A man is brought to the ED after ingesting a toxic alcohol. Which common alcohol is also used therapeutically as an antidote?
A. Methanol
B. Ethanol
C. Isopropanol
D. Propylene glycol

B. Ethanol

The principal cellular description of ethanol’s action is:
A. Selective opioid receptor blockade
B. Pure NMDA antagonism
C. Isolated calcium channel blockade
D. Multiple receptor-channel signaling effects

D. Multiple receptor-channel signaling effects

Ethanol elimination is best described as:
A. Zero-order metabolism
B. First-order metabolism
C. Enterohepatic cycling
D. Renal saturation only

A. Zero-order metabolism

After equivalent exposure, how is ethanol duration best predicted?
A. Urine pH
B. Plasma protein binding
C. Dose administered
D. Body temperature

C. Dose administered

A patient acutely intoxicated with ethanol is at greatest immediate risk for:
A. Hypertensive crisis
B. Respiratory failure
C. Agranulocytosis
D. Malignant hyperthermia

B. Respiratory failure

Years of heavy ethanol use most directly predispose to damage involving:
A. Spleen, thyroid, skin
B. Retina, marrow, pituitary
C. Adrenal, lung, bladder
D. Liver, pancreas, peripheral nerves

D. Liver, pancreas, peripheral nerves

Chronic ethanol exposure increases hepatotoxic risk from acetaminophen primarily by:
A. Blocking glucuronidation
B. Depleting glycine stores
C. Inducing CYP2E1
D. Inhibiting sulfation

C. Inducing CYP2E1

The consequence of ethanol-induced CYP2E1 activity is increased formation of acetaminophen’s:
A. Toxic metabolite
B. Glucuronide conjugate
C. Sulfate ester
D. Renal precipitate

A. Toxic metabolite

Methanol poisoning becomes dangerous largely because alcohol dehydrogenase generates:
A. Oxalate
B. Acetaldehyde
C. Lactate
D. Formate

D. Formate

A patient after ingesting windshield fluid develops blurred vision and severe acidosis. Most likely toxin?
A. Ethylene glycol
B. Methanol
C. Ethanol
D. Isopropanol

B. Methanol

In methanol poisoning, death most classically results from:
A. Respiratory failure
B. Hepatic rupture
C. Ventricular fibrillation
D. Hemorrhagic stroke

A. Respiratory failure

Ethylene glycol toxicity is most closely associated with formation of:
A. Formate and lactate
B. Acetone and ketones
C. Toxic aldehydes and oxalate
D. Uric acid and xanthine

C. Toxic aldehydes and oxalate

A patient with antifreeze ingestion later develops which major organ injury?
A. Retinal necrosis
B. Pancreatic failure
C. Myocardial fibrosis
D. Kidney damage

D. Kidney damage

The acid-base finding most associated with ethylene glycol poisoning is:
A. Respiratory alkalosis
B. Severe acidosis
C. Metabolic alkalosis
D. Mixed alkalemia

B. Severe acidosis

A hospitalized patient in acute ethanol withdrawal is most appropriately treated with:
A. Disulfiram
B. Fomepizole
C. Diazepam
D. Acamprosate

C. Diazepam

Benzodiazepines reduce ethanol withdrawal symptoms mainly by:
A. Facilitating GABAA activation
B. Blocking opioid receptors
C. Inhibiting alcohol dehydrogenase
D. Repleting thiamine stores

A. Facilitating GABAA activation

Which drug class is specifically listed for both prevention and treatment of acute ethanol withdrawal syndrome?
A. Opioid antagonists
B. Aldehyde dehydrogenase inhibitors
C. NMDA antagonists
D. Benzodiazepines

D. Benzodiazepines

Which agent listed for withdrawal is vitamin B1?
A. Acamprosate
B. Thiamin
C. Fomepizole
D. Naltrexone

B. Thiamin

Thiamin is required for synthesis of which coenzyme?
A. Pyridoxal phosphate
B. Tetrahydrofolate
C. Thiamine pyrophosphate
D. S-adenosylmethionine

C. Thiamine pyrophosphate

In a patient suspected of alcoholism, thiamin is administered primarily to prevent:
A. Wernicke-Korsakoff syndrome
B. Alcoholic hallucinosis
C. Delirium tremens
D. Hepatorenal syndrome

A. Wernicke-Korsakoff syndrome

The table specifically recommends giving thiamin to alcohol-related patients by which route?
A. Oral
B. Sublingual
C. Inhaled
D. Parenteral

D. Parenteral

The toxicity profile listed for thiamin is:
A. Severe hepatotoxicity
B. None
C. QT prolongation
D. Agranulocytosis

B. None

The interaction profile listed for thiamin is:
A. Strong CYP induction
B. Opioid antagonism
C. None
D. MAO inhibition

C. None

Which chronic alcoholism medication is a nonselective competitive opioid receptor antagonist?
A. Naltrexone
B. Disulfiram
C. Thiamin
D. Acamprosate

A. Naltrexone

Both naltrexone and acamprosate are used primarily to:
A. Treat delirium tremens
B. Reverse coma
C. Prevent Wernicke syndrome
D. Reduce relapse risk

D. Reduce relapse risk

Which formulation detail applies to naltrexone?
A. Topical patch only
B. Oral or long-acting parenteral
C. Intrathecal depot only
D. Sublingual spray only

B. Oral or long-acting parenteral

A patient with alcohol use disorder takes oxycodone for chronic pain. Which relapse-prevention drug may block opioid analgesia?
A. Naltrexone
B. Acamprosate
C. Disulfiram
D. Thiamin

A. Naltrexone

In a physically opioid-dependent patient, which alcoholism drug may precipitate withdrawal?
A. Disulfiram
B. Fomepizole
C. Naltrexone
D. Acamprosate

C. Naltrexone

Which toxicity is specifically listed for naltrexone?
A. Renal oxalosis and liver toxicity
B. Respiratory failure and liver toxicity
C. Rash and liver toxicity
D. GI effects and liver toxicity

D. GI effects and liver toxicity

Acamprosate is best described mechanistically as having:
A. Pure opioid agonist effects
B. NMDA antagonism and GABAA agonism
C. Aldehyde dehydrogenase activation
D. Alcohol dehydrogenase inhibition

B. NMDA antagonism and GABAA agonism

Which chronic alcoholism drug has a poorly understood mechanism?
A. Acamprosate
B. Naltrexone
C. Fomepizole
D. Chlordiazepoxide

A. Acamprosate

Which adverse effect pair is listed for acamprosate?
A. Visual loss and coma
B. Flushing and hypotension
C. GI effects and rash
D. Dizziness and allergy

C. GI effects and rash

Which drug deters drinking by causing aldehyde accumulation if ethanol is consumed?
A. Naltrexone
B. Acamprosate
C. Fomepizole
D. Disulfiram

D. Disulfiram

Disulfiram acts primarily by inhibiting:
A. CYP2E1
B. Aldehyde dehydrogenase
C. Alcohol oxidase
D. Monoamine oxidase

B. Aldehyde dehydrogenase

Which chronic alcoholism drug is noted as rarely used?
A. Naltrexone
B. Acamprosate
C. Disulfiram
D. Thiamin

C. Disulfiram

Taken alone, disulfiram usually causes:
A. Little effect
B. Severe respiratory failure
C. Visual hallucinations
D. Opioid withdrawal

A. Little effect

A patient on disulfiram drinks wine. Which reaction is expected?
A. Bradykinesia and rigidity
B. Hyperglycemia and polyuria
C. Miosis and constipation
D. Flushing, nausea, hypotension

D. Flushing, nausea, hypotension

Which symptom is part of the classic disulfiram-ethanol reaction?
A. Hematuria
B. Headache
C. Diplopia
D. Tinnitus

B. Headache

In acute methanol poisoning, the direct pharmacologic target of fomepizole is:
A. Alcohol dehydrogenase
B. Aldehyde dehydrogenase
C. Opioid receptors
D. GABAA receptors

B. Aldehyde dehydrogenase

Fomepizole benefits toxic alcohol ingestion by:
A. Enhancing renal oxalate clearance
B. Neutralizing formate directly
C. Preventing toxic metabolite formation
D. Reversing chronic neuropathy

C. Preventing toxic metabolite formation

Which poisoning is an indication for fomepizole?
A. Acetaminophen overdose
B. Ethanol withdrawal
C. Disulfiram reaction
D. Methanol ingestion

D. Methanol ingestion

Which additional poisoning is also treated with fomepizole?
A. Isopropanol ingestion
B. Ethylene glycol ingestion
C. Salicylate overdose
D. Carbon monoxide poisoning

B. Ethylene glycol ingestion

Fomepizole is specifically described as an:
A. Orphan drug
B. Topical antiseptic
C. Competitive opioid antagonist
D. Parenteral vitamin

A. Orphan drug

Which adverse effect is listed for fomepizole?
A. Visual loss
B. Severe hepatotoxicity
C. Dizziness
D. Opioid dependence

C. Dizziness

Which additional adverse event is a rare fomepizole toxicity?
A. Respiratory arrest
B. Oxalate nephropathy
C. Pancreatitis
D. Allergic reaction

D. Allergic reaction

Besides fomepizole, which agent can reduce toxic alcohol metabolism by outcompeting substrates at alcohol dehydrogenase?
A. Disulfiram
B. Ethanol
C. Thiamin
D. Acamprosate

B. Ethanol

Ethanol can serve as an antidote in methanol or ethylene glycol poisoning because it has:
A. Higher alcohol dehydrogenase affinity
B. Greater renal excretion
C. Stronger opioid antagonism
D. Less CNS penetration

A. Higher alcohol dehydrogenase affinity

Which ethanol clinical use is unrelated to toxic alcohol ingestion?
A. Oral maintenance therapy
B. Relapse prevention
C. Topical antisepsis
D. Withdrawal prophylaxis

C. Topical antisepsis

chlordiazepoxide, diazepam, lorazepam are what?

benzos

A patient drinks homemade alcohol and develops visual symptoms, severe acidosis, then progressive unresponsiveness. Which additional feature is classically associated with this poisoning?
A. Seizures
B. Hemoptysis
C. Mydriasis
D. Choreoathetosis

A. Seizures

Methanol toxicity is most characteristically associated with which combination?
A. Pancreatitis and ileus
B. Coma and seizures
C. Nephrosis and polyuria
D. Ataxia and jaundice

B. Coma and seizures

A patient with decades of alcohol use develops multisystem injury. Which additional system is specifically listed among chronic ethanol toxicities?
A. Lymphatic system
B. Central nervous system
C. Reproductive tract
D. Reticuloendothelial system

B. Central nervous system

In the ED, a confused patient with suspected alcoholism is still intoxicated. Which adjunct should be administered now to reduce neurologic risk?
A. Disulfiram
B. Naltrexone
C. Thiamin
D. Fomepizole

C. Thiamin

Thiamin administration is recommended in patients suspected of alcoholism who present with:
A. Acute intoxication or withdrawal
B. Only chronic cirrhosis
C. Only alcoholic pancreatitis
D. Only visual symptoms

A. Acute intoxication or withdrawal

Which benzodiazepine example listed is commonly used in acute ethanol withdrawal?
A. Buspirone
B. Diazepam
C. Zolpidem
D. Haloperidol

B. Diazepam

Which additional listed benzodiazepine was specifically named for acute ethanol withdrawal management?
A. Clonazepam
B. Midazolam
C. Chlordiazepoxide
D. Temazepam

C. Chlordiazepoxide

Which adverse effect is specifically listed for fomepizole?
A. Headache
B. Flushing
C. Seizures
D. Liver failure

A. Headache

A patient treated with fomepizole for ethylene glycol poisoning develops mild medication-related symptoms. Which pair is most consistent with the table?
A. Visual loss and coma
B. Nausea and dizziness
C. Rash and hypotension
D. Tremor and diarrhea

B. Nausea and dizziness

ophthalmoplegia, ataxia and disturbances of mentation and consciousness

Wernicke-Korsakoff syndrome

shaking, confusion, high blood pressure, fever, hallucinations, death

delirium tremens

(1) intrauterine growth retardation, (2) microcephaly, (3) poor coordination, (4) underdevelopment of midfacial region (appearing as a flattened face), and (5) minor joint anomalies

fetal alcohol syndrome

Ethanol is a (vasoconstrictor/vasodilator), probably as a result of both CNS effects and direct smooth muscle relaxation caused by its metabolite, acetaldehyde.

vasodilator

_______ appears to play a pivotal role in the progression of alcoholic liver disease and may be a fruitful therapeutic target.

TNF-a

Heavy drinking—and especially “binge” drinking—are associated with both atrial and ventricular _______.

arrhythmias

The most common hematologic disorder seen in chronic drinkers is mild _______ resulting from alcohol-related folic acid deficiency.

anemia

Excess _______ production appears to contribute to the metabolic disorders that accompany chronic alcoholism and to both the lactic acidosis and _______ that frequently accompany acute alcohol poisoning.

NADH

hypoglycemia

Significant (increase/depression) of myocardial contractility has been observed in individuals who acutely consume moderate amounts of alcohol, ie, at a blood concentration above 100 mg/dL.

depression

Since ethanol has low _______ , it requires concentrations thousands of times higher than other misused drugs

potency

an estimated 15–30% of chronic heavy drinkers eventually develop severe _______ disease

liver

_______ contributes to elevated portal blood pressure and esophageal and gastric venous varices.

Cirrhosis