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60 proof is equal to what percent alcohol?
What is the rate-limiting step of fermentation of ethanol? What drug inhibits it?
- Ethanol to acetaldehyde by ADH (in liver and stomach)
- Inhibited by pyrazoles
What does disulfiram do?
Inhibits aldehyde dehydrogenase so acetaldehyde cant be broken down to acetate. Treatment of alcoholism.
4 pharmacological treatments of alcoholism?
- Disulfuram, pyrazoles, naltrexone, antidepressants
- (70% have reduction in drinking)
4 symptoms of alcoholism
Craving, loss of control, physical dependence, tolerance
How much is 1 unit of alcohol in ml and g? What is the legal limit BAC in mg/dl?
- 1 unit = 10 ml or 8 g EtOH
- Legal BAC= 80 mg / dl (.08)
Where is most alcohol absorbed?
Sm intestine (duodenum) and stomach
4 elimination routes of ethanol?
Liver, kidney, lungs, sweat glands
Effects on CNS?
- Depressant- facilitates GABA, may inhibit NMDA glutamate receptors
- *resp depression occurs bc depression of brainstem resp drive (primary cause of acute alcohol lethality!)
- Long term: memory loss and cerebellar atrophy, peripheral neuropathy
Cardiovascular, renal, sexual, GI effects?
- Vasodilation (hypothermia), increase HDL/decrease LDL, coagulation defects when used long-term
- Increase urine flow
- Gonadal toxin, frontal lobe disinhibitor, decreases testosterone w chronic abuse
- Low doses stimulate appetite while high doses depress appetite (7 cal/g), ulcers and diarrhea
Effect of alcohol on liver
- Stimulation cytochrome P450, production of ROS
- Fatty liver-> fibrosis-> cirrhosis (due to altered lipid metab and NADH accumulation)
- AST and GGTP will be elevated
- Portal hypertension (GI bleeding) and salt/ water retention
- Triglycerides increase after damage
T or F: acute alcohol poisoning causes mainly CNS symptoms but also hyperglycemia
F: does cause mainly CNS symptoms but also HYPOGLYCEMIA (and alcoholic ketoacidosis)
Other chronic effects of alcohol abuse=
- Diabetes (damaged pancreas)
- Gout (increased uric acid)
- Megaloblastic anemia (decreased folate)
- Also decrease in magnesium and phosphate
What drugs have additive effects w alcohol?
CNS depressants, some antihypertensives, oral anticoagulants, hypoglycemic agents
Aspirin and acetaminophen with alcohol?
- Aspirin-gastric beeding
- Acetominophen- toxicity
Drugs with reduced uptake w alcohol?
Penicillin and diazepam (long term only)
Signs of fetal alcohol syndrome
- Low IQ
- Small heads
- Poor coordination
- Flat face
- Thin lips
- Philtrum missing
Dental problems of alcoholics
- Poor OH
- decreased salivation
- Oral cancer
Which other type of alcohol has a therapeutic use? what is it used for?
Isopropanol is used as rubbing alcohol and is a dental disinfectant. (2nd most commonly ingested alcohol)
Kinetics of isopropanol
- Rapid complete uptake from GI
- Metabolized to acetone
- Elimination in kidneys and lung
Toxicity and treatment of 70% isopropanol poisoning
- Toxic dose adult: 2-4ml/ kg
- Child: 3 swallows
- Monitor, cardiac and resp support, intravenous fluid for hypotension, hemodialysis
Methanol sources and kinetics
- Volatile, odor, antifreeze and paints
- Absorbed from GI in 30-90 min (also skin and lung absorption)
- Hepatic metabolism to formaldehyde and formic acid
Toxicity and treatment 40% methanol poisoning
- Toxic adult dose: 10 ml= blindness
- CNS depression (Headache, cerebral edema), ocular toxicity, GI mucosal irritation, blood acidosis (causes lethality)
- Treat with cardiac and resp support, hemodialysis, EtOH as antidote, correct acidosis and hypoglycemia
Ethylene glycol sources and kinetics
- Colorless, non volatile, sweet taste (poor mans alcohol. But lets be real- how expensive is hawkeye vodka??)
- In antifreeze coolants etc
- Rapidly absorbed in the GI, renal filtration
- Low ADH affinity
- Metabolized to glycoaldehyde, glycolic acid, oxalic acid
Ethylene glycol poisoning symptoms and treatment?
- CNS depression (exhilaration, nausea, acidosis, convulsions, coma), renal tox/ failure, cardiopulmonary symptoms ( tachycardia, HTN, failure)
- Treat with hemodialysis, correct acidosis, fliud/electrolyte imbalance, resp depression, serum calcium, EtOH as antidote or 4-methylprazole