B6.041 Prework 3: Alcohol Use Disorder

Question 1

standard drink

Answer 1

14-15 g of EtOH

Question 2

alcoholic content of common beverages

Answer 2

beer 3-6%
wine 8-14%
fortified wine 20%
liquor 40-90%

Question 3

absorption of alcohol

Answer 3

rapidly absorbed
primarily absorbed in duodenum
rate is extremely variable

Question 4

factors that influence BAC

Answer 4

amt and alcohol concentration of beverage
rate of drinking
food consumption and composition
gastric emptying and gastric metabolism
patient’s use of meds w interaction effects

Question 5

major pathway of ethanol metabolism

Answer 5

ethanol> acetaldehyde> acetate> acetyl CoA > CO2 + H2O + energy (7 kcal/gm)

1. alcohol dehydrogenase
2. aldehyde dehydrogenase
3. TCA cycle

Question 6

location of metabolism of alcohol

Answer 6

90-98% in liver

Question 7

kinetics of alcohol metabolism

Answer 7

alcohol dehydrogenase saturates at low to moderate BACs
0 order kinetics @ moderate BACs
-7 g per hour elimination
-15 mg% per hour disappearance

Question 8

accumulation of acetaldehyde

Answer 8

aldehyde dehydrogenase usually not rate limiting
symptoms: headache, gastritis, nausea, dizziness (hangover)
can be caused by inhibition of aldehyde dehydrogenase

Question 9

CNS effects of alcohol

Answer 9

CNS depressant
apparent stimulatory effects result from depression of inhibitory control mechanisms in the brain
characteristic response: euphoria, impaired thought processes, decreased psychomotor efficiency

Question 10

what is a reinforcer

Answer 10

substance whose pharmacological effects drive the user to continue to use it

Question 11

positive reinforcing effects of alcohol

Answer 11

euphoria
altered consciousness
relief of anxiety and other negative emotions
relief of withdrawal symptoms

Question 12

what neural system is implicated in alcohol reinforcement

Answer 12

mesocorticolimbic system

• prefrontal cortex
• nucleus accumbens
• VTA

Question 13

animal models of alcohol reinforcement

Answer 13

animals can be selectively bred to self administer alcohol in preference to other usually reinforcing liquids

• intra cranial injections into VTA
• different neurotransmitter levels in mesocorticolimbic system compared to non-alcohol preferring animals

Question 14

neurotransmitter effects of alcohol

Answer 14

increases dopamine in mesocorticolimbic system
activated opioid peptide system
facilitates GABA transmission
blocks NMDA receptors

Question 15

euphoria/pleasure

Answer 15

increased dopamine

increased opioids

Question 16

anxiolysis/ataxia

Answer 16

increased GABA

Question 17

sedation/ amnesia

Answer 17

increased GABA

decreased NMDA

Question 18

withdrawal symptoms (neurotransmitters)

Answer 18

decreased GABA

increased NMDA

Question 19

craving

Answer 19

decreased opioids

Question 20

effects of alcohol on GI tract

Answer 20

increased incidence of cancer (esophagus, stomach, liver)
gastritis
malabsorption
pancreatitis
liver disease

Question 21

clinical symptoms of acute alcoholic gastritis

Answer 21

anorexia
epigastric pain
vomiting (w or w/o hematemesis)

Question 22

effects of ethanol on small intestine

Answer 22

decreased absorption (folate, thiamine, B12)
increased absorption (iron)

Question 23

symptoms of acute alcoholic pancreatitis

Answer 23

constant epigastric pain
pain worse after eating
low grade fever
epigastric tenderness

Question 24

complications of pancreatitis

Answer 24

acute, recurrent, or chronic
abscess or pseudocyst formation
exocrine insufficiency
endocrine insufficiency
hemorrhagic pancreatitis

Question 25

manifestations of alcohol liver disease

Answer 25

fatty liver hepatitis cirrhosis

Question 26

alcoholic fatty liver

Answer 26

liver tender and may be enlarged 2-3x normal GGTP, AST, and ALT usually elevated moderately reversible in several weeks with abstinence

Question 27

alcoholic hepatitis

Answer 27

jaundice low grade fever enlarged tender liver persistently elevated AST, ALT, alk phos

Question 28

alcoholic cirrhosis

Answer 28

``` jaundice: elevated AST, ALT, bilirubin ascites, peripheral edema decreased albumin gynecomastia, testicular atrophy hard, nodular liver; enlarged spleen easily bruised, elevated PT, decreased platelets spider angiomata ```

Question 29

major complications of cirrhosis

Answer 29

``` portal HTN -esophageal varices and bleeding -bleeding hemorrhoids -encephalopathy hepatoma ```

Question 30

causes of anemia in alcoholism

Answer 30

``` blood loss -gastritis, varices -decreased platelets -elevated PT hypersplenism decreased folate absorption decreased EPO ```

Question 31

effects of alc on cardiovascular system

Answer 31

cardiomyopathy HTN stroke

Question 32

acute CNS effects of alc

Answer 32

intoxication blackouts coma

Question 33

alcohol intoxication symptoms

Answer 33

``` euphoria assertiveness irritability loss of behavioral inhibitions dysarthria ataxia ```

Question 34

alcoholic blackout

Answer 34

intoxicated, alert new learning (memories) not recorded retrograde amnesia for period of blackout duration usually several hours related to rate of increase in BAC, not in absolute level

Question 35

alcoholic coma

Answer 35

leads to death by respiratory depression lethal BAC 500-700% literally tolerance to lethal BAC lethal synergism with other sedative hypnotics hyperosmolarity becomes a problem with these levels

Question 36

chronic CNS effects of alc

Answer 36

``` depression polyneuropathy W-K syndrome tolerance withdrawal alcohol dementia central pontine myelinosis marchiafava-bignami syndrome ```

Question 37

pscyh illness correlations with alcoholism

Answer 37

``` antisocial personality -20% of male alcs -5% of female alcs affective disorder -20% of female alcs -5% male alcs ```

Question 38

alcohol induced depression

Answer 38

symptoms identical to major depressive disorder occurs after several weeks to months of heavy drinking resolves 2-21 days after cessation of alcohol

Question 39

wernicke's encephalopathy

Answer 39

``` clinical features: -6th nerve paralysis/palsies -truncal ataxia -confusion due to thiamine deficiency give high dose of thiamine cerebellar degeneration often prominent and may occur as isolated finding ```

Question 40

Korsakoff's syndrome

Answer 40

``` often occurs w Wernicke's inability to retain new information usually irreversible -50% perm disables -25% partial recovery w abstinence ```

Question 41

alcoholic dementia

Answer 41

memory impairment cognitive dysfunction cerebral atrophy common

Question 42

what % of patients in general medical practice are drinking at a hazardous level

Answer 42

20%

Question 43

at risk drinking

Answer 43

directly harmful or correlated w greater risk of health problems

Question 44

at risk drinking- men

Answer 44

> 14 per week | 4 or more per occasion

Question 45

at risk drinking - women

Answer 45

>7 per week | 4 or more per occasion

Question 46

BAC in diagnosing alcoholism

Answer 46

>300% anytime 150% in patient not obviously intoxicated >100% in patient during routine exam

Question 47

MCV

Answer 47

elevated in 40-95% of actively drinking alcs associated w folate def in 1/3 of alcoholics more marked in alcs who smoke returns to normal with 2-4 months of abstinence

Question 48

GGTP

Answer 48

elevated in 75% of alcs with evidence of liver disease

Question 49

AST

Answer 49

elevated in 30-75% of alcs

Question 50

ALT

Answer 50

elevated in 50% of alcs

Question 51

AST/ALT

Answer 51

>1 | AST + ALT < 300 identifies 90% of patients w alcohol liver disease and 77% of patients with nonalcohol liver disease

Question 52

CDT

Answer 52

>20 indicated heavy use for several months

Question 53

CXR in alcs

Answer 53

30% have old or new rib or vertebral fractures compared to 1% of controls

Question 54

treatment of minor withdrawal

Answer 54

benzos | GABA agonists

Question 55

treatment of major withdrawal (DTs)

Answer 55

``` supportive GABA agonists antipsychotics phenobarbital gabapentin a2 agonists ```

Question 56

pharm options for ttx of alcoholics

Answer 56

disulfram (Antabuse) naltrexone (revia) Acamprosate (campral)

Question 57

disulfram

Answer 57

inhibits metabolism of acetaldehyde

Question 58

naltrexone

Answer 58

opioid antagonist | perhaps better for attenuating relapse than maintaining abstinence

Question 59

Acamprosate

Answer 59

? GABA agonist and glutamate receptor antagonist | perhaps better for abstinence than relapse

Question 60

other treatments for alcohol use disorder

Answer 60

``` AA education groups cognitive therapy MET (motivational enhancement therapy) psychodynamic therapy marital and fam therapy pharm ```