Environmental Topics

Question 1

what are the 5 major causes of childhood mortality that are preventable

Answer 1

Infections:

pneumonia

diarrhea: loss of electrolytes, dehydration, death, giardia, e.coli, campylobactor, rotovirus

malaria

measles

neonatal

Question 2

what about climate change contributes to health….

Answer 2

look in robbins

Question 3

barium acetate

Answer 3

poison!

Question 4

phase 1 reactions

Answer 4

hydrolysis
reduction
oxidation

Question 5

Cytochorome P450 enzyme (CYP)

Answer 5

digests toxins

great variation in CYP acivity among individuals

Question 6

phase II reactions

Answer 6

glucuronidation
sulfation
methylation
conjugations

Question 7

environmental pollution

Answer 7

Table 9-1!

outdoor

• ozone
• -particulates

indoor-

• CO–> chronic exposure, not symptomatic until 30-40%, cherry red cheeks
• radon
• formaldehyde

Question 8

lead toxicity in a child

Answer 8

low levels – still have significant effects (decreased IQ)

higher levels- death at 150

Question 9

lead toxicity in an adult

Answer 9

not as harmful effects in adult

bone–> radio dense deposits
CNS- peripheral neuropathies, encephalopathy, mental deterioration
Blood–> anemias, basophilic stippling

Question 10

mercury toxicity

Answer 10

intracellular glutathione is the protective mechanism for this toxicity

Question 11

arsenic

Answer 11

found in herbs and certain ground waters

interferes with oxidative phosphorylation

GI
CNS
Cardiovascular effects

cancer in almost any tissues, mostly lung and skin

chronic exposure:
skin cancers (squamous and basal cell carcinomas)
lichenation
hyperpigmentation- axilla, soles of feet (not on sun exposed surfaces)

Question 12

cadmium toxicity

Answer 12

causes skin changes, irritation, itching

overtime can be toxic

obstructive lung disease

Itai-Itai disease–> bony defects with renal disease

Question 13

ozone

Answer 13

At risk:
healthy adults and children
lung inflammation
athletes, outdoor workers

decreased lung function
increased airway reactivity
decreased exercise capacity

Question 14

xenobiotics

Answer 14

exogenous environmental chemicals

Cytochrome P-450 enzyme system - detoxifies or activates xenobiotics and both apparently generate ROS

Question 15

table 9-2
human diseases associated with occupationl exposures
industrial/agricultural

Answer 15

look at it!

carbon tetrachloride

benzene- gasoline

minearl/dusts/ pneumoconioses - coal, silica, asbestos (higher bronchogeneic carcinomas, mesotheliomas) beryllium

vinyl chloride- plastics, causes angiosarcoma of the liver

phthalates- plastic

DDT- very effective against mosquito carrying malaria

Question 16

tobacco effects

tables 9-3
9-4

Answer 16

8 years difference in life span b/w smokers and nonsmokers

most common exogenous cause of human cancers

strongly linked to development of atherosclerosis

cessation of smoking greatly reduces, within 5 years, the overall mortality and the risk of death from cardiovascular disease.

lung cancer mortality decreases by 21 % within 5 years, but the excess risk lasts for 30 years

Question 17

alcohol

Answer 17

chronic effects:
liver
GI/esophagus- esophageal varices (Portal HTN) 
Brain- wernickes, korsakoff
heart- dialted cardiomyopathies
pancreas
fetal alcohol syndrome
nutrient depletion- depletes B vitamins, vitamin A

alcohol is metabolized to acetaldehyde—> further to acetate

Question 18

oral contraceptives

Answer 18

venous thromboembolism
cancer ?
hepatic adenomas (over long periods of time on these)

increased risk if there is prothrombin or factor V Leiden mutations

prevent ovulation or prevent implantation

Question 19

acetaminophen

Answer 19

widely used

LD50 is large (point at which 50% of people die)

liver effects- necrosis, treated with anasylcysteine

overdoses

Question 20

ASA (aspirin)

Answer 20

bleeding

precipitates allergy/bronchospasm

Question 21

Hormone replacement therapy

Answer 21

estrogen/progesterones

Question 22

cocaine

Answer 22

figure 9-15

1/2 life of cocaine is 40 minutes (very short)
so there is no safe dose of cocaine

block dopamine reuptake:
euphoria, paranoia, hyperthermia (hyperpyrexia)

Block norepinephrine reuptake:
HTN, cardiac arrhythmias, myocardial infarct, cerebral hemorrhage and infarct

Question 23

heroin

Answer 23

-morphine is a synthetic form of this

Question 24

amphetamines

Answer 24

sudafed is used to make this

produces euphoria followed by crash

Question 25

marijuana

Answer 25

medical marijuana:
nausea, pain, glaucoma, appetite issues (Cancer cachexia indications)

ingested types:
potent, hallucinations

Question 26

look at table 9-5

Answer 26

see especially pulmonary and CNS adverse drug reactions of things that you are prescribing

Question 27

thermal injuries

Answer 27

look at! tables

Question 28

primary insufficiency

Answer 28

not getting enough food.

Question 29

secondary insufficiency

Answer 29

infection
acute/chronic illnesses
chronic alcoholism
malabsorption

elderly population

Question 30

protein-energy malnutrition

Answer 30

BMI less than 16

Marasmus-
- somatic protein compartment (striated muscle)
decreased T cells–> viruses, parasites, fungal infections
m-melting, wasting

Kwashiorkor

• visceral protein component diminshed
• low albumin levels, ascites, protuberant bellies
• edema, skin, hair changes

Question 31

anorexia

Answer 31

highest death rate of any psychiatric disorder- body image dysmorphism

amenorrhea

hypokalemia

this is starving

Question 32

bulimia

Answer 32

binging/perging

hypokalemia

look at back of their hands
-scarring on the back of the hand from teeth

Question 33

hypokalemia secondary to anorexia and bulimia cause what?

Answer 33

muscle cramping

GI tract shuts down, motility/peristalsis

cardiac arrhythmia’s- cardiac arrest

Question 34

table 9-9, table 9-10 (trace elements)

Vitamin Deficiencies

Answer 34

what to know:
emphasize deficiency states

ADEK: fat soluble vitamins

• stored in the liver
• Vitamin A has toxic manifestations
• Vitamin E is related to clotting

A- retinoids

D- activated form best regarded as a steroid hormone

• rickets
• osteomalacia
• toxicity? RDA is low for vitamin D

Vitamin- C
-scurvy

Question 35

beriberi

Answer 35

know

Question 36

wernicke/Korsakoff syndromes

Answer 36

know

Question 37

pellagra

Answer 37

know

Question 38

vitamin A deficiency

Answer 38

keratomalacia
corneal ulcer
bitot spots

squamous metaplasia in the lung

kidney stones

cancers?

Question 39

obesity

Answer 39

BMI greater than 30

leptin- elaborated when you are full, hormone to QUIT eating

adiponectin- secreting to cause fat-burning, utilization of fat tissue

adipose tissue
-proinflammatory adipocytes

gut hormones
-ghrelin - stimulates appetite

Question 40

what are the general consequences of obesity

Answer 40

cancer- esophageal adenocarcinomas

atherosclerosis

cardiovascular disease

Question 41

3 white devils

Answer 41

processed sugar
white flour
white milk

related to high incidence of type II DM

-carbohydrates