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63 Cards in this Set
- Front
- Back
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Major impairment of mental & physical control. Slurred speech, blurred vision, lack of motor skill. Legal intoxication level in all states
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0.14-0.15%
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Unconciousness, threshold of coma
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0.40% BAL
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Death from respiratory failure
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0.60% BAL
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RX for ACUTE EtOH intoxication?
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Symptomatic support
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What is EtOH's MoA?
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1. Increases GABA-mediated inhibition
2. Inhibits NMDA receptors 3. Alters fluidity of neural membranes. |
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What is responsible for the sedative and ataxic effects of EtOH?
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GABA-mediated inhibition
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What is responsible for causing blackouts when consuming EtOH?
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inhibition of NMDA receptors
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Why will drinking EtOH before bed not result in better sleep?
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EtOH suppresses REM sleep.
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What is EtOH's effect on the overall CNS system?
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Depresses ALL areas of CNS.
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What causes hypothermia when consuming EtOH?
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Depression of Hypothalamus.
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How do patients die b/c of alcohol intoxication?
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Depression of Medullary respiratory and CV centers.
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What causes stimulation or behavorial changes in a person after 1 or 2 drinks?
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Depression of INHIBITORY control mechanism of reticular activating system.
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About 0.40% of BAL can result in death because?
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Depression of Respiratory center.
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What is a moderate amount of EtOH on the CV system produce?
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Peripheral vasoDILATION causing slight DECREASE in BP, heat loss.
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What is the effect of REGULAR moderate consumption of EtOH on CV system?
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Decreases risk of heart disease (↑ HDL, ↓ platelet aggregation).
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What is the effect of a HIGH DOSE of EtOH on the CV?
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Myocardial depression
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What is the effect of CHRONIC consumption of EtOH on the heart?
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Alcoholic Cardiomyopathy
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Explain the effects of EtOH on the GI tract @ 1. low doses, and 2. high doses
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. At low doses, alcohol STIMULATES salivary and gastric acid secretion.
2. High concentrations of alcohol (>20%) may INHIBIT gastric acid secretion and peptic activity. |
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What is the effect of chronic ingestion of EtOH on the INTESTINES?
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↓ absorption of FOLIC ACID, THIAMINE, niacin, other vitamins, constipation or diarrhea.
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What is the effect of chronic EtOH use on the pancreas?
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Pancreatitis
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What is the effect of chronic EtOH consumption on the LIVER?
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1. nduction of hepatic microsomal enzyme system and other enzyme systems. (low drug levels)
2. Chronic excessive use fatty (NADH) → infiltration, hepatitis and hepatic cirrhosis. 3. Biochemical changes (EtOH = carbs) |
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What are the effects of EtOH on diuresis and testosterone (endocrine effects)?
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1. Less ADH--> more urination
2. Less Testosterone (infertility?) |
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__________% of ethanol ingested is completely oxidized in the body. The rest is excreted via the urine and expired air.
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90-98
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At BAC > .01% the metabolism of ethanol follows ______________order kinetics.
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zero
(metabolizes 1 drink/hr) |
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What enzyme is most important (also rate limiting) in the metabolism of EtOH
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Alcohol Dehydrogenase
EtOH + (AD)--> Acetaldehyde Takes place in liver cytosol. |
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What is the limiting factor for the alcohol dehydrogenase mediated step?
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Availability of NAD.
Low NAD = low gluconeogenesis = Hypoglycemia! |
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What produces free radicals in EtOH metabolism?
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Microsomal mixed function oxidase system
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2-10% of excreted EtOH may be found in urine and ____________ __________-
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Exhaled AIR. Alveolar alcohol concentration is an accurate estimate of blood concentration.
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What effects the rate of ABSORPTION of EtOH?
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1. [EtOH]
2. Food content 3. Alcohol dehydrogenase in GI Tract 4. Oral absorption occurs passively and is complete. Peaks in 1 hour. |
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Compare and contrast the metabolism of methanol to ethanol.
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same: metabolised by Alcohol Dehydrogenase
Different: breakdown products are FORMIC ACID and FORMALDEHYDE |
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What kinetics is methanol metabolism?
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Zero order, but SLOWER than ethanol.
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What causes metabolic acidosis and retinal cell toxicity?
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Methanol breakdown products:
Formic Acid (MA) Formaldehyde (RCT) |
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What are the consequences of chronic alcoholism?
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Fatty liver, hepatic cirrhosis, pancreatitis, severe depression, dementia, psychosis, Wernicke Korsakoff Syndrome, cardiomyopathy, peripheral neuropathy, anemia, increased susceptibility to infection.
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What are the effect of EtOH damange @ cellular level?
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1. Free radicals interefre with DNA/proteins
2. Fatty acid interfere with protein syn and mitochondria 3. Acetaldehyde damages cytoskeleton & Ab production 4. END ORGAN DAMAGE |
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What is the treatment for chronic alcoholsm?
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Vitamin B replenishment [beri-beri], adequate dietary intake, diazepam for management of Wernicke's Syndrome, disulfiram (?).
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What is the consequence of EtOH + CNS depressant?
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Potentiation of CNS depressant. Significant impairement of psychomotor function.
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EtOH + hypoglycemics?
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Potentiation of Hypoglycemic effects.
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What hypoglycemics can cause disulfriam-like effect when taken with EtOH?
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Chloropropamide & Tolbutamide
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EtOH and Warfarin?
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-T1/2 of warfarin decreased by CHRONIC used of EtOH
-Warfarin may be increased in LIVER DISEASE -occasional EtOH = warfarin not effected. |
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EtOH + Aspirin
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Gastric Hemorrhage
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EtOH + acetaminophen?
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Liver Damage, death.
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EtOH + anticonvulsants (Phenytoin)?
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-T1/2 of phenytoin decreased with large doses of EtOH
-EtOH associated with seizures |
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What antimicrobials produce a disulfriam effect with EtOH?
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1. Chloramphenicol
2. Furazolidone 3. METRODINDAZOL 4. Quinacrine |
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What is the effect of Isonazid with EtOH
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Increases metabolism of isonazid.
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Pt presents with anxiety, NV, elevation of HR, BP, hallucinations, illusions, and seizures. What phase of EtOH WITHDRAWAL?
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Phase 1 (24-48 hours)
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Delirium Tremens (severe tremors), agitation, and halllucinations.
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Stage 2 EtOH withdrawal.
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Acute organic psychosis, confusion, severe autonomic symptoms.
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Stage 3 EtOh withdrawal (72-105 hours)
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What agents are used to treat Delirum Tremens for EtOH Withdrawal?
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Chlordiazepoxide and Diazepam.(both benzo's)
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What are used for seizures associated with EtOH withdrawal?
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Phenytoin
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What drugs are used for EtOH Abstinence?
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Disulfuram, Naltrexone, Acamprosate, SSRI's, and Sodium Oxybate (?)
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What drug used for ETOH abstinence inhibits aldehyde dehydrogenase leads to increase blood levels of acetaldehyde following ingestion of alcohol.
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Disulfuram
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What is the rationale for using Disulfuram for EtOH abstinence?
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An individual ingesting alcohol while on disulfiram experiences a distinctly unpleasant reaction due to acetaldehyde accumulation. The signs and symptoms of the disulfiram alcohol interaction begin within 5 10 minutes of alcohol ingestion; lasting for several hours, and include nausea, vomiting, pulsating headache, palpitations, vasodilation, hypotension, hyperventilation.
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What are CI's to using disulfuram?
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Severe myocardial disease, psychosis. Patients taking medication containing alcohol (Nyquil).
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What drug blocks the rewarding effects of EtOH?
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Naltrexone.
Limitation is possibility of liver damage at high dose. |
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What drug is an anti-craving used to maintain abstinence by blocking NMDA, Ca2+, and activating GABA-A receptors?
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Acamprosate.
"Balances GABA and Glutamate in the brain." |
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Depression causes people to drink alcohol. What is used to maintain EtOH abstience in this group?
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SSRI's.
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A baby with CNS dysfunction (Low IQ; microencephaly)
Prenatal or postnatal growth retardation. Cluster of facial abnormalities, limb anomalies, brain and heart anatomical defects. |
Fetal Alcohol Syndrome
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Less severe than FAS, but can cause behavioral/learning problems. Caused by as little as one drink/week increases agressive behavior in child.
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Fetal Alcohol Effect.
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What causes (a) some CNS depression, (b) slow metabolic acidosis produced by formic acid major cause of death, and (c) a specific damage to retinal cells caused by formaldehyde leading to blindness?
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Methanol poisoning.
4mL = blindness 80-150mL = fatal |
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What is the rationale for treating methanol tox with ethanol?
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Ethanol competes with methanol for alcohol dehydrogenase thereby decreasing the rate of methanol oxidation. This competition forms the basis of ethanol's use in the treatment of methanol intoxication
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What other methods are used to treat methanol poisoning?
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1. Gastric lavage/hemodialysis
2. NaHCO3 for MA 3. Delay methanol metabolism with ethanol. |
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You patient has oxalate crystals in his urine. What has he overdosed on?
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Ethylene Glycol.
Oxidation to glycolate and oxalic acid = MA and renal damage! |
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What drug is effective for both methanol and ethylene glycol toxicities?
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Fomepizole
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