Carcinogenesis and tobacco Flashcards
Who gets lung cancer more, women or men?
women
note: lung cancer has the highest estimated cancer deaths
characteristics of solitary pulmonary nodule
● Lesion
ERB-1 or EGFR mutation treated with what?
erlotinib
gefitinib
cetuximab
- mut is associated with 50-80% of NSCLC
Her2/ERB-2 mutation treated with?
trastuzumab (herceptin)
VEGF mut treated with?
bevacizumab (avastin)
Most lung cancer presents in what stage?
stage 3 - too late to operate on
hallmark of obstructive apnea
pharyngeal occlusion during sleep
- lipid accumulation in soft tissue of the pharynx –> upper airway narrowing
(in day time, pharyngeal dilator muscles maintain patency)
Most common therapy for sleep apnea
aside from weight loss its
continuous positive airway pressure (CPAP), mask worn during sleep
- delivers positive pressure into nasal and oral pharynx, pushing tongue forward and dilating collapsing lateral and posterior pharyngeal walls.
transudative: protein rich or poor? Δ in what? LDH, Prot? Caused by?
non-protein rich
non-inflammatory
Δ in hydrostatic forces
LDH
Exudative: protein rich or poor? Δ in what? LDH, Prot? Caused by?
protein rich - inflammatory process
Δ in permeability forces
LDH > 0.6
Prot > 5
Caused by: neoplasm, infxn PE GI, Drugs Autoimmune
Ave airway size in kids vs adults?
- where is it narrowest?
child: 4mm diameter
adults: 8mm in diam
big deal with narrowing/edema
R= 1/r4
cricoid is the narrowest part of airway in kids (adults is glottis)
larynx diff in kids vs adults?
kids: larynx is higher + more anterior epiglottis is floppy, intercostals weaker, diaphragm flatter
laryngomalacia
most common cause of chronic stridor
big floppy epiglottis
outgrown by 1-2 yrs
Most common form of acute airway obstruction in children?
What is its most common cause?
Croup
- parainfluenza
(its a cold in adults)
90% of People with generalized anxiety disorder (GAD) will answer yes to what ?
during the past 4 weeks, have you been bothered by feeling worried, tense, or anxious most of the time?
Panic disorder (PD) has suicide rate comparable to what? - what % of the population experiences panic attacks?
Major depression
20-40% of people with PD have made an attempt
20% of pop exp. panic attacks (not disorder) –> anticipatory anxiety
hallmark of panic disorder?
unexpected panic attacks - spontaneous unpredictable
Who experiences unexpected panic attacks?
pts w/ phobia, post-traumatic stress disorder
what biologic parameters can cause panic disorder?
- excess NE + dysregulation of noradrenergic system (ie hypersensitivity to a-2-antagonist)
- caffeine, adenosine antagonist
- dysregulation of GABA
pharmacotherapy for panic disorders
- Controlled breathing therapy (CBT)
- SSRI- SNRI - first line
- Benzodiazepines (dependence =( )
- GABAergic meds
tobacco accounts for what % of all cancers?
25-30%
170,000 cancer deaths per year
Which types of cancers is tobacco an imp risk factor for?
Lung (~85%)
Oral cavity, larynx, pharynx
Esophagus
Bladder
Cessation during which period of pregnancy can reduce risk of low birth weight to that of never smokers?
w/in 3-4 months
How can we help pts quit smoking?
MPOWER Monitor protect offer warn enforce raise
AHQR guidelines: 5 A's Ask Advise Assess Assist Arrange
Factors that increases risk of teens to start smoking
exposure to second hand smoke or smoker in household
usually pts, would not wish addiction on kids
FDA approved drug to help reduce cravings/symptoms of withdrawl in tobacco use
- MOA
- contraindic
FDA approved Bupropion (zyban or welbutrin SR)
- inhibits reuptake of dopamine/norepi, reduce cravings/symptoms
- contraindication: seizure disorder, mood disorder
*this is actually an antidepressant that can help quit smoking
First designer drug for tobacco dependence
Vernicline (chantix)
- partial agonist at nicotine receptor –> release dopamine (not inhibit the reuptake like bupropion)
- blocks binding of exogenous nicotine (decreases smoking reward)
