Chapter 16 Cholinesterase Inhibitors
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Transcript Chapter 16 Cholinesterase Inhibitors
Chapter 38
Drug Abuse II: Alcohol
Copyright © 2013, 2010 by Saunders, an imprint of Elsevier Inc.
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
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Basic Pharmacology of Alcohol
Central nervous system effects
Acute effects
• General depression of CNS function
Enhances GABA-mediated inhibition
Dose-dependent
Binds with 5-HT3 receptors
• Activation of the reward circuit
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Basic Pharmacology of Alcohol
Chronic effects
Two neuropsychiatric syndromes
• Wernicke’s encephalopathy
• Korsakoff’s psychosis
Impact on cognitive function
Effect on sleep
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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
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Basic Pharmacology of Alcohol
Pharmacokinetics
Absorption
Distribution
Metabolism
Blood levels
Tolerance
Physical dependence
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Basic Pharmacology of Alcohol
Drug interactions
CNS depressants
Nonsteroidal anti-inflammatory drugs
Acetaminophen
Disulfiram
Antihypertensive drugs
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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
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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
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Drugs for Alcohol Use Disorder
Drugs used to facilitate withdrawal
Drugs used to maintain abstinence
Other drugs used in the treatment of alcohol
abuse
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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)
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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)
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Fig. 38–1. Ethanol metabolism and the effect of disulfiram.
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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
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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
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Drugs Used to Maintain Abstinence
Topiramate (Topamax)
Reduces craving for alcohol
Ondansetron (Zofran)
Selective 5-HT3 receptor antagonist
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Nutritional Support, Fluid
Replacement, and Antibiotics
B vitamins
Thiamine
Folic acid
Cyanocobalamin
Vitamin supplements
Fluid replacement therapy
Antibiotics
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