Chapter 23 Basic And Clinical Pharmacology

Front 1

A sedative-hypnotic drug that in low-moderate amounts relieves anxiety and fosters a feeling of well-being or even euphoria.

Back 1

Alcohol

Front 2

A person is unable to limit their alcohol consumption.

Back 2

Alcohol abuse

Front 3

A person continues to drink in spite of adverse medical or social consequences related directly his alcohol consumption.

Back 3

Alcoholism

Front 4

Ethanol is a small water-soluble molecule that is absorbed rapidly from the ____ ______.

Back 4

GI tract

Front 5

True or False
After ingestion of alcohol in the presence of food, peak blood concentrations are reached within 30 minutes.

Back 5

False.
Fasting state.

Front 6

Distribution of alcohol is rapid and approximates ______ _______ ______.

Back 6

Total Body Water

Front 7

Why do women have a higher peak concentration of alcohol than men?

Back 7

Women have lower total body water and first-pass metabolism is different.

Front 8

True or False
Over 90% of alcohol consumed is reduced in the liver.

Back 8

False
Oxidized

Front 9

Most alcohol is oxidized in the ______, and the remainder is excreted through the ______ and in the ________.

Back 9

Liver
Lungs and Urine

Front 10

What order kinetics does the rate of oxidation of alcohol follow?

Back 10

Zero order kinetics.

Front 11

The cytosolic enzyme that catalyzes the conversion of alcohol to acetaldehyde.

Back 11

Alcohol dehydrogenase

Front 12

Where is ADH found?

Back 12

Primarily in the liver, but small amounts are located in the brain and stomach.

Front 13

Why are Asians more prone to alcoholism?

Back 13

ADH enzyme activity is reduced due to a polymorphism.

Front 14

True or False
Women have larger amounts of gastric ADH.

Back 14

False
Smaller

Front 15

Alcohol oxidation generates an excess of which cofactor in the liver?

Back 15

NADH

Front 16

What causes the metabolic disorders associated with chronic alcoholism and also the lactic acidosis and hypoglycemia associated with acute alcohol poisoning?

Back 16

NADH build-up in the liver.

Front 17

Which drug inhibits alcohol dehydrogenase?

Back 17

Fomepizole

Front 18

Which drug inhibits aldehyde dehydrogenase?

Back 18

Disulfiram

Front 19

When large amounts of ethanol are consumed, the ______ ________ ________ system becomes saturated owing to the depletion of which cofactor?

Back 19

Alcohol dehydrogenase system
NAD+

Front 20

During chronic alcohol consumption, ______ activity is induced.

Back 20

MEOS

Front 21

Much of the acetaldehyde formed from alcohol is oxidized in the liver in a reaction catalyzed by mitochondrial NAD-dependent ________ _________.

Back 21

Aldehyde dehydrogenase

Front 22

When ethanol is consumed in the presence of ___________, acetaldehyde accumulates and causes an unpleasant reaction of facial flushing, nausea, vomiting, dizziness, and headache.

Back 22

Disulfiram

Front 23

In people of Asian descent, there is a deficiency in the activity of the mitochondrial form of _______.

Back 23

ALDH

Front 24

True or False
Alcohol is a CNS stimulant.

Back 24

False
Depressant

Front 25

Acute ethanol exposure _______ the action of GABA at GABAa receptors.

Back 25

enhances

Front 26

Ethanol inhibits the ability of glutamate to open the cation channel associated with the __________ subtype of glutamate receptors.

Back 26

NMDA

Front 27

What aspects of cognitive function is the NMDA receptor implicated in?

Back 27

Learning and memory

Front 28

Ethanol ________ activity of large conductance Ca2+- activated and voltage-gated K+ channels.

Back 28

Enhances.

Front 29

Ethanol ________ the activity of adenylyl cyclase.

Back 29

Enhances

Front 30

True or False
Increased adenylyl cyclase is a marker for alcoholism.

Back 30

False
Lowered.

Front 31

True or False
Ethanol interacts with PKC and intracellular signaling cascades (MAPK, tyrosine kinase, neurotrophic factor receptors).

Back 31

True

Front 32

What does alcohol do to myocardial contractility?

Back 32

Depresses it.

Front 33

True or False
Alcohol causes relaxation and vasodilation of smooth muscle except uterine smooth muscle, which it contracts.

Back 33

False
Uterine relaxant.

Front 34

True or False
The tissue damage caused by chronic alcohol ingestion doesn't occur because of processing a heavy load of a metabolically active substance.

Back 34

False

Front 35

What are specific mechanisms (5) implicated in tissue damage due to chronic alcohol consumption?

Back 35

Increased oxidative stress.
Depletion of glutathione
Damage to mitochondria
Growth factor dysregulation
Potentiation of cytokine-induced injury.

Front 36

What (4) things can lead to death due to alcoholism?

Back 36

Liver disease
Cancer
Accidents
Suicide

Front 37

True or False
Alcoholic fatty liver is a reversible condition.

Back 37

True

Front 38

Who is more susceptible to alcoholic hepatotoxicity, men or women?

Back 38

Women

Front 39

True or False
Chronic alcohol abuse leads to alteration of phospholipid peroxidation and activation of the innate immune system.

Back 39

True

Front 40

The innate immune system can be activated by ________ ________ that access the liver as a result of ethanol-inducedd changes in the intestinal tract.

Back 40

Bacterial endotoxins.

Front 41

TNF ___ is elevated in alcoholic liver disease.

Back 41

Alpha

Front 42

_________ depletes GSH, vitamins, trace metals, and decreases transport and secretion of proteins.

Back 42

Acetaldehyde.

Front 43

True or False
Chronic pancreatitis, gastritis, anemia, and small intestine injury are common side effects of chronic alcohol consumption.

Back 43

True

Front 44

A precipitation of withdrawal symptoms when alcohol consumption is terminated.

Back 44

Physical dependence

Front 45

Alcohol withdrawal symptoms classically consist of ______________.

Back 45

Hyperexcitability

Front 46

Delirium tremens is hallucinations, delirium, fever, and tachycardia that occurs ____ or more days after withdrawal.

Back 46

2

Front 47

What are the signs of mild dependence which occurs 1-4 days after alcohol discontinuation?

Back 47

Anxiety, insomnia, and tremor

Front 48

In severe cases of dependence, what are signs that occur 1-3 days following alcohol discontinuation?

Back 48

Hallucinations and seizures.

Front 49

Characterized by craving and drug seeking behavior.

Back 49

Psychological dependence

Front 50

__-regulation of NMDA and voltage-sensitive ___ channels may underlie the seizures that accompany alcohol withdrawal syndrome.

Back 50

Up
Ca2+

Front 51

GABAa- mediated responses are __-regulated in chronic alcohol exposure.

Back 51

down

Front 52

Ethanol modulates neural activity in the brain's mesolimbic dopamine reward circuit and increases dopamine release in the ______ _________.

Back 52

Nucleus Accumbens

Front 53

Ethanol intake and seeking behavior are affected by CB-1, appetite-regulation system, and the _____ response system.

Back 53

Stress (CRF)

Front 54

What are some effects of consumption of large amounts of alcohol over extended periods?

Back 54

Paresthesia, ataxia and gait disturbances, dementia, impaired visual acuity, optic nerve degeneration.

Front 55

This disorder is rare but characterized by paralysis of external eye muscles, ataxia, and a confused state that may progress to coma and death.

Back 55

Wernicke-Korsakoff syndrome

Front 56

Wernicke-Korsakoff is associated with _________ deficiency.

Back 56

Thiamine

Front 57

Chronic alcohol consumption is associated with ________ cardiomyopathy with __________ hypertrophy and fibrosis.

Back 57

Dilated
Ventricular

Front 58

Arrhythmias occur due to abnormalities in __________ or __________ metabolism as well as enhanced release of catecholamines.

Back 58

Potassium or Magnesium

Front 59

True or False
Moderate alcohol consumption prevents coronary heart disease and reduces mortality.

Back 59

True

Front 60

Moderate ethanol intake raises serum ____ levels which appears to protect agains atherosclerosis.

Back 60

HDL

Front 61

True or False
Alcohol directly inhibits the proliferation of all cellular elements in bone marrow.

Back 61

True

Front 62

Mild anemia caused by chronic alcohol consumption is related to _____ _______ deficiency.

Back 62

Folic acid

Front 63

_____ deficiency may result from GI bleeding.

Back 63

Iron

Front 64

What are 3 disorders of fluid and electrolyte balance found in chronic alcoholics?

Back 64

Ascites, Edema, and Effusions.

Front 65

True or False
Secondary aldosteronism can occur as a result of chronic alcoholism.

Back 65

True

Front 66

Impaired hepatic gluconeogenesis results in _________.

Back 66

hypoglycemia

Front 67

Increased cortisol and growth hormone result in _______.

Back 67

ketosis.

Front 68

True or False
Chronic maternal alcohol abuse during pregnancy is associated with mental retardation and cogenital malformation.

Back 68

True.

Front 69

Immunological changes for the lungs include suppression of alveolar macrophages, inhibition of chemotaxis, and _________ T-lymphocytes.

Back 69

Reduced

Front 70

Immunological changes in the liver include enhanced activity of _______ and _______ ________ cells.

Back 70

Kupffer
Hepatic stellate

Front 71

Chronic consumption of alcohol when on an anticoagulant or anticonvulsant results in a/an _________ in effect.

Back 71

Decrease

Front 72

Chronic consumption of alcohol when on isoniazid results in a/an _______ in effect.

Back 72

Decrease

Front 73

Chronic consumption of alcohol when on cefoperazon, metronidazole, and griseofulvin results in a ________ reaction.

Back 73

disulfiram-like

Front 74

The most important goals in the treatment of acute alcohol intoxication are to prevent _______ _________ and __________ of __________.

Back 74

respiratory depression and aspiration of vomitus.

Front 75

How can you alter hypoglycemia and ketosis?

Back 75

Administration of glucose

Front 76

How should you protect against Wernicke-Korsakoff syndrome?

Back 76

Administration of thiamine

Front 77

True or False
Persons in mild alcohol withdrawal need pharmacological assistance.

Back 77

False

Front 78

In severe cases of alcohol withdrawal, what treatment is used?

Back 78

Substitution of alcohol with a long-acting sedative hypnotic then tapering.

Front 79

S.A. has liver disease and is suffering from severe alcohol withdrawal, how would you treat him?

Back 79

Lorazepam or oxazepam substitution followed by tapering for several weeks possibly months.

Front 80

A long-acting mu-opioid antagonist used to reduce craving for alcohol and to reduce the rate of relapse to either drinking or alcohol dependence.

Back 80

Naltrexone

Front 81

C.R. is an opioid dependent alcoholic suffering from severe alcoholism. What risk are associated with a 50 mg po qd naltrexone dose?

Back 81

Opioid withdrawal syndrome

Front 82

J.B. is a patient suffering from alcoholism who has severe liver disfunction. Should he be given naltrexone?

Back 82

No. Naltrexone is a potential hepatotoxin.

Front 83

This drug possibly restores the balance between glutamate and GABA systems. It is enteric coated and given 3x/day, and is largely eliminated renally.

Back 83

Acamprostate

Front 84

Disulfiram inhibits aldehyde dehydrogenase as well as ________ which leads to depletion of NE stores.

Back 84

Dopamine beta-hydroxylase.

Front 85

S.R. is being treated for chronic alcoholism. After 12 hours, nurses report acneiform eruptions and the patient complaining of a garlicky or metallic taste. What drug has S.R. probably been given?

Back 85

Disulfiram

Front 86

What CYP enzymes does disulfiram inhibit?

Back 86

2C9, 2E1, and 3A4