This document summarizes information about various alcohols including ethanol, methanol, and ethylene glycol. It discusses their pharmacokinetics, mechanisms of action, toxicity, clinical uses, and interactions. Ethanol is widely consumed but also commonly abused and causes medical and societal costs. Methanol and ethylene glycol toxicity occurs from industrial and other exposures. Fomepizole is used to treat methanol and ethylene glycol poisoning by inhibiting alcohol dehydrogenase. Benzodiazepines are used to treat ethanol withdrawal while naltrexone, acamprosate, and disulfiram are used to treat chronic alcoholism.
In chemistry, alcohols are organic compounds that carry at least one hydroxyl functional group bound to their aliphatic substructure. The term alcohol originally referred to the primary alcohol ethanol, which is used as a drug and is the main alcohol present in alcoholic beverages.
In chemistry, alcohols are organic compounds that carry at least one hydroxyl functional group bound to their aliphatic substructure. The term alcohol originally referred to the primary alcohol ethanol, which is used as a drug and is the main alcohol present in alcoholic beverages.
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Biochemistry of water - presentation given by Dr. Karthikeyan Pethusamy at department of biochemistry, Maulana Azad Medical College. To make slides simple, less information is given in slides. More information was shared during the presentation.
Preparation, reactions, Acidity, effect of substituents on acidity, structure and uses of carboxylic acid and identification tests for carboxylic acid, amide and ester
Uploader's Note:
The following Text, information and materials used in this presentation do not own by the uploader.
This presentation is all about Alcoholism-sign, effects, symptoms and treatment..
Special thanks to Mayo clinic organization for providing information for this presentation...
thank you.. and enjoy...
"keep moving forward"
Biochemistry of water - presentation given by Dr. Karthikeyan Pethusamy at department of biochemistry, Maulana Azad Medical College. To make slides simple, less information is given in slides. More information was shared during the presentation.
Preparation, reactions, Acidity, effect of substituents on acidity, structure and uses of carboxylic acid and identification tests for carboxylic acid, amide and ester
alcohol perturbs the balance between excitatory and inhibitory influences in the brain, resulting in Anxiolysis. An increased reaction time, diminished fine motor control, impulsivity, and impaired judgement be come evident when the concentionof alcohol in the blood is 20-30mg/dl.
More than 50% of persons are grossly intoxicated by a conc. Of 150mg/dl.
The defintion of intoxication varies by country.
Alcohol can be measured in saliva, urine,sweat,and blood, level in exheled air remains the primary method of assessing the level of intoxication.
Ethanol (CH 3 CH 2 OH) is a water-soluble alcohol that rapidly crosses cell membranes.
Absorption of ethanol occurs via the gastrointestinal system, primarily in the stomach (70 percent) and duodenum (25 percent), with a small amount absorbed by the remaining intestine .
When the stomach is empty, peak blood ethanol levels are reached between 30 and 90 minutes after ingestion.
Alcohol is a CNS depressant drug that is used socially in our society for many reasons (e.g., to
enhance the flavor of food, to encourage relaxation and conviviality, for feelings of celebration, and as a
sacred ritual in some religious ceremonies). Therapeutically, it is the major ingredient in many
OTC/prescription medications. It can be harmless, enjoyable, and sometimes beneficial when used
responsibly and in moderation. Like other mind-altering drugs, however, it has the potential for abuse and,
in fact, is the most widely abused drug in the United States (research suggests 5% to 10% of the adult
population) and is potentially fatal. Frequently, the client in a residential care setting has been using alcohol
in conjunction with other drugs. It is believed that alcohol is often used by clients who have other mental
illnesses to assuage the pain they feel. The term “dual diagnosis” is used to mean an association between
the use/abuse of drugs (including alcohol) and other psychiatric diagnoses. It may be difficult to determine
cause and effect in any given situation to determine an accurate diagnosis. However, it is important to
recognize when both conditions are present so that the often-overwhelming problems of treatment are
instituted for both conditions.
This plan of care addresses acute intoxication/withdrawal and is to be used in conjunction with CP:
Substance Dependence/Abuse Rehabilitation.
Explore animal anatomy with our latest presentation! Discover animal tissues, organs, and organ systems in simple terms, perfect for NEET UG exam prep. Get ready to ace your exam with this easy-to-understand guide! #NEETUG #Biology
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NATIONAL MEDICAL COMMISSION (N.M.C.)
M.B.B.S. UNDERGRADUATE CURRICULUM Vol. I
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NATIONAL MEDICAL COMMISSION (N.M.C.)
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NUMBER –PH2.1
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In this lecture, we will discuss essential medicines lists, including the WHO EML and NLEM. We will discuss the criteria for inclusion on these lists, the benefits of having an essential medicines list, and how to develop an essential medicines list for a specific setting.
This lecture is intended for healthcare professionals, medical students and the general public.
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Prepare for NEET PG with these topic-wise recall one-liners. Master the subject by reviewing the key concepts and mechanisms of action for each drug, as well as their indications, adverse effects, and toxicities. With this approach, you can effectively learn and retain the essential information necessary to excel in your exam.
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Alpha Blockers: Mechanisms and Clinical ApplicationsShivankan Kakkar
This presentation provides an overview of alpha blockers, a class of drugs used in the treatment of various medical conditions such as hypertension, benign prostatic hyperplasia, and Raynaud's disease. The presentation discusses the mechanism of action of alpha blockers, their classification, and their clinical applications. It also covers the adverse effects associated with their use and precautions that need to be taken while prescribing these drugs. This presentation is useful for healthcare professionals who want to gain a better understanding of alpha blockers and their use in clinical practice.
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Synthetic fiber production is a fascinating and complex field that blends chemistry, engineering, and environmental science. By understanding these aspects, students can gain a comprehensive view of synthetic fiber production, its impact on society and the environment, and the potential for future innovations. Synthetic fibers play a crucial role in modern society, impacting various aspects of daily life, industry, and the environment. ynthetic fibers are integral to modern life, offering a range of benefits from cost-effectiveness and versatility to innovative applications and performance characteristics. While they pose environmental challenges, ongoing research and development aim to create more sustainable and eco-friendly alternatives. Understanding the importance of synthetic fibers helps in appreciating their role in the economy, industry, and daily life, while also emphasizing the need for sustainable practices and innovation.
We all have good and bad thoughts from time to time and situation to situation. We are bombarded daily with spiraling thoughts(both negative and positive) creating all-consuming feel , making us difficult to manage with associated suffering. Good thoughts are like our Mob Signal (Positive thought) amidst noise(negative thought) in the atmosphere. Negative thoughts like noise outweigh positive thoughts. These thoughts often create unwanted confusion, trouble, stress and frustration in our mind as well as chaos in our physical world. Negative thoughts are also known as “distorted thinking”.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
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2. INTRODUCTION
• Alcohol is widely consumed.
• Like other sedative- hypnotic drugs, alcohol in low to
moderate amounts relieves anxiety and fosters a
feeling of well-being or even euphoria.
• However, alcohol is also the most commonly abused
drug in the world, and the cause of vast medical and
societal costs.
• Ethanol and many other alcohols with potentially toxic
effects are also used as fuels and in industry—some in
enormous quantities. In addition to ethanol, methanol
and ethylene glycol toxicity occurs with sufficient
frequency to warrant discussion.
3. ALCOHOL-USE DISORDERS
• Individuals who use alcohol in dangerous situations (eg,
drinking and driving or combining alcohol with other
medications) or continue to drink alcohol despite adverse
consequences related directly to their alcohol consumption
suffer from alcohol abuse.
• Individuals with alcohol dependence have characteristics of
alcohol abuse and additionally exhibit physical dependence
on alcohol (tolerance to alcohol and signs and symptoms
upon withdrawal). They also demonstrate an inability to
control their drinking and devote much time to getting and
using alcohol, or recovering from its effects.
• The alcohol-use disorders are complex, with genetic as well as
environmental determinants.
4. BASIC PHARMACOLOGY OF ETHANOL
• Pharmacokinetics
• Ethanol is a small water-soluble molecule that is absorbed rapidly from the
gastrointestinal tract. After ingestion of alcohol in the fasting state, peak blood
alcohol concentrations are reached within 30 minutes. The presence of food in
the stomach delays absorption by slowing gastric emptying. Distribution is rapid,
with tissue levels approximating the concentration in blood. The volume of
distribution for ethanol approximates total body water (0.5–0.7 L/kg). In the
central nervous system (CNS), the concentration of ethanol rises quickly, since the
brain receives a large proportion of total blood flow and ethanol readily crosses
biologic membranes.
• Over 90% of alcohol consumed is oxidized in the liver; much of the remainder is
excreted through the lungs and in the urine. The excretion of a small but
consistent proportion of alcohol by the lungs can be quantified with breath alcohol
tests that serve as a basis for a legal definition of “driving under the influence”
(DUI) in many countries.
• The typical adult can metabolize 7–10 g (150–220 mmol) of alcohol per hour.
5. BASIC PHARMACOLOGY OF ETHANOL
• Two major pathways
of alcohol metabolism
to acetaldehyde have
been identified
(Figure–1).
• Acetaldehyde is then
oxidized to acetate by
a third metabolic
process.
6. • Which metabolite of ethanol is
responsible for causing headache,
hypotension, nausea, and vomiting
(“hangover”)?
• Acetaldehyde
7. BASIC PHARMACOLOGY OF ETHANOL
A. Alcohol Dehydrogenase Pathway
The primary pathway for alcohol metabolism involves alcohol
dehydrogenase (ADH), a family of cytosolic enzymes that catalyze the
conversion of alcohol to acetaldehyde.
B. Microsomal Ethanol-Oxidizing System (MEOS)
This enzyme system, also known as the mixed function oxidase system,
uses NADPH as a cofactor in the metabolism of ethanol and consists
primarily of cytochrome P450.
C. Acetaldehyde Metabolism
Much of the acetaldehyde formed from alcohol is oxidized in the liver
in a reaction catalyzed by mitochondrial NAD-dependent aldehyde
dehydrogenase (ALDH). The product of this reaction is acetate, which
can be further metabolized to CO2 and water, or used to form acetyl-
CoA.
8. • What is the first step in ethanol metabolism?
• Alcohol dehydrogenase converts ethanol to
acetaldehyde.
• What is the second step in ethanol
metabolism?
• Acetaldehyde dehydrogenase converts
acetaldehyde to acetate.
9. BASIC PHARMACOLOGY OF ETHANOL
• Pharmacodynamics of Acute Ethanol Consumption
A. Central Nervous System
The CNS is markedly affected by acute alcohol consumption. Alcohol
causes sedation, relief of anxiety and, at higher concentrations,
slurred speech, ataxia, impaired judgment, and disinhibited behavior,
a condition usually called intoxication or drunkenness.
B. Heart
Significant depression of myocardial contractility has been observed
in individuals who acutely consume moderate amounts of alcohol.
C. Smooth Muscle
Ethanol is a vasodilator, probably as a result of both CNS effects
(depression of the vasomotor center) and direct smooth muscle
relaxation caused by its metabolite, acetaldehyde. In cases of severe
overdose, hypothermia—caused by vasodilation—may be marked in
cold environments.
10. BASIC PHARMACOLOGY OF ETHANOL
• Consequences of Chronic Alcohol Consumption
A. Liver and Gastrointestinal Tract
Liver disease is the most common medical complication of alcohol abuse; an
estimated 15–30% of chronic heavy drinkers eventually develop severe liver disease.
B. Nervous System
1. Tolerance and dependence—The consumption of alcohol in high doses over a long
period results in tolerance and in physical and psychological dependence.
2. Neurotoxicity—Consumption of large amounts of alcohol over extended periods
(usually years) often leads to neurologic deficits. The most common neurologic
abnormality in chronic alcoholism is generalized symmetric peripheral nerve injury,
which begins with distal paresthesias of the hands and feet. Degenerative changes
can also result in gait disturbances and ataxia. Other neu-rologic disturbances
associated with alcoholism include dementia and, rarely, demyelinating disease.
Wernicke-Korsakoff syndrome is a relatively uncommon but important entity
characterized by paralysis of the external eye muscles, ataxia, and a confused state
that can progress to coma and death.
11. • A 40-year-old man with a 20-year history of alcohol abuse is
brought to the hospital by his friends because he was difficult to
rouse. He ate a large meal several hours ago. He is emaciated and
lethargic. Examination shows severely restricted horizontal eye
movements and ataxia of both upper extremities. The most likely
cause of these findings is a deficiency of which of the following
nutrients?
A. Folic acid
B. Vitamin A
C. Vitamin B1 (thiamine)
D. Vitamin B6 (pyridoxine)
E. Vitamin B12 (cobalamin)
• Correct answer : C. Vitamin B1 (thiamine)
• The clinical features are characteristic of Wernicke
encephalopathy seen in chronic alcoholics due to thiamine
deficiency.
12. BASIC PHARMACOLOGY OF ETHANOL
C. Cardiovascular System
1. Cardiomyopathy and heart failure—Alcohol has complex effects on the
cardiovascular system. Heavy alcohol consumption of long duration is associated with
a dilated cardiomyopathy with ventricular hypertrophy and fibrosis.
2. Arrhythmias—Heavy drinking—and especially “binge” drinking—are associated
with both atrial and ventricular arrhythmias.
3. Hypertension—A link between heavier alcohol consumption (more than three
drinks per day) and hypertension has been firmly established in epidemiologic studies.
4. Coronary heart disease—Although the deleterious effects of excessive alcohol use
on the cardiovascular system are well established, there is strong epidemiologic
evidence that moderate alcohol consumption actually prevents coronary heart
disease (CHD), ischemic stroke, and peripheral arterial disease.
D. Blood
Alcohol indirectly affects hematopoiesis through metabolic and nutritional effects
and may also directly inhibit the proliferation of all cellular elements in bone marrow.
The most common hematologic disorder seen in chronic drinkers is mild anemia
resulting from alcohol-related folic acid deficiency. Iron deficiency anemia may result
from gastrointestinal bleeding.
13. BASIC PHARMACOLOGY OF ETHANOL
E. Endocrine System and Electrolyte Balance
Chronic alcohol use has important effects on the endocrine system and on fluid and electrolyte
balance. Clinical reports of gynecomastia and testicular atrophy in alcoholics with or without
cirrhosis suggest a derangement in steroid hormone balance.
F. Fetal Alcohol Syndrome
Chronic maternal alcohol abuse during pregnancy is associated with teratogenic effects, and
alcohol is a leading cause of mental retardation and congenital malformation. The abnormalities
that have been characterized as fetal alcohol syndrome include (1) intrauterine growth
retardation, (2) microcephaly, (3) poor coordination, (4) underdevelopment of midfacial region
(appearing as a flattened face), and (5) minor joint anomalies. More severe cases may include
congenital heart defects and mental retardation.
G. Immune System
The effects of alcohol on the immune system are complex; immune function in some tissues is
inhibited (eg, the lung), whereas pathologic, hyperactive immune function in other tissues is
triggered (eg, liver, pancreas).
H. Increased Risk of Cancer
Chronic alcohol use increases the risk for cancer of the mouth, pharynx, larynx, esophagus, and
liver.
14. • Acute alcohol intoxication does what to
warfarin metabolism?
• Inhibits warfarin metabolism, thereby
increasing warfarin blood levels
• Chronic alcohol use does what to warfarin
metabolism?
• Induces warfarin metabolism, thereby
decreasing warfarin blood
15. PHARMACOLOGY OF OTHER
ALCOHOLS
• Methanol (methyl alcohol, wood
alcohol) is widely used in the
industrial production of synthetic
organic compounds and as a
constituent of many commercial
solvents.
• The special susceptibility of humans
to methanol toxicity is due to
metabolism to formate and
formaldehyde, not due to methanol
itself.
• Toxic levels of formate, causes
characteristic visual disturbance plus
coma, seizures, acidosis, and death
due to respiratory failure.
• Fomepizole, an alcohol
dehydrogenase inhibitor, is approved
for the treatment of methanol
poisoning.
16. • A 21-year-old man is brought to the emergency department by friends because of blurred vision,
headache, abdominal pain, nausea, and vomiting for 30 minutes. His friends say that he drank 60
mL of wood alcohol 1 hour ago after a bet at a fraternity house party. His pulse is 58/min and
regular, respirations are 28/min and shallow, and blood pressure is 130/72 mm Hg. Physical
examination shows no other abnormalities. Laboratory studies show:
• Serum
Na+ – 139 mEq/L
Cl− – 85 mEq/L
K+ – 4.5 mEq/L
HCO3− – 13 mEq/L
• Urine
pH – 5
Crystals – none
• Arterial blood gas analysis on room air:
pH – 7.28
PO2 – 108 mm Hg
PCO2 – 22 mm Hg
• Which of the following is the most appropriate initial treatment for this patient?
(A) Intravenous ethanol therapy
(B) Intravenous sodium bicarbonate therapy
(C) Oral acetylcysteine therapy
(D) Oral activated charcoal therapy
(E) Hemodialysis
• Correct answer : (A) Intravenous ethanol therapy
• Explanation: This is a case of methyl alcohol poisoning. Intravenous ethanol is administered to
prevent toxicity and complications like blindness.
17. • In methyl alcohol poisoning there is CNS
depression, cardiac depression and optic nerve
atrophy. These effects are produced due to:
A. Formaldehyde and formate
B. Acetaldehyde
C. Pyridine
D. Acetic acid
• Correct answer : A. Formaldehyde and formate
acid
• Methyl alcohol is converted
into formaldehyde by alcohol dehydrogenase. It
is in turn converted to formic acid by aldehyde
dehydrogenase.
18. PHARMACOLOGY OF OTHER
ALCOHOLS
• Polyhydric alcohols such as ethylene glycol are used as
heat exchangers, in antifreeze formulations, and as
industrial solvents. Young children and animals are
sometimes attracted by the sweet taste of ethylene glycol
and, rarely, it is ingested intentionally as an ethanol
substitute or in attempted suicide. Although ethylene glycol
itself is relatively harmless and eliminated by the kidney, it
is metabolized to toxic aldehydes and oxalate.
• Toxic aldehydes and oxalate, causes kidney damage and
severe acidosis.
• As with methanol poisoning, early fomepizole is the
standard treatment for ethylene glycol poisoning.
19. ALCOHOLS- SUMMARY
DRUGS MECHANISM OF
ACTION, EFFECTS
CLINICAL
APPLICATIONS
PHARMACOKINETICS, TOXICITY AND
INTERACTIONS
ETHANOL Multiple effects
of
neurotransmitter
receptors, ion
channels, and
signaling
pathways
Antidote in
methanol
and
ethylene
poisoning;
topical
antiseptic
• Zero-order metabolism: duration
depends on dose
• Toxicity: Acutely, central nervous
system depression and respiratory
failure. Chronically, damage to
many systems, including liver,
pancreas, gastrointestinal tract,
and central and peripheral nervous
systems
• Interactions: Induces CYP2E1,
increased conversion of
acetaminophen to toxic metabolite
• Methanol: Poisonings result in toxic levels of formate, which causes characteristic visual disturbance plus
coma, seizures, acidosis, and death due to respiratory failure
• Ethylene glycol: Poisoning creates toxic aldehydes and oxalate, which causes kidney damage and severe
acidosis
20. DRUGS USED IN ACUTE ETHANOL
WITHDRAWL
DRUGS MECHANISM OF
ACTION, EFFECTS
CLINICAL APPLICATIONS PHARMACOKINETICS,
TOXICITY AND
INTERACTIONS
Benzodiazepines
(Oxazepam;
lorazepam;
diazepam;
chlordiazepoxide)
BDZ receptor
agonists
that facilitate
GABA-
mediated
activation of
GABAA receptors
Prevention and
treatment of acute
ethanol withdrawal
syndrome
See Sedative
hypnotics
Thiamine
(vitamin B1)
Essential vitamin
required for
synthesis of the
coenzyme
thiamine
pyrophosphate
Administered to patients
suspected of having
alcoholism (those
exhibiting acute alcohol
intoxication or alcohol
withdrawal syndrome)
to prevent Wernicke-
Korsakoff syndrome
Administered
parenterally
• Toxicity: None
• Interactions:
None
21. • Which benzodiazepines are commonly used
to treat alcohol withdrawal?
• Oxazepam; lorazepam; diazepam;
chlordiazepoxide
22. DRUGS USED IN CHRONIC
ALCOHOLISM
DRUGS MECHANISM OF
ACTION, EFFECTS
CLINICAL
APPLICATIONS
PHARMACOKINETICS, TOXICITY AND
INTERACTIONS
Naltrexone Nonselective
competitive
antagonist of
opioid
receptors
Reduced risk of
relapse in individuals
with alcoholism
Available as an oral or long-acting parenteral
formulation
• Toxicity: GI effects and liver toxicity; will
precipitate a withdrawal reaction in
individuals physically dependent on opioids
and will prevent the analgesic effect of
opioids
Acamprosate Poorly understood
NMDA receptor
antagonist and
GABAA agonist
effects
Reduced risk of
relapse in individuals
with alcoholism
Toxicity: GI effects and rash
Disulfiram Inhibits aldehyde
dehydrogenase,
resulting in
aldehyde
accumulation
during ethanol
ingestion
Deterrent to drinking
in individuals with
alcohol dependence;
rarely used
Toxicity: Little effect alone but severe and
potentially dangerous flushing, headache,
nausea, vomiting, and hypotension when
combined with ethanol
Topiramate or gabapentin: for patients who do not tolerate or respond to other medications
23. • Which opioid antagonist is given orally to
decrease cravings in alcoholism?
• Naltrexone
• What enzyme does disulfiram inhibit?
• Acetaldehyde dehydrogenase, leading to a
build up of acetaldehyde
24. DRUGS USED IN ACUTE METHANOL
OR ETHYLENE GLYCOL TOXICITY
DRUGS MECHANISM OF ACTION,
EFFECTS
CLINICAL APPLICATIONS PHARMACOKINETICS,
TOXICITY AND
INTERACTIONS
Fomepizole Inhibits alcohol
dehydrogenase,
prevents conversion
of methanol and
ethylene glycol to
toxic metabolites
Methanol and
ethylene glycol
poisoning
Orphan drug
• Toxicity:
Headache, nausea,
dizziness, rare
allergic reactions
• Ethanol: Higher affinity than methanol or ethylene glycol for alcohol
dehydrogenase; used to reduce metabolism of methanol and ethylene glycol to
toxic products
25. • Treatment of alcohol dependence is by all
except?
A. Disulfiram
B. Naltrexone
C. Flumazenil
D. Acamprosate
• Correct answer : C. Flumazenil
• Flumazenil is a benzodiazepine antagonist. It is
not used for the treatment of alcohol
dependence.