an informative lecture on pharmacology of alcohols with juicy quotes and fantastic pics.... <3 .... satya

8. The first glass is for myself, the second
for my friends, the third for good
humour, and the fourth for my
enemies….

11. PHARMACOLOGY OF
ALCOHOLS
DR. V. SATHYANARAYANAN MD
PROFESSOR OF PHARMACOLOGY

12. INTRODUCTION
• Alcohol refers to ethyl alcohol or ethanol
• Manufactured by fermentation of sugars
• Major source of commercial alcohol –
molasses (byproduct of sugar industry)

15. ALCOHOLIC BEVERAGES
• BEERS- fermentation of germinating cereals
• Alcohol content is 3 – 6 %
• WINES: Fermentation of natural sugars as present in
grapes and other fruits
• Undistilled light wines 9 – 12 %
• Fortified wines – port, sherry 16 – 22 % alcohol
• Effervescent wines – champagne 12 – 16% alcohol
• RUM, GIN, WHISKEY, BRANDY, VODKA
• Alcohol content 40 – 45%

21. ALCOHOLIC BEVERAGES
• Taste, flavor, value
•  presence of higher ethers, higher alcohols, aldehydes,
esters, volatile oils which are formed during ‘maturation’ of
‘maturation
the beverage

25. PHARMACOLOGICAL ACTIONS
CNS
• CNS depressant
• The features at lower concentration 
• (30-100mg/dl) are
• Excitation, euphoria
• Altered mood & feelings
• Loss of social inhibitions
• Relieve anxiety

31. Alcohol removes inhibitions –
like that scared little mouse who got drunk and
shook his whiskers and shouted: "Now bring
on that damn cat!"”

32. PHARMACOLOGICAL ACTIONS
With increasing concentration
(100 – 150mg/dl)
• Mental clouding
• Disorganization of thought
• Impairment of memory
• Alteration of perception
• Drowsiness
• Loss of self-control

38. PHARMACOLOGICAL ACTIONS
With high concentrations
(150 – 200mg/dl )
Make the person
sloppy
• ataxic
• drunk….!!

44. One reason I don’t drink is that I want
to know when I am having a good
time…….

45. PHARMACOLOGICAL ACTIONS
• 200 – 300mg/dl  stupor
• above this 
• unconsciousness,
• Paralysis of medullary centres,
• death
• ( due to respiratory depression )

48. ALCOHOL
• Driving is dangerous
• Impaired performance
• Obliteration of fine discrimination, precise movements
• Increased errors

50. Don’t drink and drive, you might hit a
bump and spill your drink…..

52. PHARMACOLOGICAL ACTIONS
• Induce sleep –
• poor quality &
• early morning awakening
• Disorganized sleep architecture
Raises pain threshold & alters reaction to it

55. PHARMACOLOGICAL ACTIONS
• Exerts anticonvulsant action  followed by
lowering of threshold
• Precipitate seizures in epileptics
• Tolerance
• Chronic alcohol abuse damages brain
neurons

61. CVS
• Tachycardia,
• mild rise in BP
• Large doses: Decrease BP
• Chronic alcoholism 
• Hypertension,
• Arrhythmias
• Regular intake of small to moderate amounts
 Increase HDL, decrease LDL cholesterol

64. A cross – eyed cop arrests three cross-eyed
drunks.
He turns to the first cross-eyed drunk and
says, “What’s your name?”
And the second cross-eyed drunk says,
“Miles MacDuffy”.
The cross-eyed cop says, “I wasn’t talking to
you”
And the third cross-eyed drunk says, “I didn’t
say anything!”

65. BODY TEMPERATURE
• Produces Sense of warmth
due to cutaneous and gastric vasodilatation
• increases heat loss in cold surroundings
• may be harmful
• High doses depress temperature regulating center

68. RESPIRATION
• Brandy or whisky are reputed as respiratory stimulants
• Irritate buccal and pharyngeal mucosa – transiently
stimulate respiration
• Don’t depend on this, because
Directly Depresses respiratory centre

70. GIT
• Irritant  Increases gastric secretion
• Appetizer
• Vomiting, mucosal congestion and gastritis
• Decrease tone of LES  increase reflux
•
• Chronic alcoholism  chronic gastritis
• Altered bowel movement
• Acute pancreatitis

75. LIVER
• Causes accumulation of fat in liver
• Liver enlargement,
• fatty degeneration,
• cirrhosis
• Induces microsomal enzymes

78. SKELETAL MUSCLE
• Allays fatigue
• Chronic intake 
• Myopathy, weakness

81. KIDNEY
• Diuresis (decreases ADH )
• Does not impair renal function

83. SEX
• Reputed as an aphrodisiac
• Induces aggressive sexual behavior
• but
impairs performance
• Chronic  impotence,
• testicular atrophy,
• gynaecomastia,
• infertility

89. ENDOCRINE
• Moderate  hyperglycemia and other sympathetic effects
•
Acute intoxication  hypoglycemia
(inhibition of gluconeogenesis ,
depletion of hepatic glycogen)

93. LOCAL ACTION
• Astringent
• Antiseptic – ( maximum at 70% )
• Rubefacient
• Counterirritant
• Applied topically has a cooling effect
• Cause Irritation,
• burning sensation if applied to delicate skin

96. MECHANISM OF ACTION
• Promotes GABAA receptor mediated
synaptic inhibition (through chloride channel
opening)
• Inhibits NMDA receptors and kainate receptors
• Promoting the function of 5HT3 receptor
• Indirectly reduce neurotransmitter release by
inhibiting neuronal Ca2+ channels
• block uptake of adenosine
• Enhanced turnover of NA in brain
• Alteration of activity of Na+K+ ATPase and adenyl
cyclase
• PKC, PKA mediated alteration of phosphorylation

99. PHARMACOKINETICS
• Absorption from intestines is very fast.
• Limited first pass metabolism  stomach and
liver
• From skin – minimal (adults) significant (infants)
• Widely distributed
• Crosses BBB efficiently
• Freely crosses placental barrier
• 98% oxidized in liver
• Excreted through kidneys and lungs

100. PHARMACOKINETICS
Ethyl Alcohol Aldehyde
Alcohol Acetaldehyde Acetate CO2+H2O
dehydro- dehydro-
genase genase
• Metabolism follows zero order kinetics
• 10ml of absolute alcohol / hour is degraded
in unit time, irrespective of blood concentration
• Rate of consuming drinks governs whether a
person will get drunk

104. INTERACTIONS
• Synergizes with hypnotics,
• antipsychotics,
• antidepressants,
• antihistamines,
• opioids  marked CNS depression 
chances of accidents
• Acute alcohol inhibits phenytoin, tolbutamide
metabolism
• chronic alcohol induces microsomal enzymes
hasten the metabolism of other drugs

108. INTERACTIONS
• Disulfiram like reaction with
• sulfonylureas (chlorpropamide)
• Cefaperazone
• metronidazole
• Aspirin + alcohol more gastric bleeding
• Alcohol + insulin, sulfonylureas  enhances
hypoglycemia
• Alcoholics more prone to paracetamol toxicity

112. “Alcohol may be man's worst enemy,
but the bible says love your enemy…..”

114. FOOD VALUE
• Requires no digestion
• Metabolized rapidly
• Energy yielding substrate : 7 Cal/g,
Cal/g
•  cannot be stored
• Who Take alcohol suffer from nutritional deficiencies
• Alcohol is an imperfect and expensive food

116. CONTRAINDICATIONS
• Peptic ulcer
• GERD
• Epilepsy
• Severe liver disease
• Unstable personalities

117. CONTRAINDICATIONS
• Pregnancy  fetal alcohol syndrome -
• IUGR,
• low IQ,
• Microcephaly,
• facial, other abnormalities,
• infections,
• miscarriage,
• stillbirths,
• low birth-weight babies

121. GUIDELINES FOR SAFE DRINKING
• 1 – 2 drinks per day is usually safe
• > 3 drinks / day  associated with adverse
health effects….
• Do not drive or engage in hazardous activities
after drinking
• Do not drink if an interacting drug has been taken
lower for women…
• Safe limits are
• 1 drink = 50ml of spirits = 400ml of beer =
150ml of wine = 18 – 20g alcohol

127. TOXICITY
• Side effects of moderate drinking: nausea, vomiting,
flushing, hangover, traffic accidents
• Acute alcoholic intoxication:
• Gastritis, Hypotension, Collapse
• Respiratory depression
• Hypoglycemia
• Coma
• Death
• Fatal blood alcohol concentration  > 400
mg/dl

136. TREATMENT
• Gastric lavage,
• maintain patent airway and
• take steps to prevent aspiration of vomitus
• Fluid and electrolyte balance
• Correction of hypoglycemia  Glucose infusion
• Thiamine 100mg in 500ml of glucose i.v infusion
• Check and correct blood potassium and phosphate
• Insulin + fructose drip  accelerate alcohol
metabolism
• In severe cases 
• Positive pressure respiration,
• Haemodialysis

137. A JOKE ON BARBARA
Barbara Beanbag has been to
market and is walking home
carrying a duck.
A drunk comes staggering along
in the other direction, stops and
says, “Hey! What are you
doing with that pig?”
Barbara looks at him coldly and
replies, “This is not a pig, it’s a
duck!”
“I know”, says the drunk, “I was
talking to the duck!”

138. I stopped drinking, but only when I
sleep.

139. CHRONIC ALCOHOLISM
• Tolerance develops
• Psychic dependence,
• Physical dependence occurs
only on heavy and round the clock
drinking
• associated with nutritional deficiencies
• Impaired mental,
physical performance

143. A JOKE ON DEATH
demonstrate
• A biology teacher wished to
harmful effects of alcohol on living
organisms. he showed them a beaker with pond
water full of worms. When he added some alcohol
into the beaker the worms doubled-up and died.
• "Now," he said, "what do you learn from this?”
• An eager student gave his answer.
• "Well the answer is obvious," he said "if you
drink alcohol, you'll never have worms."

144. COMPLICATIONS
• Polyneuritis, pellagra, anemia
• Tremors, seizures, loss of brain mass
• Wernicke’s encephalopathy, Korsakoff ’s
psychosis.
• Cirrhosis of liver
• Impotence, infertility , gynacomastia
• Hypertension, cardiomyopathy, CHF, arrhythmias
• Stroke
• Malignancy
• Immune function is depressed
• teratogenicity

147. WITHDRAWAL SYNDROME
• Consists of anxiety, sweating, tremor
• Impairment of sleep, confusion
• Hallucinations
• Delirium tremens
• Convulsions and collapse.

149. TREATMENT
• Psychological and medical supportive measures
• Benzodiazepines (Diazepam, chlordiazepoxide)
preferred for substitution therapy
• Naltrexone, nalmefene - To prevent relapse of
alcoholism, alcohol craving during withdrawal
• Acomprostate (NMDA antagonist and GABA
agonist) prevent relapse
• Ondansetron (5 HT3 antagonist) , topiramate
• Clonidine, propranolol  reduces sympathetic
activity
• Baclofen, rimonabant useful in alcohol withdrawal

152. CLINICAL USES
• As antiseptic
• Rubefacient and counterirritant for sprains,
joint pains etc
• To prevent bedsores
• To reduce body temperature in fever
• Intractable neuralgias, severe cancer pain 
injection around the nerve
• Appetite stimulant and carminative (50ml of 7 –
10% alcohol)
• Methanol poisoning

156. DISULFIRAM
• In inhibits the enzyme aldehyde dehydrogenase
irreversibly.
• Alcohol  acetaldehyde // acetate  CO2 + H2O
• When alcohol is ingested after disulfiram, the
concentration of acetaldehyde increases
• Aldehyde syndrome (Flushing, burning sensation,
headache, sweating, uneasiness, tightness in chest,
dizziness, vomiting, visual disturbances, mental
confusion, fainting, circulatory collapse) duration 1 – 4
hrs
• Used as an aversion technique in chronic alcoholics
Who have desire to leave the habit
• Sensitization to alcohol develops after 2 – 3hrs after 1st
dose, lasts for 7 – 14 days

158. DISULFIRAM
• Treatment should be given in hospital
• ADR: Rashes, metallic taste, nervousness, malaise,
abdominal upset
• Contraindication: Physical dependence to alcohol
• D/I: Inhibit CP450 enzymes  prolongs half life of many
drugs

162. When I read about the evils of drinking,
I gave up reading.

163. Always remember that I have taken more
out of alcohol than alcohol has taken out of
me….

166. METHYL ALCOHOL
• Methyl alcohol is used to denature ethyl alcohol
• Accidental mixing of methanol  alcoholic
beverages methanol poisoning on ingestion
• Methanol  formaldehyde  formic acid
• follows zero order kinetics, t ½ - 20 – 60 hrs
• CNS depressant
• Formic acid  toxic effects
• Blood level of > 50mg/dl methanol  severe
poisoning
• 15ml of methanol  blindness
• 30ml of has caused  death
• Fatal dose 75 -100ml

168. MANIFESTATIONS
• Takes 30 hrs to appear
• Vomiting, headache, epigastric pain,
headache pain
• uneasiness, dyspnoea, bradycardia,
hypotension,
• blurring of vision, blindness, delirium and
vision
coma
• Acidosis  due to formic acid
• Specific toxicity  Retinal damage
• Death is due to respiratory failure

172. TREATMENT
• Keep the patient in a dark, quiet room
• protect eyes from light
• Gastric lavage with sodium bicarbonate ( within 2 hrs of
ingesting methanol )
• ABC
• Supportive measures
• IV sod. bicarbonate infusion (prevents retinal
damage and other symptoms)
• Ethanol (10% in water) by nasogastric tube
• 0.7ml/kg followed by 0.15ml/kg/hour drip
• Continue Treatment for several days

176. TREATMENT
• Take care of Hypoglycemia
• Fomepizole (4 – methylpyrazole)  (specific inhibitor
of alcohol dehydrogenase) 15mg/kg I.V loading dose
followed by 10mg/kg every 12 hrs – not available
commercially in india
• Folate therapy: calcium leucovorin 50 mg injected 6 th
hourly (enhance formate oxidation )
• Potassium Chloride infusion – (hypokalemia due to
NaHCo3
• haemodialysis

180. ETHYLENE GLYCOL POISONING
• Industrial solvent, coolant, antifreeze
• Sporadically seen
• Specially in children
• Ethylene glycol  glycoaldehyde  glycolic acid
• Intoxication similar to ethanol
• Acidosis, cardiopulmonary complication, renal
tubular necrosis
Treatment:
Fomepizole (orphan drug)
Ethanol

182. Mrs. Meyerowitz is having tea with Mrs. Abramowitz.
“These cookies of yours are too delicious,” raves Mrs.
delicious
Meyerowitz, “I have already had five of them.”
“Seven,” smiles Mrs. Abramowitz, “but who is counting?”

185. I like whiskey. I respect it. I always did, and
that is why I never drink it…..!