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BPS > Kruse DSA: Pharmacology of Alcohol > Flashcards

Kruse DSA: Pharmacology of Alcohol Flashcards

(50 cards)

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1
Q

Drugs we use for the tx of acute alcohol withdrawal syndrome

A
  • Diazepam
  • Lorazepam
  • Oxazepam
  • Thiamine
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2
Q

Drugs for the prevention of alcohol abuse

A
  • Acmprosate
  • Disulfiram
  • Naltrexone
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3
Q

Drugs for the tx of acute methanol or ethylene glycol poisonin

A
  • Ethanol

- Fomepizole

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4
Q

What is fetal alcohol syndrome

A

-a syndrome of craniofacial dysmorphia, heart defects, and mental retardation caused by the teratogenic effects of ethanol consumption during pregnancy

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5
Q

Wernicke Korsakoff syndrome

A

-syndrome of ataxia, confusion, and paralysis of the EO muscles that is associated with chronic alcoholism and thiamine deficiency

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6
Q

Where does alcohol get absorbed the most?

A

-the small intestine

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7
Q

What order kinetics does alcohol follow?

A
  • zero order

- independent of time and concentration

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8
Q

What enzyme metabolizes alcohol?

A
  • Alcohol dehydrogenase (ADH)

- aldehyde dehydrogenase (ALDH)

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9
Q

What does fomepizole inhibit

A

-alcohol dehydrogenase

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10
Q

What does disulfiram inhibit?

A
  • Aldehyde dehydrogenase

- gives you a bitch of a hangover

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11
Q

What does ADH do?

A
  • converts ethanol to acetaldehyde

- in the liver

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12
Q

What other thing is required to vonvert ethanol to acetaldehyde?

A
  • NAD+

- so, NADH comes out of there too

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13
Q

What does aspirin do in this DSA?

A
  • inhibits gastric ADH and can increase ethanol bioavailability
  • Fomepizole inhibits ADH and is used in tx of acute methanol or ethylene glycol poisoning
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14
Q

What is acetadehyde also dependent on?

A

-NAD+

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15
Q

What does acetaldehyde get converted to?

A
  • acetic acid

- (produces NADH)

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16
Q

Which drug inhibits ALDH?

A

-disulfiram, a drug used for the tx of alcohol abuse and dependence

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17
Q

does ALDH have genetic polymorphisms?

A
  • yes

- Asians… remember Ross the boss tanaka

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18
Q

What is the microsomal ethanol oxidizing system (MEOS)?

A
  • oxidases (CYP450’s) use NADPH as a cofactor in the metabolism of ethanol to acetaldehyde
  • higher concentrations of alcohol
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19
Q

Which cyp does chronic alcoholism induce?

A
  • CYP2E1

- enhanced activation of toxins, free radicals, and hydrogen peroxide

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20
Q

What big ion channel does ethanol affect?

A
  • NMDA subtype of glutamate receptors
  • glutamate= primary excitatory NT in CNS
  • GABA receptor… inhibitory in CNS
  • enhances effects of GABA receptor and leads to an increased depression of the CNS
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21
Q

What is the most common cause for both acute and chronic pancreatitis in the US?

22
Q

Why do alcoholics get fatty liver?

Study These Flashcards
A

-inhibition of both the TCA cycle and the oxidation of fat…. owing to the generation of excess NADH produced

23
Q

What is tolerance

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A

-reduced behavioral or physiological response to the same dose of ethano

24
Q

What is that severe sign of alcohol withdrawal?

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A

-delirium tremens

25
What is Wernicke-Korsakoff syndrome?
- paralysis of the EO muscles, ataxia, and a confused state that can progress to coma and death - Associated with thiamine deficiency and rarely seen in the absence of alcoholism - Tx with thiamine will improve ovular problems, ataxia, and confusion, but most pts are left with a chronic disabling memory disorder known as Korsakoff's psychosis
26
What did studies show about alcohol and CHD?
-moderate alcohol consumption prevents CHD and reduces mortality more than in ppl who abstain or are heavy consumers or alcohol
27
Why do chronic drinkers have mild anemia
-folic acid deficiency
28
Why the iron deficiency anemia?
-GI bleeding
29
What is the weird thing that happens with body temp
-due to increased cutaneous and gastric blood flow, sweating may occur while the internal body temp falls
30
Why would someone going through withdrawal experience hyponatremia?
-vasopressin release is increased during withdrawal... so they retain a shit ton of water
31
What is the leading cause of mental retardation and congenital malformation ?
-Alcohol
32
What all comes with the Fetal alcohol syndrome package?
- Intrauterine growth retardation - Microcephaly - poor coordination - underdevelopment of midfacial region - minor joint abnormalities
33
Does the fetal liver have alcohol dehydrogenase activity?
-nah
34
What enzyme levels are increased from chronic ethanol consumption?
- CYP450s - particularly, CYP2E1 - acetaminophen will fuck these people up
35
What do we do to manage acute alcohol intoxication?
- prevent severe resp depression and aspiration of vomitus - Glucose can tx metabolic things like hypoglycemia and ketosis - Thiamine to protect against the Wernicke-Korsakoff syndrome - Potassium may be needed in the event of severe vomiting
36
What drug can we give them if they are having a really bad withdrawal?
- long acting benzos (diazepam) - less frequent dosing and built in tapering effect - but watch out for pts with a compromised liver because then pharmacologically active metabolites may accumulate
37
What do we do for someone in withdrawal but they're liver function sucks?
- give them a short acting benzo like lorazepam or oxazepam | - rapidly converted to inactive metabolites and are useful in pts with liver disease
38
What is Naltrexone?
- approved for tx of alcohol and opiate dependence - MOA: mu opioid receptor antagonist (long acting) - reduces craving for alcohol and the rate of relapse to either drinking or acohol dpendence for the short term
39
When is Naltrexone contraindicated?
-in pts with acute hepatitis or liver failure
40
What do we have to make sure the patient is clear of before we give them Naltrexone?
- must be opioid-free!!!!! | - Naltrexone will create an acute withdrawal syndrome
41
Acamprosate
- MOA: weak NMDA receptor antagonist and GABAa receptor agonist - Reduces short-term and long-term relapse rates - elminated in urine as an uncharged drug; use caution in patients with kidney disease - can be used in combo with naltrexone or disulfiram
42
Disulfiram
- MOA: irreversibly inhibits aldehyde dehydrogenase and causes exteme discomfort in pts who drink alcoholic beverages - Slowly absorbed from GI tract with onset of action from 3-12 hrs; effects may persist up to 14 days from previous dose - hepatotoxic, inhibits metabolism of other therapeutic agnets
43
What should we not mix disulfiram with?
-other drugs that contain alcohol
44
What is the caveate with disulfiram?
-the pts must be highly motivated and have supportive therapy
45
should we give disulfiram in a state of alcohol intoxication?
-no!
46
What is the most common characteristic symptom in methanol poisoning ?
-blurred vision (like being in a snowstorm)
47
tx of methanol poisoning
- resp support - suppression of metabolism by ADH (ethanol and fomepizole) - Hemodialysis to enhance methanol removal - alkalinzation to counteract the metabolic acidosis (bicarb)
48
Which has a higher affinity for ADH, methanol or ethanol?
- ethanol actually, that is why you give them a drink lol | - remember fomepizole inhibits ADH and is approved for the tx of methanol poisoning
49
What is ethylene glycol metabolized to?
-toxic aldehydes and oxalate
50
Tx for ethylene glycol
- hemodialysis - ethanol infusion - Fomepizole

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