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14 Cards in this Set
- Front
- Back
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alcohol abuse definition
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maladaptive pattern of use associated with one or more of:
fail to fulfill work, home, school function recent alcohol use in a physically hazardous situation recurrent legal problems due to use of alch continued use despite alcohol related problems or interpersonal problems |
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hazardous drinking
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exceeds threshold for responsible drinking
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problem drinking
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causes harm, but not enough to meet criteria for alcohol abuse
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alcohol abuse and dependence
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drinking that leads to repeat physical, social, psych harm and inability to stop drinking
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alcohol dependence
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3 or more of following:
1. tolerance 2. withdrawl 3. substance taken in large quantities 4. persistant desire to cut down 5. time spent in obstaining, using, or recovering from alc 6. social, recreational, or occupational tasks are sacrificed for drinking habit 7. associated physical or psychological problems related to drinking |
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CAGE questionnaire
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felt need to cut down drinking
felt annoyed by criticism of you drinking felt guilty about drinking take morning eye openers to ease a hangover or calm nerves |
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alcohol metabolism
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alcohol -> acetaldehyde (via alcohol dehydrogenase in liver and stomach)
acetaldehyde -> acetate (via acetaldehyde dehydrogenase - lacking in Asians and inhibited by disulfiram) |
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absorption sites of alcohol
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small bowel > stomach
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liver catabolism pathways
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alcohol dehydrogenase
microsomal enzyme oxidation system - cytochrome p450 2e1 - revs up on increased use of alcohol |
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effect of alcohol on metabolism
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increased NADH/NAD ratio -> enhanced fatty acid synth, decreased FA breakdown, inhibit gluconeogenesis -> build up of fatty acids
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progression of liver damage due to alcohol
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normal -> fatty liver -> fibrosis or viral hepatitis -> micronodular cirrhosis -> macronodular cirrhosis with hepatocellular carcinoma
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labs in alcoholic hepatitis
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AST:ALT 2:1
AST < 3x ULN (rarely higher) INR increased (uncorrectable by vit K) increased bilirubin decreased albumin increased WBC anemia decreased platelets hyponatremia |
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therapy for alcoholic liver disease
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abstinence is the best
nutrition support steroids if they have discrimination test > 32 |
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risk factors for acetaminophen toxicity
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overdose
increased cytochrom p450 activity due to chronic alchohol, anticonvulsants, INH/Rifampin decreased capacty for glucuronidation or sulfation - chronic liver disease depleted glutathione stores - malnutrion, alcohol exposure |
