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SD IV: Block 3 Week 2 > Environmental Disorders 03: Drugs > Flashcards

Environmental Disorders 03: Drugs Flashcards

1
Q

What are the levels of alcohol consumption that cause drowsiness?

A

200 mg/dL

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2
Q

What are the levels of alcohol consumption that cause stupor?

A

300 mg/dL

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3
Q

Why is gastric metabolism of alcohol decreased in women?

A

dec. levels of alcohol dehydrogenase

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4
Q

Understand the main points in this chart.

A

Understand.

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5
Q

What is the pathology behind Asian flush syndrome?

A

Substitution of lysine for glutamine at residue 487 (normal allele ALDH21, inactive variant ALDH 22)

ALDH22 protein has dominant-negative activity (one copy of ALDH22 allele ↓ acetaldehyde dehydrogenase activity)

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6
Q

C/F of Asian flush syndrome?

A
  • Experience nausea, flushing, tachycardia, and hyperventilation
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7
Q

How does too much oxidation of alcohol lead to NAD deficiency and what are the effects?

A

Alcohol oxidation by alcohol dehydrogenase reduces NAD to NADH leading to an increase in the NADH/NAD ratio * NAD deficiency

  • Accumulation of fat in the liver
  • Lactic acidosis
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8
Q

Metabolism in the liver of alcohol by what enzyme produces reactive O2 species?

A

CYP2E1

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9
Q

Alcohol can cause release of endotoxin from gram-negative bacteria in intestinal flora. How can this then affect the liver?

A
  • stimulates production of TNF and other cytokines from macrophages and Kupffer cells, leading to hepatic injury
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10
Q

How does alcohol affect the CNS?

A

Low levels acts as depressant

Higher levels act as stimulant

At even higher levels lower medullary centers of respiration are depressed.

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11
Q

How does chronic alcoholism change the gross appearance of the liver?

A
  • Fatty change followed by alcoholic hepatitis and cirrhosis
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12
Q

There is an increased risk of what type of cancer when one has cirrhosis and why does this occur?

A
  • Cirrhosis is associated with portal hypertension and ↑risk for hepatocellular carcinoma
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13
Q

What are ways chronic alcoholism can affect the GI tract?

A

massive bleeding from gastritis, gastric ulcer

Mallory-Weiss syndrome: tear of distal esophagus due to retching

Boerhaave Syndrome rupture of distal esophagus due to retching

Esophageal varices (associated with cirrhosis)

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14
Q

Peripheral neuropathies and Wernicke-Korsakoff syndrome is caused by what deficiency that is du to chronic alcoholism?

A

thiamine (Vit B1) deficiency

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15
Q

How is central pontoon myelonosis caused in an alcoholic?

A

due to rapid IV fluid correction of hyponatremia

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16
Q

How does chronic alcoholism affect the heart?

A

leads to Dilated congestive cardiomyopathy (Alcoholic Cardiomyopathy) Hypertension: ↑ catecholamines

Dec HDL > inc risk of CHD

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17
Q

How does chronic alcoholism affect the pancreas?

A

acute and chronic pancreatitis

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18
Q

How can chronic alcoholism affect the baby during pregnancy?

A

Fetal alcohol syndrome (microcephaly, growth retardation, and facial abnormalities in the newborn)

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19
Q

How can chronic alcohol consumption affect hamtopoiesis?

A

Folic acid deficiency: ↓reabsorption in jejunum; macrocytic anemia

Acquired sideroblastic anemia: defect in heme synthesis

Anemia of chronic disease: common anemia in alcoholics

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20
Q

How can chronic alcoholism affect the MSK?

A

rhabdomyolysis (direct alcohol effect on muscle)

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21
Q

Drinckers with 1 copy of ALDH2*2 allele are at inc. risk for what type of cancer?

A

esophageal cancer

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22
Q

Lab findings for chronic alcoholism.

A

inc risk for developing an inc. anion gap metabolic acidosis

lactic acidosis
B-OHB ketoacidosis

Hyperuricemia because lactic acid competes with uric acid excretion

Hypertriglyceridemia because inc. Production of glycerol 3-phosphate, the key substrate for triglyceride synthesis in the which is the key substrate for triglyceride synthesis in the liver.

AST> ALT because alcohol is a mitochondrial toxin that causes release of AST

Inc serum GGT alcohol induces SER hyperplasia causing inc synthesis of GGT

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23
Q

What is methanol used as typically?

A

windshield washer fluid (end product: formic acid)

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24
Q

What is methanol the main complication of ingestion of methanol?

A

blindness due to optic atrophy

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25
Q

What is the treatment for methanol?

A

IV infusion of ethanol or fomepizole which inhibits alcohol dehydrogenase

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26
Q

C/F of isopropyl alcohol ingestion?

A

fruity odor to breath (acetone)

deep coma

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27
Q

Does ingestion of isopropyl alcohol lead to inc. anion gap or osmolal gap?

A

osmolal gap

28
Q

What is the treatment of isopropyl alcohol?

A

hemodialysis

29
Q

What is ethylene glycol used as?

A

antifreeze

30
Q

Main complication of ingestion of ethylene glycol?

A

acute renal failure

31
Q

Treatment of ethylene glycol?

A

IV infusion of ethanol or fomepizole

32
Q

What drugs can lead to granulocytopenia, aplastic anemia, and pancytopenia?

A

antineoplastic agents, immunosuppressives, chloramphenicol

33
Q

What drugs can cause urticaria, macule, papule, vesicles, petechiae, exfoliative dermatitis, fixed drug eruptions, and abnormal pigmentation?

A

antineoplastic agents, sulfonamides, hydantoins, some antibiotics, and many other agents

34
Q

What drugs are associated with cardiomyopathy complications?

A

Doxorubicin, daunorubicin

35
Q

What drugs are associated with tubulointersticial disease with papillary necrosis?

A

Phenacetin, salicylates

36
Q

What drugs are associated with diffuse hepatocellular damage?

A

Halothane, isoniazid, acetaminophen

37
Q

Which drugs are associated with cholestasis?

A

chlorpromazine, estrogens, contraceptives

38
Q

What drugs are associated with lupus erythematous syndrome (drug-induced lupus)?

A

hydralazine procainamide SHIPP drugs

39
Q

What drugs are associated with bleeding?

A

warfarin, dabigatran

40
Q

Dabigatran has what indications?

A
  • to prevent thromboembolism in patients with atrial fibrillation who are at high risk for thrombotic stroke
41
Q

What does Dabigatran directly inhibit?

A

thrombin

42
Q

Complications of MHT?

A

menopausal hormone therapy leads to:

  • ↑ risk of breast cancer, stroke, and venous thromboembolism
  • No effect on incidence of coronary heart disease
43
Q

Use of OCs can have what adverse effects

A

Cervical cancer risk in women infected with HPG

Thromboembolism: 3 to 6 fold ↑ risk of venous thrombosis and pulmonary thromboembolism (increased hepatic synthesis of
coagulation factors)

CVS disease: inc. risks in women over 35 years who smoke

Hepatic adenomas

44
Q

OCs confer a protective effect in what types of cancer?

A

endometrial and ovarian cancer

45
Q

OCs do not increase risk of what cancer?

A

breast cancer

46
Q

What are some adverse effects of anabolic steroids?

A
  • gynecomastia and testicular atrophy in males
  • growth of facial hair and menstrual changes in women
47
Q

What is the toxic metabolite in acetaminophen?

A

NAPQ

48
Q

What is overdose of acetaminophen treated by?

A

reated by N-acetylcysteine, which restores GSH levels

49
Q

What type of damage does acetaminophen cause to the liver?

A

In serious overdose, liver failure with centrilobular necrosis extending to entire lobules,

50
Q

How does acute salicylate overdose lead to coma?

A
  • Initially: alkalosis due to stimulation of respiratory center in medulla
  • Later: metabolic acidosis, accumulation of pyruvate and lactate
  • Metabolic acidosis ↑formation of non-ionized forms of salicylates, which diffuse into brain and produce nausea to coma
51
Q

S/E aspirin toxicity?

A

headaches, dizziness, ringing in the ears (tinnitus)

acute erosive gastritis

bleeding tendency

52
Q

Proprietary analgesic mixtures of aspirin and phenacetin or its active metabolite acetaminophen taken over several years can have what S/E?

A

renal papillary necrosis

53
Q

How is Rene Syndrome caused?

A

usual in children with chickenpox or influenza infection who ar given aspirin

associate of aspirin and infection

54
Q

S/E seen in Reyes syndrome?

A

encephalopathy
micro vesicular fatty change
inc. transaminases

55
Q

Is there physical dependence in cocaine or psychologic withdrawal?

A

no physical dependence but profound psychologic withdrawal

56
Q

How does cocaine effect neurotransmission?

A

CNS: block reuptake of dopamine in CNS
leads to seizures, hyperpyrexia

At adrenergic nerve endings: blocks reuptake of both epinephrine and
n@orepinephrine while stimulating presynaptic release of norepinephrine

57
Q

Risks of cocaine on heart?

A

MI

58
Q

What physical feature change can be seen in cocaine users?

A

perforation of nasal septum in snorters

59
Q

What are some adverse physical effects of opiate use like heroin specifically?

A
  • Reactions to the cutting agents or contaminants
  • Hypersensitivity to the drug or its adulterants
    heroine im pharmacologic
  • Diseases contracted incident to the use of contaminated needles

Sudden death

Skin
granulomatous runs in skin and lungs from material used to “cut” (dilute) drug

abscesses, cellultis

pulmonary injury

Inc risk of infections like tricuspid endocarditis, mostly Stap Auerus

Kidneys
focal and segmental clomerulosclerosis

60
Q

What can long-term use of methamphetamine lead to? (complications)

A

Long-term use leads to violent behaviors, confusion, and psychotic features including paranoia and hallucinations

61
Q

Another name for NDMA?

A

ectasy

62
Q

How does MDMA affect serotonin levels in body?

A
  • Increase in serotonin release in the CNS
  • Interferes with serotonin synthesis: leads to post use drop in serotonin that is only slowly replenished
63
Q

What are some beneficial effects of marijuana?

A

treat nausea secondary to cancer chemo

pain relieve in chronic conditions

64
Q

S/E of pot?

A

inability to judge time, speed, and distance in potential automobile accidents

65
Q

Match

sedative hypnotics

psychomotor stimulants

opioid narcotics

hallucinogens, and cannobinoids

cocaine, methamphetamine, ecstasy

marijuana

heroin, oxycodone

barbiturates, ethanol

A

Sedative-hypnotics(barbiturates, ethanol),
psychomotor stimulants (cocaine, methamphetamine, ecstasy), opioid narcotics (heroin, oxycodone),
hallucinogens, and cannabinoids (marijuana)

SD IV: Block 3 Week 2 (8 decks)

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