Alcohol

Question 1

Ethylene Glycol

Answer 1

• Ethylene glycol used as heat exchangers, in antifreeze formulations, and as industrial solvents.
• Young children are sometimes attracted by the sweet taste of ethylene glycol

Question 2

physical dependence symptoms

Answer 2

• insomnia
• tremor
• seizure
• nausea/vomiting
• diarrhea
• arrhythmia

Question 3

Medical applications of ethanol

Answer 3

1. 10-15g/day increases serum HDL levels

2. delays onset of labor

Question 4

Drug that inhibits ADH

Answer 4

Fomepizole

Question 5

what does ADH do?

Answer 5

converts ethanol to acetaldehyde

Question 6

What enzyme converts acetaldehyde to acetate?

Answer 6

aldehyde dehydrogenase

Question 7

drug that inhibits aldehyde dehydrogenase

Answer 7

disulfiram

Question 8

ethanol facilitates action at which receptors?

Answer 8

GABA-A

Question 9

Ethanol inhibits

Answer 9

the ability of glutamate to activate NMDA receptors

Question 10

acute effects of alcohol

Answer 10

• sedation
• loss of inhibition
• impaired judgment
• slurred speech and ataxia

Question 11

what does aldehyde dehydrogenase do?

Answer 11

converts acetaldehyde to acetate

Question 12

Effects of alcohol on liver

Answer 12

a) reduced gluconeogenesis –> hypoglycemia

b) progresses on to fatty liver, hepatitis, cirrhosis and liver failure

Question 13

fomepizole

Answer 13

inhibits ADH

Question 14

disulfiram

Answer 14

inhibits Aldehyde dehydrogenase

Question 15

effects of ethanol on the GIT

Answer 15

a) inflammation, scarring, and bleeding of the gut wall

b) increased risk of pancreatitis

Question 16

effects of ethanol on the CNS

Answer 16

a) peripheral neuropathies

b) thiamine deficiency can occur (Wernicke-Korsakoff)

Question 17

Effects of ethanol on the endocrine system

Answer 17

a) gynecomastia

b) testicular atrophy

Question 18

Effects of ethanol on the cardiovascular system

Answer 18

1. increased incidence of:
   a) HTN
   b) anemia
   c) dilated cardiomyopathy
2. ingestion of moderate quantities (10-15g/day) raises serum levels of HDL

Question 19

Wernicke-Korsakoff Syndrome

Answer 19

• uncommon
• Characterized by:
  a) paralysis of the external eye muscles
  b) ataxia
  c) confused state
• can progress to coma and death
• associated with thiamine deficiency
• patients suspected of having W-K syndrome should receive thiamine therapy
• ocular symptoms, ataxia, and confusion often improve with thiamine administration
• most patients are left with a chronic disabling MEMORY disorder known as Korsakoff’s psychosis

Question 20

Fetal Alcoholic Syndrome (FAS)

Answer 20

➢	Intrauterine growth retardation
➢	Microcephaly
➢	Poor motor coordination
➢	Underdevelopment of the mid-facial region (appearing as a flattened face)
➢	Minor joint anomalities

Question 21

Treatment of Acute Alcohol Intoxication

Answer 21

➢ Supportive Measure:
• Prevent respiratory depression & aspiration pneumonia
• Give fluids and electrolytes

➢ Pharmacological measure:
• Give glucose to treat hypoglycemia and ketosis
• Thiamin (100 mg) is given to protect against Wernike-Korsakoff syndrome
• Prevent seizures, delirium, & arrhythmia
• Restore K, Mg, & Phosphate ions

Question 22

Long-term consequences of Wernicke-Korsakoff syndrome

Answer 22

most patients are left with a chronic disabling MEMORY disorder known as Korsakoff’s psychosis

Question 23

Patient presents with: Insomnia, tremor, anxiety, life threatening seizures, visual hallucinations, delirium tremens

Answer 23

symptoms of alcohol withdrawal

Question 24

Patient presents with paralysis of the external eye muscles, ataxia and confused state. History of drinking

Answer 24

Wernicke-Korsakoff syndrome

Question 25

Management of alcohol withdrawal symptoms

Answer 25

a) thiamine b) restoration of fluid electrolyte balance c) long-acting sedative-hypnotic drug i.e. BZD (diazepam, chlordiazepoxide) d) in patients with liver disease Lorazepam or oxazepam are preferred because they don't require hepatic oxidation e) Intensity of withdrawal effects reduced by clonidine or propranolol

Question 26

Drugs approved to treat alcoholism

Answer 26

a) disulfiram b) naltrexone c) acamprosate

Question 27

Ethylene Glycol metabolism

Answer 27

ethylene glycol --(ADH)--> Glycoldehyde --(Aldehyde dehydrogenase)--> Glycol acid--> oxalic acid

Question 28

MOA of the drug used in management of alcohol withdrawal syndrome

Answer 28

Clonidine = alpha 1 blocker

Question 29

Toxic effects of Ethylene Glycol toxicity

Answer 29

* Excitation followed by central nervous system depression. * After a delay of 4–12 hours, severe metabolic acidosis develops from accumulation of acid metabolites and lactate. * Finally, delayed renal insufficiency follows deposition of oxalate in renal tubules

Question 30

Drug of choice for management of alcoholic withdrawal in patients with liver disease

Answer 30

Lorazepam or oxazepam preferred because they don't require hepatic oxidation

Question 31

disulfiram

Answer 31

approved to treat alcoholism ➢ Aldehyde dehydrogenase inhibitor ➢ If a patient on disulfiram consumes ethanol then acetaldehyde accumulates ➢ This leads to nausea,vomiting, headache, flushing & hypotension

Question 32

Other drugs with disulfiram-like effects

Answer 32

* Metronidazole * Cephalosporins (not all) * Sulfonylurea hypoglycemic drugs * Griseofulvin

Question 33

How is methanol metabolized?

Answer 33

methanol-- (ADH)--> formaldehyde --(aldehyde dehydrogenase)--> formic acid

Question 34

used to manage profound metabolic acidosis

Answer 34

bicarbonate

Question 35

naltrexone

Answer 35

opioid antagonist approved to treat alcoholism

Question 36

patient comes in with respiratory failure, a severe anion gap with metabolic acidosis and ocular damage

Answer 36

suspect methanol poisoning

Question 37

Methanol

Answer 37

➢ Constituent of windshield cleaners & “canned heat” ➢ Intoxication includes: • visual dysfunction, GI distress, Shortness of breath & loss of consciousness ➢ Methanol metabolized to formic acid, which may cause: • severe acidosis and retinal damage/blindness

Question 38

acamprosate

Answer 38

NMDA antagonist approved to treat alcoholism

Question 39

treatment of methanol poisoning

Answer 39

➢ Gastric lavage ➢ Ethanol is given I.V as it is a preferred substrate for alcohol dehydrogenase • So methanol is not metabolized to formaldehyde ➢ Fomepizole is given, which is an inhibitor of alcohol dehydrogenase ➢ Rx with bicarbonate (to manage profound metabolic acidosis) ➢ Hemodialysis done in high alcohol levels

Question 40

Symptoms of Methanol intoxication

Answer 40

- visual dysfunction - GI distress - Shortness of breath - loss of consciousness

Question 41

Treatment of Ethylene Glycol Toxicity

Answer 41

* Ethanol * Fomepizole * Supportive measures

Question 42

Physiological dependence

Answer 42

deprivation of the drug results in severe anxiety