___ release which promotes GABA inhibition of DA release

glutamate

What causes Wenicke Korsakoff

thiamine deficiency

What causes encephalopathy

liver failure-> accumulation of ammonia

Mild deficits with alcohol will be seen with more than ___, moderate at ____ drinks/episode, substantial with 10 drinks/episode

5 drinks/episode 7-9 10 (6-7 days/week)

Brain damage from alcohol will cause increased _____ and loss of ______

increased ventricular space | loss of grey matter (dendrites and cell bodies

What is the process of hepatocytes turning into CT due to EtOH

Fatty liver with abnormal fat metabolism-> ROS + hepatic inflammation (alcoholic steahepatitis)-> alcoholic fibrosis from stellate cells making collagen-> liver failure also 1-2% get hepatocellular carcinoma

What liver functions are lost with cirrhosis (there are 4)

blood clotting, albumin, growth and immune factors, drug and toxin metabolism

Sx of cirrhosis? (4)

hemorrhage, edema+ascites, immune dysfunction, decreased toxin removal

Acetaldehyde will cause ____ in blood vessels

fibrosis

EtOH can cause _____ due to disruption of potassium homeostasis

Arrhythmias

With modest alcohol consumption, what are some protective effects from EtOH

less atherosclerosis, stroke, PAD, decreased clotting, inflammation, increased plasminogen

Adolescents will have ____ sedation and motor impairment from alcohol. They suffer ____ memory loss

decreased greater (easier to continue drinking to high BAC)

What are some CNS dysfunction things caused by fetal alcohol spectrum disorder (behavioral + neuropsychological)

B: poor impulse, judgement, concentration and attention, fail to consider consequences Neuro: *trouble with math and reading*, low IQ, poor exec fxn, short term memory problems, lack of social skills, visual spatial deficits

What is worse in FASD, binging or continual drinking?

binging

FASD: aspect of development at _______ determine outcomes

time of drinking

____ is an antibiotic that can also inhibit acetaldehyde dehydrogenase

Metronidazole

Alcohol Use Disorders Flashcards

(78 cards)