lecture 84 Flashcards
svensson -- pharmacology of alcohol use and misuse
what is alcohol?
when used colloquially, refers to a beverage containing ethanol
chemically, refers to organic compounds characterized by one or more hydroxyl (-OH) groups attached to a carbon atom of an alkyl group (hydrocarbon chain)
what is AUD?
alcohol use disorder
associated with compulsive alcohol consumption, the loss of control of intake, and the emergence of a negative emotional state when alcohol is not accessible
what is alcohol withdrawal syndrome?
a set of symptoms that manifest in ppl upon abrupt cessation of chronic alcohol ingestion
include anxiety, insomnia, palpitations, HA, GI upset, and other constitutional symptoms
may progress to withdrawal seizures and delirium tremens
what is alcohol poisoning?
a potentially life threatening condition arising from acute ingestion of excessive alcohol
what is CUSP?
key signs of acute alcohol poisoning
C – cold, clammy skin
U – unconscious
S – slow or irregular breathing
P – puking uncontrollably
what is fomepizole?
an inhibitor of ADH
used in tx of methanol and ethylene glycol poisoning
what is disulfiram?
an inhibitor of ALDH
used in tx of AUD
what is naltrexone?
an opioid receptor antagonist primarily working at the mu receptor
what is acamprosate?
used in tx of AUD
mechanism not fully known but primarily acts as an NMDA receptor antagonist
modulation of the glutamatergic system
what is ADH?
alcohol dehydrogenase
converts ethanol to acetaldehyde
what is ALDH?
aldehyde dehydrogenase
converts acetaldehyde to acetyl CoA
what is the MEOS?
microsomal ethanol oxidizing system
functions at high ethanol consumption to convert ethanol to acetaldehyde
what is CYP2E1?
primary enzyme in MEOS
how is ethanol removed from the body?
90% is via hepatic metabolic mostly by ADH
what is the moa of ethanol?
acts as a general CNS depressant, primarily by enhancing neuronal GABA and inhibiting glutamate
combing alcohol with other CNS depressants would have a potentiating effect
what is unique about ethanol’s metabolism?
exhibits dose-dependent metabolism
small increases in dose can result in disproportionate increases in the blood concentration achieved
when do symptoms of alcohol withdrawal appear?
minor symptoms can begin within hours of cessation
seizures occur within the first 2 days
delirium tremens may occur after 2 days and last up to 7 days
what can delirium tremens present like?
agitation
hallucinations
disorientation
diaphoresis
what are the effects that food has on ethanol concentration?
food slows gastric emptying, reducing the rate of ethanol absorption and reducing the saturation of metabolism
what are the clinical effects of ethanol depending on BAC?
0-0.05% – mild
0.06-0.15% – increased impairment
0.16-0.3% – severe
0.31-0.45% – life threatening
what are the stages of AUD and what are they mediated by?
binge/intoxication – basal ganglia
withdrawal/negative effect – amygdala
preoccupation/anticipation – prefrontal cortex
what type of seizures can arise from withdrawal?
generalized tonic-clonic seizures
