Week 7 Flashcards
what should all patients be asked regardless of how much they smoke?
asked about their interest in quitting assessed if they are nicotine dependant, offer appropriate pharmacotherapy advised to quit offered referral to proactive telephone callback cessation service
smoking cessation guidelines?
ask and assess assess nicotine dependance by asking: - minutes till first cigarette after waking? - how many cigarettes a day? - withdrawal symptoms/ cravings in previous quit attempts?
some symptoms of nicotine withdrawal?
irritability insomnia anxiety poor concentration dysphoria/ depressed
NRT clinical suitability?
everyone, including CVD
varenicline clinical suitability?
not for children not in pregnancy not in people with psychiatric disorder decrease dose in renal impairment
bupropion clinical suitability?
not for current/ past seizures do not mix with drugs that lower seizure threshold not in concurrent monoamine oxidase inhibitors
moa of dependance and withdrawal of opiates?
increased mu opioid receptor internalization and degradation decreased officiation of u-opioid signal transduction hyper activation of adenylyl cyclase signalling = enhanced GABA release and increased gene transcription via activation of transcription factors
onset/ duration of withdrawal for opiates?
heroin onset= 8-24 hrs, duration= 4-10 days methadone onset = 12-48 hrs, duration= 10-20 days
withdrawal scale for opiates?
COWS, SOWS
substitution therapies for opiates?
clonidine buprenorphine methdone
opiate substitution: AIMS
decreased spread of BBV decrease injection related harms decrease crime rates improve engagement in tx
how does naloxone help with constripation?
binds to u opioid receptors in the gut
risk of opiates?
OD, respiratory depression, miscarriage risk in withdrawal, IVDU related harms leukoencephalopathy (smoked heroin)
risk mitigation of opiates?
avoid use in chronic pain lowest dose for shortest time avoid combination with other CNS depressants
which drug class can kill in intoxication and withdrawal?
benzodiazepines
withdrawal scale used for benzos?
CIWA-B
onset and duration of withdrawal for benzos?
short acting:1-2 days; 2-7 days long acting: 2-4 weeks; 2-8 weeks
what is common mucosal immune system?
priming of lymphocytes i none mucosal tissue can induce protective immunity at other mucosal surfaces important in vaccine development
which lymphocytes are found in the GALT?
gamma-delta T cells CD8 alpha/beta T ell CD8 alpha/alpha T cells
function of J chain?
attaches poly-Ig receptor and is responsible for transporting both IgA and IgM across epithelial surfaces into lumen
what is oral tolerance?
a state of systemic hypo responsiveness induced by feeding protein
how does an immune response cause MS?
T cells recognize myelin epitopes and activate macrophages to damage myelin by phagocytosis cytokines and toxic mediators released by T cells, microglia and macrophages cause myelin damage autoantibodies through binding to myelin and activating complement facilitate phagocytosis mediated by macrophages
effects of estrogen and progesterone on immune response?
estrogen stimulates immune response progesterone dampens immune response
how are NKC involved FRT?
host defence, implantation and pregnancy
what does seminal fluid contain?
TGF-B, spermidine, PGs = other mediators with inhibitory unction on NKC, lymphocyte and complement function
what MHC class do trophoblasts express?
modified; HLA-G
3 strategies for the survival of conceptus?
reduced or modified transplantation Ag expression on trophoblast: don’t express classic MHCI modulation of maternal immune system to protect fetus from recognition, attack and suppression placenta is a bbarrier through which maternal effector lymphocytes cannot act
grading system for BrCa?
nottingham grading system
grading system for prostate cancer?
gleason scoring system
what are the recommendations for genetic testing for hereditary cancer syndrome?
personal/ Fhx medical history that indicates inherited cancer risk test results can be adequately interpreted results provide info that will help guide medical care
what is tumour grading?
histopathological description of tumour cells
what is tumour staging?
the extent of cancer provides prognosis and tx plan
what are some methods for laboratory detection of neoplasia?
H&E staining immunocytochemistry to confirm tumour histogenesis and subtype gene profiling techniques
what are some examples of tumour marker?
alpha-fetoprotein PSA - PrCa and benign prostatic hyperplasia hCG carcinoembryonic Ag - colorectal cancer CA125 - ovarian Ca Ca15-3 - evaluate effect of tx in advanced BrCa
what are paraneoplastic syndromes?
tumour associated syndromes where symptoms are not directly related to tumour or local hormonal
what cells are in the lamina propria?
lymphocytes, DC, mast cells, macrophages, plasma cells, neutrophils etc
how do integrin antagonists work in IBD?
inhibit a4b7 from binding to MADCAM1 in the intestines
what controls class switching of B cell to IgA?
TGF-B
key things about the brain endocrine immune system interactions:
immune responses are heavily regulated from the outputs of the CNS T cells under this influence and these mediators can change he type of immune response we have
role of PGE2 in pregnancy?
potent suppressor of both antigen presentation and T cell expression of IL2
how is innate immunity enhanced in pregnant women?
increase number of peripheral blood monocytes and granulocytes increased expression of Fc receptor on macrophages = increased phagocytosis increased concentration of estrogen = enhanced macrophage phagocytic activity
some symptoms of cannabis withdrawal?
anger, aggressive, irritiable sleep disturbances (strange dream) anxiety, nervousness decreased appetite restlessness
what is the use for immunocytochemistry?
to confirm tumour histogenesis and subtype o eg routine IHC evaluation of estrogen receptors & progesterone receptors and HER2 expression, Ki67 expression o prognosis and the selection of anti-cancer treatments
molecular diagnostics of neoplasia?
• molecular histopathology using in-situ hybridization techniques • gene profiling technology
