Alcohol - Goldstein

Front 1

Occassional alcohol use in ___% of adult population

Back 1

67%

Front 2

Chronic substantial alcohol use in adults = ___%

Back 2

10%

Front 3

Social cost of alcohol _____/yr

(from crime, accidents, sickness, death)

Back 3

$100 billion

Front 4

Alcohol from GIT is rapid and ______

Back 4

complete

Front 5

On an empty stomach, will reach peak blood levels of alcohol in ____ mins

Back 5

40 mins

Front 6

____ in lg quantities can slow absorption

Back 6

Beer

Front 7

Distribution of alcohol is proportional to ____ content of tissues

Back 7

Water

Front 8

Urine alcohol level can be approximately ___% of BAL

Back 8

130

Front 9

_____ is not reliable for estimation of BAL

Back 9

Urine

Front 10

Alveolar air is approximately ___% of BAL

Back 10

.05%

Front 11

________ is reliable for estimating BAL

Back 11

Alveolar Air

Front 12

BAC = .05 effect (2)

Back 12

Euphoria
Minor motor disturbances

Front 13

BAC = .06 effect

Back 13

Nystagmus

Front 14

BAC = .08 effect

Back 14

Reduced Glare Response

Front 15

BAC = .1 effect

Back 15

Significant motor response

Front 16

BAC = .35 + effect

Back 16

death

Front 17

Alcohol biotransformation is ______ kinetics

Back 17

zero order

Front 18

Alcohol is excreted via (2)

Back 18

- Lungs
- Kidney

Front 19

___ % of ethanol is oxidized by the liver

Back 19

90%

Front 20

Rate limiting step in alcohol breakdown (due to limited amount of cofactor = _____)

Back 20

Alcohol dehydrogenase
Co-factor = NAD

Front 21

System for metabolizing alcohol in the liver - in SER

Back 21

Microsomal Ethanol Oxidizing System

Front 22

Microsomal Ethanol Oxidizing System uses ___ as co-factor

Back 22

NADPH

Front 23

Normal adult biotransforms ___ mL of absolute alcohol per hr

Back 23

10

Front 24

Compared to M, non-alcoholic F have a 25% dec in

Back 24

1st pass metabolism of alcohol

Front 25

Compared to M, non-alcoholic F have a 60% dec in _____

Back 25

Gastric alcohol dehydrogenase activity

Front 26

Alcoholic F only had ___% of the 1st metabolism of non-alcoholic M (aka basically nonexistent)

Back 26

6%

Front 27

Alcohol sedation causes impaired

Back 27

Judgement

Front 28

Alcohol causes reduction of these 2 CNS aspects

Back 28

- Dec cortical inhibition of subcortical centers
- Dec transmition from RAS

Front 29

Ultimate effect of alcohol influenced by (2)

Back 29

- set
- setting

Front 30

Amnesia from alcohol - info only remembered if placed in same degree of intox

Back 30

State dependent learning

Front 31

Acute alcohol can diminish hepatic biotrasnformation and therefore can __________

Back 31

Inc t1/2 of other drugs

Front 32

Alcohol + ___________ may cause an increase effect

Back 32

CNS depressant

Front 33

Possible mechs of alcohol CNS depression (not established)

Back 33

- Shift of membrane from gel --> fluid
- Membrane disordered = loss of activity

Front 34

Alcohol heart ADRs

Back 34

Dec myocardial ctx

Front 35

Alcohol ADR = BV dilation direct and indirect

Back 35

- Direct: acetaldehyde depresses vascular smooth muscle
- Indirect: depression of vasomotor center

Front 36

Alcohol causes loss of body heat, so if ingested in a cold env, may cause

Back 36

Hypothermia

Front 37

Renal effects of alcohol = dec ____________

Back 37

ADH from posterior pituitary --> diuresis

Front 38

Low ethanol concentration GI ADR

Back 38

- Inc appetite (prob bc dec anxiety)
- Inc gastrin

Front 39

High ethanol concentration GI ADR (3)

Back 39

- N/V
- Inc emptying time
- Bleeding

Front 40

______ from alcohol is due to
- poor nutrition
- depletion of hepatic glycogen
- dec GNG

Back 40

Hypoglycemia

Front 41

Alcohol ADR = hyper_______

Back 41

Hyperuricemia

Front 42

Tx of alcohol OD is similar to tx of ______

Back 42

Barbiturates

Front 43

________ is effective to tx alcohol OD

Back 43

Hemodialysis

Front 44

Mild form of alcohol withdraw --> so if give alcohol, will help

Back 44

Hangover

Front 45

In regards to tolerance, _____ is not significant, but _____ is

Back 45

Enzymative (biotransformational) is not significant but cellular is

Front 46

Develops as tolerance occurs

Back 46

Physical dependence

Front 47

For withdraw sx's to occur, _____ does not have to = 0

Back 47

BAC

Front 48

Mild alcohol withdraw begins ____ hrs after last drink

Back 48

6-8 hrs

Front 49

Mild alcohol withdraw sx's (6)

Back 49

- Anxiety
- Sweating
- Insomnia
- Hyperreflexia
- Tremors
- Vomit

Front 50

Peak of severe alcohol withdraw occurs

Back 50

24-48 hrs after last drink

Front 51

Severe alcohol withdraw sx
- Confusion
- Hallucinations (all kinds)
- ANS hyperactivity = sweating, mydriasis, tachycardia

Back 51

Delirium Tremens

Front 52

Severe alcohol withdraw sx's (4)

Back 52

- Disorientation
- Hallucination
- Delirium Tremens
- Seizures

Front 53

Tx of alcohol withdraw is a medical emergency b/c ___ risk of death

Back 53

5-10%

Front 54

Drugs tx of alcohol withdraw (2)

Back 54

- BZ's for agitation
- Phenytoin for seizure prophylaxis

Front 55

Nutrition probs with alcohol (3)

Back 55

- Folic acid def (megaloblastic anemia)
- Iron def
- Niacin def (pellagra)

Front 56

Vit B3 (Niacin) def

Back 56

Pellagra

Front 57

Folic acid def causes

Back 57

Megaloblastic anemia

Front 58

Peripheral neuropathy caused by alcohol withdraw (3)

Back 58

- Axon degen of motor nerves
- Paresthesias
---> releated to thiamine def

Front 59

Chronic alcohol cardiomyopathy (2)

Back 59

- Fatty infiltrate of myocardium
- Fibrosis replacement of tissue

Front 60

Chronic alcohol use causes dilation of BV's around (2)

Back 60

Nose
Eyes

Front 61

3+ drinks per day causes ___

Back 61

HTN

Front 62

Chronic alcoholism causes inc in _____ and dec in _____--> decs CAD

Back 62

inc HDL; dec LDL

Front 63

Alcoholic fatty liver can progress to ________

Back 63

Hepatitis

Front 64

80% of pts with alcoholic hepatitis have

Back 64

5 yr+ hx of heavy alcohol intake

Front 65

When fibrosis of alcoholic hepatitis spreads to portal tracts

Back 65

Portal Cirrhosis

Front 66

Hematologic effects of chronic alcohol use (2)

Back 66

- Hemolytic anemia
- Thrombocytopenia

Front 67

CNS sx's of chronic alcohol use (2)

Back 67

- Wernicke's Encephalopathy
- Korsakoff's Psychosis

Front 68

Chronic alcohol abuse causes
- early in syndrome
- related to thiamine def
- cerebellar ataxia
- confusion
- polyneuropathy

Back 68

Wernicke's Encephalopathy

Front 69

Chronic alcohol use
- continuation of earlier syndrome
- poor short term memory
- thiamine given IV

Back 69

Korsakoff's

Front 70

Cancers caused by alcohol use (5)

Back 70

- Esophagus
- Pharynx
- Larynx
- Liver
- Pancreas

Front 71

FAS occurs with ____ of absolute alcohol/day

Back 71

2.5 ounces

Front 72

FAS effects (6)

Back 72

- Dec IQ
- Dec height/weight (for life)
- Face defects
- Atrial septal defect
- Uncoordinated
- Inc rate of spont abortion

Front 73

Heart defect that occurs with FAS

Back 73

Atrial septal defect

Front 74

Facial defects that occur with FAS (2)

Back 74

- Hypoplasia of maxilla
- Short palpebral fissures

Front 75

Most effective tx for chronic alcoholism

Back 75

Psychotherapy

Front 76

Drugs used for chronic alcoholism (3)

Back 76

- Disulfuram
- Naltrexone
- Acamprosate

Front 77

Disulfuram used for chronic alcoholism MOA

Back 77

- Inhibits aldehyde dehydrogenase --> accum of acetylaldehyde

Front 78

Disulfuram causes accum of acetylaldehyde which causes (6)

Back 78

- Garlic aftertaste
- N/V
- Weakness
- Confusion
- Impotence
- Extreme vasodilation

Front 79

Disulfuram causes extreme vasodilation which causes (3)

Back 79

- Flushing of skin
- H/A
- Hypothension --> tachycardia

Front 80

Disulfuram contraindications (2)

Back 80

- Heart dz
- Coronary occlusion

Front 81

Only ____ mL are needed to induce Disulfuram's rxns

Back 81

7.5

Front 82

Pts who take Disulfuram to tx alcoholism need to avoid (3)

Back 82

- Alcohol in foods
- Aftershave lotion
- OTC cough syrups
Etc

Front 83

Disulfuram has a slow elimination, so pt may experience severe rxn to alcohol even up to ____ days following last dose

Back 83

14 days

Front 84

Disulfuram reduces biotransformation of _____, so may need to lower the dose (3)

Back 84

- Phenytoin (given proph to prevent seizure)
- BZ's
- oral anticoagulants

Front 85

2 drugs that produce disulfuram type rxns (2)

Back 85

- Sulfonamide Oral Hypoglycemia
- Metronidazole

Front 86

Acamprosate used to tx chronic alcoholism MOA

Back 86

Decs central glutamate --> decs withdraw sx's

Front 87

Narcotic antagonist used to tx chronic alcoholism

Back 87

Naltrexone

Front 88

Naltrexone theorized MOA in tx'ing chronic alcoholism

Back 88

- Decs CBF --> decs release of endorphins from frontal cortex-thalamus-limbic system loop

(less euphoria with alcohol)

Front 89

Naltrexone reported results in tx'ing alcoholism (4)

Back 89

- Dec drinks/day
- Inc compliance
- Dec relapse
- More successful in coping with relapse

Front 90

Naltrexone used to tx chronic alcoholism other reported effects (3)

Back 90

- Dysphoria
- Anorexia
- Wt loss

Front 91

Naltrexone ADRs in treating chronic alcoholism are the same as treating narcotic addiction + increased _________

Back 91

N/V

(so causes anorexia and wt loss)

Front 92

4 possible mechanisms of naltrexone in treating chronic alcoholism (best is dec euphoria)

Back 92

- Dec euphoria
- Inc dysphoria
- Alters alcohol pharmacokinetics
- Enhances + effects of alcohol