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alcohol abuse
CBN III
42
Medical
Graduate
02/15/2011

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Term
what % of drinkers have a problem?
Definition
10%
Term
what characterizes alcohol absorption?
Definition
rapid and complete from the GI tract. empty stomach: peak levels in ~40 min. food in stomach: delays absorption.
Term
what characterizes alcohol distribution?
Definition
proportional to water content of tissues
Term
can urine alcohol levels be used for determining level of impairment?
Definition
no - can be ~130% of blood level
Term
what characterizes alveolar air as a representation of blood levels?
Definition
~.05% of blood level, proportionally. this is reliable for estimating blood level.
Term
what characterizes a .05 G/dL BAC (blood alcohol concentration)?
Definition
euphoria/minor motor disturbances
Term
what characterizes a .06 G/dL BAC?
Definition
nystagmus
Term
what characterizes a .08 G/dL BAC?
Definition
reduced glare response (legal limit)
Term
what characterizes a 0.10-0.15 G/dL BAC?
Definition
significant motor incoordination
Term
what characterizes a 0.20-0.30 G/dL BAC?
Definition
amnesia
Term
what characterizes a 0.30-0.35 G/dL BAC?
Definition
coma
Term
what characterizes a >0.35 G/dL BAC?
Definition
death
Term
what characterizes biotransformation of alcohol?
Definition
90%+ of ethanol is oxidized primarily by hepatic tissue in a zero-order process. the remainder is excreted via lungs and urine. etoh -> (alcohol dehydrogenase [rate limiting, needs NAH+]) -> acetaldehyde -> (aldehyde dehydrogenase) -> acetate -> acetyl CoA -> CO2 + H2O + 7/1 cal/g
Term
what is the microsomal ethanol oxidizing system (MEOS)?
Definition
this is in the hepatic smooth endoplasmic reticulum and can undergo enzyme induction. it utilizes NADPH (+O2+H+) -> NADP+ and H2O. appears to function at a fairly high BAC. in a normal adult, this biotransforms at approximately 10 mL absolute etoh/hour. in an alcoholic: slightly higher if liver function is normal (enzyme induction)/slightly lower if liver disease.
Term
what is the gender difference in alcohol metabolism?
Definition
(non-alcoholic) females have ~25% *less in 1st-pass metabolism of etoh and ~60% *less in gastric alcohol dehydrogenase activity. alcoholic females had only 6% of the first pass metabolism of non-alcoholic males, i.e., it was basically non-existent.
Term
what are the acute CNS effects of alcohol?
Definition
sedation, impaired judgment, ataxia, disinhibited behavior. reduction of cortical inhibition of subcortical centers. reduction of transmission in polysynaptic pathways of the RAS. ultimate effect influenced by both set/setting. amnesia: state-dependent learning (can only remember things learned at that level of intox.). blackout: severe-short term memory deficit, occurs during high BAC, most alcohol-induced violent behavior occurs during this state. interacts w/other CNS depressants. acute alcohol can temporarily diminish hepatic biotransformational capacity of other drugs. mechanism of alcohol's CNS depression effect not established: possible shift of cell membrane gel -> fluid or membrane more disordered.
Term
what are the acute CV effects of alcohol?
Definition
decreased myocardial contractility. blood vessels: vasodilation (direct - depression of vascular smooth muscle by acealdehyde/indirect - depression of medullary vasomotor center). loss of body heat: etoh ingestion in cold environment - may equal hypothermia.
Term
what are the acute renal effects of alcohol?
Definition
increased release of ADH from posterior pituitary (therefore diuresis can occur w/liquor shots as well as beer)
Term
what are the acute GI effects of alcohol?
Definition
low concentration: increased appetite, increased gastrin. high concentration: irritation, n/v, increased emptying time, bleeding.
Term
what are the acute misc. effects of alcohol?
Definition
hypoglycemia: due to poor nutrition, depletion of hepatic glycogen, decreased gluconeogenesis. hyperuricemia.
Term
what is tx for acute OD?
Definition
similar for barbiturates. hemodialysis, if needed is effective.
Term
what characterizes hangover?
Definition
mild form of etoh withdrawal: fatigue, vertigo, h/a (pulsating), weakness, GI irritation, dehydration. readministration of etoh can decrease some of these symptoms.
Term
what are the chronic effects of alcohol abuse?
Definition
tolerance, physical dependence, withdrawal syndrome, nutritional toxicity, systemic effects and skeletal muscle degeneration
Term
what characterizes tolerance w/chronic alcohol abuse? physical dependence?
Definition
enzymatic (biotransformational): not very significant. cellular: very significant. degree of tolerance proportional to amount consumed per day and duration of consumption. occurs in social and alcoholic drinkers. physical dependence occurs as tolerance develops.
Term
what characterizes withdrawal w/chronic alcohol abuse?
Definition
degree related to amount and duration of ethanol abuse. BAC does not have to reach zero. mild: begins w/in 6-8 hrs after last drink - anxiety, irritability, sweating, insomnia (rebound REM), hyperreflexia, tremors, vomiting. severe: occurs ~24 hrs after last drink/peaks @ 24-48, disorientation, visual hallucinations, delirium tremens (global confusion, auditory/visual/tactile hallucinations, ANS hyperactivity: mydriasis, sweating, tachycardia, and seizures: tonic-clonic.
Term
how is alcohol withdrawal treated?
Definition
BZDs for agitation, phenytoin if seizures are likely. medical emergency: 5-10% chance of death.
Term
what characterizes possible nutritional toxicity effects with chronic alcohol abuse?
Definition
folic acid deficiency (megaloblastic anemia), iron deficiency, niacin deficiency, and peripheral neuropathy (axonal degeneration of motor nerves, paresthesias, related to thiamine deficiency).
Term
can chronic alcohol abuse cause skeletal muscle degeneration?
Definition
yes
Term
what characterizes CV effects w/chronic alcohol abuse?
Definition
cardiomyopathy (fatty infiltration of the myocardium, fibrosis replacement of functional tissue), dilation of blood vessels around eyes/nose, HTN at 3+ drinks/day, elevation in high-density lipoproteins (appears to reduce CAD), reduction in low-density lipoproteins (also appears to reduce CAD).
Term
what characterizes liver effects w/chronic alcohol abuse?
Definition
initially: alcoholic fatty liver, which is reversible, but can progress to alcoholic hepatitis: cell damage, necrosis w/inflammation, jaundice, and fibrosis. 80% of hepatitis pts have at least a 5 yr of of heavy alcohol intake. portal cirrhosis: fibrosis extends to portal tracts.
Term
what characterizes hematological effects w/chronic alcohol abuse?
Definition
hemolytic anemia and thrombocytopenia
Term
what characterizes CNS effects w/chronic alcohol abuse?
Definition
wernicke-korsakoff syndrome. wernicke's encephalopathy: early phase, related to thiamine deficiency (cerebellar ataxia, confusion/disorientation, polyneuropathy). korsakoff's psychosis: later continuation of the syndrome - poor short term memory (similar to alzheimer's). tx: thiamine IV.
Term
what are common cancers associated w/alcohol abuse?
Definition
esophagus, pharynx, larynx, liver, and pancreas
Term
what is fetal alcohol syndrome?
Definition
this occurs reliably with approximately 2.5 ounces of absolute alcohol per day. low IQ, smaller birth weight, length, head circumference, facial defects (hypoplasia of the maxilla and short palpebral fissures), atrial septal defect, and poor muscle coordination. increased rates of spontaneous abortion.
Term
what is the most effective and best chance for complete/permanent recovery from chronic alcoholism?
Definition
psychotherapy
Term
what is pharmacologic tx for chronic alcoholism?
Definition
disulfiram, acamprosate and naltrexone
Term
what characterizes disulfiram as pharmacologic tx for chronic alcoholism?
Definition
disulfiram inhibits aldehyde dehydrogenase (level can be 5-10x > than from same amount of alcohol ingested without disulfiram). accumulation of acetaldehyde causes: garlic-like aftertaste, n/v, weakness/confusion, impotence, extreme vasodilation (flushing of skin, severe h/a, hypotension/tachycardia - all may be severe).
Term
when is disulfiram contraindicated?
Definition
in pts w/severe myocardial dz or coronary occlusion. pts need to abstain from alcohol for up to 14 days following last dose.
Term
what are drug interactions w/disulfiram?
Definition
reduces biotransformation of phenytoin (may need to lower dose) as well as BZDs (longer acting) and oral anticoagulants.
Term
what other drugs can produce a disulfiram-like reaction?
Definition
sulfonamide oral hypoglycemics and metronidazole
Term
what characterizes acamprosate as pharmacologic tx for chronic alcoholism?
Definition
this acts to reduce central glutamate levels. some data show that a persistent hyperglutamatergic state contributes to pathogenesis of alcoholism & contributes to hyperactivity occurring during withdrawal. reduces symptoms of protracted withdrawal, e.g., insomnia, anxiety, restlessness, and dysphoria.
Term
what characterizes naltrexone as pharmacologic tx for chronic alcoholism?
Definition
naltrexone is a narcotic antagonist which decreases etoh-induced increased blood flow in the R prefrontal cortex (likely via etoh-induced release of endorphins w/in the frontal cortex-thalamus-limbic system loop). most commonly reported effect of naltrexone: decrease in alcohol use, fewer drinks per day, alcoholic beverages tasted less pleasant, experienced less of a 'high' from alcohol, improved compliance with treatment program, reduced relapse, lower dropout rate, longer time to relapse, and more successful in coping with relapse when it occurred.
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