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Pharm & Ototoxicity > Quiz 2 > Flashcards

Quiz 2 Flashcards

1
Q

What is a controlled substance?

A

drug or chemical whose manufacture, possession and use are regulated by the government due to the potential for abuse, addicition or harm

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2
Q

Schedule 1

A

substances with high potential for abuse & no accepted medical use
heroin
LSD
ecstasy
peyote - religious use by Native Americans; Small spineless cactus native to the desert of south TX and north Mexico (contains psychoactive alkaloids, particularly mescaline)
most dangerous
potentially severe physical and psychological dependence

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3
Q

Schedule II

A

Substances with high potential for abuse but with accepted medical uses with severe restrictions
morphine & fentanyl
cocaine
methamphetamine
oxycodone
can lead to severe physical and psychological dependence & are dangerous

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4
Q

Schedule III

A

substances with lower potential for abuse the II and accepted medical uses
anabolic steroids
codeine with aspirin or acetaminophen
moderate to low potential for physical and psychological dependence

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5
Q

Schedule IV

A

substances with low potential for abuse relative to III drugs
diazepam
lorazepam

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6
Q

Schedule V

A

Substances with a lower potential for abuse than Schedule IV and consisting of preparations containing limited quantities of certain narcotics
generally used for antidiarrheal, antitussive & analgesic purposes
Cough preparations with < 200 mgs of codeine or per 100 milliliters (e.g., Robitussin AC)
Lomotil (for diarrhea)
Lyrica (for nerve pain/neuropathy)

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7
Q

factors that increased the risk of ADR were

A

Increasing age of the child
An average increased risk of 1.06 for each year
Increasing number of drugs
An average increased risk of 1.25 for each additional drug
Oncological treatment
An average increased risk of 1.90 compared to other Rx

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8
Q

ADRs were common in

A

hospitalized children

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9
Q

Children who had undergone GA were at ____ greater risk of developing an ADR

A

6x

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10
Q

GA agents and opiate analgesics were a significant cause of ADRs in hospitalized children

A

true

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11
Q

Nervous System

A

symptoms of ADR here: dizziness, drowsiness, confusion, altered judgement, headaches

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12
Q

Eyes

A

symptoms of ADR here: blurred/double vision, erythema multiforme (allergic reaction to some antibiotics, NSAIDS, & infections that causes skin lesions like bumps, plaques, blisters and can lead to Stevens-Johnson Syndrome)

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13
Q

Stevens-Johnson Syndrome:

A

painful skin rash that spreads & blisters
increased risk if PT has HLA-B 1502 gene

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14
Q

are frequent targets for drug toxicity

A

eyelids & conjunctiva

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15
Q

Auditory-vetibular system

A

symptoms of ADR here: dizziness, vertigo, HL, tinnitus

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16
Q

most common side effects of medications

A

HL & tinnitus

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17
Q

Skin

A

symptoms of ADR here: acne, drug-induced itching & redness, herpes simplex (viral infection that produces cold sores, genital inflammation or conjunctivitis), sweating, hives, Steven Johnson Syndrome (affects skin & membranes)

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18
Q

affects skin & membranes

A

Steven Johnson Syndrome

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19
Q

viral infection that produces cold sores, genital inflammation or conjunctivitis

A

herpes simplex

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20
Q

what is the immune system

A

constellation of responses mounted by body to attacks from outside the body

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21
Q

what is an antigen

A

a substance that elicits an immune response

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22
Q

antigen-specific

A

recognize and act against particular antigens

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23
Q

systemic

A

not confined to initial infection site but works throughout the body

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24
Q

memory

A

recognize and mount an even stronger attack to the same antigen next time

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25
Q

self/non-self recognition

A

achieved by every cell displaying a marker based on the major histocompatibility complex (MHC)
any cell without this marker are treated as non-self & attacked

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26
Q
  • group of genes coding for cell surface proteins essential for immune system
A

MHC

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27
Q

what is autoimmune and ex

A

self/non-self recognition process breaks down and the IS attacks the body’s own cells
MS, sudden SNHL, rheumatoid arthritis, Type I diabetes

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28
Q

what bappens during an allergy response

A

The immune system normally protects the body by identifying and attacking harmful substances, like bacteria and viruses. However, sometimes it mistakenly identifies harmless substances, like dust or pollen, as threats. In these cases, the immune system’s response is too strong, leading to an overreaction.
this is known as an allergy
When the immune system responds excessively to these harmless substances, it causes symptoms like sneezing, itching, and inflammation.

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29
Q

what are allergens

A

harmless substances that trigger this allergic response, such as dust or pollen, are referred to as allergens

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30
Q

IS fluid systems

A

hematopoietic & lymphatic

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31
Q

Hematopoietic system

A

includes RBCs, WBCs & pluripotent hematopoietic stem cell
all develop in the bone marrow

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32
Q

erythrocytes

A

RBCs

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33
Q

what do erythrocytes (RBCs) in the hematopoietic system do

A

carry oxygen

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34
Q

leukocytes

A

WBCs

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35
Q

what do leukocytes (WBCs) in the hematopoietic system do

A

fight infections

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36
Q

thrombocytes

A

platelets
help control bleeding

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37
Q

where do the cells in the hematopoietic system develop

A

from the bone marrow

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38
Q

what are pleuripotent hematopoietic stem cells in hematopoietic system

A

type of stem cell that can differentiate into cells from any of the three germ layers in the body, and are thought to be the source of most cell types

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39
Q

how do pleuripotent hematopoietic stem cells differentiate into different cell types

A

through interactions with dozens of glycoproteins called hematopoietic growth factors

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40
Q

what are hematopoietic growth factors

A

naturally occurring substances which regulate the production of circulating blood cells

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41
Q

what is lymph

A

clear, transparent, colorless
flows in lymphatic vessels alongside blood vessels to make a protective covering over tissues and organs

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42
Q

responsible for the production and development of blood cells

A

hematopoietic system

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43
Q

what is the lymphatic system

A

helps protect and maintain the fluid environment of your body by filtering and draining lymph away from each region of the body

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44
Q

helps protect and maintain the fluid environment of your body by filtering and draining lymph away from each region of the body

A

lymphatic system

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45
Q

what are lymph nodes

A

lymph nodes along lymph vessels to filter lymphatic fluid - area where antigens are presented to the immune system

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46
Q

where antigens are presented into the immune system

A

lymph nodes

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47
Q

Antigens are presented to T cells in ______, which are distributed throughout the bod

A

lymph nodes

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48
Q

protect body from infection and part of IS

A

leukocytes (WBCs)

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49
Q

subdivisions of leukocytes

A

granulocytes
agranulocytes

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50
Q

what are granulocytes

A

subdivision of leukocyte
contain large granules in the cytoplasm (secretory granules)

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51
Q

contain large granules in the cytoplasm (secretory granules)

A

granulocytes

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52
Q

examples of granulocytes

A

neutrophils (55-70%)
eosinophils (1-3%)
basophils (.5-1%)

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53
Q

what are agranulocytes

A

without granules, lack granules in their cytoplasm

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54
Q

contain large granules in the cytoplasm (secretory granules)

A

granulocytes

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55
Q

example of agranulocytes

A

lymphocytes

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56
Q

single large nucleus with no granules

A

lymphocytes

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57
Q

what are examples of lymphocytes

A

B & T cells
and monocytes

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58
Q

circulate in the blood and lymph systems and make home in lymphoid organs

A

lymphocytes

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59
Q

b lymphocyte production

A

bone marrow

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60
Q

t lymphocyte production

A

thymus gland

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61
Q

produced in the bone marrow and mature in the thymus

A

t lymphocyte production

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62
Q

what are T cells

A

involved in cell-mediated immunity
doesn’t depend on antibodies for its adaptive immune functions and primarily driven by mature T cells

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63
Q

involved in cell-mediated immunity

A

t cells

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64
Q

what are b cells

A

involved in humoral immunity (related to antibodies)
produces antigen-specific antibodies and primarily driven by B cells

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65
Q

involved in humoral immunity (related to antibodies)

A

b cells

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66
Q

what is the function of b and t cells

A

is to recognize non self antigens during antigen presentation

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67
Q

what are primary organs of IS

A

bone marrow, thymus gland

68
Q

what are the secondary organs of the IS

A

at or near portals of entry for pathogens
Adenoids, tonsils, spleen, lymph nodes, Peyer’s patches (within the intestines), and appendix

69
Q

originate in the bone marrow and then migrate to the other primary and secondary lymph organ

A

WBCs

70
Q

where is the thymus located

A

behind the breastbone above the heart

71
Q

what are immunogobulins or antibodies

A

large y shaped proteins secreted by the plasma and are clones of primed B cells

72
Q

what is the function of immunogobulins/antibodies

A

used to identify & neutralize foreign objects like bacteria or viruses
antibody recognizes a unique molecule of the pathogen called an antigen

73
Q

what do antibodies form from and what do they do

A

form gamma globulin part of the blood proteins

they inactivate antigens through various mechanisms

74
Q

examples of immunogobulins/antibodies

A

IgG
IgA
IgM
IgD
IgE

75
Q

function of IgG

A

dominates secondary immune system & only antibody that crosses placental barrier to the fetus and protects newborn for 3-6mos
mediates type II reaction & type III reactions

76
Q

function of IgM

A

dominates in primary immune responses
mediates type II reactions

77
Q

function of IgE

A

mediates type I reactions

78
Q

responsible for 3-6 mo immune protection of newborns that is conferred by the mom

most dominant immunoglobulin and only one to cross placental barrier to provide immunity to fetus

A

IgG

79
Q

dominates in primary immune responses

A

IgM

80
Q

describe the development of immunogobulins/antibodies

A

immuno-competent immature B lymphocyte stimulates to maturity,
when a B cell encounters an antigen it becomes fully mature
the binding of antigen to b cell receptors causes it to become primed preparing for activation
primed B cell goes through clonal selection where it divides through mitosis to produce clones of itself, these clones become plasma cells that produce antibodies
after a lag period (up to 14 days) the plasma cells start to produce antibodies at high rates (~2000 molecules/second) for about 4 to 5 days. This is known as the primary immune response.
antibodies produced by the plasma cells help to neutralize the antigen
Some B cells become long-lived memory cells that remain in the body and remember the antigen
if the same antigen is encountered again the memory cells facilitate a faster and more effective immune response = secondary immune response

81
Q

describe the primary immune response

A

after a lag period (up to 14 days) the plasma cells start to produce antibodies at high rates (~2000 molecules/second) for about 4 to 5 days.

82
Q

describe the secondary immune response

A

if the same antigen is encountered again the memory cells facilitate a faster and more effective immune response

83
Q

what is the difference between the primary and secondary response

A

primary: happens when IS encounters antigen for first time, slow response (5-10 days) for antibodies to appear, B cells are activated

secondary: happens upon re-exposure to the same antigen, faster (1-3 days) due to memory cells created in primary response, stronger and more rapid

84
Q

IgM dominates the primary response, while IgG dominates the secondary.

A

true

85
Q

The primary response relies on memory cells formed during the primary response.

A

false
secondary respnose

86
Q

Immunity can be either

A

natural or artificial
innate or acquired/adaptive
active or passive

87
Q

Active natural

A

Develops slowly, is long term, and antigen specific
(contact with infection)

88
Q

Active artificial

A

Develops slowly, lasts for several years, and is specific to the antigen for which the immunization was given
(immunization-vaccines)

89
Q

Passive natural

A

Develops immediately, is temporary, and affects all antigens to which the mother has immunity
(trans-placental mother-to-child)

90
Q

Passive artificial

A

Develops immediately, is temporary, and affects all antigens to which the donor has immunity

injection of gamma globulin

91
Q

they offer active artificial immunization and aim to teach the body’s immune system to recognize and block viruses

A

vaccines

92
Q

how do vaccines work

A

Activate IS T cells to detect the presence of a virus and peaks around 10-18 days after the shot
Instructs B cells to create antibodies that block virus from replicating and the T-killer cells to destroy the infected cells
with all vaccines, body is left with a supply of memory T-lymphocytes and B-lymphocytes that will remember how to quickly fight that particular antigen (virus) in the future

93
Q

how do covid vaccines work

A

spike protein is injected - found on the corona virus that causes COVID 19, acts like an instruciton manual in our muscle cells that tells them to produce spike protein
once spike protein is made your cells will have it on their surface and break down the mRNA from the vaccine, IS responds by producing antibodies against the spike protein
after the immune response memory cells are created to remember the spike protein and if exposed in the future the memory cells will recognize it and rapidly defend against it

94
Q

key benefit of mRNA vaccines

A

they train the IS to fight the virus w/out causing an actual infection or illness

95
Q

target cells in the immune system for immediate-type reactions

A

mast cells & basophils (WBCs)

96
Q

what are mast cells

A

found in connective tissue
part of the IS and contains granules rich in histamine & heparins

97
Q

what is heparin

A

anticoagulant to prevent blood clots

98
Q

what is histamine

A

chemical used to fight infections

99
Q

what happens if histamine is released in the body inappropriately or in too high quantity

A

causes an allergic reaction

100
Q

takes 7-10 days of sensitizing exposure for mast cells and basophils to both to become primed with IgE antibodies

A

true

101
Q

what is an allergic cascade

A

complex and rapid series of reactions that results in the symptoms of an allergic reaction

102
Q

explain the process of an allergic cascade

A

first time an allergen enters the body, it triggers an immune response. In people with allergies, their immune system mistakenly identifies the allergen as a threat. B cells produce IgE antibodies specific to the allergen.

These IgE antibodies attach to mast cells and basophils

Upon subsequent exposure to the same allergen, it binds to the IgE antibodies on the surface of the mast cells and basophils and causes the mast cells and basophils to release various chemical mediators, such as histamine, leukotrienes, and prostaglandins which leads to inflammation and other symptoms of allergies like itching, swelling, etc.

103
Q

what is the immediate hypersensitivity reaction

A

when an allergen binds to an IgE antibody on mast cells & basophils that causes histamine etc to be released leading to inflammation and other symptoms of itching, swelling etc.

104
Q

In some cases, the allergic response can lead to chronic inflammation, where the immune system continues to react to the allergen even in the absence of it.

A

true

105
Q

type I allergic reaction

A

mediated by IgE
most severe types of reactions
e.g. anaphylaxis, asthma symptoms & dermatitis

106
Q

type II allergic reactions

A

mediated by IgG, IgM
hemolysis (break down) of red blood cells (blood disorder)
some forms off anemia, blood transfusion reactions & some types of tissue transplant rejection

107
Q

Type III allergic reactionsmediated by IgG

A

mediated by IgG
e.g. arthralgia (muscle/join pain) and fever
lymphadenopathy - swollen lymph nodes

108
Q

What is anaphylaxis and its effects on the body?

A

aka anaphylactic shock

severe progressive whole body reaction to a chemical that has become an allergen

life threatening and can occur any time within minutes to a couple of hours

109
Q

how does anaphylaxis work

A

after exposure like a bee sting venom you suffer a mild allergic reaction sensitizing the immune system then when they are exposed to that allergen again anaphylaxis happens quicker and is severe or even life threatening

110
Q

common causes of anaphylaxis

A

drugs - most common is penicillin but also anesthesia meds
food allergies - peanuts & shellfish
insect bites - bee stings & fire ants
pollen & other inhaled allergies although rare

111
Q

what makes you at risk for anaphylaxis

A

hx of any type of allergic reaction
for some it appears with no known cause usually because first exposure causes mild/no symptoms

112
Q

during anaphylaxis, tissues in other parts of the body release histamine and other substances causing airways to tighten and leads to other symptoms like

A

abdominal pain
anxiety
dizziness
skin redness, hives, itchiness, pale & blue skin
slurred speech
nausea/vomiting & diarrhea
swelling of face, eyes and/or tongue

113
Q

some drugs can cause an anaphylatic like (anaphylactoid) reaction when people are first exposed to them

A

true

114
Q

what are examples of an anaphylactoid reaction

A

ex: morphine, radiographic contrast material like iodine, aspirin etc.
systemic and not immune system reactions and don’t require prior sensitization to an antigen as required in true anaphylaxis

115
Q

symptoms & risk of complications and treatment are the same for both anaphylaxis and anaphylactoid

A

true

116
Q

treatment for anaphylaxis

A

Epinephrine (adrenaline) to reduce body’s allergic response
Oxygen to help compensate for restricted breathing
Intravenous (IV) antihistamines and cortisone to reduce inflammation and swelling in order to open airways
A beta-agonist (such as albuterol) to relieve breathing symptoms

117
Q

anaphylactoid or an anaphylaxis/anaphylactic shock is an EMERGENCY medical condition

A

true

118
Q

difference bw anaphylaxis and anaphylactoid

A

Anaphylaxis is immune-mediated (IgE-dependent), whereas anaphylactoid reactions are non-immune-mediated (IgE-independent).

Anaphylactoid reactions can be triggered by non-allergic factors like medications or physical stimuli.

anaphylactoid: not an immune response and why it can happen with the first exposure; Not dependent on IgE antibodies

anaphylaxis: immune response; Triggered by an immune response involving Immunoglobulin E (IgE).

119
Q

When exposed to an allergen, the body’s immune system produces IgE antibodies that bind to mast cells and basophils, leading to the release of histamine and other chemicals that cause the symptoms.

A

anaphylaxis

120
Q

these reactions are caused by a direct activation of mast cells and basophils, which release histamine and other mediators without the involvement of the immune system.

A

anaphylactoid

121
Q

what is a teratogen

A

any substance, organism, or physical agent that can cause developmental abnormalities or birth defects in a developing embryo or fetusf

122
Q

Teratogens can interfere with normal development, leading to congenital malformations or functional deficits that can manifest at birth or later in life.

A

true

123
Q

drug examples of teratogens

A

isotretioin (accutane) for severe cystic acne (99% teratogenic)

thalidomide - first used as a sedative and used to treat nausea in pregnant women

124
Q

side effects of thalidomide in offspring

A

caused limb reduction defects (phocomelia) in offspring of those who took it as well as congenital heart disease, malformations of inner and outer ear, and ocular abnormalities

125
Q

what causes teratogens

A

drugs
infections
environmental factors

126
Q

infection examples of teratogens

A

rubella (german measles)

127
Q

symptoms of rubella

A

causes significant HL, heart, neurological and eye defects

128
Q

environmental examples of teratogens

A

radiation

129
Q

radiation effects on babies

A

can cause miscarriage, birth defects, intellectual disability, intrauterine growth retardation and childhood cancers like Leukemi

130
Q

when will the FDA approve teratogenic drugs

A

therapeutic benefits outweigh the risk
physician labeling clearly contraindicates use during pregnancy
ex: thalidomide is useful for treatment of Leprosy, multiple myoloma, and some AIDS symptoms
FDA requires testing of all new drugs for teratogenic potential during drug toxicity in animal studies

131
Q

what is the new Pregnancy & Lactation Labeling Rule (PLLR - Final Rule June 2015)

A

improves the risk vs benefit assessment of drugs used for pregnant and nursing moms

132
Q

what are the 3 main category recommendations of PLLR

A

fetal risk summary
clinical considerations
data

133
Q

describe PLLR fetal risk summary

A

Characterizes the likelihood, from both human and animal data, that a drug increases the risk of four types of developmental abnormalities

134
Q

what are the 4 types of developmental abnormalities of the fetal risk summary

A

Structural anomalies, fetal and infant mortality, impaired physiologic function, and alterations to growth

135
Q

describe clinical considerations in PLLR

A

Discussing fetal risk from inadvertent exposure and prescribing decisions based on drug effects on labor, delivery, and fetus

136
Q

describe data in PLLR

A

Detailed discussion of available data; human data appears before animal data

137
Q

human genome contains _______ billion nucleotides making up ~ 25,000 genes that may encode > 100,000 proteins

A

~ 3

138
Q

what is pharmacogenomics

A

aka pharmacogenetics

study of the role of the genome in drug responses

combo of genetics & pharmacology

studies how the genetic makeup of a PT affects their response to drugs

139
Q

specific proteins in the body that drugs bind to in order to exert their effects and are common across the population,

A

drug target receptors

140
Q

most people have drug target receptors in similar forms, allowing drugs to work as intended for most individuals.

A

true

141
Q

genetic differences can be highly significant for the success or failure of drug therapy

A

true

142
Q

describe how genetic variations or polymorphism in a gene encoding receptors affects the success or failure of drug therpy

A

Some have genetic variations (mutations or polymorphisms) in the genes that encode these receptors, altering the structure or function of the receptors, potentially changing how effectively a drug can bind to its target and work as expected.

143
Q

Human genomes are ~ _____% identical regardless of race, ethnicity, or geographic region

A

99

144
Q

If one nucleotide in a specific position is exchanged with another nucleotide, the alteration is referred to as

A

Single nucleotide polymorphism or SNP (pronounced “SNIP”)

145
Q

Majority of nucleotide variations are

A

SNPs

146
Q

what do SNPs do

A

can affect protein amount or function by altering coding sequence of transcription or mRNA translation, which could be pharmacologically important

147
Q

Other variations (mutations) include

A

Insertions, deletions, duplications, and translocations of one or more nucleotides or even entire chromosomes

148
Q

common in major enzymes that metabolize phase I and II reactions

A

genetic polymorphisms

149
Q

benefits of pharmacogenomics

A

Developing better vaccines
Decreasing overall health care costs
Establishing gene phenotypes prior to the use of certain medications
Matching the right drug and correct dose to patients’ genotype
Advanced screenings for disease or disease susceptibility to monitor conditions and maximize therapy

150
Q

Development of drugs to accurately target specific diseases based on genetic information resulting in

A

improved therapeutic effects
decreased damage to healthy cells

151
Q

Pharmacogenomics could facilitate the creation of personalized drug therapy resulting in greater safety and efficacy of drugs

A

true

152
Q

Cytochrome P450 (CYP) liver enzyemes metabolize _____ classes of drugs

A

> 30

153
Q

clinically significant polymorphisms are in

A

both phase 1 (CYP family of enzymes) and phase II liver enzymes

154
Q

what is the effect of clinically significant polymorphisms

A

most of these polymorphisms produce no clinically significant effects in the absence of drug therapy

But they can and do result in clinically significant drug efficacy and toxicity for individuals with these polymorphisms compared to those without

155
Q

insertion

A

addition of nucleotides into DNA sequence

156
Q

deletion

A

segment of DNA is removed from a chromosome

157
Q

duplications

A

segment of DNA is copied one or more times in the genome resulting in multiple copies of the same genetic material within a chromosome

158
Q

translocations

A

one or more nucleotides or even entire chromosomes

159
Q

Genetic Polymorphisms
common in major enzymes that metabolize

A

phase I and II reactions

160
Q

example of genetic polymorphism

A

: inherited variation of enzymatic hydrolysis of the short-acting muscle relaxant, succinylcholine by the enzyme serum cholinesterase

161
Q

1 in ~ every 2000 ______ has a genetic alteration of the plasma enzyme serum cholinesterase

A

Caucasians

162
Q

what is the function of the enzyme serum cholinesterase

A

to metabolize the muscle relaxant succinylcholine (given IV with general anesthesia)

163
Q

The altered enzyme has a 1000 fold decreased affinity for succinylcholine, causing

A

Decreased metabolism, slow elimination, & prolonged circulation

164
Q

A sufficiently high plasma level of_______ would lead to respiratory paralysis and death if not supported with artificial respiration till the drug clears from the body

A

succinylcholine

165
Q

what is succinylcholine

A

a muscle relaxant commonly usedd in anesthesia

166
Q

produces antigen-specific antibodies and primarily driven by these cells

A

humoral immunity (b cells)

167
Q

doesn’t depend on antibodies for its adaptive immune functions and primarily driven by mature T cells

A

cell mediated immunity (T cells)

Pharm & Ototoxicity (10 decks)

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