Acute alcohol intoxication – Pharmacology B. Pharma 5th Semester PDF Notes

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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