Term4 wk1 lecture 6 on inflammation Flashcards
Boils, furuncles, and abscess are example of the following inflammation:
a. fibrinous inflammation
b. inflammatory inflammation
c. suppurative inflammation
d. serous inflammation
c. Suppurative inflammation.
An exudate consisting of large numbers of neutrophils, liquefied debris of necrotic cells, and edema fluid.
Of the following cell derived mediators, which of the following are secreted by platelets.
- Leukotrienes
- serotonin
- Histamine
- Prostaglandins
Answer:
2. and 3.
Which of the following inhibits platelet aggregation and causes vasodilation
- Cox1
- PGl2
- TXA2
- PGE2
- Prostacyclin PGL2 inhibits platelet aggregation and causes vasodilation and has opposite effect of TXA2. Both TXA2 and PGL2 are derivative of Cyclooxygenases.
How can we stop Arachidonic acid its derivatives.
Steroid administration can stop Phospholipases, which in turn, will stop Arachidonic acid and its derivatives.
Why drugs with short half lives can be given once a day?
This is because of the high initial concentration in relation to the EC50.
initial dose has a higher effect that last longer, regardless of the short half life.
E = Emax xC/C+Ec50
What happens to the effect, if you double the dose ?
a. Double the plasma concentration
b. triple the effect.
c. Prolong the effect by one half.
d. A + C
e. B+C
D
Doubling the dose will double the drug plasma concentration.
• Therefore, doubling the dose will prolong the drug effect by one half-life.
A patient c/o lethargy, wt gain, and generalized swelling. She is found to have TSH of 164 (NL: 0.03-5). Pt is given 75 mg IV levothyroxine with half life of 9 days. which of the following represents, doubling the IV dose to 150 microgram affecting plasma dose and half life
a. double the increase in drug plasma conc with double the half life duration.
b. Double the increase in plasma concentration with no change in half life.
c. Double in plasma concentration with prolonging the drug effect by one half life.
d. since it is IV drug, no change in half life or drug conc.
C. Doubling the dose will double the drug plasma concentration.
• Therefore, doubling the dose will prolong the drug effect by one half-life.
What cells can cause freckles a. dermal macrophages b. basal keratinocytes c. Melanocytes only. d. A+B E. C +B
D:
Although melanocytes are the only source of melanin, adjacent basal keratinocytes in the skin can accumulate the pigment (e.g., in freckles), as can dermal macrophages.
Melanin can be stored by other cells (freckles), nevus cells, melanophages
A 79 y/o male with PMH of dementia, died after falling from 3 feet stair case. Heart biopsy showed brown pigmentation, most likely represents:
- Hemochromatosis
- lipofuscin
- saponification
- hemosiderosis
Answer: Lipofsucin granules: old age related.
Old age people!
58 y/o retired nurse with no PMH presented to the office c/o right toe pain x 1 day. She reports that she woke up with a swollen toe with redness x 1 day. She denies fever, chills, n/v, any fall, or trauma. She admits applying topical OTC antibiotics without any relief. She admits to high protein diet and heavy ethoH intake, since she has recently retire and has been celebrating her retirement. PE: right toes: swollen and red. Tender to touch. vitals: T = 37 degrees, HR: 67, BP: 131/67, R 18. Labs: creatine 1.2, WB 11. serum Uric acid level: 800 mg. Upon needle aspiration of the right toe, negative bifirenges noted:
Which of the following is not clinical presentation.
a. Gout
b. Pseudogout only
c. septic arthritis.
d. b+C
D.
The patient has gout.
why do most drugs follow first order kinetics?
a. Enzymes and sites are saturated.
b. plasma concentration is well below Km ( conc. of drug to saturate half of the receptors).
c. Because the initial concentration are high
B.
CL = Vmax x C/Km, since Km is always very high, c can be ignored.
Clearance: Vmax/Km; concentration is less than Km and can be ignored.
Rate of elimination = clearance x conc.
Does increasing the infusion rate, double the steady state when compared to doubling the infusion rate.
a. yes
b. no
Doubling the infusion rate doubles the Css. • But increasing the infusion rate does not influence the time required to reach Css.
Which of the following would decrease half life
a. heart failure
b. obesity
c. cyp induction
d. Cyp inhibition.
c.
Cyp induction will increase metabolism, thus decreasing half life of the medication.
what is saturation kinetics?
a. when Km is less than conc.
b. When Km exceeds Con.
c. When km equals Conc.
d. when Km is linear.
a.
When km is less than the concentration. When drug concentration exceeds Km, nonlinear kinetics is observed.
Zero order elimination.
Which of the following is zero order Elimination?
a. constant amount of drug elimination regardless of the dosage concentration.
b. constant fraction of the drug eliminated regard to the drug dosage.
c. Constant drug amount regard to the dosage concentration.
a.
The rate of elimination is maximal and independent of drug concentration.
• Elimination is zero-order.
• A constant amount of drug is eliminated per unit time.
• Recall that in first-order kinetics a constant fraction of drug is eliminated per unit time.
54 y/o comes in c/o generalized edema, with SOB and chest pain x1 wk. Diagnostics: CXR showed left sided pleural effusion. Echo showed pericardial effusion. A repeat fat pad bx showed amyloidosis with the evidence of having apple green biferingence on polarized light, after congo staining with red. Which type of amyloidosis possibly the pt have.
a. AL amyloidosis
b. AA
c. B2 Amyloid and B2 macroglobulin amyloidosis
d. all of the above.
e not enough information.
E.
46 y/o female with PMH of DM, HTN, and obesity presented with hypocalcemia; a thyroid nodule bx confirmed medullary ca of the thyroid, in addition tumor cells noted to be in amyloid background.
a. AL amyloidosis
b. AA
c. B2 Amyloid and B2 macroglobulin amyloidosis
d. all of the above.
e not enough information.
f. A calcitonin precursor protein
f.
Which of the following types of Amyloidosis are not inherited and are due to abnormal accumulation of the normal protein aggregates.
A. Systemic senile amyloidosis
b. Lambda amyloidosis (AL)
c. Familial Mediterranean fever.
B.
Multiple myeloma is an example.
Does GI tract contributes towards first pass ?
a. yes
b. yes
a. Yes. Liver is the site of metabolism, but GI track can contribute towards first pass.
Other organs that contribute toward drug metabolism, include skin, liver-of course, GI track, lungs, and kidneys.
Where do first pass reactions occur?
a. Golgi bodies,
b. nucleus,
c. Lysozymes.
d. ER
e. mitochondria.
D. ER
First pass reactions occur in smooth ER and Second phase reactions occur cytoplasm.
Which of the following correct sets of medications that are inducers of P450
a. phenobarbital, rifampin, ampicillin, carbamazepine.
b. Phenobarbital, metronidazole, ampicillin.
c. Phenobarbital, rifampin, carbamazepine, St. Johns Wort
d. Tylenol, phenobarbital, rifampin.
c
Inducers increase metabolism and as a result lower the plasma concentration.
Foreign substances that can enter the cell, similar to steroid action, can activate the transcription machinery and make a desired toxic or non toxic cellular product.
a. peroxisomes,
b catalysts
c. xenobiotics
d. probiotics
C. Xenobiotics.
They come in to the cell and take dictate the transcription.
Go to ACE and GET a Key Chain: Pneumonic made by Aisha for P450 Inhibitors or Inducers?
Amiodarone C: Cimetidine E: Erythromycin G: grape fruit K: Ketoconazole C: chloramphenicol
P450 Inhibitors!
Will metabolize drug slowly, can have toxic levels of the drug in the blood.
Would rifampin induce or inhibit P glycoprotein
Yes you are correct!
It will induce P 450 as a result, more drug in the plasma and less in the intestinal cells for absorption.
REMEMBER:
All P450 inducers ALSO INDUCE P GLYCOPROTEINS.
Which of the following sets of medications are not inducers of P glycoproteins.
a. Macrolides, ketoconazole
b. Macrolides mostly
c. grapefruit
d. B+C
e. None of the above
D
MACROLIDES ARE INHIBITORS OF P Glycoprotein.
when given with digoxin, digoxin is not kicked out into the lumen and is absorbed with high levels in the blood.
Grapefruit juice inhibits both CYP3A4 and P-glycoprotein in the small intestine.
In Tylenol poisoning, sulfation and gluconation:
a. Phase I
b. Phase II reaction c.
or both.
Phase II.
Using CyP2E1 reaction. Same enzyme used for alcohol.
Which of the following are toxic metabolites in Tylenol Over dose (OD).
a. glucornate
b. N-acetyl benoquinoneapine (NAPQ)
c. Marceptopuric acid.
b.
Hurry…..Need glutathione to convert NAPQ to Marceptopuric acid; Drug of choice is NAC.
if severe, call transplant center!
A pesticide handler, who is obese with a 40 PPY smoking history wants to lose weight. He admits to you that he eats a lot barbecue meat with cauliflower rice. and likes to barbecue his meat like dark. You recommend, since he is 450 pounds, a weight loss medication that gets metabolized via P450 pathway.
Would you consider higher dose of this medication, with the above risk factors or a lower dose.
. (don’t laugh-answer correctly).
Higher/ lower dose?
Higher dose, since he has all the risk factors that lead to induction of P450, quickly metabolizing the drug.
Good luck with the weight loss; may be better than fasting.
Aromatic hydrocarbons in cigarette smoke cause AhR-mediated P450 enzyme induction. • Charcoal-broiled foods and cruciferous vegetables induce CYP1A enzymes. • Industrial workers exposed to some pesticides metabolize certain drugs more rapidly than non-exposed individuals
Glomerular filtration is affected by which of the following?
a. Pressure, PH, Lipophilicity
b. Pressure, small molecules (<20,000 D), Hydrophilicity
c. PH, Lipophilicity
b
PH and Lipophilicity do not affect glomerular filteration but they do affect reabsorption.
function of Laminin and fibronectin are following:
a. connect the cells and the ECM together.
b. connect the ECM component together
c. give signals for differentiate and proliferation.
e. all of the above
f. none of the above.
e. a and b only
e. all of the above.
GAG and Protoeoglycan:
a. have negative charge, store steroids type growth factors
b. store growth factors.
c. make up ECM and have negative charges, store growth factors.
C.
Which cells have tendency to proliferate and differentiate.
a. skin (labile), liver (stable)
b. skin only
c. neuron ( permanent
d. Gi track (labile)
a.
stable cell do not have stem cells but can come out of the G0, if need be, like liver cells.
the Liver, kidney, pancreas, endothelial cells, fibroblasts and smooth muscle cells • Have a limited capacity to regenerate after injury except for the liver
which of the following is strongest stimulus for growth factors
a. Hypoglycemia
b. Hyperglycemia,
c. ischemia,
d. hypoxia
c. Ischemia.
Ischemia is a strong stimulus for vascular endothelial Growth Factor (FEGF)