Pharmacology of Alcohol and Drugs of Abuse - Linger

Question 1

most commonly abused drug in world

Answer 1

ethanol

Question 2

75% adults in US

Answer 2

use alcohol

only 8% become disorder

Question 3

ethanol PK

Answer 3

amphipathic - hydrophilic and hydrophobic

first pass metabolism
zero order kinetics

Question 4

BAC sedation, high, slower rxn time

Answer 4

50-100

Question 5

BAC impaired motor fxn, slurred speech, ataxia

Answer 5

100-200

Question 6

BAC emesis, stupor

Answer 6

200-300

Question 7

BAC coma

Answer 7

300-450

Question 8

BAC resp depression and death

Answer 8

> 500

Question 9

0.08% BAC

Answer 9

= 80mg/dL blood alcohol concentration

Question 10

tolerance

Answer 10

decrease in responsiveness to drug following repeated exposure

can happen in acute alcohol consumption

Question 11

sensitization

Answer 11

reverse tolerance

increase in responsiveness to drug following repeated exposure

with cocaine

Question 12

drugs sedative hypnotics

Answer 12

class B - benzos and newer drugs - plateau

class A - barbs, alclhol, older sedative hypnotic - linear - to coma

Question 13

enzyme of alcohol metabolism

Answer 13

alcohol dehydrogenase (ADH)

aldehyde DH (ALDH)

microsomal ethanol oxidizing system (MEOS)
-CYP450s

Question 14

enzyme mutations

Answer 14

hyperactive AHD
low active ALDH

accumulate of acetaldehyde

adverse effects

Question 15

disulfram

Answer 15

inhibit ALDH

aka anabuse

Question 16

fomepizole

Answer 16

inhibit ADH

tx - methanol OD - so don’t metabolize it

Question 17

ethanol vs. methanol

Answer 17

ethanol higher affinity for ADH

tx of methanol poisoning

Question 18

acetaldehyde

Answer 18

toxic - from alcohol metabolism

Question 19

metabolize 1 mol of ethanol

Answer 19

need 2 mol NAD+

saturate enzymes quickly - zero-order kinetics

Question 20

tx of alcohol intox

Answer 20

resp support
gastric lavage - naloxone (short acting)
fluid replacement
short acting benzo
thiamine (prevent wernicke)
glucose

mostly supportive

Question 21

receptors for ethanol

Answer 21

NMDA - glutamate - excitation (memory impairment)
-ethanol decrease NMDA

GABA-A - inhibition
-ethanol increase NMDA

Question 22

liver and alcohol

Answer 22

fatty liver > hepatitis > cirrhosis > liver failure

Question 23

CV and alcohol

Answer 23

cardiomyopathy
HF
arrhythmia
HTN
stroke
coronary heart disease

Question 24

cancer and alcohol

Answer 24

increased risk

-mouth, pharynx, esophagus, liver

Question 25

CNS and alcohol

Answer 25

altered expression - NMDA and GABA-A receptors

Question 26

tolerance to alcohol

Answer 26

has a limit still get resp depression

Question 27

tx for seizure in alcohol OD

Answer 27

diazepam - fasting acting - IV

Question 28

diazepam vs. oxazepam

Answer 28

diazepam - fast and IV | oxazepam - slow and PO

Question 29

thiamine

Answer 29

prevents wernicke encephalopathy

Question 30

alcohol withdrawal syndrome

Answer 30

anxiety, insomnia, tremor, palps, nausea, anorexia go away days may persist for months

Question 31

delirium tremens

Answer 31

tachy, HTN, low grade fever, tremor, diaphoresis, delirium, agitation with alcohol withdrawal

Question 32

detox from alcohol

Answer 32

benzos

Question 33

long acting benzos

Answer 33

diazepam and chlordiazepoxide cause liver damage

Question 34

short acting benzos

Answer 34

lorazepam and oxazepam for pt with liver disease

Question 35

tx of alcohol depedence

Answer 35

``` naltrexone acamprosate disulfiram - anabuse topiramate ondansetron ```

Question 36

naltrexon

Answer 36

longer acting opioid receptor antagonist reducing craving and relapse rates - alcohol dependence

Question 37

acamprosate

Answer 37

weak NMDA antagonist GABA-A agonist reduce short and long term relapse rates alcohol dependence

Question 38

disulfiram

Answer 38

inhibit ALDH - discomfort in pt who drunk alcohol - accumulation of adehyde

Question 39

abuse

Answer 39

pattern of substance use leading to significant impairment

Question 40

dependence

Answer 40

compulsive use of substance despite significant problems resulting from such use psych physio

Question 41

psych dependence

Answer 41

addiction

Question 42

physical dependence

Answer 42

dependence - withdrawal syndrome occurs

Question 43

withdrawal

Answer 43

evidence of physical dependence

Question 44

drugs of abuse in brain

Answer 44

mesolimbic dopamine system VTA MFB - medial forebrain bundle - DA neurons

Question 45

sensitization

Answer 45

with cocaine more higher response to same dose over time

Question 46

drugs of abuse on GPCRs

Answer 46

opioids cannabinoids GHB hallucinogens - LSD, mescaline, psilocybin

Question 47

drugs of abuse on monoamine transporters

Answer 47

cocaine amphetamines ecstasy

Question 48

drugs of abuse on ion channels

Answer 48

``` nicotine alcohol benzos dissociative anesthetics - phencyclidine and ketamine inhalants ```

Question 49

GABA

Answer 49

inotropic

Question 50

cocaine

Answer 50

inhibit DAT

Question 51

methadone

Answer 51

long acting opioid used for substitution therapy

Question 52

buprenorphine

Answer 52

mix agonist/antagonist

Question 53

smoking cessation

Answer 53

bupropion - antidepressant

Question 54

varenicline

Answer 54

partial neuronal nAChR agonist -for smoking cessation only suicidal ideation

Question 55

lozenge

Answer 55

nicotine dependence

Question 56

adverse of lots of methanol

Answer 56

blindless tx - fomepizole or ethanol and sodium bicarb

Question 57

benzo antagonist

Answer 57

flumazenil

Question 58

spike alcohol

Answer 58

benzo