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46 Cards in this Set
- Front
- Back
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Explain the absorption of alcohol.
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It is readily absorbed.
20-30% in the stomach, the rest in upper bowels. The rate is influenced by food consumption. |
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When is the max BAL (Blood alcohol level) achieved?
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Within 30-90 minutes of drinking.
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What about the distribution of alcohol in the body?
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It has a a big volume of distribution and distributes in total body water.
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Does alcohol cross the placenta?
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Yes
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How much of alcohol is excreted unchanged and from what routes?
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2-10% are excreted through the lungs, urine and sweat
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Which are the enzymes which metabolize alcohol?
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Alcohol dehydrogenase converts ethanol to acetaldehyde (toxic), and then Aldehyde dehydrogenase oxidates it to acetate.
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What happens at very high BAL with alcohol metabolism?
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It is also metabolized by a CYP450 which is then also induced. (CYP2E1)
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Why do some Asians tolerate less alcohol than others?
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Because about 10% of Chinese, Koreans and Japanese are homozygous for the inactive form of aldehyde dehydrogenase (ALDH).
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Is alcohol metabolism first or zero order?
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Zero order
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What coenzymes are needed for alcohol metabolism?
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NAD+ is needed as it is reduced to NADH by the two enzymes. Thus there is a buildup of NADH and a possible depletion of NAD+.
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What are the mechanisms by which alcohol exerts its actions?
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Alcohol acts particularly on glutamate (excitatory) synapses, by inhibiting them.
It also inhibits their respective NMDA receptors. Alcohol is a agonist at GABA-A-2L, cause hyperpolarization much in the same manner as benzodiazepines. |
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So what is the mechanism of withdrawal from alcohol?
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Hyperexcitability in the CNS due to upregulation of the glutamate receptors. This is also the cause of seizures.
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Can glutamate damage the cells?
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Yes, high levels of glutamate is excitotoxic and may damage the neurons, so brain damage may occur during withdrawal from alcohol.
Glutamate toxicity has also been implicated in Alzheimer's disease. |
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What are the isoforms of ALDH? Which one is active? What is their difference?
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ALDH2-1 Is the active form in liver mitochondria.
ALDH2-2 is dominant yet inactive and protects against alcoholism by an disulfiram-like effect. |
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What may result from the change in NAD/NADH ratio from alcohol use?
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Hyperlactacidemia
Hyperuricemia Hypoglycemia Hyperlipidemia Ketosis |
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What is the BAL that produces an intoxicating effect?
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It varies among individuals.
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At low to moderate doses, does alcohol act as a stimulant or depressant?
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It acts as a depressant but because of depression of certain areas of the brain which leads to loss of judgement, disinhibition etc it may appear as a stimulation.
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What are symptoms of hangover?
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Dizziness, nausea, vomiting, headache and tremors.
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What are side effects of high levels of acute alcohol intake?
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Medullary depression ->
Lethargy, amnesia, hypothermia, hypoglycemia, stupor, COMA, RESP. DEPRESSION, cardiomyopathy, hyper/hypotension, and cardiovascular collapse may occur. |
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What is the lethal dose of alcohol?
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The median lethal dose is 400-500mg/100ml blood.
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Why is there incr. in diuresis during alcohol intake?
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Because of an alteration of neuroendocrine activity.
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Can alcohol be healthy?
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Yes, moderate intake of 1-2 drinks per day has shown decreased risk of coronary artery disease.
Higher intake levels of alcohol is associated with higher incidence of cardiovascular events. |
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What are the acute and chronic effects of alcohol on the GI tract?
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Low doses increase gastric acid secretion.
High doses decrease both the HCl secreation and motility of the gut. Chronic alcohol use can cause gastritis, diarrhea, esophageal dysfunction, pancreatitis, and malabsorption syndromes. |
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What are the effects of alcohol on the liver?
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It may cause fatty liver, which eventually leads to cirrhosis and hepatic encephalopathy and hepatocellular carcinoma.
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What are the typical facial features of the fetal alcohol syndrome?
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Small head circumference.
Mental retardation. Thin upper lip. Small midface. Small eye opening. Skinfolds at corners of the eyes. Low nasal bridge. Short nose. Indistict groove between nose and upper lip. |
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What are the abnormalities of the FAS?
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Growth retardation
Dysmorphic facial features Skeletal malformations Cardiac abnormalities Kidney abnormalities Delayed development / mental retardation Auditory / visual deficits Poor motor co-ordination Hyperactivity Attention deficits Learning disabilities Socially / emotionally immature Impulsive / disinhibited / lack of fear Highly suggestible Difficulties understanding rules / need routine Lying / stealing Cause / effect relationship missing Diverse speech and language disorders / delays Autism Bi-polar disorder Obsessive-compulsive disorder Reactive attachment disorder Sensory defensiveness Sleep disorders Poor short term memory Lack of abstract thought |
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Which are the drugs used to change drinking patterns?
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Disulfiram
Naloxone Acamprosate |
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What is the mechanism of action of Disulfiram?
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It inhibits ALDH, thus causing a buildup of acetaldehyde if consumption of alcohol occurs leading to unpleasant symptoms.
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What is the mechanism of action of Naloxone?
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It blocks opioid receptors and apparently attenuates the craving for alcohol.
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What is the mechanism of action of Acamprosate?
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It stabilizes the glutaminergic system and therefore increases abstinence.
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When, after ingestion of alcohol do the disulfiram symptoms appear?
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They can appear after 10 minutes after ingestion and can last several hours.
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What are the symptoms of disulfiram+alcohol?
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Flushing of the face.
Throbbing in head and neck and pulsating headache. Dyspnea Nausea and vomiting. Sweating, thirst. Chest pain. Tachycardia and palpitations. Hypotension. Giddiness. Weakness. Blurred vision. Confusion. |
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Which are the groups of drugs with which alcohol may interact?
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Anesthetics Antibiotics
Anticoagulants Antidepressants Antihistamines Antipsychotics Antiseizure drugs Anxiolytics Analgesics (narcotic and non-narcotic) Cardiovascular drugs NSAIDs Oral hypoglycemics |
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What are contraindications to alcohol consumption?
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Pregnancy
Liver disease GI ulcers cardiac or skeletal myopathy |
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What are the therapeutic uses of alcohol?
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Solvent for water-insoluble drugs.
Rubbing agent. Sponge bath for fever. Skin disinfectant. Some other therapeutic uses. |
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How is methanol metabolized?
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By the same mechanisms as that of ethanol.
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What are the metabolic products of methanol?
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Methanol --> Formaldehyde --> Formic acid
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What are the symptoms of methanol intoxication?
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Acidosis, partial or complete blindness, headache, dizziness, delirium, nausea and vomiting.
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What is the treatment of methanol poisoning?
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First Bicarbonate to correct the acidosis.
Then give ethanol to compete for metabolism. Blood dialysis. |
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What is isopropyl alcohol?
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A potent CNS and respiratory depressant.
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What are the signs and symptoms of isopropyl poisoning?
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Extreme abdominal pain, nausea and vomiting.
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What is the treatment options for isopropyl alcohol poisoning?
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Only dialysis. Ethanol administration does nothing.
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Where can ethylene glycol be found?
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In anti-freeze products.
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What is the metabolic route of ethylene glycol?
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Same as ethanol.
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What is formed from the breakdown of ethylene glycol?
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Oxalic acid which is toxic.
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What is the treatment of ethylene glycol poisoning?
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Gastric lavage, bicarbonate, methylene blue for methemoglobinemia, and ethanol to decr. its metabolism.
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