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Chapter 38

Chapter 38. Drug Abuse II: Alcohol. Alcohol. Most commonly used and abused psychoactive agent in the United States Some therapeutic use Primarily used for nonmedical purposes Moderate consumption: prolongs life, reduces risk of dementia and cardiovascular disorders

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Chapter 38

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  1. Chapter 38 Drug Abuse II: Alcohol

  2. Alcohol • Most commonly used and abused psychoactive agent in the United States • Some therapeutic use • Primarily used for nonmedical purposes • Moderate consumption: prolongs life, reduces risk of dementia and cardiovascular disorders • Excessive consumption: diminishes quality and quantity of life

  3. Basic Pharmacology of Alcohol • Central nervous system effects • Acute effects • General depression of CNS function • Enhances GABA-mediated inhibition • Dose-dependent • Activation of the reward circuit • Binds with 5-HT3 receptors

  4. Basic Pharmacology of Alcohol • Chronic effects • Two neuropsychiatric syndromes • Wernicke’s encephalopathy • Korsakoff’s psychosis • Impact on cognitive function • Effect on sleep

  5. Basic Pharmacology of Alcohol • Other pharmacologic effects • Cardiovascular system • Respiration • Liver • Stomach • Kidney • Pancreas • Sexual function • Cancer: breast and colorectal cancer • Pregnancy and lactation • Impact on longevity

  6. Basic Pharmacology of Alcohol • Pharmacokinetics • Absorption • Distribution • Metabolism • Blood levels • Tolerance • Physical dependence

  7. Basic Pharmacology of Alcohol • Drug interactions • CNS depressants • Nonsteroidal anti-inflammatory drugs • Acetaminophen • Disulfiram • Antihypertensive drugs

  8. Basic Pharmacology of Alcohol • Acute overdose • Vomiting, coma, pronounced hypotension and respiratory depression • Therapeutic uses • Topical • Oral • Intravenous • Replacement of calories and fluid • Local injection • Nerve block

  9. Alcohol Use Disorder • Relapsing disorder • Impaired control over drinking • Preoccupation with alcohol consumption • Use of alcohol despite awareness of adverse consequences • Distortions in thinking • Influenced by genetics and psychosocial and environmental factors

  10. Drugs for Alcohol Use Disorder • Drugs used to facilitate withdrawal • Drugs used to maintain abstinence • Other drugs used in the treatment of alcohol abuse

  11. Drugs Used to Facilitate Withdrawal • Benzodiazepines • Chlordiazepoxide (Librium, others) • Diazepam (Valium) • Oxazepam (Serax) • Lorazepam (Ativan) • Adjuncts to benzodiazepines • Carbamazepine (antiepileptic drug) • Clonidine (alpha-adrenergic blocker) • Atenolol and propranolol (beta-adrenergic blockers)

  12. Drugs Used to Maintain Abstinence • Disulfiram aversion therapy • Refrain from drinking • Causes irreversible inhibition of aldehyde dehydrogenase • Effects caused by alcohol plus disulfiram are referred to as acetaldehyde syndrome • Patients must be carefully chosen • Patients must be thoroughly informed to avoid all forms of alcohol • Sauces, cough syrups • Alcohol applied to the skin (lotions, colognes, liniments)

  13. Fig.38–1. Ethanol metabolism and the effect of disulfiram.

  14. Drugs Used to Maintain Abstinence • Naltrexone (Revia) • Pure opioid antagonist • Decreases craving for alcohol • Blocks reinforcing effects of alcohol • Mechanism unclear • Adverse effects • Nausea • Headache

  15. Drugs Used to Maintain Abstinence • Acamprosate (Campral) • Reduces unpleasant feelings brought on by abstinence • Devoid of direct anxiolytic, anticonvulsant, and antidepressant activity • Does not cause alcohol aversion • Administered orally • Excreted unchanged in the urine • Adverse effects and drug interactions • Diarrhea • Avoid during pregnancy

  16. Drugs Used to Maintain Abstinence • Topiramate (Topamax) • Reduces craving for alcohol • Ondansetron (Zofran) • Selective 5-HT3 receptor antagonist

  17. Nutritional Support, Fluid Replacement, and Antibiotics • B vitamins • Thiamine • Folic acid • Cyanocobalamin • Vitamin supplements • Fluid replacement therapy • Antibiotics

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