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Alcohol is a ___.
drug
What is the functional group found in alcohol molecules?
OH
hydroxyl
Methanol is ___ and (should / shouldn’t) be consumed.
toxic
shouldn’t
Where may methanol occasionally be found?
Home brew alcohol
What is methanol metabolised into?
Formaldehyde (fixes tissue)
> Formic acid (dissolves you)
What is the main symptom of methanol poisoning?
Blindness
How is methanol poisoning treated?
Ethanol +/- dialysis
What enzyme metabolises both methanol and ethanol?
Alcohol dehydrogenase
By which principle does drinking ethanol help with methanol poisoning?
Competitive inhibition by ethanol
i.e it competes with methanol for the alcohol dehydrogenase enzymes
Which group of women are advised not to drink alcohol?
Pregnant women
Why does drinking on a full stomach reduce the rate of alcohol absorption?
Reduced gastric emptying
So more alcohol is metabolised in the stomach instead of being absorbed into the bloodstream
What is the recommended weekly intake of alcohol for men and women?
14 units
If a patient is consuming alcohol regularly over a week, they should have several ___ days.
rest
Alcohol is soluble in ___.
water
Alcohol absorption in the stomach is ___.
Where in the GI tract is mainly responsible for alcohol absorption?
minimal
Small bowel
Which drugs increase the rate of gastric emptying and therefore increase the rate at which alcohol is absorbed in the small bowel?
Antihistamines (inc. rate of emptying)
Metoclopramide (for gastroparesis, inc. rate of emptying)
Domperidone (“”)
Drinking high concentrations of alcohol will result in it being absorbed (more quickly / more slowly).
Why?
more slowly
Irritates gastric mucosa > delays empyting
What drinks are aerated and tend to be absorbed quickly?
Champagne, prosecco etc.
Do women have a lower tolerance for alcohol than men?
Yes
Why do females have a lower tolerance for alcohol than men?
Males have a leaner body mass on average
More water > greater volume for dilution
Females have lower alcohol dehydrogenase activity as well
Which enzyme, which metabolises alcohol, do females have less of compared to men?
Alcohol dehydrogenase
Where is most alcohol metabolised?
Liver
Apart from the liver, where else is alcohol metabolised?
Pancreas
Brain
Apart from in the urine, where else is alcohol excreted?
Breath
Sweat
Stool
Alcohol is removed from the blood at 15mg/100ml/hour - how many units is this roughly equivalent to?
1 unit per hour
Alcohol concentration peaks ___ hour after consumption.
one
Because blood concentration of alcohol decreases linearly, what shouldn’t you do the morning after heavy drinking?
Drive
Certain ethnic groups have reduced levels of which enzyme?
Which groups?
Alcohol dehydrogenase
Aborigines, eskimos etc.
Why do some people flush and feel sick after drinking alcohol?
Low levels of ALDEHYDE dehydrogenase - acetaldehyde is unpleasant and toxic
Which drugs, used to manage chronic alcoholism, cause flushing and nausea in people who then drink alcohol?
Aldehyde dehydrogenase inhibitors
e.g disulfiram (Antabuse)
Why do you achieve a higher alcohol tolerance the more alcohol you drink?
Alcohol dehydrogenase activity UPREGULATED
Which alternate pathway of alcohol metabolism is activated in chronic drinkers?
Which family of proteins does it require?
MEOS pathway
Cytochrome P450 family
What is one of the biggest risk factors for head and neck cancers?
Alcoholism
Which three biochemical processes are impaired by chronic alcoholism?
Gluconeogenesis
Kreb’s Cycle
Fatty acid oxidation
Why may you get sore after a night of heavy drinking?
Kreb’s Cycle inhibited
Switch to anaerobic metabolism
Production of lactic acid
Which two processes start in the liver when blood glucose is low during a night of heavy drinking?
Gluconeogenesis
Glycogenolysis
using fat, proteins etc.
Why do you get the munchies after a night of heavy drinking?
Hypoglycaemia
People with which condition should be careful when heavy drinking?
Diabetes
Why does drinking alcohol make you gain weight?
Fatty acid oxidation impaired
Excess lipid synthesis
Plus the alcohol contains loads of calories anyway
Both alcoholic and diabetic ketoacidosis involve a metabolic acidosis due to the buildup of ketones in the blood. What is the thing differentiating these two diseases?
Diabetic ketoacidosis - hyperglycaemia
Alcoholic ketoacidosis - little/no hyperglycaemia
Alcohol is a CNS (stimulant / depressant).
depressant
The level of which neurotransmitter is increased by alcohol consumption?
GABA
The CNS effects of alcohol consumption are __-dependent.
dose
Why is unconsciousness dangerous in someone who is acute intoxicated?
Swallowing impaired
Vomiting
Aspiration pneumonia (brush up on lung lobes)
Why else may you die while acutely intoxicated?
Trauma (misadventure, falls, fighting etc.)
Vomiting (metabolic alkalosis, Mallory-Weiss tear, Boerhavve syndrome (gastric tear), acute pancreatitis)
Does alcohol make you pee more?
Yes
Why does alcohol make you pee more?
Sheer volume consumed
Which hormone, responsible for water reabsorption, is inhibited by alcohol?
ADH / Vasopressin
What is the result of the inhibition of ADH by alcohol?
Reduced water reabsorption
Higher volume of less concentrated urine
Why does acute intoxication give you the sensation of a heavy heartbeat?
Negative inotrope (reduced contractility)
So heart rate increases to maintain cardiac output
Binge drinking of alcohol can cause a spontaneous supraventricular tachycardia - what is this condition called?
Holiday heart syndrome
What are the factors contributing to headache after drinking alcohol?
Congeners - i.e the substances used to make alcohol smell a certain way
Serotonin
Dehydration
Acetic acid
Apart from chemicals in alcohol, what contributes to a hangover after acute intoxication?
Dehydration
Any drug which inhibits ____ may see some use as a hangover cure.
prostaglandins
Why do some people who drink alcohol have heartburn the next morning?
Alcohol is a smooth muscle relaxant
> inhibition of lower oesophageal sphincter (also snoring), gastric acid irritates oesophageal mucosa