Term
| scope of alcohol abuse problem |
|
Definition
~5% (+M, -F) develop alcohol problems
$1.7B/year in treatment/management
3rd most important cause of mortality |
|
|
Term
| distribution of alcoholism |
|
Definition
affects everybosy
all races and SES
STRONG genetic component |
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Term
| DSM criteria for alcohol ABUSE |
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Definition
1+:
-recurrent use with failure to fulfill major role obligations
-recurrent use in dangerous situations (car)
-recurrent alcohol related legal problems
-continued use despite social/interpersonal problems |
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Term
| DSM criteria for alcohol DEPENDENCE |
|
Definition
3+:
-tolerance
-withdrawal
-taking in larger amounts
-persistent desire/unsuccessful quitting
-spend time obtaining alcohol
-give up other areas of life to drink
-use is continued despite knowing a problem exists |
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|
Term
alcohol as a drug:
-characteristics
-main effects |
|
Definition
-a weak drug, so need to take in lots
-CNS depressant
-affects brain from top down: cortex>limbic>cerebullum>reticualr formation>medculla
-low doses: stimulant from disinhibition of inhibitory control centers |
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|
Term
| *mechanisms of action of alcohol* |
|
Definition
gets into and expands membranes
**enhances activity of GABA-a receptor (GABA=inhibitory NT)**
**inhibits excitatory glutaminergic transmission**
there are NO alcohol antagonists |
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|
Term
| GABA/glutamate interaction |
|
Definition
GABA in (-) on neuron
Glutamate is (+) on neuron
act in balance to get normal homeostatic response
ALCOHOL-->makes net effect on neuron depressant by altering inhibitory/excitatory balance (increase GABA activity, decrease Glutamate activity) |
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|
Term
alcohol pharmacokinetics
absorption |
|
Definition
very small molecule so radiply and quickly absorbed
absorbed from stomach, proximal part of small intestine
rate of absorption increases with rapid gastric emptying and is absence of fats and carbs |
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|
Term
alcohol pharmacokinetics
distribution and excretion |
|
Definition
-distributed to all tissues rapidly
-blood levels directly related to levels in tissues
-BAC: mg/100mL
-oxidized in liver: *alcohol dehydrogenase (>90%)
-lungs, urine, sweat
body eliminates ~1 drink/hour
easy out because it's small |
|
|
Term
| enzymes of alcohol metabolism |
|
Definition
ADH
alcohol dehydrogenase
alcohol-->acetaldehyde
ALDH
aldehyde dehydrogenase
acetaldehyde-->excreted products
acts quickly
both require NAD for energy |
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Term
|
Definition
toxic
build up causes negative side effects
some populations (Asian) hav ea less active ALDH causing acetaldehyde building --> flushing, palpitations (tend not to drink) |
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Term
|
Definition
<50: increased social behavior, euphoria
50-100: lack of concentration
100-150: ataxia, motor effects, impaired memory
200: lack response to sensory stimuli
250: coma
500: death |
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|
Term
| treatment of acute alcohol OD |
|
Definition
*watch the patient*
prevent vomit aspiration
support CVS
treat for hypoglycemia, dehydration
no way to enhance elimination
treat for other toxicities
can use sedatives if pt is violent |
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|
Term
|
Definition
increased liver enzymes
after 1-2 weeks metabolism of ethanol incresed by 20-30% |
|
|
Term
|
Definition
the more the brain is exposed to alcohol the smaller the effect
brain resets its homeostatsis |
|
|
Term
|
Definition
| e.g. acquisition of motor skills to overcome impairment |
|
|
Term
|
Definition
homestasis is reset and requires continued administration of alcohol to maintain
removal of drug affords withdrawal symptoms |
|
|
Term
|
Definition
alcohol craving
tremors
AND dysfuntion
insomnia, bad dreams
anxiety
GI upset
5-10 hrs later
peaks 2-3 days
lasts 4-5 days |
|
|
Term
alcohol withdrawal
delirium tremens |
|
Definition
life threatening condition in ~5% of true alcoholics going through withdrawal
tachycardia
hyperthermia
hallucinations
=/- seizures
severe agitation |
|
|
Term
| order of SEs with withdrawal in chronic drinker |
|
Definition
real serious symptoms show up in one day (seizures, hallucinations, tremors)
ANS symptoms come in a few days later
usually ok by day 7 |
|
|
Term
| treatment of alcohol withdrawal |
|
Definition
restore ion and thiamine (Vit B def.)
suppress withdrawal syndrome with BDZ
do NOT use antisychotics to control hallucinations (will cause convulsions) |
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|
Term
toxic consequences of chronic alcohol consumption
LIVER |
|
Definition
|
|
Term
toxic consequences of chronic alcohol consumption
GI |
|
Definition
gastritis
interference with vitamin B (thiamine) absorption |
|
|
Term
toxic consequences of chronic alcohol consumption
NERVOUS SYSTEM |
|
Definition
alcoholic blackouts
fragmented sleep
peripheral nerve injury
Wernicke-Korsakoff syndrome
impaired visual acuity |
|
|
Term
toxic consequences of chronic alcohol consumption
CARDIO |
|
Definition
mild anemia
increased BP
(cardio-protective to have 1 glass wine/day) |
|
|
Term
toxic consequences of chronic alcohol consumption
ENDOCRINE |
|
Definition
impotence
sterility
feminization |
|
|
Term
toxic consequences of chronic alcohol consumption
TERATOGENIC |
|
Definition
|
|
Term
toxic consequences of chronic alcohol consumption
IMMUNE SYSTEM/CANCER |
|
Definition
compromised immune system
many cancers |
|
|
Term
fetal alcohol syndrome
FAS |
|
Definition
drinking in 1st trimester - threshold unknown, so just don't do it
characteristic children:
flat facial features
congenital heart defects
MR
slow growth
susceptibility to infection |
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Term
| drugs used in the pharmacological treatment of alcoholism |
|
Definition
*Disulfram (antabuse)
*Naltrexone |
|
|
Term
|
Definition
-blocks ALDH and cause an increase of aldehypde
-causes unpleasant side effects as result of drinking: headache, nausea, confusion, vomiting, sweating, hypotension
-not a cure
-poor compliance |
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|
Term
|
Definition
-opioid antagonist that may act to reduce "craving"
-not a cure, effective when combined with behavioral therapy
-blocks endorphins
-only works in ~50% |
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