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Pharm Final > ETOH > Flashcards

ETOH Flashcards

1
Q

Where can ETOH travel in the body?

A

Everywhere water travels and across BBB (because it is so small) even though it is water soluble

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2
Q

Do women or men have a lower total body water content? fat content?

A

women - lower water content (small volume of distribution) and higher fat content

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3
Q

two ways ethanol is converted to acetaldehyde (resp. for hangover)?

A

alcohol dehydrogenase and microsomal ethanol oxidizing system (for chronic/binging)

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4
Q

acute ETOH ingestion affect on GABA, dopamine, ACh, and ADH?

A
  • potentiates GABA (inhibitory NT)
  • increased dopamine
  • inhibits ACh (sedation/delirium)
  • Inhibits ADH (diuretic)
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5
Q

low level of acute ETOH ingestion effects on CNS

A

sedation
anxiety relief
sense of well being
euphoria

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6
Q

moderate levels of acute ETOH ingestion effects on CNS

A

decreased attention
decreased info processing
decreased motor skills

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7
Q

high level of acute ETOH ingestion effects on CNS

A 
slurred speech
ataxia
impaired judgement 
disinhibited behavior
coma
respiratory depression
death
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8
Q

ETOH acute & chronic affects on heart?

A

acute: decreased contractility with moderate amounts
chronic: dilated/congestive cardiomyopathy, arrythmias (binging/withdrawl), HTN (if greater than 3 drinks a day)

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9
Q

ETOH acute affects on smooth muscles?

A

vascular smooth mm relaxation/dilation (hypothermia in OD)

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10
Q

ETOH acute affects on GI?

A

acute: acute pancreatitis, gastritis, upper GI bleed

Chronic: chronic pancreatitis (most common cause), protein malnutrition (decreased food intake), vitamin deficiency (irritates intestine lining/pancreas so less pancreatic enzyme released)

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11
Q

chronic effects of ETOH on CNS?

A

withdrawl/addiction

bilateral peripheral neuropathy (thiamine deficiency)** common

ataxia (cerebellum) & dementia (cortex)

Wernicke-korsakoff

blurred vision/optic nerve degeneration (irreversible)

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12
Q

what is wrench-korsakoff syndrome?

A

medical emergency (or death)

wernicke encephalopathy: paralysis of eye muscles, ataxia, confusion from thiamine deficiency (tx with thiamine)

korsakoff’s: psychosis/dementia with confusion and impaired memory

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13
Q

chronic effects of ETOH on liver?

A

most common medical complication of ETOH abuse

alcoholic fatty liver (reversible) to hepatitis to fibrosis to cirrhosis to liver failure

increased risk if: long use, heavy use, woman, or Hx of Hep B or C

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14
Q

Chronic GI effects of ETOH?

A

chronic pancreatitis (most common cause)

protein malnutrition

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15
Q

chronic effect on bone marrow/blood?

A

mild anemia (from folic acid deficiency)

iron deficiency anemia (from GI bleed)

thrombocytopenia (first line to decrease due to direct effect)

*severe heavy use can reduce ALL cell lines eventually

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16
Q

chronic endocrine effects of ETOH

A

gynecomastia
testicular atrophy
hypoglycemia (inhibits gluconeogenesis)

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17
Q

chronic effects of ETOH on fetus?

A

teratogen/fetal alcohol syndrome:

growth retardation
low birth weight
microcephaly
poor coordination
flattened face
cog. disabilities
congenital heart abnormalities
18
Q

chronic effects of ETOH on immune system?

A

increased risk of infection (pneumonia)

hyperactivity with inflammatory liver/pancreas damage

19
Q

chronic effects of ETOH on cancer?

A 
mouth
larynx
pharynx
esophagus
liver
breast
20
Q

ETOH inhibits the metabolism of which drugs?

A

sedative hypnotics
phenothiazine
TCADs
tylenol (acetaminophen)

21
Q

ETOH increases the effect of what drugs?

A

vasodilators and hypoglycemics

22
Q

Result of combining ETOH and CNS depressants?

A

sedation or fatal CNS depression

23
Q

Why shouldn’t you mix ETOH and tylenol? What is the max dosage of tylenol for drinkers? how many drinks a day increases risk for hepatotoxicity from acetaminophen?

A

acetaminophen is metabolized to a toxic compound (the liver usually breaks this down quickly), if it is busy metabolizing ETOH than the toxic compound can’t be metabolized and quickly damages liver

max dose 2 mg per day

3 drinks per day increases risk for liver damages

24
Q

describe stage 1 of acute alcohol withdrawal (onset and Sx)

A 
0-8 hours
tachycardia
mild tremors
nausea
nervousness
25
Q

describe stage 2 of acute alcohol withdrawal (onset and Sx)

A 
12-24 hours
pronounced tachycardia
marked tremors
hyperactive/alert
increased startle response
insomnia/nightmares
illusions/hallucinations
ETOH craving
26
Q

describe stage 3 of acute alcohol withdrawal (onset and Sx)

A

12-48 hours
increased Sx and seizures possible
tachycardia

27
Q

describe stage 4 of acute alcohol withdrawal (onset and Sx)

A

3-5 days

delirium tremens: tremors, tachycardia, hyperpyrexia, confusion, agitation, tremor, insomnia, sweating

28
Q

Drug class of choice for seizure prevention and treatment in acute alcohol withdrawal?

A

benzos

29
Q

dosing options for benzos?

A

intermittent: depending on Sx
scheduled: given on admission than tapered for 3-4 days until Sx stop
loading: 10-20 mg Diazepam every hour until Sx stop or 1-2mg lorazepam

30
Q

nutritional supplements considerations for ETOH withdrawl?

A

thiamine: 100 mg IM and than orally for 3 days (prevents WK syndrome)
- always give before glucose (needed to metabolize glucose)

magnesium (IV)

electrolytes (IV)

Vitamines: like iron or folic acid (correct anemia)

31
Q

How to correct fluid deficit for pt with ETOH withdrawal Sx?

A

5% dextrose in 1/2 normal saline (can mix in potassium and phosphate)

32
Q

how to correct hallucinations from ETOH withdrawl?

A

benzos or haloperidol (may lower seizure threshold)

33
Q

seizure treatment in ETOH withdrawal?

A

benzos (high dose if Hx of seizures)

34
Q

treatment of high BP and HR in ETOH withdrawl?

A

beta blockers or alpha agonist (clonidine)

35
Q

chronic therapy options for ETOH addiction?

A

disulfiram (drug rxns)
naltexone
acaprosate (no drug rxns)

36
Q

MOA of disulfiram?

A

blocks acetaldehyde dehydrogenase causing acetaldehyde to accumulate making patient SICK with ETOH consumption (educate about mouthwash and cough syrup)

37
Q

SE of disulfiram?

A

occurs in minutes and lasts hours:

flushing
HA
N/V
sweating 
hypotension
confusion
38
Q

Other drugs that cause similar rxn to alcohol as disulfiram (because they block acetaldehyde dehydrogenase)?

A

metronidazole
cefotetan
trimethroprim
(all antibiotics)

39
Q

MOA of naltexone?

A

opioid receptor antagonist that decreases craving for ETOH and rate of relapse in the short term (but can be used chronically)

40
Q

MOA of acamprosate?

A

antagonizes GABA to reduce cravings and when combine with CBT decrease relapse

41
Q

SE of acamprosate?

A

GI irritation and rash

Pharm Final (3 decks)

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