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57 Cards in this Set
- Front
- Back
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what drug do you use for an agitated drunk
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haloperidol
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what drugs do you avoid using on a drunk
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antihistamines, anticholinergics, sedatives, atypical antipsychotics
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what are the sx of alcohol withdrawal
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hyperexcitability
convulsions toxic psychosis delirium tremens |
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what is korsakoff psychosis
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long lasting memory problems (confabulations)
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what is another name for increasing severity of withdrawal after multiple episodes
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kindling
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what is the drug and suppliment combo for alcohol withdrawal
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Use a benzodiazepine taper (chlordiazepoxide or lorazepam)
or carbamazepine - 100 mg IM X1, then, 50 mg q day X5 days folate - 1 mg q day multivitamins - 1 po q day |
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what is the opiod antagonist used to reduce cravings in alcoholics
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naltrexone
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when should someone not get naltrexone
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if they have decreased liver function or if they are being treated with an opioid
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what drug that reduced cravings in alcoholics can be used even if they have decreased liver function
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Acamprosate (Campral)- can be used in conjunction with naltrexone
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what is the MOA of Acamprosate (Campral)
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blocks NMDA(glutamate) and activates GABA
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what is the MOA of disulfiram
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BLOCKS ALDEHYDE DEHYDROGENASE and with alcohol consumption is causes acetaldehyde syndrome
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what qualifies an alcoholic
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1 pint hard liquor for at least 30 days
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what are the sx of delirium tremens
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mental confusion, fluctuating LOC, tremor, agitation, autonomic overactivity ( increase bp, hr, resp)
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why is disulfiram minimally effective
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because the patient will just discontinue the drug if they want to resume drinking
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what drugs are used for acute alcohol withdrawl
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a) Diazepam (Valium, generic)
b) Lorazepam (Alzapam, Ativan, generic) c) Oxazepam (Serax, generic) d) Thiamine (generic) |
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what drugs are used for the prevention of alcohol abuse
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a) Acamprosate (Campral)
b) Disulfiram (Antabuse) c) Naltrexone (ReVia, generic) |
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what drugs are used for acute methanol or ethylene glycol poisoning
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a) Ethanol (generic)
b) Fomepizole (Antizol) |
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what is alcohol dependence
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consumption of alcohol in spite of adverse medical or social consequences related directly to alcohol consumption (terminology preferred over alcoholism)
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what kind of genetic alteration can protect against alcoholism
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polymorphisms in alcohol dehydrogenase and aldehyde dehydrogenase
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what kind of compound is ethanol and how does this relate to its biologic properties
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amphipathic so it can cross membranes and spread everywhere that water goes
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what can aspirin do when ethanol is present
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inhibits gastric ADH and can increase ethanol bioavailability
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what does Fomepizole do and what is it used for
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inhibits ADH and is used in the treatment of acute methanol or ethylene glycol poisoning
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(a) 2 mol of ___are required to convert 1 mol of ethanol to acetic acid (required by both ADH and ALDH)
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NAD
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why can the liver only metabolize 7-10 g ethanol and hour
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because it does not have enough NAD
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what happens to people with the ALDH polymorphism that drink alcohol
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develop high acetaldehyde concentrations and may experience facial flushing, light headedness, palpitations, nausea, and general “hangover” symptoms- ppl that drink alot with this have increased risk for liver disease due to acetaldehyde
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what are Microsomal ethanol oxidizing system (MEOS)
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(1) Mixed function oxidases (cytochrome P450s) use NADPH as a cofactor in the metabolism of ethanol to acetaldehyde
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what happens to MEOs with chronic alcohol consumption
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induces MEOS activity (2E1) and can result in the enhanced activation of toxins, free radicals, and hydrogen peroxide
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what is defined as intoxication in most states
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80 mg/dl...08 % BAC
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what does alcohol do to glutamate
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inhibits the ability of glutamate to open the cation channel of the NMDA receptor and leads to an increased depression of the CNS--this can cause the memory loss
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what does alcohol do to GABA
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enhances the effects of GABA on the GABAA receptor and leads to an increased depression of the CNS
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what happens to the heart with acute moderate intake of alcohol
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Depression of myocardial contractility l (i.e., at BAC above 100 mg/dl)
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what does ethanol do to smooth muscle
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vasodilation bc (depression of the vasomotor center) and smooth muscle relaxation caused by the metabolite acetaldehyde, overdose cause hypothermia caused by vasodilation
uterine muscle relaxation |
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what are the se of disulfiram
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Hepatotoxic and inhibits the metabolism of other therapeutic agents (phenytoin, oral anticoagulants, isoniazid, caffeine, barbiturates)
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what is the tx of ethylene glycol overdose
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(1) Hemodialysis
(2) Ethanol infusion (3) Fomepizole |
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why is ethylene gycol overdosed on
what is it metabolized to |
its sweet and its antifreezetoxic
aldehydes and oxalate |
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what is most common sx of methanol poisoning
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blurred vision (“like being in a snowstorm”)
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whats the tx of methanol poisoning
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Respiratory support, Suppression of metabolism by ADH (ethanol and fomepizole) Hemodialysis to enhance methanol removal, Alkalinization to counteract metabolic acidosis (bicarbonate), Ethanol has a higher affinity than methanol for ADH and is often used intravenously
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what is the time frame for onset of action and duration of action for disulfiram
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Slowly absorbed from GI tract with onset of action from 3-12 hours; effects may persist up to 14 days from previous dose
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what drug can naltrexone not be combined with
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disulfiram
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how long can naltrexone prevent relapse for
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12 weeks
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how long can acamprosate prevent relapse for
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greater than 6 months
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what are sx of moderate form of alcohol withdrawl
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characterized by tremor, anxiety, and insomnia, occur 6-8 hours after alcohol consumption is stopped and usually abate in 1-2 days
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what is the disadvantage of using long acting benzo for detox
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pharmacologically active metabolites may accumulate, especially in patients with compromised liver function
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what is the benefit of using short acting benzo for detox
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Rapidly converted to inactive metabolites and are useful in patients with liver disease
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using sedative hypnotics how long does it take to restore cns function
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several months
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chronic alcholol consumption causes increase in ____ ensymes
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cyp450
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why can chronic alcholol use cause increase cancer
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ii) Acetaldehyde and reactive oxygen species produced by increased CYP450 activity can damage DNA
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what are sx of Fetal alcohol syndrome why does this happen
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(1) Intrauterine growth retardation
(2) Microcephaly (3) Poor coordination (4) Underdevelopment of midfacial region (5) Minor joint abnormalities iv) Ethanol crosses the placenta and the fetal liver has little or no alcohol dehydrogenase activity and must rely on the mother’s liver for elimination |
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what does alcohol have to do with diuresis
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inhibits the release of vasopression resulting in enhanced diuresis
Vasopressin release is increased during withdrawal resulting in water retention and dilutional hyponatremia |
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what role does alcohol have on sex
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first increased libido and with chronic use it causes decrease
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what can alcohol do to skel mus
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increase weakness and increase creatine kinase
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what can alc do to immune sys
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can increase inflam in liver and decrease immune in lungs- causing more infections or worsening current infxns
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what can alc do to blood
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mild anemia resulting from alcohol-related folic acid deficiency
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what can happen to vision after chronic drinking
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Painless blurring of vision occurs over several weeks of heavy alcohol consumption, with changes typically bilateral and symmetric (optic nerve degeneration may follow)
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what does the accum of fat in the liver due to alc result from
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inhibition of both the tricarboxylic acid cycle and the oxidation of fat, in part, owing to the generation of excess NADH produced
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how does alc cause pancreatitis
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direct toxic effects on pancreatic acinar cells, alters pancreatic epithelial permeability, and promotes the formation of protein plugs and calcium carbonate-containing stones
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what can alc do to the stomach
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disrupt the gastric mucosal barrier and cause acute and chronic gastritis, drinks w more than 40% alc have a direct toxic effect on gastric mucosa--> acute epigastric pain (relieved with antacids or histamine H2-receptor blockers)
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