Quiz 2 Flashcards
What is a controlled substance?
drug or chemical whose manufacture, possession and use are regulated by the government due to the potential for abuse, addicition or harm
Schedule 1
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
Schedule II
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
Schedule III
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
Schedule IV
substances with low potential for abuse relative to III drugs
diazepam
lorazepam
Schedule V
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)
factors that increased the risk of ADR were
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
ADRs were common in
hospitalized children
Children who had undergone GA were at ____ greater risk of developing an ADR
6x
GA agents and opiate analgesics were a significant cause of ADRs in hospitalized children
true
Nervous System
symptoms of ADR here: dizziness, drowsiness, confusion, altered judgement, headaches
Eyes
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)
Stevens-Johnson Syndrome:
painful skin rash that spreads & blisters
increased risk if PT has HLA-B 1502 gene
are frequent targets for drug toxicity
eyelids & conjunctiva
Auditory-vetibular system
symptoms of ADR here: dizziness, vertigo, HL, tinnitus
most common side effects of medications
HL & tinnitus
Skin
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)
affects skin & membranes
Steven Johnson Syndrome
viral infection that produces cold sores, genital inflammation or conjunctivitis
herpes simplex
what is the immune system
constellation of responses mounted by body to attacks from outside the body
what is an antigen
a substance that elicits an immune response
antigen-specific
recognize and act against particular antigens
systemic
not confined to initial infection site but works throughout the body
memory
recognize and mount an even stronger attack to the same antigen next time
self/non-self recognition
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
- group of genes coding for cell surface proteins essential for immune system
MHC
what is autoimmune and ex
self/non-self recognition process breaks down and the IS attacks the body’s own cells
MS, sudden SNHL, rheumatoid arthritis, Type I diabetes
what bappens during an allergy response
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.
what are allergens
harmless substances that trigger this allergic response, such as dust or pollen, are referred to as allergens
IS fluid systems
hematopoietic & lymphatic
Hematopoietic system
includes RBCs, WBCs & pluripotent hematopoietic stem cell
all develop in the bone marrow
erythrocytes
RBCs
what do erythrocytes (RBCs) in the hematopoietic system do
carry oxygen
leukocytes
WBCs
what do leukocytes (WBCs) in the hematopoietic system do
fight infections
thrombocytes
platelets
help control bleeding
where do the cells in the hematopoietic system develop
from the bone marrow
what are pleuripotent hematopoietic stem cells in hematopoietic system
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
how do pleuripotent hematopoietic stem cells differentiate into different cell types
through interactions with dozens of glycoproteins called hematopoietic growth factors
what are hematopoietic growth factors
naturally occurring substances which regulate the production of circulating blood cells
what is lymph
clear, transparent, colorless
flows in lymphatic vessels alongside blood vessels to make a protective covering over tissues and organs
responsible for the production and development of blood cells
hematopoietic system
what is the lymphatic system
helps protect and maintain the fluid environment of your body by filtering and draining lymph away from each region of the body
helps protect and maintain the fluid environment of your body by filtering and draining lymph away from each region of the body
lymphatic system
what are lymph nodes
lymph nodes along lymph vessels to filter lymphatic fluid - area where antigens are presented to the immune system
where antigens are presented into the immune system
lymph nodes
Antigens are presented to T cells in ______, which are distributed throughout the bod
lymph nodes
protect body from infection and part of IS
leukocytes (WBCs)
subdivisions of leukocytes
granulocytes
agranulocytes
what are granulocytes
subdivision of leukocyte
contain large granules in the cytoplasm (secretory granules)
contain large granules in the cytoplasm (secretory granules)
granulocytes
examples of granulocytes
neutrophils (55-70%)
eosinophils (1-3%)
basophils (.5-1%)
what are agranulocytes
without granules, lack granules in their cytoplasm
contain large granules in the cytoplasm (secretory granules)
granulocytes
example of agranulocytes
lymphocytes
single large nucleus with no granules
lymphocytes
what are examples of lymphocytes
B & T cells
and monocytes
circulate in the blood and lymph systems and make home in lymphoid organs
lymphocytes
b lymphocyte production
bone marrow
t lymphocyte production
thymus gland
produced in the bone marrow and mature in the thymus
t lymphocyte production
what are T cells
involved in cell-mediated immunity
doesn’t depend on antibodies for its adaptive immune functions and primarily driven by mature T cells
involved in cell-mediated immunity
t cells
what are b cells
involved in humoral immunity (related to antibodies)
produces antigen-specific antibodies and primarily driven by B cells
involved in humoral immunity (related to antibodies)
b cells
what is the function of b and t cells
is to recognize non self antigens during antigen presentation
what are primary organs of IS
bone marrow, thymus gland
what are the secondary organs of the IS
at or near portals of entry for pathogens
Adenoids, tonsils, spleen, lymph nodes, Peyer’s patches (within the intestines), and appendix
originate in the bone marrow and then migrate to the other primary and secondary lymph organ
WBCs
where is the thymus located
behind the breastbone above the heart
what are immunogobulins or antibodies
large y shaped proteins secreted by the plasma and are clones of primed B cells
what is the function of immunogobulins/antibodies
used to identify & neutralize foreign objects like bacteria or viruses
antibody recognizes a unique molecule of the pathogen called an antigen
what do antibodies form from and what do they do
form gamma globulin part of the blood proteins
they inactivate antigens through various mechanisms
examples of immunogobulins/antibodies
IgG
IgA
IgM
IgD
IgE
function of IgG
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
function of IgM
dominates in primary immune responses
mediates type II reactions
function of IgE
mediates type I reactions
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
IgG
dominates in primary immune responses
IgM
describe the development of immunogobulins/antibodies
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
describe the primary immune response
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.
describe the secondary immune response
if the same antigen is encountered again the memory cells facilitate a faster and more effective immune response
what is the difference between the primary and secondary response
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
IgM dominates the primary response, while IgG dominates the secondary.
true
The primary response relies on memory cells formed during the primary response.
false
secondary respnose
Immunity can be either
natural or artificial
innate or acquired/adaptive
active or passive
Active natural
Develops slowly, is long term, and antigen specific
(contact with infection)
Active artificial
Develops slowly, lasts for several years, and is specific to the antigen for which the immunization was given
(immunization-vaccines)
Passive natural
Develops immediately, is temporary, and affects all antigens to which the mother has immunity
(trans-placental mother-to-child)
Passive artificial
Develops immediately, is temporary, and affects all antigens to which the donor has immunity
injection of gamma globulin
they offer active artificial immunization and aim to teach the body’s immune system to recognize and block viruses
vaccines
how do vaccines work
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
how do covid vaccines work
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
key benefit of mRNA vaccines
they train the IS to fight the virus w/out causing an actual infection or illness
target cells in the immune system for immediate-type reactions
mast cells & basophils (WBCs)
what are mast cells
found in connective tissue
part of the IS and contains granules rich in histamine & heparins
what is heparin
anticoagulant to prevent blood clots
what is histamine
chemical used to fight infections
what happens if histamine is released in the body inappropriately or in too high quantity
causes an allergic reaction
takes 7-10 days of sensitizing exposure for mast cells and basophils to both to become primed with IgE antibodies
true
what is an allergic cascade
complex and rapid series of reactions that results in the symptoms of an allergic reaction
explain the process of an allergic cascade
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.
what is the immediate hypersensitivity reaction
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.
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.
true
type I allergic reaction
mediated by IgE
most severe types of reactions
e.g. anaphylaxis, asthma symptoms & dermatitis
type II allergic reactions
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
Type III allergic reactionsmediated by IgG
mediated by IgG
e.g. arthralgia (muscle/join pain) and fever
lymphadenopathy - swollen lymph nodes
What is anaphylaxis and its effects on the body?
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
how does anaphylaxis work
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
common causes of anaphylaxis
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
what makes you at risk for anaphylaxis
hx of any type of allergic reaction
for some it appears with no known cause usually because first exposure causes mild/no symptoms
during anaphylaxis, tissues in other parts of the body release histamine and other substances causing airways to tighten and leads to other symptoms like
abdominal pain
anxiety
dizziness
skin redness, hives, itchiness, pale & blue skin
slurred speech
nausea/vomiting & diarrhea
swelling of face, eyes and/or tongue
some drugs can cause an anaphylatic like (anaphylactoid) reaction when people are first exposed to them
true
what are examples of an anaphylactoid reaction
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
symptoms & risk of complications and treatment are the same for both anaphylaxis and anaphylactoid
true
treatment for anaphylaxis
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
anaphylactoid or an anaphylaxis/anaphylactic shock is an EMERGENCY medical condition
true
difference bw anaphylaxis and anaphylactoid
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).
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.
anaphylaxis
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.
anaphylactoid
what is a teratogen
any substance, organism, or physical agent that can cause developmental abnormalities or birth defects in a developing embryo or fetusf
Teratogens can interfere with normal development, leading to congenital malformations or functional deficits that can manifest at birth or later in life.
true
drug examples of teratogens
isotretioin (accutane) for severe cystic acne (99% teratogenic)
thalidomide - first used as a sedative and used to treat nausea in pregnant women
side effects of thalidomide in offspring
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
what causes teratogens
drugs
infections
environmental factors
infection examples of teratogens
rubella (german measles)
symptoms of rubella
causes significant HL, heart, neurological and eye defects
environmental examples of teratogens
radiation
radiation effects on babies
can cause miscarriage, birth defects, intellectual disability, intrauterine growth retardation and childhood cancers like Leukemi
when will the FDA approve teratogenic drugs
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
what is the new Pregnancy & Lactation Labeling Rule (PLLR - Final Rule June 2015)
improves the risk vs benefit assessment of drugs used for pregnant and nursing moms
what are the 3 main category recommendations of PLLR
fetal risk summary
clinical considerations
data
describe PLLR fetal risk summary
Characterizes the likelihood, from both human and animal data, that a drug increases the risk of four types of developmental abnormalities
what are the 4 types of developmental abnormalities of the fetal risk summary
Structural anomalies, fetal and infant mortality, impaired physiologic function, and alterations to growth
describe clinical considerations in PLLR
Discussing fetal risk from inadvertent exposure and prescribing decisions based on drug effects on labor, delivery, and fetus
describe data in PLLR
Detailed discussion of available data; human data appears before animal data
human genome contains _______ billion nucleotides making up ~ 25,000 genes that may encode > 100,000 proteins
~ 3
what is pharmacogenomics
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
specific proteins in the body that drugs bind to in order to exert their effects and are common across the population,
drug target receptors
most people have drug target receptors in similar forms, allowing drugs to work as intended for most individuals.
true
genetic differences can be highly significant for the success or failure of drug therapy
true
describe how genetic variations or polymorphism in a gene encoding receptors affects the success or failure of drug therpy
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.
Human genomes are ~ _____% identical regardless of race, ethnicity, or geographic region
99
If one nucleotide in a specific position is exchanged with another nucleotide, the alteration is referred to as
Single nucleotide polymorphism or SNP (pronounced “SNIP”)
Majority of nucleotide variations are
SNPs
what do SNPs do
can affect protein amount or function by altering coding sequence of transcription or mRNA translation, which could be pharmacologically important
Other variations (mutations) include
Insertions, deletions, duplications, and translocations of one or more nucleotides or even entire chromosomes
common in major enzymes that metabolize phase I and II reactions
genetic polymorphisms
benefits of pharmacogenomics
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
Development of drugs to accurately target specific diseases based on genetic information resulting in
improved therapeutic effects
decreased damage to healthy cells
Pharmacogenomics could facilitate the creation of personalized drug therapy resulting in greater safety and efficacy of drugs
true
Cytochrome P450 (CYP) liver enzyemes metabolize _____ classes of drugs
> 30
clinically significant polymorphisms are in
both phase 1 (CYP family of enzymes) and phase II liver enzymes
what is the effect of clinically significant polymorphisms
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
insertion
addition of nucleotides into DNA sequence
deletion
segment of DNA is removed from a chromosome
duplications
segment of DNA is copied one or more times in the genome resulting in multiple copies of the same genetic material within a chromosome
translocations
one or more nucleotides or even entire chromosomes
Genetic Polymorphisms
common in major enzymes that metabolize
phase I and II reactions
example of genetic polymorphism
: inherited variation of enzymatic hydrolysis of the short-acting muscle relaxant, succinylcholine by the enzyme serum cholinesterase
1 in ~ every 2000 ______ has a genetic alteration of the plasma enzyme serum cholinesterase
Caucasians
what is the function of the enzyme serum cholinesterase
to metabolize the muscle relaxant succinylcholine (given IV with general anesthesia)
The altered enzyme has a 1000 fold decreased affinity for succinylcholine, causing
Decreased metabolism, slow elimination, & prolonged circulation
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
succinylcholine
what is succinylcholine
a muscle relaxant commonly usedd in anesthesia
produces antigen-specific antibodies and primarily driven by these cells
humoral immunity (b cells)
doesn’t depend on antibodies for its adaptive immune functions and primarily driven by mature T cells
cell mediated immunity (T cells)
