Home Books Katzung & Trevor's Pharmacology: Examination & Board Review, 12e

Chapter 23: Alcohols

A 45-year-old moderately obese man has been drinking heavily for 72 h. This level of drinking is much higher than his regular habit of drinking 1 alcoholic drink per day. His only significant medical problem is mild hypertension, which is adequately controlled by metoprolol. With this history, this man is at significant risk for

(A) Bacterial pneumonia

(B) Cardiac arrhythmia

(C) Hyperthermia

(D) Tonic-clonic seizures

(E) Wernicke-Korsakoff syndrome

This man’s regular rate of alcohol consumption is not high enough to put him at risk of long-term consequences such as Wernicke-Korsakoff syndrome, increased susceptibility to bacterial pneumonia, or alcohol withdrawal seizures. This pattern of “binge drinking” does put him at increased risk of cardiac arrhythmia. The answer is B.

A 42-year-old man with a history of alcoholism is brought to the emergency department in a confused and delirious state. He has truncal ataxia and ophthalmoplegia. The most appropriate immediate course of action is to administer diazepam plus

(A) Chlordiazepoxide

(B) Disulfiram

(C) Folic acid

(D) Glucosamine

(E) Thiamine

This patient has symptoms of Wernicke’s encephalopathy, including delirium, gait disturbances, and paralysis of the external eye muscles. The condition results from thiamine deficiency but is rarely seen in the absence of alcoholism. The diazepam is administered to prevent the alcohol withdrawal syndrome. Glucosamine is primarily used for pain associated with arthritis. The answer is E.

The cytochrome P450-dependent microsomal ethanol oxidizing system (MEOS) pathway of ethanol metabolism is most likely to be maximally activated under the condition of low concentrations of

(A) Acetaldehyde

(B) Ethanol

(C) NAD⁺

(D) NADPH

(E) Oxygen

The microsomal ethanol-oxidizing system (MEOS) contributes most to ethanol metabolism at relatively high blood alcohol concentrations (>100 mg/dL), when the alcohol dehydrogenase pathway is saturated due to depletion of NAD⁺. So, the MEOS system contributes most when the NAD⁺ concentration is low. NADPH and oxygen are cofactors for MEOS reactions. The concentration of acetaldehyde does not appear to affect the rate of either the ADH or the MEOS reactions. The answer is C.

A freshman student (weight 70 kg) attends a college party where he rapidly consumes a quantity of an alcoholic beverage that results in a blood level of 500 mg/dL. Assuming that this young man has not had an opportunity to develop tolerance to ethanol, his present condition is best characterized as

(A) Able to walk, but not in a straight line

(B) Alert and competent to drive a car

(C) Comatose and near death

(D) Sedated with increased reaction times

(E) Slightly inebriated

The blood level of ethanol achieved in this individual is extremely high, probably associated with coma, and likely to result in death due to respiratory arrest in a person who lacks tolerance to ethanol. The answer is C.

A homeless middle-aged male patient presents in the emergency department in a state of intoxication. You note that he is behaviorally disinhibited and rowdy. He tells you that he has recently consumed about a pint of a red-colored liquid that his friends were using to “get high.” He complains that his vision is blurred and that it is “like being in a snowstorm.” His breath smells a bit like formaldehyde. He is acidotic.

Consumption of which of the following is the most likely cause of this patient’s intoxicated state?

(A) Ethanol

(B) Ethylene glycol

(C) Isopropanol

(D) Hexane

(E) Methanol

Behavioral disinhibition is a feature of early intoxication from ethanol and most other alcohols but not the solvent, hexane. Ocular dysfunction, including horizontal nystagmus and diplopia, is also a common finding in poisoning with alcohols, but the complaint of “flickering white spots before the eyes” or “being in a snowstorm” is highly suggestive of methanol intoxication. In some cases, the odor of formaldehyde may be present on the breath. In this patient, blood methanol levels should be determined as soon as possible. The answer is E.

After assessing and stabilizing the patient’s airway, respiration, and circulatory status, fomepizole was administered intravenously. Which of the following most accurately describes the therapeutic purpose of the fomepizole administration?

(A) Accelerate the rate of elimination of the toxic liquid that he consumed

(B) Combat acidosis

(C) Inhibit the metabolic production of toxic metabolites

(D) Prevent alcohol withdrawal seizures

(E) Sedate the patient

In patients with suspected methanol intoxication, fomepizole is given intravenously to inhibit the ADH-catalyzed formation of toxic metabolites. The answer is C.

The regular ingestion of moderate or heavy amounts of alcohol predisposes to hepatic damage after overdose of acetaminophen because chronic ethanol ingestion

(A) Blocks acetaminophen metabolism

(B) Causes thiamine deficiency

(C) Displaces acetaminophen from plasma proteins

(D) Induces hepatic drug-metabolizing enzymes

(E) Inhibits renal clearance of acetaminophen

Chronic use of ethanol induces CYP2E1, an isozyme that converts acetaminophen to a cytotoxic metabolite. This appears to be the cause of the increased susceptibility to acetaminophen-induced hepatotoxicity found in individuals who regularly ingest alcohol. The answer is D.

A 23-year-old pregnant woman with alcoholism presented to the emergency department in the early stages of labor. She had consumed large amounts of alcohol throughout her pregnancy. This patient’s infant is at high risk of a syndrome that includes

(A) Ambiguous genitalia in a male fetus and normal genitalia in a female fetus

(B) Failure of closure of the atrial septum or ventricular septum

(C) Limb or digit malformation

(D) Mental retardation and craniofacial abnormalities

(E) Underdevelopment of the lungs

This woman’s infant is at risk for fetal alcohol syndrome, a syndrome associated with mental retardation, abnormalities of the head and face, and growth deficiency. This syndrome is a leading cause of mental retardation. The answer is D.

The combination of ethanol and disulfiram results in nausea and hypotension as a result of the accumulation of

(A) Acetaldehyde

(B) Acetate

(C) Methanol

(D) NADH

(E) Pyruvate

The nausea, hypotension, and ill feeling that result from drinking ethanol while also taking disulfiram stems from acetaldehyde accumulation. Disulfiram inhibits acetaldehyde dehydrogenase, the enzyme that converts acetaldehyde to acetate. The answer is A.

The intense craving experienced by those who are trying to recover from chronic alcohol abuse can be ameliorated by a drug that is an

(A) Agonist of α₁ adrenoceptors

(B) Agonist of serotonin receptors

(C) Antagonist of β₂ adrenoceptors

(D) Antagonist of opioid receptors

(E) Inhibitor of cyclooxygenase

Naltrexone, a competitive inhibitor of opioid receptors, decreases the craving for alcohol in patients who are recovering from alcoholism. The answer is D.

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Chapter 23: Alcohols

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Chapter 23: Alcohols

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