Exam 2 General Flashcards
What happens to TH if binding proteins increase?
concentration of free TH falls and TSH is stimulated to correct free TH levels and a new equilibrium will be established
High free T4 low TSH
hyperthyroidism
Low free T4 high TSH
hypothyroidism
If you decrease binding proteins what happens to free TH levels?
increase
L isomers vs D isomers
L are the naturally occurring isomers and D have a small fraction of the activity that L has
Where is T4 best absorbed?
from duodenum and ileum
Is absorption slowed by mild hypothyroidism?
no
What can absorption be impaired by?
severe hypothyroidism with ileus
What is the MC form of adult hypothyroidism?
hashimoto’s thydoiditis
What is cretinism?
infatile hypothyroidism
neuro impaitment, deaf mutism, develop failures, iodine deficient areas
What can hasten regression of goiter?
full replacement dose of TH to suppress TSH
What is the treatment for subtotal thyroidectomy?
Thioamide drug till euthyroid (~ 6 wk)
KI 10 days prior to surgery to reduce size and vascularity
β-blocker to antagonize catecholamines
What is the dawn effect?
(morning glucose increase) → overnight dosing important
In a patient with severe hypoglycemia, the differential diagnosis between self-administered insulin overdose and a tumor that produces excess insulin can be made by determining plasma levels of what?
c peptide
What is the window of peak fertility?
day 9-15 of menstrual cycle
7 main categories of contraception
Surgical sterilization Intrauterine devices (IUDs) Combination Estrogen/Progestin methods Progestin-only methods Barrier methods Natural Family Planning Emergency contraception
Secondary benefits of combo E/P
Improved acne
Regulation/control of menstrual cycle
Lighter and shorter periods (anemia)
Improved cramps (dysmenorrhea)
Bone protection if at risk for osteopenia (anorexics)
Decreased risk of ovarian and endometrial cancers
What are the brands of levonorgestrel- IUDs and for each what is their approved duration of use?
Mirena (5 yrs)
Liletta (3 yrs)
Skyla (3 yrs)
MC type of breast ca
Estrogen receptor positive (ER+)
If Estrogen receptor positive (ER+) if progesterone receptor likely positive or negative
positive
1st line Estrogen receptor positive (ER+)
Surgical and/or radiation therapy, plus tamoxifen
What breast ca responds best to tamoxifen
ER+/PR+/HER2-
First line for HER2 positive
Surgical and/or radiation therapy, plus trastuzumab
What mutation is triple negative breast ca associated with
BRCA1
Triple negative (ER negative, PR negative and HER2 not amplified) treatment
Surgical and/or radiation therapy, plus cytotoxic chemo
What are the 6 ca tx modalities
Surgery
Radiotherapy
Chemotherapy
Endocrine therapy
Monoclonal Ab/Biologics
Small molecule inhibitors
Primary induction chemotherapy
1’ tx in patients presenting with adv solid ca or mets for which no alt tx exists→ palliative measure to improve overall QOL, and to ↑ survival by delaying tumor progression (not a cure)
1’ tx for disseminated cancer such as leukemia (meant to be curative)
Neoadjuvant chemotherapy
irst step to shrink tumor burden prior to local therapy (surg/rad)
Adjuvant chemotherapy
additional treatment after primary local therapy to ↓ risk of ca recurrence
What does a chievement of a therapeutic effect in tumor cells & minimization of adverse effects in non-tumor cells typically require?
combo of drugs w/ diff:
MOA
dose limiting tox
mech of susceptibility to resistance
What drugs are rapidly growing tumors most sensitive?
cell-cycle specific chemo drugs (CCS)
What ca have high growth fraction?
acute leukemias, aggressive high-grade lymphomas (hodgkin’s)
Define Cell Cycle-Nonspecific (CCNS) Drugs
Anticancer drugs capable of exerting their actions on cancer cells that are cycling or in the resting state (Go compartment)
What is the purpose of the treatment-free period?
want the shortest possible treatment free period to allow for:
recovery of the most sensitive normal tissues (usually bone marrow, gastrointestinal tract),
but not enough time for recovery of cancer cells
How do disseminated ca grow?
exponentially
What is the log-kill hypothesis?
killing action of CCS drugs follows 1st order kinetics in which a given dose kills a PROPORTION of ca pop not a constant number
How do solid tumors frow?
Gompertzian growth pattern in which first exponentially grows then growth rates DECLINE as tumor expands
Best therapy for solid tumors
adjuvant chemo to dec burden before surg/rad
Best therapy for disseminated ca
induction chemo
consolidation
maintenance chemo for mo-yrs until disappeared
Why are common sites for anti-ca drug toxicity normal tissues that have a high growth factor?
anti- ca drugs target proliferating cells
Why do high tumor burdens have greater change of MDR?
accumulate more mutations
