Environmental and Nutritional Disorders: Part II Flashcards
smokeless tobacco leads to what cancer?
oral cancer
tobacco decreases the overall survival through what effects?
dose-dependent ( this is why it is important to ask pack-years when taking a history)
Is nicotine a direct cause of tobacco related diseases?
no, but it is strongly addictive
What effect does nicotine have on the body?
ganglionic stimulation and depression; tumor promotion
What substances in tobacco smoke cause toxicity to cilia and what does this mean?
formaldehyde and nitrogen oxides; it paralyzes those cilial hairs, so they can’t remove unwanted things from entering the lungs–> gives us the smoker cough
agents in tobacco smoke have a direct irritant effect on the tracheobronchial mucosa, which leads to what?
inflammation and increased mucus production (bronchitis)
cigarette smoke causes the recruitment of what to the lung?
recruitment of leukocytes to the lung, with increase of local elastase production and subsequent injury to lung tissue leading to emphysema
what are the potent carcinogens directly involved in the development of lung cancer?
polycyclic hydrocarbons and nitrosamines
what is a multiplicative effect?
when something has a higher incidence of occurring due to an underlying condition or exposure to another toxin
what is the multiplicative effect of smokers and asbestos and uranium workers?
there is a ten-fold higher incidence of lung carcinomas in asbestos and uranium workers who smoke
what is the multiplicative effect of smokers and alcoholics?
higher incidence of laryngeal and oral cancers
cigarette smoking is associated with what cancers?
esophagus, pancreas, bladder, kidney, cervix, liver, colon and bone marrow
what are the most common diseases caused by cigarette smoking?
involve the lung and include: emphysema, chronic bronchitis, and COPD
cigarette smoking is also strongly linked to what cardiac issue?
atherosclerosis and its major complication MI
what is the multiplicative effect of those who smoke who also have HTN and hypercholesterolemia?
higher incidence of MI
How many cardiac deaths in the US each year are associated with passive smoke exposure?
30-60k
what does maternal smoking increase the risk of?
spontaneous abortion, preterm births, and intrauterine growth retardation
What are some new smoking associated diseases?
increased risk of type II DM, RA, age-related macular degeneration, ectopic pregnancy, and erectile dysfunction
What does electronic cigarettes put one at risk for?
acute lung injuries
What is alcohol abuse disorder?
chronic relapsing brain disease characterized by impaired ability to stop or control alcohol use despite adverse social, occupational, or health consequences
what occurs in a non-alcoholic when they consume 200 mg of etoh?
drowsiness
what occurs in a non-alcoholic when they consume 300 mg etoh?
stupor
what occurs in a non-alcoholic when they consume greater than 300 mg of etoh?
coma and possibly respiratory arrest
What is EtOH tolerance?
chronic alcoholics metabolize EtOH at a higher rate because they are inducing higher levels of alcohol dehydrogenase in the liver
what does alcohol dehydrogenase due to etoh?
it oxidizes it to acetaldehyde
what happens to the acetaldehyde produced by alcohol dehydrogenase?
it is converted into to acetate by ADH, which is then utilized in the mitochondrial respiratory chain
what are ~50% of asians lacking?
aldehyde dehydrogenase (ADH)- they have ALDH2 which is the inactive variant
what are the effects of etoh on the CYP2E1 system?
it competes with other CYP2E1 substrates and delays drug catabolism, potentiating the depressant effects of narcotic, sedative, and psychoactive drugs in the CNS
what is the relationship between etoh and gram negative bacteria that is in the intestine?
gram negative bacteria will release endotoxin, which causes a release of TNF from macrophages and Kupffer cells, which ultimately leads to hepatic injury
what effect does alcoholism have on the brain?
cerebellar degeneration: atrophy of the superior part (anterior) of the vermis
what are the effects of acute alcoholism on the body?
CNS effects (depressant, respiratory arrest) but also hepatic steatosis (fatty liver) acute gastritis, and ulceration
what are the effects of chronic alcoholism on the body?
shortened life span due to damage to the liver, GI tract, CNS, cardiovascular system, and pancreas
what is cirrhosis of the liver associated with?
portal hypertension and increased risk for hepatocellular carcinoma
what is the effect of the thiamine deficiency associated with alcoholism?
peripheral neuropathies and Wernicke-Korsakoff syndrome, cerebral atrophy, cerebellar degeneration, and optic neuropathy
what does alcoholic cardiomyopathy lead to?
dilated congestive cardiomyopathy and hypertension; heavy EtOH use associated with liver injury leads to decreased HDLs, which increases the likelihood of coronary heart disease
what are the symptoms of fetal alcohol syndrome?
microcephaly, growth retardation, and facial anomalies in newborns; decreased mental function as child grows
what are the benefits associated with EtOH?
moderate amounts (250 ml of wine) increases HDLs, which inhibit platelet aggregation, decreases fibrinogen levels, which possibly protect against coronary heart diease
what causes wernicke encephalopathy?
thiamine deficiency
what is the clinical presentation of wernicke encephalopathy?
acute appearance of psychotic symptoms and ophthalmoplegia
Is wernicke encephalopathy reversible?
yes- if treated with thiamine
what morphological features are found within the brain in patients with wernicke encephalopathy?
foci of hemorrhage and necrosis in the mammillary bodies and in the walls of the third and fourth ventricles
what occurs if wernicke encephalopathy is untreated?
it leads to Korsakoff syndrome, which is irreversible
what are the clinical presentations of korsakoff syndrome?
disturbances of short term memory and confabulation
what are the symptoms associated with cerebellar dysfunctioning in chronic alcoholics?
truncal ataxia, unsteady gait, and nystagmus; histologic changes: atrophy and loss of granule cells in the anterior vermis
almost half of all drug related deaths are due to what?
problems with bone marrow or blood cells
what is a common adverse reaction of the antibiotic minocycline?
discoloration of the skin; the drug metabolite/iron/melanin pigment are deposited which creates the dark cutaneous involvement
drug-induced hypersensitivity reactions most commonly present as what?
skin rashes, which may mimic autoimmune disorders, hemolytic anemia or immune thrombocytopenia
what 2 drugs are the 2 most frequently reported to have adverse reactions?
warfarin( vitamin K antagonist) and pradaxa (inhibits thrombin) both are anticoagulants
what is menopausal hormone therapy?
replaces estrogens with progesterone (ok in early menopause but not good for long term)
what are the risks and benefits of MHT?
5-6x increased risk for breast cancer; may protect against ASCVD if less than 60 years old; increased risk of stroke and DVT/PE
what are the adverse effects of oral contraceptives?
increased risk of cervical cancer especially if + for HPV; protects against endometrial and ovarian cancers; increased risk for venous thrombosis and PE
what are the risks for smokers taking oral contraceptives?
they are 2x more likely to develop CAD if they are over 35 years old and smoke
what are hepatic adenomas?
rare and benign; seen with older patients with prolonged oral contraceptive use
what are the adverse effects of anabolic steroids?
stunted growth, acne, gynecomastia, testicular atrophy, facial hair, and menstrual changes in women, psychiatric issues, and increased risk of MI
what are the adverse effects of acetaminophen?
unintentional overdoses; acute liver failures- centrilobular necrosis and liver transplant
What is a normal dosing of acetaminophen? what is considered a toxic dose of acetaminophen? and what results when this level is reached?
.5 g; 15-25 g; nausea, vomiting, and shock
how would you treat someone with acetaminophen overdose and when should you do it?
treat with N-acetylcysteine within 12 hours; this can stop liver damage from occurring
what is considered an accident overdose of aspirin in children? and in adults?
children 2-4 grams; adults: 10-30 grams
what causes death following overdose of aspirin?
alkalosis due to stimulation of respiratory center in the medulla
what are the effects of acute salicylate poisoning on the brain?
nausea, coma
what are the main effects of chronic salicylate poisoning (salicylism)?
TINNITUS; headache, dizziness, bleedings, coma; but focus on TINNITUS
what causes analgesic nephropathy?
when a patient takes phenacetin (which is an active metabolite of aspirin) and aspirin over the years–> it leads to renal papillary necrosis and analgesic nephropathy
