TIN Flashcards
nsaids m of a and side effects
inhibit cox enzymes - reduce PG, thromboxanes - mediating pain. cox1 - side effects, cox 2 therapeutic.
adverse - dyspepsia, nausea and vom, CV, renal, nephro, bronchospasm
corticosteroids and side effects
glucocorticoid intracellular receptor bind - trigger gene process - inhibit genes for CK, Th, fibroblast, osteoblast, COX2, NO, histamine, IgG.
reduced response to infection, osteoporosis, hyperglycaemia, muscle wasting, CNS efect.
osteoarthritis explain
degenerate joint disease - non-inflammatory affecting weight bearing jts, loss of articular cartilage and forming thick subchondral bone, wear and tear factors. factors include pain, jt stiffness, joint deformation, reduced range of motion
explain rheumatoid arthritis
autoimmune causing swollen painful joints due to inflammation of synovium and erosion of cartilage and bone.
5-aminosalicylates
scavenge toxic oxygen metabolites produced by neutrophils. side effects are gi, malaise, headache
TNF alpha antagonists
bind to TNF alpha and inhibit- inhibiting leukocyte migration. adverse - infection, injection reaction, headache, autoantibody, malignancy, lymphoproliferative.
Rituximab
Anti CD20 monoclonal antibody.. bind to CD20 on B cell and lyse. adverse is infection, muscle pain, weakness, infusion
Abatercept
bind to CD80/86 on APC. Prevent full T cell activation and reduce cytokines. adverse effects - infection, infusion and malignancy.
methotrexate - 2 mechanisms explain
for anti-inflammatory, inhibits enzymes in purine metabolis - increasing adenosine thus inhibit T cell, B cell. for RA. teratogenic. for cancer, inhibit dihydrofolate reductase reducing tetrofolate and interfere with DNA synthesis.
explain gout
increased plasma urate - painful intermittent arthritis due to accumulation of sodium urate in synovial jts, inflammatory response leads to neutrophils etc. in the joint .- release ros and proteolytic enzymes
colchinine
inhibit neutrophil migration, chemotaxis, adhesion and phagocytosis.
integrin antagonist
IgG monoclonal antibody - against alpha4beta7 integrin on leukocytes. inhibit T cell adhesion to MADCAM in GI and preventing GI inflammation
leukotriene receptor antagonist
leukotriene cysL1 antagonist, blocking leurkotrienes in lung and therefore reducing bronchoconstriction.
pyridamine.purine analogue (fluorouracil)
inhibit thymidylate synthetase- false nucleotide inhibiting synthesis
alkylating agents and platinum compounds
produce reactive chemical groups forming covalent bonds with DNA, can form cross bridges.
vinca alkaloids
bind to B tubulin and prevent polymerisation
taxanes
freeze microtubules in non-functional polymerised state
topoisomerase 1 inhibitors
inhibit this, accumulation of breaks and cell death (this enzyme enables supercoiled DNA to uncoil, replicate, repair and transcribe)
anthracyclines
intercation of DNA, top 2 inhibition 0 accumulation of dna breaks
podophyllotoxins
top 2 inhibition
antiandrogens
inhibit competitively androgens at receptors - cytoproterone has prostegerone effects reducing testorernce but does cause impotence, flushes, reduced libido
gnrh analogue
inhibit this secretion from pituitary long term
aromatase inhibitors
aromatase converts androstenedione and testosterone to estriol and estradiol, but this causes hot flush, vaginal dry, weakness, headache. not before menopause.
serms (tamoxifen)
compete with oestrogen for receptor. anti-oestrogen can be cardioprotective, can agonise elsewhere
TK inhibitors
involved in signalling in proliferation - angiogenesis, invasion, metastasis, small molecules all end in ib
mTOR inhibitors
inhibit growth pathways - inhibiting angiogenesis, tumour cell proliferation and growth.
trastuzumab ipilimumab cetuximab bevacizumab rituximab nivolumab
HER 2 antibody Bind to CTLA4 - prevent inactivation of T cells. Anti EGFR antibody Anti VEGFR antibody CD20 antidody - lyse abnormal B cells anti PD1 - stop rpogrammed death of CTLs
risk factors breast cancer
age, female, family, oes exposure, OCP, HRT, obesity and alcohol
3 types of breast cancer best to worst
ER+ve, HER2 -ve
HER2+ve
Triple negative
how does breast cancer present
screening, palpable mass, skin tenderness
investigations for breast cancer
mammogram, ultrasound, core biopsy, histopathology.
Rx for breast cancer
Early - surgery, radiotherapy. can give targeted therapy, chemo usually only if young high grade. locally advanced need neoadjuvant chemo first. metastatic just symptomatic relief.
3 types of NSCLC and explain
adenocarcinoma - most common from mucosal cell of bronchial epithelium
squamous cell carcinoma - more aggressive
large cell - more undifferentiated
where do SCLC come from and how present
system disease, from neuroendocrine cells.
presentation of lung cancr
dry cough, haemophytis, wheeze, recurrrent pneumonia and dyspnoea.
Ix for lung cancer
chest x ray, CT and abdo,
Rx lung cancer
sc: limited chemo and radiation
nsc: surgery, chemo if sprad to lymph nodes
progression of GI cancer
normal -> dysplasia -> polyp -> invasion to submucosa.
Cx of bowel cancer
change in bowel habits, anaemia, rectal bleed, bowel obscturction
Ix bowel cancer
colonoscopy, biopsy, CT abdomen.
Rx bowel cancer
early - surgery, locally advanced - surgery and neoadjuvant chemo, stage 4 is incurable but can do chemo
how does radiotherapy work
breaking bonds in DNA - cell chekcpoints then kill
adverse effect of radiotherapy
local tissue damage in fast turnover - GI, BM, epidermis, tissue damae to non-proliferating more serious. fibrosis, scarring, telangie.
how to pronounce death
- look and listen to breath for 2 mins, 2, listen to chest for 2 mins, listen to heart for 2 mins, feel for pulse, light in pupils, response to pain, re-check ID.
signs of hereditary cancer
successive generations, younger age, multiple cancer, both organs, not usually in that gender.
why genetic counselling
guide treatment, inherited cancer risk, can be interpreted
explain grading and srtaging
Graded on differentiation GX, G0-G4
TMN staging Tx,0-4 on size, Nx,0-3 on lymph nodes, Mx,0-1 on metz. can be collated to stage 0-4.
side effect of cytotoxic antineoplastics
myelosuppression, reduced wound healing, alopecia, GI damage, sterility, teratogenicity
