Alcohol
Content
Alcohol
• Acute
alcohol intoxication
• Methanol
poisoning and its treatment
• Mechanism
of disulfiram
• Drugs
used for the treatment of alcohol dependence
Intended Learning Outcomes
At the end of this lecture,
student will be able to
• Explain
acute alcohol intoxication
• Explain
methanol poisoning and its treatment
• Outline
the mechanism of disulfiram
• List
the drugs used for the treatment of alcohol dependence
Acute
alcohol intoxication
Life Threatening signs of alcohol poisoning include:
·
Inability to Wake up
·
Irregular breathing (10 second or more between
breaths)
·
Vomiting
·
Seizures
·
Slow breathing (fewer than 8 breaths per minute)
·
Hypothermia (Low body temperature), bluish skin
color, paleness
• 600ml
of pure alcohol in 70 Kg bodyweight: Fatal effect
• Coma
due to CNS depression, severe hypoglycemia
• Treatment
• Maintenance
of vital functions
• Thiamine
100 mg (Bolus IV)
• Glucose
50% 50 ml IV for hypoglycemia
• MgSO4
2-4g IV over 1-2 hrs
Chronic
alcoholism
Neuropsychiatric
syndromes
• Korsakoff’s
psychosis, hallucinosis, suicidal tendencies, wernicke’s encephalopathy
Nutritonal
deficiencies
• Polyneuritis
due to thiamine deficiency & anaemia
Organ damage leading
to
• Hepatic
cirrhosis, chronic pancreatitis, cardiomyopathy, optic nerve degeneration
Alcohol
dependence
• Precise
mechanism not known
• Upregulate
NMDA receptor & voltage sensitive calcium channel
• Down
regulate GABAA mediated ressponses
• Treatment:
– Detoxification
– rehabilitation
Drugs for
Alcohol dependence
• Aversion drugs: Disulfiram, citrated Ca
cyanide
• Opioid antagonist: Naltrexone,
Nalmefene
• Dopamine Antagonist: Tiapride
• NMDA Antagonist: Acamprosate
• Supporting drugs: Lithium,
carbamazepine, topiramate
Disulfiram
• 12
hours alcohol free
• 500
mg as single daily dose for 1-2 weeks
• 125
– 250 mg OD as maintenance dose
• Continued
upto 1 year
• Inhibits
aldehyde dehydrogenase
• Inhibits
dopamine beta oxidase
Alcohol
• Drug interactions
– Inhibits
metabolic degradation of warfarin, theophylline, benzodiazepine, carbamazepine,
tricyclic antidepressants
• contraindications
– Hepatic
and circulatory diseases
– Uncontrolled
DM
– Alcoholics
with obvious personality changes
Methyl
Alcohol
Pharmacological
Actions
• Initial
symptoms similar to ethanol
• Later
symptoms due to:
• CNS
depression
• Acidosis:
because of formic acid and other organic acids
• Toxic
effects of formaldehyde & formic acid on retinal cells
• Delayed
symptoms
• Headache
vertigo, nausea, vomiting
• Severe
abdominal pain
• Dyspnoea
• Motor
restlessness
• Bradycardia
• Coma
followed by death
• Preceded
by blindness
Treatment
• Hospitalization
& nursing care
• Gastric
lavage, activated charcoal
• Treatment
of acidosis/ hypoglycemia
• Inhibition
of methanol metabolism: ethanol, fomepizole
• Promotes
metabolic degradation of formate
• Folinic
acid 1mg/Kg IV wih folic acid img/Kg IV 4 hourly for 6 doses
• Hemodialysis
in severe case
Summary
• Chronic
alcoholism leads to Korsakoff’s psychosis, hallucinosis, suicidal tendencies,
wernicke’s encephalopathy Hepatic cirrhosis, chronic pancreatitis,
cardiomyopathy, optic nerve degeneration
• Regular
consumption of alcohol associated with hypertension and conduction defects
• Methanol
poisoning: Coma preceded by blindness
• Hemodialysis
in severe case of methanol poisoning
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