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117 Cards in this Set

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In Lipophilic Toxicant Metabolism - in what phase does hydrolysis, reduction, and oxidation take place
phase 1

a primary metabolite (reactive electrophilic) is produced. e.g oxygen free radicals
In lipophilic toxicant metabolism the primary metabolit may undergo a phase II reaction which involves
confugation with endogneous substrate yielding a secondary metabolite

e.g glucuronidation, sulfation, methylation, conjugation
benzoapyrene metabolism in lung, skin tumors involves what PHASE I reaction
cytochrome P450-dependent monooxigenase system

other E.g of Phase 1
1. flavin-containing monooxygenase system involving nicotine in the liver
2. peroxidase-dependent cooxidation of 2-napthylamine and the link to bladder cancer
napthylamine's second metabolite which is excreted in urine and linked to bladder cancer has under gone
glucuronidaiton

(Phase II reaction)
another example: is glutathione conjugation leading to vinyl chloride (secondary metabolite) leading to angiosarcoma of the liver
Minamata disease
named after minimata Bay - mercury fish were allowed to be caught and consumed

Mercury under went a phase II biomethylation and bioaccumulated
Toxic effects depend on what five things
1. Genetic variations in enzyme acitivity
2. predominant pathway
3. nutritional/hormonal status
4. exognenoug substances
5. repair pathways
the acute nicotine effects are via
catecholamines

increase HR, BP, CBF, contractiligy, CO
mobilization of free fatty acids, addiction
what effect does tobacco have on the fetus
fetal hypoxia
why might tobacco cause acute respiratory tract infections
ciliatoxins and irritants
what effects does ethanol have on the CNS
it acutely depresses
what are the chronic effects of ethanol
systemic effects, vitamin deficiencies
what is the blood alcohol content which may cause ataxia
drowsiness
stupor
death
ataxia 100mg/dL
drowsiness 200
stupor 300
death 500
what is the elimination rate for ethanol
9 gm ETOH per hour

10% in urine, seat, breath, 90% metabolized to acetaldehyde
tolerance to alcohold due to the induction of
cytochrome p450 CYP2E1
why might asian populations might have a distinct reaction to ethanol
reduced activity of aldehyde dehydrogenase

women have lower levels of alcohol dehydrogenase
what are the 4 main mechanisms for the development of a fatty liver due to consumption of alcohol

note: this fatty liver is acute, asymptomatic, and reversible
1. increased catabolism peripheral fat
2. increased NADH for lipid synthesis
3. Decreased fatty acid oxidation in Mitochondria
4. decreased transport lipoproteins from liver (microtubule dysfunction)
in acute alcoholic hepatitis what are three pathological characteristics
1. necrosis
2. PMNs
3. Mallory's hyaline

acute alcoholi hepatitis is symtpomatic and reversible
5 mechanisms of direct toxicity in acute alcoholic hepatitis
1. glutathione depletion
2. mitochondrial injury
3. altered methionine metabolism
4. cytokine release from Kupffer cells
5. Hypoxia
10% to 15% of alcoholics develop cirrhosis of the liver what are some symtoms
path: hard, shrunken liver

pt may be weak, wasted, ascites, GI bleed, coma
Wernicke syndrome
due to alcohol via thiamine deficiency. ataxia, cognition, opthalmoplegia, nystagmus
Korsakoff syndrome
due to alcoholism
via toxicity and thiamine deficiency
memory loss
protective effects of alcohol
increased HDL
decreased platelet aggregation
effects of alcohol on cardiovascular system - negative
hypertension due to catecholamine release
dilated cardiomyopathy
most common preventable cause of Mental retardation
fetal alcohol syndrome

growth retardation, microcephly
barbiturates and benzodiazepines are what kind of drugs
sedative hypnotics
aphtamines are toxic to what kind of neurons
serotonin
what are some symtoms of acute intoxication with amphtamines
sweating, tremors, restlessness, confusion, delirium, convulsions, coma death
alkaloid extracted from leaves of erythroxylon coca
cocain

crack cocaine is a freebase cocaine
chronic abuse of cocain leads to
insomnia, anxiety, paranoia, hallucinations
what happens with an overdose of cocain
seizures, cardiac arrhythmias, respiratory arrest
what is cocainse's mechanism
blocks reuptake of dopamine, serotonin, catecholamines in presynaptic terminals
when cocaine blocks the reuptake of dopamine - the resulting symptoms are
eurphoria, paranoia, hyperthermia
when cocaine blocks the reuptake of NE causing NE to bind the adrenergic receptor more the resulting symptoms are

(name 3)
hypertension, caridac arrhythmia, myocaridal infarct, cerebral hemorrhage and infarct
why does cocain accelerate atheroslcerosis
1. enhanced platelet ativation/ aggregation
2. increased PAI
3. increased endothelial permability
heroin, codeine, morphine are what kind of drugs
opioid narcotics
the side effects of these types of drugs are anxiolytic, sedation, mood changes, nausea, and respiratory depression
opioid narcotics
an overdose on opioid narcotics results in what
convulsions, cardiorespiratory arrest, death
these drugs may lead to infection (IVDA)
opioid narcotics

skin, subcutaneous, heart valves (staph aureus), liver (viral hepatitis), lungs
most common preventable cause of Mental retardation
fetal alcohol syndrome

growth retardation, microcephly
barbiturates and benzodiazepines are what kind of drugs
sedative hypnotics
aphtamines are toxic to what kind of neurons
serotonin
what are some symtoms of acute intoxication with amphtamines
sweating, tremors, restlessness, confusion, delirium, convulsions, coma death
alkaloid extracted from leaves of erythroxylon coca
cocain

crack cocaine is a freebase cocaine
chronic abuse of cocain leads to
insomnia, anxiety, paranoia, hallucinations

overdose: seizures, cardiac arrhythmias, respiratory arrest
what is cocainse's mechanism
blocks reuptake of dopamine, serotonin, catecholamines in presynaptic terminals leading to eurphoria, paranoia, and hyperthermia
why does cocain accelerate atheroslcerosis
1. enhanced platelet ativation/ aggregation
2. increased PAI
3. increased endothelial permability
heroin, codeine, morphine are what kind of drugs
opioid narcotics
the side effects of these types of drugs are anxiolytic, sedation, mood changes, nausea, and respiratory depression
opioid narcotics

drugs may also lead to infection - skin, subcutaneous, heart valves (staph, liver (liver hepatitis, lung etc..
an overdose on opioid narcotics results in what
convulsions, cardiorespiratory arrest, death
PCP and LSD are examples of what kind of drugs
chemical hallucinogens
Marijuana is an example of what kind of drug
natural hallucinogen
marijuana's active ingredient is
THC
chronic use of marijuana may induce
lung damage (not a carcinogenic)
5% of all drugs are metabolized by
CYP1A2
and 12% of caucasians have variants with reduced activity
oral contraceptives/ HRT have increased risk of
stroke
MI (smokers over 35)
thrombosis/PE
breast cancer (HRT)
endometiral cancer (HRT
ADR
Adverse Drug reactions
for what cancer is OCP protective

(contraceptives)
endometrail and ovarian
what is the therapeutic dose of acetaminophen
.5 gm
at what does dose acetaminophen yield hepatic necrosis
15-25gm
what is the acute toxic dose of aspirin

what does it cause
2-4 gm kids / 10-30 gm adults

respiratory alkalosis then metabolic acidosis
the chronic toxicity of this drug leads to acute erosive gastritis, petechiae, renal papillary necrosis
aspirin
what is the dose of aspirin that may cause chronic toxicity
3+ gm per day
why does aspirin cause petechiae
COS inhibition
radioactive decay product of uranium emits radiation associated w/ lung cancer
radon
colorless odorless gas w/ 200x affinity for Hb
carbon monoxide
absorption of lead is enhaced by
calcium/iron, and zince deficiency

greater in children (80-85% in bone and teeth, 5-10% in blood, rest in soft tissue)
how does lead lead to hypochromic anemia
via the inhibition of iron incorporation into heme
how does lead affect CNs
inverse correlation between IQ and blood lead level
how does lead affect Gi tract and kidneys
lead colic and renal failure


inhibits membrane associate enzymes
lead impairs the production of what vitamin
active vitamin D
how does lead influence reproduction
infertility, delayed puberty, fetal toxicity
organophosphates (type of insecticide irreversibly inhibit
cholineresterases
carbamates
reversibly inhibit cholineesterase
agent orange is
a dioxin (TCDD) and herbicide

which is carcinogenic an teratogenic, and immunotsuppressive
aflatoxin B1 a mycotoxin has been linked to
liver cancer
the phytotoxin cycasin has been linked to A
ALS
saxitoxin is a natural toxin linked to
paralytic shellfish poisoning
body surface area burned effects outcome how
20% BSA = shock
over 50% = death
BSA re burns refers to
Body surface area
head = 9%
neck = 1
arm = 9 each
trunk = 18 each side
leg = 18
1st degree burn means
partial thickness burn through epidermis only
2nd degree burn
partial thickness through epidermis and superficial dermis
full thickness burns (3rd and 4th degree characteristics?
dry, white, or charred
toatl destruction of epidermis and dermis
20% BSA burned leads to
increased local intersitial osmotic pressure and increased vascular permeability
inhalation injury due to smoke may be delayed how long
24 -48 hours
how does 40% BSA affect metabolic rate
doubles metabolic rate and
why might you get heat cramps
voluntary muscles cramps do to electrolyte imbalance do to exertional sweating
what are the three steps on your way to hyperthermia
1. heat cramps
2. heat exhuastion - (prostraiton and collapse do to hypovolemia do to water depletion do to seating w/ inadequate fuid replaement - normal core temp
3. heat stroke
three groups of people at risk for heat strokes
1. elderly
2. military recruits,
3. athletes at risk
50% mortality if temp is above
106
loss of thermoregulation and hypothermia aggreavated by
humidity and ethanol (cutaneous vasodilation)
at what temp do you see systemic efects of hypothermia
below 90F

LOC, bradycardia, AFib
what is a direct local effect of hypothermia on
crystallizatoin of water w/ increased salt
what is an indirect local effect of hypothermia
vasoconstriction and permeability (edema, and ischemia)
the resistance to electrical injury is inversely proportional to
water content
Low voltage causes
ventricular fibrillation
high voltage causes
paralysis of medullary centers, asystole
HAPE and HACE stand for what

they occur as high altitude above 4000 m
HAPE pulmonary edema

HACE high altitude cerebral edema
CAGE, "bends", chokes, stagers, caissons disease of the bone are all due to
rapid decompression - barotrauma / decompression sickness
two forms of protein energy malnutrition
somatic: skeletal muscle depleted - marasmus
visceral: organs and liver - depleted in kwashiorkor
what diagnostic test could you use to asses visceral protein energy stores
serum protein analysis
secondary protein energy malnutrition includes what two categories
1. malabsorption: impaired utiliazation or excess losses
2. chronically ill patiens with depletion of fat and muscle, edema
syndrome X has what symptoms
abdominal abesity
insulin resistance
incread TAG
Decreased HDL
Hypertension
Coronary artery disease
cytokine secreted by adipocytes
Leptin

crosses BBB and binds leptin receptor. inhibits anabolic circuits and triggers catabolic circuits. reduces food intake and promotes energy expenditure.
elevated blood levels (low CSF levels) in most obese persons
a mutation in POMC and PC1 (4) cause what
obesity

they are leptin receptors. autsomal recessive, rare. hyperphagia, childood onset massive obesity
a leptin receptor common (5 to 8%) of obese persons which leads to the inabilit to stimulate energy consumption
melanocotin receptor
essential for the formation of second order leptin neurons
SIM1 transcription factor

mutation in obese persons?
prevents diverticulosis
dietary fiber
diet which limits MI
fruits, veggies, limited meat and processed foods
reverses preneoplastic lesions
retinoic acid
how does a high fiber diet protect from cancer
1. decrease transit time
2. certain fibers bind carcinogens
non-neoplastic lung reaction to inhalation of mineral dusts in the workplace
pneumoconioses -

now includes reacations to organic and inorganica particulates, fumes, and vapors
what size particle of dust is most harmful in causing pneumoconioses
1 to 5 microm
most prevalent chronic occupational disease in the world
silicosis
what is silicosis
inhaled silica which is engulfed by marcophages and triggers an inflammatory response
what is the disease spectrum f silicosis
slowly progressing disease w/ upper zone nodules progresin to coalescend scars to progressive massive fibrosis
fibers which may cause asbestos related disease
serpentine fibers (most common and less pathogenic)
amphibole fibers (more pathogenic)
how does asbestos stimulate pulmonary fibrosis
the fibers are ingested by phagocytes and they timulate fibrosis