Chapter 9 Part 2 Flashcards
Deaths associated with alcohol use include…
drunken driving, alcohol-related homicides, suicide, cirrhosis of the liver
How is alcohol distributed throughout the body?
in direction proportion to the blood level!
Legal definition of drunk driving in US
80 mg/dL
BA level that causes drowsiness
200mg/dL
BA level that causes stupor
300 mg/dL
In what form is alcohol found in blood?
Acetaldehyde
Enzyme responsible for EtOH oxidation
alcohol dehydrogenase
CYP involved in alcohol breakdown
CYP2E1
Decrease in NAD causes…
fat accumulation in liver
Alcohol cerebellar degeneration
atrophy of superior part of vermis
acute alcoholism sxs
CNS depression, hepatic steatosis, acute gastritis, ulceration
Chronic alcoholism impact on liver
steatosis, alcoholic hepatitis, cirrhosis, portal hypertension, increased risk for hepatocellular carcinoma
Chronic alcoholism impact on GI
bleeding from gastritis, gastric ulcer, esophageal varices
Chronic alcoholism impact on Thiamine
peripheral neuropathy and wernicke-korsakoff due to deficiency, cerebral atrophy, cerebellar degeneration
Chronic alcoholism on alcoholic cardiomyopathy
dilated congestive cardiomyopathy, decrease HDL and increase in coronary heart dz
Positive effects of moderate amounts of alcohol
increase HDL, inhibit platelet aggregation, decrease levels of fibrinogen
Wernicke encephalopathy
occurs due to thiamine deficiency, acute psychotic symptoms and ophthalmoplegia, hemorrhage of mamillary bodies
Korsakoff syndrome
disturbances of short term memory and confabulation
Definition of adverse drug reaction
untoward effects of drugs given in therapeutic settings
Presentation of drug-induced hypersensitivity
skin rashes most common
Two drugs that most frequently cause adverse reactions
warfarin and dabigatran –excessive bleeding or thrombosis
Action of warfarin
Vitamin K antagonist
Action of dabigatran
inhibits thrombin
What is menopausal hormone theory?
Hormone replacement for post-menopausal women containing estrogens and progesterone
Adverse reactions associated with MHT
increased risk of breast CA, VTE–should not be used long term
Oral Contraceptive AE conclusions
does not increase breast CA, increase risk of cervical CA, 3-6x increase in VTE, does not increase CAD in young women but increases 2x in smokers>35, hepatic adenoma
AR associated with anabolic steroids
stunted growth, acne, gynecomastia, testicular atrophy, facial hair and menstrual changes in females, psych issues, increased MI risk
AR associated with acetaminophen
centrilobular necrosis that may progress to liver failure
What enzyme breaks down acetaminophen?
CYP2E1
Acetaminophen breakdown metabolites
NAPQ, combines with glutathione
Injury produced by NAPQI
binding to hepatic proteins, depletion of GSH leading to increased risk of ROS damage
AR associated with aspirin
acts on brain (alkalosis by stimulating medulla) leading to metabolic acidosis, nausea, coma
Chronic aspirin toxicity
HA, dizziness, tinnitus, bleeding, coma, vomiting, diarrhea, gastric ulceration, analgesic nephropathy
Side affects of cocaine
intense euphoria and stimulation, HTN, tachycardia, arrhythmia, myocardial ischemia, hyperpyrexia, fetal hypoxia and spontaneous abortion, perforated nasal septum, decreased lung capacity
Neurotransmitters involved in cocaine usage
DA and NE
AE of opiates
resp depression, arrhythmia, cardiac arrest, pulmonary edema, endocarditis, lung abscess, foreign body granulomas, amyloidosis, glomerulosclerosis
Effects of opiates on CNS
euphoria, hallucination, somnolence, sedation
AE of methamphetamine
violent behavior, confusion, psychotic sx
AE of MDMA
increase in serotonin, euphoria; decreases 5HT receptors and synthesis, increase adrenergic and DA effects
Marijuana AE
increased heart rate, possible change in BP causing angina in CAD pt, cognitive and psychomotor impairment, carcinogens
AE of glue sniffing
cognitive abnormalities, MRI-detectable brain damage, violence, aggressive behavior
AE of bath salts
agitation, psychosis, MI, suicide
What does the clinical significance of a burn injury depend on?
depth of burn, percent of body covered by burn, internal injuries, promptness and efficacy of treatment
First degree burn
superficial, epidermis only
second degree burn
partial thickness, epidermis and dermis (blistering
third degree burn
full thickness, extending to subcutaneous tissue
Pathogenesis of shock in burn victims
burns>20% body surface causes rapid shift of body fluids to interstitial compartment; generalized edema and pulm edema can be severe, develops a hypermetabolic state causing increased heat loss and increased need for nutritional support
Pathogenesis of sepsis in burn victims
burn site ideal for microorganism so most will be colonized, most commonly with P. aeruginosa, MRSA, candida
Pathogenesis of respiratory insufficiency in burn victims
within 24-48 hours, direct heat effects upper airway and noxious gas inhalation can lead to inhalation and airway obstruction
Pathogenesis of hypertrophic scars in burn victims
original bone and site of graft may have excessive collagen deposition
Heat cramps result from… and cause…
Result from loss of electrolytes and cause cramping of muscles
Heat exhaustion results from… and causes…
Results from hypovolemia caused by dehydration and causes collapse
Heat stroke caused by… and leads to…
lack of sweating leads to multiorgan dysfunction, hyperkalemia, tachycardia, arrhythmia, RYR1 stimulation causing muscle contraction
Malignant hyperthermia
RYR1 mutation characterized by “heat-stroke-like” rise in body temp and muscle contractures following exposure to anesthetics
Pathogenesis of hypothermia
physical disruptions within cells caused by water crystallization; vasoconstriction and increased vascular permeability leading to edema and hypoxia
Clinical symptoms of hypothermia
loss of consciousness, bradycardia, afib
Types of electrical injuries
Burns, vfib or cardiac resp failure
Sources of ionizing radiation
x-rays, gamma rays, high energy neutrons, alpha and beta particles
AE of ionizing radiation
fibrosis, mutagenesis, carcinogenesis, teratogenesis
Curie (Ci)
radiation emitted
Gray (Gy)
energy absorbed by target tissue
Sievert (Sv)
equivalent dose that responds to absorbed dose multiplied by relative biologic effectiveness of radiation
Determinants of radiation effect
rate of delivery, field size, cell proliferation, oxygen effects and hypoxia, vascular damage
Morphology of ionizing radiation
nuclear swelling, giant cells, polymorphic nuclei, multinucleated, cytoplasmic swelling, endothelial cell proliferation and collagenous hyalinization, scarring and contractions
Acute effects of radiation to hematopoietic and lymphoid systems
marrow aplasia, neutropenia, lymphopenia, thrombocytopenia, aplastic anemia
Common sites of fibrosis after radiation treatment
lungs, salivary glands, colorectal and pelvic areas
Major morphologic consequences of radiation injury
erythema, edema, hyperpigmentation, acute tissue loss, interstitial fibrosis, mucosal injury, ulceration, ovary and testes destruction, anemia
CA risk from radiation exposure
increased risk of leukemia and solid tumors in hiroshima, thyroid CA in Chernobyl, “second cancer” development from radiation treatments
