Lecture 17: Alcohol

Question 1

what enzyme converts ethanol to acetaldehyde?

Answer 1

ADH

Question 2

what enzyme transforms acetaldehyde -> acetic acid

Answer 2

ALDH

Question 3

sex differences in ADH levels

Answer 3

lower in women

Question 4

genetic variation in ALDH

Answer 4

mutation in Asian populations

Question 5

factors that can affect metabolism

Answer 5

• food in the stomach
• rate of drinking
• amount of alcohol dehydrogenase in stomach lining
• type of alcohol

Question 6

blood alcohol concentration

Answer 6

index of amount of alcohol in blood, measured in grams %

Question 7

how many grams of absolute alcohol does a standard drink contain

Answer 7

14 g

Question 8

what are subjective changes at 0.05 gm%

Answer 8

• personality changes
• relief from anxiety
• social lubricant
• disinhibition

Question 9

subjective changes at 0.08 gm%

Answer 9

• significant disinhibition
• impaired judgement
• impaired cognition
• impaired motor function

Question 10

subjective changes at 0.15 gm%

Answer 10

• marked ataxia
• major motor impairments
• impaired reaction time
• blackouts

Question 11

subjective changes at 0.3 gm%

Answer 11

• increased sedation/hypnosis
• approaching general anesthesia
• approaching coma

Question 12

what is a lethal dose for 50% of people

Answer 12

0.4 gm%

Question 13

what receptors does alcohol act at

Answer 13

non-competitive inhibitor of AMPA/kainite receptors at high concentratioins

Question 14

which receptors are most sensitive to alcohol

Answer 14

NMDARs

Question 15

how does acute alcohol affect NMDAR function

Answer 15

inhibits

Question 16

how does chronic alcohol affect NMDAR expression

Answer 16

upregulates

Question 17

how does acute alcohol affect dopamine pathways

Answer 17

activates DA reward pathways

Question 18

how does chronic alcohol use affect DA pathways

Answer 18

hypodopaminergic state, associated w/ dysphoria

Question 19

how does acute alcohol affect GABA(A)R

Answer 19

enhances function
- alcohol may bind directly to the receptor, increase presynaptic GABA release, or release GABAergic steroids

Question 20

how does chronic alcohol use affect GABA(A)Rs

Answer 20

downregulation
- due to initial overstimulation by alcohol

Question 21

first line treatment for alcohol withdrawal

Answer 21

benzodiazepine

Question 22

Disulfiram function

Answer 22

inhibits ADLH; results in increase in acetaldehyde
- causes nausea, vomiting, palpitation, blurred vision when alcohol is consumed

Question 23

how effective is Disulfiram

Answer 23

effective pharmacologically, but poor adherance to meds = limited use in clinical practice

Question 24

Naltrexone function

Answer 24

at high doses, it acts as an inhibitor to reduce withdrawal symptoms

Question 25

Acamprosate mechanism

Answer 25

not fully known; probably involves NMDAR

Question 26

Acamprosate receptor activity

Answer 26

partial co-agonist at NMDAR; may attenuate hyperexcitability associated w/ withdrawal & abstinance

Question 27

which withdrawal is more effective in maintaining abstinance than preventing relapse

Answer 27

Acamprosate

Question 28

contingency management

Answer 28

patients get incentives for meeting behavioral goals - strong empirical support - some evidence that these programs are only effective during the active period

Question 29

CBT approach

Answer 29

grounded in social learning theories & principles of operant conditioning - use behavioral & cognitive strategies to cope w/ high risk situations