How does Naloxone work in Alcohol toxicity/dependence/withdrawl? - USMLE Forums
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Old 03-10-2014
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Question How does Naloxone work in Alcohol toxicity/dependence/withdrawl?

Hey everyone,

Okay, this is kinda confusing. If anyone has read MTB3 Psychiatry chapter, you are probably familiar of this question. On page 486 of MTB, Nalaxone is used for Chronic management of alcoholics. I thought maybe its a type, but its again mentioned on page 487 for treatment of alcohol withdrawl, use Naloxone, and also on pg 488 "Naltrexone implants has been shown to be effective in long-term treatment of opiod dependence, alcohol dependence..."

How does Naloxone link up to alcohol's withdrawl or toxicity? Naloxone works on opiod (mu) receptors which open K+ channels and close Ca++ channels thereby reducing synaptic input; Alcohol works via GABA(a) receptors, increasing chloride influx and hyperpolorization.

Whats the mechanism of action for Naloxone to work in alcoholics? I don't see any connection or link of whatsoever...
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Old 03-10-2014
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in CK many things do not make sense especially questions about treatment
in many cases u just need to memorize those blindly
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Old 03-11-2014
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Quote:
Originally Posted by MedicalExaminer View Post
in CK many things do not make sense especially questions about treatment
in many cases u just need to memorize those blindly
Well, thats the default setting for most things in CK, I agree

But first, lets try to decipher it with some logic.
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Old 03-11-2014
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Hi,

There are a lot of errors on the step 3 book, unlike the step 2ck book, it think it's a typo, from what I remember from step 1 it's naltrexone which is used and not naloxone. I would add that naloxone is given IV hence it cant be used chronically unlike naltrexone which is given P.O.
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Old 03-11-2014
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Yep, it's naltrexone, please do correct that.

Some times in Medicine we just have to digest facts as very little is known about the "mechanism" of how things work. We're in luck in this case though as there IS an elegant explanation of how naltrexone works which I remember form my med school.

So an important aspect of alcohol dependence is "psychological". (We all emphasize on the "physical" dependence aspect and the classical withdrawal symptoms). It has been hypothesized that alcohol works on a neural pathway called the "reward pathway" to produce it's psychological effects. This is the pathway which makes the chronic alcoholic "crave" for alcohol.

One of the receptors involved in this neural pathway happens to be one of our opioid receptors and naltrexone acts by blocking it.

Simply put, naltrexone can be used as a maintainance therapy to help alcoholics avoid craving for alcohol (along with psychotherapy/AA, aversion therapy etc.)

I don't think it's used commonly in clinical practice though. Definitely don't choose it as the first answer if other more conventional options are available.
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