What is the maximum concentation of ethanol?
this is because anything higher than 12% is toxic to the yeast
higher concentrations are attained by distillation
For this course, a drink consists of how much of:
beer - 12 ounces
wine - 5 ounces
liquor - 1.5 ounces (of 80 proof)
How much alcohol by percentage does rum have to contain to be 100 proof?
Alcohol is a generalized CNS _______
If alcohol is a general depressant, why does it initially act like a stimulant?
It depresses inhibitory control, leading to disinhibition euphoria
What functions are affected first by ethanol?
basically areas of the brain involved in the most highly integrated functions
so...reticular activating systems and cortical ites
you lose integration control by the cortex so thought an dmotor processes that are most dependent on training and previous experience are first affected
Why can't ethanol be used as an anesthetic?
1. it's too long acting to be a clinically useful anesthetic
2. and it only reaches anesthesia at near lethal concentrations
Is ethanol a vasodilator or vasoconstrictor? What does this mean for thermoregulation?
It's a vasodilator - due to central vasomotor depression
this means you lose body heart - you get a drop in core temperature
You have a sense of warmth, but the body temp has actually decreased
What affect does chronic alcoholism have on the heart?
it's thoguht to be the major cause of cardiomyopathy in the western world
you get conduction defects and rhythm disturbances
Although somewhat counterintuitive, there is a strong negative correlation between chronic use of LOW amounts of ethanol and the incidence of CAD. How?
Low amounts of ethanol will increase the concentration of high density lipoproteins (the good ones) and decreasing the concentration of low density lipoproteins (the bad ones)
Low amounts of ethanol will also increase production of endogenous tissue-type plasminogen activator (TPA) so you have changes in the thrombotic potential
What are the ACUTE effects of alcohol on the liver?
interferes with the oxidative metabolism of other drugs because it depletes NAD (which is a cofactor necessary for other metabolic reactions)
it also competes for mixed function oxidase
for example, you're more sensitive to sedatives when drunk because they're not metabolized as rapidly
What are the CHRONIC effects of alcohol on the liver?
1. it increases oxidative metabolism (an inducer)
this means chronic alcoholics are LESS sensitive to sedatives then wover because they're metabolized more rapidly
2. increases hepatic synthesis and mobilization of fat and secretion of protein from hepatic cells, leading to hepatic disorders
this can be reversible with abstinence, but prolonged exposure may lead to permanent damage
What is alcohol's effect on the kidney?
it's a diuretic
acts by decreasing the release of ADH from the pituitary
this means you have a decrease in the reabsorption of water in the renal tubules
What is the effect of alcohol on the GI tract?
depends on the person
if they like it = psychic stimulation of saliva and gastric acid
10% have increased secretions
20% have depression of secretion and motility, so mucosal irritation
40% have mucosal inflammation and hyperemia leading to erosive gastritis
About how many kcal does alcohol have per gram?
What does ethanol do to cell membranes and what does this mean for receptors?
it has a membrane disordering of "fluidizing" effects
this means it non-specifically alters the characteristics of several NT receptors and enzyme systems
What receptor complex likely mediates the behavioral effects of alcohol?
likely the GABA receptor
What does it mean to say that ethanol is an amphophile?
In terms of absorption?
it's both hydrophilic and lipophilic, so it will dissolve in both water and fat
this means it has complete absorption from the GI tract after oral administration (dependin gon food content)
What are two factors of food content that affect ethanol absorption?
fatty foods will retard ethanol absorption (so french fries are good)
carbonation decreases gastric emptying time so you have more rapid absorption of, say, champagne
What is the two-step process of ethanol emtabolism?
ethanol to acetaldehyde (catalyzed by alcohol dehydrogenase - rate limiting)
acetaldehyde to acetic acid
Chronic use of alcohol may lead to _____ metabolism of ethanol.
What are the two routes of escretion for ethanol?
some through the kidney (but not much since most ethanol is metabolized)
lung - a constant 0.05% of plasma alcohol levels will be breathed out.
What are the therapeutic uses of ethanol?
cools the skin in fever
massaging lotion to prevent ulcerative sores in bedridden
injected in proximity of nerves to relieve pain due to trigeminal neuralgia or an inoperable carcinoma
antidote to methanol intoxication
as a vehicle to dissolve other drugs
What are the acute toxicites of alcohol and how is it a "self-limiting" process?
high doses can produce coma
it's self limiting because the person passes out before reaching that lethal concentration usually
(however, rapid ocnsumption of large amount may overcome this process and an unconscious patient can aspirate vomit and suffocate)
What are the chronic toxicites for alcohol?
physical dependence and tolerance
severe depression and suicide
neuropsychiatric syndromes like wernickes and korsakoff's
A hangover is from what aspects of alcohol use?
1. accumulation of acetaldehyde
2. altered cytokine metabolism = nausea, HA, fatigue
4. dehydration = electrolyte disturbances = thirst, dry mouth, dizziness
5. metabolic acidosis
6. disturbed prostaglanding synthesis
7. sleep deprivation (tremors, anxiety, restlessness)
How does Disulfiram work?
It interferes with aldehyde dehydrogenase, so you get excessive acetaldehyde levels when you drink, which makes you feel absolutely terrible
Methanol is extremely toxic. What are the early symptoms of methanol toxicity?
At what amounts will the patient go blind and at what level will the patint die from methanol?
blindness at 4 ml
severe acidosis, coma, and death at 80-150 ml
What likely causes the roxicity of methanol?
the formation of formic acid during metabolism
What is the treatment of methanol toxicity?
1. maintain respiration
2. induce emesis if the patient is ocnscious
3. MOST IMPORTANT: therapeutic goal is to reduce the acidosis by treating with bicarobnate until urinary pH is 7.5
4. Hemodialysis will help remove methanol in unconscious patient
5. oddly enough, administer ethanol to compete with the metabolism of methanol
What alcohol is in antifreeze?
What are the symptoms of an accidental ethylene glycol consumptions (usually kids and pets)?
Early: vomiting, depression, ataxia, weakness, flaccid paralysis, convulsions followed by coma
late (for survivors): renal failure, emesis, dehydration, weight loss, weakness, hematuria, anuria, tonic convulsions, coma and death in 1-3 days
What's the cause of the renal fialure in ethylene glycol consumption?
a byproduct of the metabolism is calcium oxalate crystals, which can clog of the renal tubules
What are the usual causes of death in ethylene glycol consumption?
1. metabolic acidosis
2. cardiovascular dysfunction
3. acute kidney failure
What is the treatment for ethylene glycol toxicity?
1. symptomatically deal with the emesis, acidosis and convulsions
2. give ethanol for metabolic competition
3. Fomepizole - will inhibit alcohol dehydrogenase
What are the two options for addiction relapse prevention in terms of alcoholism?