Pharm Alcohols

Front 1

Question: "Binge" drinking can cause?

Back 1

Arrhythmias

Front 2

Question: PT presents with confusion and delirious state, with truncal ataxia, and opthalmoplegia, what should be administered?

Back 2

Diazepam to prevent alcohol withdrawal and thiamine

Note: PT is present with Wernicke's encephalopathy, which results from thiamine deficiency.

Front 3

Question: Cytochrome P450 in the microsomal ethanol oxidizing system (MEOS) of ethanol metabolism will most likely be activated under low concentration of?

Back 3

NAD+

Note: MEOS contributes most to ethanol metabolism at high blood alcohol concentrations, when the alcohol dehydrogenase pathway is saturated due to depletion of NAD+. NADPH and O2 are cofactors for MEOS.

Front 4

Question: Impairment to drive is between?
Blood levels greater than what are usually lethal?

Back 4

60 - 80 mg/dL
>500 mg/dL

Front 5

Question: Wine may help with?

Back 5

Coronary heart disease

1 - 2 glasses a day

Front 6

Question: PT presents with blurred vision that appears as if he was in a "snowstorm", breath smells a bit like formaldehyde and is acidotic. What did he ingest that was a red-colored liquid and what can he be treated with?

Back 6

Methanol. Can be treated with ethanol for the purpose to inhibit ADH catalyzed formation of toxic metabolites.

Note: Horizontal nystagmus, diplopia and "flickering white spots" or snowstorm appearance" is common with methanol intoxication.

Front 7

Question: Moderate to heavy amounts of alcohol predisposes to hepatic damage after overdose of acetaminophen because ethanol?

Back 7

Induces liver drug-metabolizing enzymes. Converts acetaminophen to a cytotoxic metabolite.

Front 8

Question: Alcoholics are at a risk for?

Back 8

Heart failure dilated cardiomyopathy.

Front 9

Question: Fetal alcohol syndrome presents as?

Back 9

Mental retardation and craniofacial abnormalities

Front 10

Question: The combination of ethanol and disulfiram results in nausea and hypotension as a result of the accumulation of

Back 10

Acetaldehyde

Note: Disulfiram inhibits acetaldehyde dehydrogenase, which converts acetaldehyde to acetate.

Front 11

Question: The intense craving experienced by individuals who are trying to recover from chronic alcohol abuse can be ameliorated by a drug that is an

Back 11

Antagonist of opioid receptors, such as naltrexone

Front 12

What are the two systems that metabolize ethanol to acetaldehyde.

Back 12

Alcohol dehydrogenase (ADH) and microsomal ethanol oxidizing system (MEOS)

Front 13

Explain the ADH pathway for metabolizing ethanol

Back 13

NAD+ dependent, which due to its limited supply, results in zero-order kinetics.

Metabolizes low to moderate doses of ethanol.

Front 14

Explain the MEOS pathway for metabolizing ethanol

Back 14

Chronic ethanol, and at higher dosage, induces CYP450 2E1 (which also metabolizes acetaminophen), and this may also explain tolerance to ethanol

Front 15

Explain aldehyde dehydrogenase

Back 15

After acetaldehyde is formed from oxidation of ethanol via ADH or MEOS, it metabolizes it to acetate.

Front 16

Aldehyde dehydrogenase is inhibited by?

Back 16

Disulfiram, metronidazole, hypoglycemic, and some cephalosporins.

Front 17

Which nationality has deficiency in aldehyde dehydrogenase.

Back 17

Asians

Front 18

SE of ethanol

Back 18

Sedation, loss of inhibition, impaired judgement, slurred speech, and ataxia

Depresses heart, vasodilation by relaxing smooth muscles; with possible hypothermia.

Cirrhosis, scarring of the gut wall, absorption defects, pancreatitis, peripheral neuropathy, Wernicke-Korsakoff, hypertension, anemia, increase risk of breast cancer, infectious pneumonia

Gynecomastia, and testicular atrophy from altered steroid metabolism in the cirrhotic liver.

Front 19

Ethanol CNS depression with additive effects from?

Back 19

Sedative hypnotics, opioid agonist, drugs that block muscarinic and H1 histamine receptors.

Front 20

MOA of ethanol

Back 20

Facilitates action of GABA receptors, inhibits glutamate activity on NMDA

Front 21

What is Wernicke-Korsakoff?

Back 21

Ethanol abuse results in thiamine deficiency: ataxia, confusion, paralysis of extraocular muscles.

Note: Korsakoff's psychosis is prevented by thiamine treatment

Front 22

What are the signs of alcohol withdrawal?

Back 22

Insomnia, tremor, anxiety, seizures, and delirium tremens, nausea, vomiting, diarrhea, and arrhythmia.

Front 23

What is delirium tremens?

Back 23

Sweating, tremor, confusion, and hallucinations.

Front 24

How do you treat alcohol withdrawals?

Back 24

Long-acting BZ: diazepam, chlordiazepoxide, unless liver is compromised.

Short acting: lorazepam is then preferred

Front 25

How do you treat alcoholism?

Back 25

Naltrexone: opioid receptor antagonist

Acamprostate: NMDA glutamate receptor antagonist

Disulfiram: aldehyde dehydrogenase inhibitor, with acetaldehyde accumulating resulting in nausea, headache, flushing, and hypotension.

Front 26

What is methanol, how is it metabolized, and how do you treat intoxication and what are the SE?

Back 26

Wood alcohol, forms windshield cleaners and "canned heat"

Visual dysfunction; GI distress, shortness of breath, loss of consciousness, coma

Methanol --: formaldehyde --> formic acid that causes severe acidosis and retinal damage, and blindness

Front 27

Where is ethylene glycol found? Its SE and metabolism.

Back 27

Antifreeze

Leads to severe acidosis and renal damage from metabolism of ethylene glycol to oxalic acid.

Front 28

How do you treat methanol and ethylene glycol intoxication?

Back 28

Ethanol: acts as preferred substrate for oxidization by alcohol dehydrogenase

Fomepizole: inhibitor of alcohol dehydrogenase, and may slow or prevent formation of toxic metabolite.