Environmental diseases 2 Bianchi

Question 1

__________ is the leading exogenous cause of human cancers, including 90% of lung cancers

Answer 1

tobacco, responsible of 4 million deaths annually, worldwide

Question 2

Smoke contains a complex mixture of _______ chemicals

Answer 2

7000, At least 60 are carcinogens

Question 3

describe Nicotine

Answer 3

• strongly addictive
• binds to nicotinic acetylcholine receptors
• stimulates the release of catecholamines from
  sympathetic neurons

Question 4

acute effects of Nicotine:

Answer 4

-increase in heart rate
-increase in blood pressure
-elevation of cardiac contractility and
output

Question 5

__________ - directly involved in the development of lung cancer in humans
- activated by cytochromes P-450

Answer 5

Polycyclic hydrocarbons and nitrosamines

Question 6

smoking and the diseases associated with it:

Answer 6

• associated with cancers of the esophagus, pancreas, bladder, kidney, cervix, and bone
  marrow but also liver and colon (US Surgeon General)
• irritant effect on the tracheobronchial mucosa
• inflammation and increased mucus production (bronchitis)
• recruitment of leukocytes → injury to lung tissue → obstructive pulmonary disease
• strongly linked to the development of atherosclerosis

Question 7

___________:
- harms the developing fetus → intrauterine growth
retardation
- increases the risk of type 2 diabetes, rheumatoid
arthritis, age-related macular degeneration, ectopic
pregnancy, and erectile dysfunction

Answer 7

smoking

Question 8

________ is a CNS depressant:

Answer 8

Ethanol

Question 9

________ mg/dL = Drowsiness

Answer 9

200

Question 10

_________ mg/dL = Stupor

Answer 10

300

Question 11

_________ = Coma,
respiratory arrest

Answer 11

> 300mg/dL

Question 12

where does alcohol mainly get metabolized?

Answer 12

liver

Question 13

which enzymes metabolize ethanol in the liver?

Answer 13

1- alcohol dehydrogenase (constitutive)
2- cytochromes P-450 (Inducible = ↑expression)
3- catalase
All of them produce acetaldehyde
4- acetaldehyde dehydrogenase → acetic acid (activated to acetyl-CoA for Krebs cycle)

Question 14

toxic effects of Acetaldehyde?

Answer 14

lipid accumulation in the liver, inflammation of the liver, fibrosis of the liver, carcinogenesis of the liver, inhibition of protein synthesis.

Question 15

in 50% of japanese and indians the Aldehyde Dehydrogenase varies ALDH21 → ALDH22
which causes ?

Answer 15

lower metabolic activity and thus lower tolerance to alcohol.

Question 16

how does alcohol damage the liver?

Answer 16

the Alcohol dehydrogenase causes the depletion of NAD which is responsible for the malfunction of the Beta oxidation and thus causes the fat accumulation in the liver and causes acidosis.

Question 17

effects of alcohol on CNS?

Answer 17

-affects subcortical structures
that modulate cerebral cortical
activity
-disordered cortical, motor, and
intellectual behavior.
-cortical neurons and lower
medullary centers are depressed
-respiratory arrest may follow.

Question 18

effects of alcohol on gastrointestinal tract?

Answer 18

acute gastritis and ulceration

Question 19

effects of alcohol on the liver?

Answer 19

-multiple fat droplets accumulate in
the cytoplasm of hepatocytes
-fatty change or hepatic steatosis

Question 20

The adverse effects of ethanol can be classified as _______ or _______

Answer 20

acute or chronic

Question 21

fetal alcohol syndrome lead to?

Answer 21

microcephaly, growth retardation, and cognitive defects (advanced aging)

Question 22

Acetaldehyde and ROS can cause?

Answer 22

cancer of the oral cavity, esophagus, and liver

Question 23

ALDH2*2 mutation is the risk for developing ?

Answer 23

esophagus cancer

Question 24

what is Menopausal Hormone Therapy?

Answer 24

-consists of the administration of estrogens together with a progestagen → reduce the number of
fractures in women due to postmenopausal osteoporosis and other menopause-associated
disorders
-MHT increase the risk of breast cancer, stroke, and venous thromboembolism (VTE) after 5 years
of treatment

Question 25

Risks and benefits of the MHT depend on?

Answer 25

- MHT effects depend on the type of hormone therapy used (combination estrogen-progestagen versus estrogen alone) - the age and risk factor status of the woman at the start of treatment - the duration of the treatment - hormone dosage, formulation, and route of administration

Question 26

Risk and benefits of MHT?

Answer 26

- Combination estrogen-progestagen increases the risk of breast cancer: RISK - MHT may have a protective effect on the development of atherosclerosis and coronary disease in women younger than age 60 years: BENEFIT - MHT increases the risk of stroke and VTE including deep vein thrombosis and pulmonary embolism: RISK

Question 27

_________ almost always contain a synthetic estradiol (now low doses) and a variable amount of a progestin, but some preparations contain only progestins (act by inhibiting ovulation or preventing implantation)

Answer 27

oral contraceptives

Question 28

Risks and benefits of Oral Contraceptives?

Answer 28

Breast carcinoma: do not increase breast cancer risk. Endometrial cancer and ovarian cancers: protective effect against these tumors Cervical cancer: may increase risk in women infected with human papillomavirus Thromboembolism: even low-dose (less than 50 µg of estrogen) twofold to fourfold increased risk of venous thrombosis and pulmonary thromboembolism, particularly in women who are carriers of the factor V Leiden mutation. lower than the risk of thromboembolism associated with pregnancy. Cardiovascular disease: no appreciable risks in nonsmokers but double in smoker women Hepatic adenoma: association between the use of OCs and this rare benign hepatic tumor especially in older women who have used OCs for prolonged periods

Question 29

__________ is the most common used analgesic in the United States (responsible for about 50% of acute liver failure, with 30% mortality)

Answer 29

paracetamol

Question 30

in some cases paracetamol might cause damage to the liver:

Answer 30

hepatocellular injury necrosis and progress to liver failure

Question 31

effects due to the chronic exposure to the Aspirin?

Answer 31

- CNS changes: hearing impairment, mental confusion, drowsiness - nonspecific symptoms: nausea, vomiting, and diarrhea - erosive gastritis: gastrointestinal bleeding and gastric ulceration - bleeding: inhibits platelet COX1 (constitutive) and then irreversibly blocks the production of thromboxane A2, the main activator of platelet aggregation

Question 31

injuries due to the aspirin?

Answer 31

- accidental poisoning or in chronic use for analgesic purposes - salicylate overdose causes alkalosis because of the stimulation of the respiratory center - followed by metabolic acidosis and accumulation of pyruvate and lactate

Question 32

effects of Cocaine?

Answer 32

Produces intense euphoria and neurologic stimulation, making it one of the most addictive drugs

Question 33

how does the cocaine work?

Answer 33

it blocks the dopamine transporters in the CNS, thus causing them to accumulate in the synaptic cleft and overstimulate the receptors on the receiving neurons.

Question 34

effects of Cocaine on human health?

Answer 34

hypertension, cardiac arrhythmia, myocardial infarction, cerebral hemorrhage and infarct

Question 35

other effects of cocaine on human health?

Answer 35

CNS: the most common acute effects on the CNS are hyperpyrexia (thought to be caused by aberrations of the dopaminergic pathways that control body temperature) and seizures The acute and chronic effects of cocaine on various organ systems are Effects on pregnancy: In pregnant women, cocaine may cause acute decreases in blood flow to the placenta, resulting in fetal hypoxia and spontaneous abortion. Neurologic development may be impaired in the fetus of a pregnant woman who is a chronic drug user. Other effects: Chronic cocaine use may cause: (1) perforation of the nasal septum in snorters → ischemic necrosis (2) decreased lung diffusing capacity in those who inhale the smoke (3) dilated cardiomyopathy.

Question 36

what do cocaine users experience?

Answer 36

- increase in alertness - feelings of well-being - euphoria - increased energy and motor activity - increased feelings of competence - Increased sexuality

Question 36

examples of Opioids:

Answer 36

natural and synthetic, include heroin and prescription drugs such as oxycodone, hydrocodone, fentanyl, tramadol, and methadone

Question 36

what is the agonist of endorphin receptors?

Answer 36

Morphine

Question 36

infections due to the heroin use:

Answer 36

-The sites most commonly affected are: -the skin and subcutaneous tissue, -heart valves, liver, and lungs. In a series of addicted patients more than 10% had endocarditis. Most cases are caused by Staphylococcus aureus -Viral hepatitis (HBV, HCV) is the most common infection among addicted persons and is acquired by the sharing of dirty needles. This practice has also led to a very high incidence of human immunodeficiency virus (HIV) infection in intravenous drug users.

Question 37

examples of Opiates:

Answer 37

morphine and codeine, derived from poppy plants

Question 38

what is heroin?

Answer 38

Heroin (opioids): Street drug derived from the poppy plant that is closely related to morphine. The use of Heroin is even more harmful than cocaine. It is cut (diluted) with an agent (often talc or quinine) thus the size of the dose is not only variable but also usually unknown to the buyer.

Question 39

effects of Heroin ?

Answer 39

Effects on the CNS euphoria, hallucinations, somnolence, sedation, rapid addiction Other adverse effects Physical effects related to: (1) the pharmacologic action of the agent (2) reactions to the cutting agents or contaminants (3) hypersensitivity reactions to the drug or its adulterants (quinine itself has neurologic, renal, and auditory toxicity) (4) diseases contracted due to the use of contaminated needles

Question 40

sudden death due to heroin:

Answer 40

- Sudden death, usually related to overdose, is an ever-present risk because drug purity is generally unknown (ranging from 2% to 90%). Addition of very potent synthetic opioids such as fentanyl and carfentanyl to heroin, greatly increases the chances of fatal overdose - Sudden death can also occur if heroin is taken after loss of tolerance for the drug built up over time. - The mechanisms of death include profound respiratory depression, arrhythmia and cardiac arrest, and severe pulmonary edema.

Question 41

pulmonary injury due to the Heroun use:

Answer 41

- moderate to severe: edema, septic embolism from endocarditis, lung abscess, opportunistic infections, and foreign-body granulomas from talc and other adulterants - granulomas occur principally in the lung but they are sometimes found in other organs (spleen, liver, and lymph nodes that drain the extremities) - examination under polarized light often highlights trapped talc crystals, sometimes enclosed within foreign-body giant cells

Question 42

damage to kidneys due to the heroin use:

Answer 42

-Kidney disease is a relatively common hazard. The two forms most frequently encountered are amyloidosis and focal and segmental glomerulosclerosis; both induce proteinuria and nephrotic syndrome.

Question 43

effects of methamphetamine?

Answer 43

feeling of euphoria, which is followed by a “crash.” Long-term use leads to violent behavior, confusion, and psychosis marked by paranoia and hallucinations

Question 43

what is methamphetamine?

Answer 43

This addictive drug is closely related to amphetamine but has stronger effects in the CNS. Use started in the early 2000 peaking in the year 2005 but has fallen steadily since that time Use of methamphetamine fell to approximately 560,000 users in 2017, a decrease of more than 50% since 2006

Question 44

mechanism of methamphetamine?

Answer 44

Methamphetamine acts by releasing dopamine in the brain, which inhibits presynaptic neurotransmission at corticostriatal synapses, altering glutamatergic transmission

Question 44

what is tetrahydrocannabinol (THC)?

Answer 44

Agonist of endocannabinoid receptors

Question 45

Characteristics of Marijuana?

Answer 45

-It is estimated that worldwide 192 million people used marijuana → most widely used illicit drug globally -Extracted from Cannabis sativa plant, which contain the psychoactive substance tetrahydrocannabinol (THC)

Question 46

effects of Marijuana?

Answer 46

- euphoria and a sense of relaxation, heightened sensory perception (e.g., brighter colors), laughter, altered perception of time, and increased appetite - beneficial effects of marijuana: - use to treat nausea after cancer chemotherapy - use to decrease pain in some chronic conditions that are otherwise difficult to treat - chronic use is associated to motor cognitive disorders as well as cardiovascular impairments - other disorders associated to the carcinogens introduced with the smoke - marijuana addiction remains controversial - In adults with multiple sclerosis (MS)-related spasticity, short-term use of oral cannabinoids improves patient-reported spasticity symptoms For some of these conditions, the effects of cannabinoids are modest; for all other conditions evaluated there is inadequate information to assess their effects