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71 Cards in this Set
- Front
- Back
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ABV = ? |
Number of units in 1 litre |
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What level of alcohol consumption is considered to be lower risk? |
No more than 2-3 units per day on a regular basis |
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What level of alcohol consumption is considered to be increasing risk? |
4 - 5 units per day on a regular basis |
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What level of alcohol consumption is considered to be higher risk? |
>6 units per day on a regular basis or >35 units per week |
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What is the classic triad of Wernicke-Korsakoff syndrome? |
- confusion
- ataxia - opthalmoplegia |
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What are the consequences of Wernicke-Korsakoff syndrome? |
- acute mental impairment - precoma and coma |
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Describe the solubility of alcohol |
Both water and lipid soluble |
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What % of ingested alcohol enters the gastric mucosal cells of the upper GI tract? |
0-5% |
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What % of ingested alcohol enters the blood? |
95-100% |
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What % of the alcohol that enters the blood is excreted via the lungs? |
2-10% |
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What % of the alcohol that enters the blood is metabolised by the kidneys? |
90-98% |
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Which enzyme converts ethanol to acetaldehyde? |
ADH - Alcohol Dehydrogenase |
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Which enzyme converts acetaldehyde to acetate? |
ALDH - Acetaldehyde Dehydrogenase |
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Describe the toxicity of acetaldehyde |
Accumulation of acetaldehyde can cause:
- flushing, nausea and vomiting - liver damage from free radicals Acetaldehyde binds and inhibitsglutathione which is an antioxidant thatprotects against hydrogen peroxide (H2O2) Acetaldehyde also binds and inhibitsenzymes which protect against freeradicals |
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What is disulfiram? |
- used to treat alcohol dependency - inhibits ALDH, increasing blood acetaldehyde - adverse effects of alcohol occur within 15 minutes of consumption, promoting abstinence - does not stop cravings, risk of acetaldehyde toxicity |
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What is the net yeild of ATP per ethanol molecule(~7 Cal/g) metabolised via ADH and ALDH?
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13 |
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As more alcohol is consumed, what pathway is increasingly used to metabolise it? |
MEOS pathway |
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What is the net yield of ATP per ethanol molecule metabolised in the MEOS pathway? |
8 |
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Which two genetic variations, more common in East Asians than White Europeans, reduce tolerance for alcohol? |
• ADH2*2 is highly active which causes anaccumulation of acetaldehyde(ALDH enzymes cant cope)
• ALDH2*2 is very inactive and also causesan accumulation of acetaldehyde |
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Describe the metabolic processes behind the development of alcoholic ketoacidosis |
• Ketone bodies in the blood areusually absorbed by other tissues(muscle) where they are metabolised
• This is restricted when largeamounts of alcohol are metabolisedbecause there is a plentiful supply ofacetate which is the preferred fuel • Thus the blood concentration ofketone bodies is much higher thanunder normal fasting conditions –Alcoholic Ketoacidosis (AKA)lower blood pH |
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How can alcohol consumption lead to lactic acidosis? |
• The high NADH/NAD+ ratio encourages pyruvatefrom glycolysis to be converted to lactate (6)instead of acetyl CoA
• Lactic acidosis (low pH in tissue and bloodaccompanied by the buildup of lactate) results inmuscle pain after drinking |
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How can alcohol consumption lead to gout? |
High blood lactate decreases uric acidexcretion by the kidneys, which leads to hyperuricemia, which can cause gout in susceptible individuals.
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What is tolerance? |
a) A need for markedly increased amounts of alcohol toachieve intoxication or desired effect
b) A markedly diminished effect with continued use of thesame amount of alcohol. |
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What is withdrawal? |
a) The characteristic withdrawal syndrome for alcohol
b) Alcohol (or a closely related substance, such as abenzodiazepine) is taken to relieve or avoid withdrawalsymptoms. |
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What are the symptoms of alcohol withdrawal? |
- Anxiety
- Irritability - Tremor - Nausea and vomiting - Raised BP, pulse, and temp - Insomnia - Transient illusions/ hallucinations - Seizures |
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What are the DTs, and how long after the last drink do they typically begin? |
DTs peak onset 48-72 hours
Confusion, hallucinations, delusions,autonomic hyperactivity. |
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In alcohol withdrawal, what happens to the levels of GABA and Glutamate? |
- GABA function is reduced - Glutamate function is increased |
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What drugs are used in the treatment of alcohol withdrawal? |
- BZs or Carbamazepine - reduce signs and symptoms - Clomethiazole in inpatient settings - Lorazepam to prevent 2nd seizure |
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What two aspects of personality increase the likelihood of addiction? |
- Sensation seeking - Impulsivity |
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What % of UK alcohol service patients have a co-morbid psychiatric disorder? |
85% |
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What % of UK alcohol service patients have an affective and/or anxiety disorder? |
81% |
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What is the main area of the brain that is targeted by drugs of addiction? |
Target the mesolimbic dopaminergic pathway consisting of the ventraltegmental area (VTA), nucleus accumbens (NAc) and prefrontal cortex
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Which is more lipid soluable - heroin or morphine? |
Heroin |
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What are the short term effects of Diamorphine (Heroin)? |
• Causes intense euphoria ‘rush’ and transcendent relaxation
• Depressed respiration – can be fatal • Clouded mental functioning • Nausea and vomiting |
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What are the long term effects of Diamorphine (Heroin)?
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• Addiction
• Blood born (HIV/AIDS, hepatitis) infections • Collapsed/scarred veins, |
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What drugs can be used to alleviate withdrawal from Diamorphine (Heroin)? |
Methadone (oral, long half life)
Buprenorphine (opioid partial agonist) Lofexidine (α2 adrenoceptor agonist) |
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Which drug can be used as a long-term substitution for Heroin? |
Methadone |
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Which drug can be used to block responses to Heroin? |
Naltrexone (opioid receptor antagonist)
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Give two examples of narcotics? |
- Morphine - Diamorphine |
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Give three examples of psychomotor stimulants? |
- cocaine - amphetamines - nicotine |
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Give two examples of psychomimetic stimulants? |
- LSD - cannabis |
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Give three examples of CNS depressants? |
- alcohol - benzodiazapines - solvents |
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What are the effects of cocaine? |
• Euphoria
• Alertness and wakefulness • Increased confidence • Heightened sexual feelings • Indifference to concerns |
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What is the mechanism of action of cocaine? |
• inhibits 5‐HT, noradrenaline anddopamine reuptake
• Increased neurotransmitters insynaptic cleft • Also blocks Na+ channels andacts as local anaesthetic • Causes vasoconstriction via α1adrenoceptors |
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What are the adverse effects of cocaine? |
• Severe psychological dependence
• Depression, dysphoria, fatigue, deterioration in motorperformance • Necrosis of nasal mucosa and septum • Overdose causes serious cardiovascular events (cardiacdysrhythmias, myocardial infarction) • Myocardial damage can cause heart failure |
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What are the effects of cocaine in pregnancy? |
Severe impairment of brain development infetus
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What are the effects of amphetamines? |
• Euphoria and excitement
• Increased stamina (mental and physical) • Appetite suppressant (anorexia) • insomnia |
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What is the mechanism of action of amphetamines? |
• Displaces noradrenaline and dopamine and inhibits their reuptake
• Increased neurotransmitters in synaptic cleft • Indirect sympathomimetic effect |
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What are the adverse effects of amphetamines? |
• Anxiety, irritability and restlessness
• Amphetamine psychosis – resembles ‘acute schizophrenicattack’ • Tolerance develops leading to risk of dependence • Long‐term methamphetamine users usually gaunt, paranoid,anxious, rotten teeth , skin sores |
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What are most legal highs? |
Amphetamines or amphetamine-like substances |
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What are the harmful effects of smoking? |
• Tolerance and dependence
• Cancer (especially lung and bladder cancer) • Coronary heart disease • Effects on respiratory system (bronchitis, emphysema, COPD) • Psychological effects |
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Which drug can be used to alleviate nicotine withdrawal? |
Clonidine (α2‐adrenoceptor agonist)
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Which drug can be used as a substitute for nicotine? |
Varenicline (nAChR agonist)
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Which drug can be used to block the effects of nicotine? |
Mecamylamine (block nicotine effects)
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Which drug can be used to reduce nicotine cravings? |
Bupropion (antidepressant)
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What is the main active component of cannabis? |
a cannabinoid called ∆9‐tetrahydrocannabinol (∆9‐THC)
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What are the effects of cannabis? |
• Both hallucinogenic and depressant actions
• Euphoria, relaxation and feelings of well being • Altered perception of time • Chronic use associated with psychotic disorders |
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What are the effects of mild, short-term cannabis withdrawal? |
Restlessness, irritability, aggression, insomnia, nausea, cramps.
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What are the effects of alcohol? |
• Increased self‐confidence
• Loss of motor control • Higher levels of intoxication mood becomes labile with euphoria,depression and aggression • Enhances the effects of other CNS depressants |
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What is the danger of combining alcohol and cocaine? |
Production of the toxic metabolite cocaethylene
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Which drugs can be used to alleviate alcohol withdrawal? |
chlordiazepoxide (long acting BDZ)
clonidine (α2‐adrenoceptor agonists) |
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Which drugs can be used to reduce cravings for alcohol? |
bupropion (antidepressant)
acamprosate (NMDA receptorantagonist for alcohol addiction) |
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Persons dependent on which drug present the most danger to other people? |
Alcohol |
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Persons dependent on which drug present the most danger to themselves? |
Cocaine |
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When is a pregnancy susceptible to alcohol? |
Predifferentiation stage (preg wk 1-4)
Embryonic period (preg wk 5-10) Fetal period (preg wk 11-40) |
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What facial features are seen on a baby with fetal alcohol syndrome? |
short palpebral fissures, flat midface, long smooth philtrum, thin upper lip
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What effects does FAS have on growth? |
low birth weight for gestational age, increasing growth failure, low weight to height
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What are the the CNS neurodevelopmental effects of FAS? |
microcephaly, structural brain anomalies, SN hearing loss, poor coordination, learning difficulties
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What are the behavioural effects of FAS? |
memory, attention, judgement, impulse control, abstraction
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What number of pregnancies exposed to alcohol develop FAS? |
~ 10% |
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What are the recommendations about alcohol consumption during pregnancy? |
- none during first 3 months - then no more than 1-2 units, 1-2 times a week |
