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255 Cards in this Set
- Front
- Back
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Acute toxicity study
- administered a single dose of the drug with two species via two routes |
observations: behavioral changes, LD50, and mortality
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Subacute toxicity study
- administered a drug for 90 days in two species via a route intended for humans |
observations: behavioral and physiological changes, blood chemistry panels, pathological findings in tissue samples
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Chronic toxicity
- administered the drug for 6-24 months, depending on the type of drug |
behavioral and physiological changes, blood chemistry levels, and pathological findings in tissue samples
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Teratogenesis
- administered drug to pregnant rats and rabbits during organogenesis |
observations: anatomical defects and behavioral changes in offspring
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Mutagenesis
- perform the Ames test in bacteria. Examine cultured animal cells for chromosomal defects |
evidence of chromosome breaks, gene mutations, chromatid exchange, trisomy, and other defects
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Carcinogenesis
- administer the drug to rats and mice for their entire lifetime |
higher than normal rate of malignant problems
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classification of CO
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pollutant and produced by combustion
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important side effects of CO
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headache followed by weakness, syncope, coma, and respiratory depression. Binds strongly to Hb
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treatment of CO poisoning
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remove from CO source
administer 100% oxygen |
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Cyanide classification
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fumigant pesticide
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important side effects of CN
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hypoxia, loss of consciousness, and respiratory arrest.
Disrupts mT respiration |
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treatment of CN poisoning
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administer sodium nitrite or sodium thiosulfate leading to production the thiocyanate that is eliminated in the urine
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how do you get lead poisoning
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batteries, lead toys, illicit alcohol, improper canning, retained bullets
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what does inorganic lead absorb in?
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well absorbed in the GI tract and by inhalation
NOT the skin |
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what does organic lead absorb in?
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well absorbed by the skin
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MOA of Pb poisoning
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Pb binds to RBCs
Blocks heme synthesis protoporphyins in urine and blood produces hypochromic and microcytic anemia RBCs have shortened life span |
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what systems in the body does Pb poisoning effect?
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Nervous system: central and peripheral effects. Wrist drop, encephalopathy in children, starts with convulsions, increased ICP, and brain edema. Fatal without prompt chelation tx
Kidneys: interstitial kidney disease, HTN, acute gout Reproductive: decreased fertility, increased stillborn (decreased sperm count) GI: loss of appetite, epigastric distress, colicky pain, constipation, blue line in gingival margin |
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how does Mercury poisoning occur?
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Hg volatile and absorbed after inhalation. Variable absorbance in GI depending on form.
MOA: binding to sulfhydroyl group on enzymes/proteins |
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what are the effects of acute mercury toxicity?
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from inhalation of Hg vapors:
chest pain metallic taste N/V renal damage severe gingivitis GI distress severe muscle tremor psychopathology |
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what is the first organ effected in acute mercury toxicity?
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Kidneys
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what are the effects of chronic mercury toxicity?
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oral & GI problems
renal insufficiency gingivitis loose teeth tremors in extremities May mimic: drug intoxication, Wilson's disease, cerebellar dysfunction ALL organ systems are affected by chronic toxicity |
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what is the treatment for mercury or lead poisoning?
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chelator pharmacotherapy
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Pharmacology of chelators
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versatile and effective antidotes for heavy metal intoxication
Flexible molecules with electronegative site to form stable covalent bonds with cation metal atoms |
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Dimercaprol
(2,3 Dimercaptopropanol) |
chelator agent
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what is Dimercaprol main use?
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indications: antidote for Arsenic, mercury, and childhood lead poisoning, Cadmium
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important side effects of Dimercaprol?
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painful at injection site
CV: tachycardia and HTN also headache, N/V, lacrimation, salvation, parathesias |
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why must caution be taken when using Dimercaprol to treat cadmium toxicity?
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may increase renal Cd concentration leading to organ toxicity
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2,3 Dimercaptosuccinic acid or Succimer
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chelator
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Succimer primary tx use.
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primarily used for chelation of Pb in children
- especially for levels > 45 ug/dL |
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important side effects of Succimer.
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N/V
loss of appetite diarrhea may occur |
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T/F
Succimer may cause slight changes in the liver enzymes or an increase in WBC count |
True
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Deferoxamine
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Chelator
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Primary use of Deferoxamine
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used for acute and chronic tx of Fe toxicity
Very selective for Fe |
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T/F
Deferoxamine can be used in the chelator treatment of Pb, Arsenic, and Hg poisoning. |
False
Deferoxamine is very selective for Fe Not used for other metal chelator |
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describe the possible side effects of Deferoxamine.
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pain and swelling at injection site
blurred vision may occur IV injection may cause flushing, severe itching, severe dizziness, fast heartbeat, and fainting therefor give IM |
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How should Deferoxamine be administered for Fe chelation?
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IM
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Possible interactions of Deferoxamine.
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May interact with prochlorperazine if you have heart failure
should not be administered with Vitamin C because of very serious interaction may occur |
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T/F
Deferoxamine can be administered with vitamin C |
False
do not administer Deferoxamine and vitamin C together > > > may lead to serious interaction |
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adverse effects of opiods
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mitotic pupils
CNS/respiratory depression |
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adverse effects of anticholinergic drugs
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dry, flushed appearance, mydriasis, bowel atony, hallucinations
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adverse effects of cholinergic drugs
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muscarinic: salivation, defecation, lacrimation, urination
nicotinic: muscle fasciculations, weakness, paralysis |
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adverse effects of stimulants
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tachycardia
HTN HYPERthermia mydriasis agitation |
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adverse effects of TCA
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anticholinergic effects
EKG abnormalities |
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Syrup of ipecac
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OTC
0.5 ml: 6 month - 12 yo 1.0 ml: 12 + yo Local irritation and central CTZ stimulation |
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when do you not administer syrup of ipecac?
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when patient has ingested corrosive acid/base
comatose patient |
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what is activated charcoal used for?
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strongly binds drugs and chemicals on the surface of charcoal particles.
when ingestion of poisonous substance has occurred |
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MOA of activated charcoal
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decreases GI absorption
give in charcoal: drug ratio: 10:1 |
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Do you give a patient both ipecac and activated charcoal?
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NO
will absorb it and doesn't produce emesis |
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teratogenic
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structural defects in unborn fetus due to interrupted embryological development
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mutangenic
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changes in DNA bases/genetic code of individuals
tested using an Ames test: in vitro culture of genetically modified Salmonella strain |
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carcinogenic
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drug effects that cause cancer
chemically induced cancer usually requires chronic exposure |
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give an example of a chronic exposure vs acute exposure of the same substance
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Ethanol:
acute toxicity: CNS depression chronic toxicity: Liver cirrhosis Arsenic acute toxicity: GI damage chronic toxicity: skin/liver cancer |
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what is the general poison information and treatment that a physician needs to know.
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1. maintain vital functions
2. prevent further exposure 3. combat pharmacological/toxicological effects 4. prevent further exposure: emesis |
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Top 5 poisoning agents
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1. household cleaning products
2. cosmetics/personal care 3. plants/mushrooms 4. hydrocarbons 5. chemicals: ethylene glycol |
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what are the factors involved in toxicity?
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1. drug induced oran toxicity
2. drug interactions 3. role of gender 4. ethnic/genetic variability |
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Hematopoetic toxicity
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agranulocytosis, anemia
measure cell counts |
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Chloramphenicol causes what organ toxicity
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Hematopoetic toxicity
- Chloramphenicol attacks bone marrow and blocks iron into heme |
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Hepatotoxicity
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cholestatic toxicity: inflammation and stasis of biliary system
hepatocellular: damages hepatocytes Measure transaminases |
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Drugs that cause hepatoxicity
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Acetaminophen
Isoniazid Troglitazone |
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Nephrotoxicity
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classified by site: interstitial nephritis, tubular necrosis, crystalluria
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Drugs that cause Nephrotoxicity
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Cisplatin: administered in large volumes to keep drug dilute in the tubules
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Cisplatin
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drug that may cause nephrotoxicity due to accumulation in the tubules
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Pulmonary toxicity
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respiratory depression
pulmonary fibrosis |
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drugs that may cause Pulmonary fibrosis.
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Bleomycin and Amiodarone
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drugs that may cause respiratory depression
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Opioids
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drug that may produce cardiotoxicity
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Doxorubicin
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Doxorubicin
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drug that may cause cardiotoxicity
produces symptoms resembling CHF |
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What does a drugs interaction with food possibly cause?
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altered drug absorption
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what may alter a drugs absorption?
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altered GI motility/secretion
binding or chelating drugs competitive for active transport |
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what may alter a drugs distribution?
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displacement from plasma protein binding sites
displacement from tissue binding sites |
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what can alter the drug biotransformation?
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altered hepatic blood flow
enzyme induction/inhibition |
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what can alter the drugs excretion?
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altered biliary excretion or entrohepatic cycling
altered urine pH, drug induced renal impairment, inhibition of active tubular secretion |
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what effects does gender place on drug toxicity?
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not well understood
- differences in responses to HIV agents, antiarrhythmia drugs, some anesthetics have been observed > primarily due to differences in mass, total water content |
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what is seen in the CYP450 system metabolism differences between men and women?
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women have higher CYP3A activity
50% of drugs are metabolized by CYP3A > increased activity > decreased drug effectiveness > females clear the drug faster |
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what are the variations in transporters and targets in males and females?
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- Pgp drug efflux pump encoded by MDR1 gene is higher in men > can be regulated by sex hormones
- many differences in gender effects on drug metabolism are due to physiochemical differences: weight, fat, protein binding, gut absorption, etc. |
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Pharmacogenetics
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genetic variation and how they relate to the effects of drug response
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Toxicogenetics
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genetic variation and how they relate to the demonstration of toxic effects in an organism
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CYP2D6 variation
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poor metabolizers
lacking 2D6 activity: 5-14% Caucasian 0-5% African 0-1%: Asians |
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if your are poor metabolizer with a CYP2D6 decreased activity, what drugs do you metabolize slower?
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opiates
TCA anti-psychotics |
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CYP2C19
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benzodiazepenes
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CYP3A4
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few reported deficits
antineoplastic drugs BZDs Statins B-antagonist |
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factors affecting placental drug transfer and effect on the fetus.
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1. physiochemical properties of drug
2. rate at which drug crosses the placenta and amount of drug reaching the fetus 3. duration of exposure 4. distribution characteristics in fetal tissues 5. stage of placental and fetal development at time of exposure 6. effects of drug used n combination |
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lipid solubility of drug in preganancy
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lipophilic drugs tend to diffuse readily across the placenta and enter fetal circulation
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Thiopental in pregnancy
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crosses the placenta immediately and produces sedation and apnea in newborn
- lipophilic drug |
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highly ionized drugs in pregnancy
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drugs cross the placenta slowly and achieve very low concentrations in the fetus
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examples of highly ionized drugs that can be taken during pregnancy
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Succinylcholine
Tubocurarine |
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what doe the Molecular size of a drug have to do with its ability to cross the placenta?
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250-500: crosses placenta easily
500-1000: crosses placenta with more difficulty 1000+: crosses very poorly |
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what are P-glycoproteins
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Placental transporters encoded with MDR1 gene pump back into maternal circulation a variety of drugs
> this may cause drug accumulation in fetus |
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how does protein binding affect drugs in pregnancy
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rate and amount transferred
- very lipid soluble drugs will not be affected by the protein binding because they cross the placental membrane rapidly - poor lipid soluble and ionized drugs transfer slowly and will be impeded by their binding to maternal plasma proteins |
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Placental-fetal drug metabolism
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placenta plays a major role of semi-permeable barrier and site of metabolism of some drugs passing through it
- Phenobarbital |
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T/F
Metabolic capacity of placenta may lead to creation of toxic metabolites and placenta may augment toxicity of drugs |
TRUE
-ethanol and benzyprenes |
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how do drugs that cross the placenta enter the fetal circulation?
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drugs that cross the placenta enter the fetal circulation via the umbilical vein
40-60% of umbilical venous blood flow enters the fetal liver and rest enters the general fetal circulation |
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T/F
woman may require drugs that are not needed by the same women when she is not pregnant |
True
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what would cardiac glycosides and diuretics be given to a pregnant patient for?
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heart failure precipitated by increased workload of pregnancy
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what would insulin be given to a pregnant patient for?
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control of blood glucose in pregnancy induced DM
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Can a drug be administered to the mother, and the fetus be the target of the drug?
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YES
Corticosteriods: to stimulate fetal lung maturation for preterm birth Phenobarbital: can induce fetal hepatic enzymes lowering the incidence of jaundice |
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Teratogenic drug actions
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single exposure to drug can affect the fetal structures undergoing rapid development at the time of exposure
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Thalidomide
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teratogen
affect the development of limbs after brief exposure in the 4-7th week of gestation, when the arms and legs develop |
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Teratogenic mechanism
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may have direct effect on maternal tissues: secondary/indirect effect on fetal tissues
interfere with passage of oxygen/nutrients through the placenta > have effect on most rapidly metabolizing tissue of the fetus important direct actions on the process of differentiation in developing tissues deficiency of critical substances appear to play role in some abnormalities |
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define teratogen
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1. results in characteristic set of malformations indicating selectivity for certain organs
2. exert effects on particular stage of fetal development 3. dose-dependent incidence |
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Counseling women about teratogenic risks
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1. fewer than 30 drugs have been identified as human teratogens for all trimesters
- just over 40 with teratogenic effects 2. risk in pregnancy is ~ 3% 3. Also address maternal -fetal risks of untreated conditions |
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what has one of the greatest influences on drug absorption in infants?
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blood flow to the site of administration
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how does GI function influence drug absorption in an infant/child?
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changes quickly in the first few days of life
may increase absorption of drug |
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what makes absorption irregular and difficult to predict in preterm infants?
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the sick preterm infant has little muscle mass and diminished peripheral perfusion to areas of administration
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what can cause a unpredictable increase in the amount od drug entering the circulation of a preterm infant? what are the effects?
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sudden improvement in perfusion
this can lead to high and potentially toxic drug concentrations |
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T/F
drugs that are partially/totally inactivated by low pH of gastric contents should NOT be administered orally to an infant. |
True
drugs absorbed in the stomach may be absorbed more completely than anticipated because of the delayed gastric emptying of an infant |
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T/F
Drugs absorbed in the small intestine may have delayed effect in an infant. |
True
because of delayed gastric emptying |
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how does peristalsis in an infant affect the absorption of drugs?
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drugs absorbed in the small intestine may be unpredictable and increase in absorption and decreased absorption of fat soluble drugs because peristalsis in and neonate is irregular and slow
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T/F
Acetominophen, Phenobarbital, and Phenytoin have decreased oral absorption in an infant. |
True
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T/F
Ampicillin and Penicillin G have increased oral absorption in an infant. |
True
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list drugs that have a normal oral absorption in an infant.
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Diazepam
Digoxin Sulfonamides |
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is the protein binding of a drug increased/decreased in a neonate?
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Decreased protein binding
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describe drug metabolism in a neonate
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lower in early neonatal life
many have slower clearance rates & prolonged elimination half lives mother may have received a drug that induced early maturation of fetal hepatic enzymes > metabolism of certain drugs in neonate is faster than expected |
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describe drug excretion in a neonate
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GFR is much lower in neonates
drugs that depend on renal function for elimination are cleared slower Toddlers may have shorter elimination half lives of drugs because increased renal elimination and metabolism |
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action of indomethacin in infant.
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rapid closure of patent ductus arteriousus
this would have to be surgically repaired in an infant |
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actions of Prostaglandin E1 in infant
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causes ductus arteriousus to remain open which can be lifesaving in an infant with transposition on the great vessels/tetralogy of fallot
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what is seen as a clinical manifestation with infusion of PGE1?
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antral hyperplasia with gastric outlet obstruction
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Elixirs
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alcoholic suspensions which the drug molecules are dissolved and evenly distributed
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Suspensions
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contains undissolved particles of drug > shaking necessary
uneven distribution is potential cause of inefficacy or toxicity in children taking Phenytoin suspensions |
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what is a major cause of dosing errors in the pediatric community?
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many pediatric doses are calculated using body weight
should use surface area |
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when taking drugs during lactation, what is the optimal times to take the medications?
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should optimally take relatively safe drug 30-60 minutes after nursing
3-4 hours before next feeding |
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what concentrations of Lithium may be found in the breast milk?
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Lithium enters breast milk in the same concentration equal to the maternal serum
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how do radioactive substances enter the breast milk?
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detectable in breast milk and may cause thyroid suppression in infants and increase risk of thyroid cancer
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T/F
calculations for medication in infants/children based on age/weight tend to be conservative and underestimate required dose |
True
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what type of dosing is the most accurate for children?
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doses based on surface area are more likely to be adequate
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what is the most important change that occurs in the elderly with respect to pharmacology?
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decreased renal function
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what alters the absorption of drugs in the elderly?
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conditions associated with age may alter the rate a drug is absorbed
altered nutritional habits, greater consumption of prescription drugs, changes in gastric emptying |
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what alters the distribution of drugs in the elderly?
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decreased lean body mass
decreased TBW Increased fat decreased serum albumin increased serum orosomucoid - maintenance dosage regimens should be altered by these factors alone |
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what alters the metabolism of drugs in the elderly?
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capacity of the liver to metabolize drugs doesn't appear to decrease consistently with age for all drugs
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List some drugs that have been observed to have NO age related hepatic clearance differences found.
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Ethanol
Isoniazid Lidocaine Lorazepam Nitrazopam Oxazepam Prazosin Salicylate Warfarin |
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T/F
the elderly are more sensitive to sedative hypnotics and analgesics |
True
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T/F
elderly have been observed to have a decreased response to b-stimulants |
True
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describe the changes found in the elderly in relation to CNS drugs.
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half lives of BZDs and BARBs are increased 50-150%
decline in renal function and liver disease contribute to reduction in elimination of compounds increased volume of distribution |
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T/F
the elderly are markedly more sensitive to analgesics respiratory effects |
true
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what are antipsychotics and antidepressants useful in treating in the elderly?
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useful in management of schizophrenia and in treatment of dementia, agitation, combativeness, and paranoid syndrome
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Are antipsychotics or antidepressants useful in the treatment of Alzheimers?
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NO
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What are the elderly more susceptible to than the young when being administered antidepressants/antipsychotics?
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TOXIC effects
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describe the changes observed in the brain in Alzheimers disease.
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marked decrease in choline acetyltransferase and other markers of cholinergic neurons activity
changes in the brain Glutamate, Dopamine, NE, 5-HT, and Somatostatin - cholinergic & other neurons die or are destroyed |
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T/F
Cerebral vasodilators are useful in the treatment of Alzheimers. |
FaLse
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name an MAOI type B that is useful in the tx of Alzheimers.
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Slegiline
L-deprenyl |
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what is Tacrine used for?
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treatment of Alzheimers disease
- long acting cholinesterase inhibitor/muscarinic modulator - orally active - enters the CNS readily - blocks ACh esterase & butylcholinesterase >> inhibitory effects on M1 & M2 receptors - increases release of NE, Dopamine, 5-HT |
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what are the adverse effects seen with Tacrine?
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N/V
Hepatic toxicity |
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List the newer AchE inhibitors that better penetrate the CNS in the treatment of Alzheimers
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Donepezil
Rivastigmine Galantamine |
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when treating a patient with Donepezil, Rivastigmine, or Galantamine, what precaution needs to be taken?
|
use caution in patients taking drugs that inhibit the CYP450 enzymes
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what are CCBs useful in the treatment of in the elderly?
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patients with atherosclerotic angina
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What potential hazard is seen in the elderly with use of b-blockers?
|
b-blockers are potentially hazardous in patients with obstructive airway disease and less used than CCB in older patients unless heart failure is present
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as an anti-HTN drug, ACE-I are less useful in the elderly unless ________?
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ACE-I less useful than thiazides unless CHF/DM is present
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why are anti-arrhythmic drugs challenging to use in elderly patients?
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challenging because of electrolyte imbalances and increased incidence of coronary artery disease
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If the clearance of Quinidine and Procainamide decrease in the treatment of arrhythmias what happens to the half-lives?
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half-lives increase
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What drug used to treat arrhythmias should be avoided in the the elderly?
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Disopyramide should be avoided due to toxicity risk
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what should be known about Lidocaine when administering it to the elderly?
|
half life is increased
loading dose decreased because of greater sensitivity in geriatric patients |
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T/F
Patients with a-fib do as well with simple control of ventricular rates as with conversion therapy |
true
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what needs to be taken into consideration with prescribing antibiotics to the elderly?
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major pharmacokinetic changes related to decreased renal function
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toxicity of Aspirin in elderly
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GI irritation and bleeding
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toxicity of new NSAIDS in elderly
|
renal damage which may be irreversible
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COX-2 selective NSAIDs in the elderly
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not any safer with regard to renal function
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what is a possible toxicity of corticosteroids in the elderly?
|
Dose and duration related osteoporosis
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T/F
adverse drug reactions are seen 2x more than the younger population |
True
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what are the major reasons for adverse drug reactions in the elderly?
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errors in prescribing on part of the practitioner
errors in drug usage by patients |
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what is the function of Oxytocin?
|
stimulates both frequency and force of uterine muscle contraction
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what are the effects of oxytocin dependent upon?
|
estrogen levels
- |
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how does oxytocin increase contractility?
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-activation of phospholipase C > releases intracellular calcium > increases contractility
- direct depolarization induced activation of voltage sensitive calcium channels > release of PG endometrial tissue |
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how is oxytocin administered?
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Parental or intranasal
NOT given orally because of increased first pass effect |
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when should oxytocin not be used?
|
should not be used if labor is progressing normally
- use in dysfunctional labor only - or induction of labor |
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adverse effects of oxytocin
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uterine rupture
cervical laceration impairment of placental circulation |
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why is oxytocin used in the third stage of labor?
|
increase uterine tone
reduces incidence of/extent of post partum hemorrhage |
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what is the mechanism of action of oxytocin in lactation?
|
intranasal administration
contraction of smooth muscle which surrounds mammary alveoli > milk ejection reflex |
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what are the primary uses of Prostaglandins in pregnancy?
|
initiating labor
therapeutic abortions cervical ripening |
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what is one mechanism responsible for primary dysmenorrhea?
|
excess production of PGF2-a
this is why NSAIDS work for menstrual cramps |
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where are prostaglandins found during pregnancy?
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found in the ovaries, myometrium
fetal membranes, amniotic fluid |
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what is the MOA of prostaglandins?
|
stimulate the generation of cAMP
|
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Dinoprostone
|
PGE2
therapeutic abortions vaginal suppositories used in the 1st few weeks of the 2nd trimester CANNOT be used in early pregnancy |
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Carboprost
|
PGF2a
IM injection used when membrane rupture but uterine contents not eliminated may be given as amniotic fluid injection > termination of 2nd trimester pregnancy |
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Misoprostal
|
intravaginal deposit
therapeutic abortion |
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Postpartum administration of Carboprost
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PGF2a
single IM injection |
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side effect of Dinoprostone given for cervical ripening
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may induce fever in 70% of patients
there are less side effects seen with Misoprostal |
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what are Ergot alkaloids used for?
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increase uterine motor activity
- primary use is post partum bleeding |
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T/F
ERgonovine and Methylergonivine are not appropriate for use of labor augmentation or induction. |
true
small doses: increase force and frequency of contraction followed by normal relaxation large doses: increase force and frequency followed by increased resting tonus |
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MOA of ergot alkaloids
-Ergonovine, Methylergonivine |
partial agonist a-adrenergic receptors
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what is the criteria for use of Tocolytic agents?
|
1. Gestational age > 20 weeks: < 34-35 weeks
2. Cervical dilation < 4 cm 3. Cervical effacement < 80% 4. NOT used if amniotic membranes have ruptured |
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contraindication of Tocolytic agents
|
1. eclampsia
2. severe pre-eclampsia 3. premature detachment of placenta 4. fetal distress |
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what is the tocolytic DOC?
|
B2-agonist
Ritodrine or Terbutaline |
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mechanism of action of Ritodrine
|
relaxation of uterine smooth muscle
IV infusion until labor controlled oral tx at end of infusion |
|
|
Terbutaline
|
b2-agonist
tocolytic agent oral/IV/SC administration |
|
|
adverse effects of Ritodrine (b2-agonist/tocolytic agent)
|
tachycardia, increased CO, increased renin secretion, hyperglycemia
|
|
|
Magnesium sulfate
|
tocolytic agent
DOC if cannot use B2-agonist well tolerated |
|
|
what concentrations of magnesium sulfate may be dangerous?
|
concentrations above 8 ug/dL may cause respiratory/cardiac arrest
|
|
|
what is the primary therapeutic use of magnesium sulfate in pregnancy?
|
control eclamptic seizures during pregnancy
-IV - DOC if cannot use b2-agonist |
|
|
adverse side effect of using Nifedipine as a tocolytic agent?
|
can produce metabolic acidosis in fetus
|
|
|
MOA of Nifedipine as tocolytic agent.
|
relaxes myometrium direct action on calcium channels
|
|
|
what PG inhibitor can be used as a tocolytic agent?
|
Indomethacin
|
|
|
important interaction of Indomethacin in pregnancy as a tocolytic agent.
|
PG-inhibitor
- premature closure of the ductus arteriosus Oligohydramnios Need US monitoring Limited gestation prior to 24 weeks |
|
|
what is gene therapy?
|
insertion of functional gene to replace a faulty protein
insertion of gene in the generation of a necessary protein |
|
|
what are the main vectors used in gene therapy?
|
liposomes
retroviruses adenoviruses |
|
|
what are the major considerations for gene therapy?
|
inherited disorders: originally the impetuous for gene tx as a medical tool
Acquired disorders: antisense mRNA, AIDS Vaccinations: infectious and noninfectious disease |
|
|
what obstacles do gene therapy face?
|
1. Gene delivery
2. What happens after altered gene is expressed? 3. Expresion time: dependent on disease 4. What happens after long term production? 5. Adverse consequences 6. Ethical concerns |
|
|
what are some adverse consequences that could be seen in gene therapy ?
|
immune response to new protein: severe immune response could inactivate a secreted product
possible autoimmune response to host tissue pathological response to viral vectors: possibility of viral replication/infection, removal of necessary viral genes for replication |
|
|
List the possible viral vectors
|
Retrovirus
Adenovirus Herpes virus LIposome |
|
|
what are the advantages of using the Retrovirus as a vector for gene therapy?
|
integrates into host cell genome providing stable gene expression
|
|
|
what are the disadvantages of using Retrovirus as a vector for gene therapy?
|
random integration may cause insertional mutations
|
|
|
what are the advantages associated with Adenovirus as a vector in gene therapy?
|
contains > 30 kb non-viral DNA > infect non dividing and dividing cells
|
|
|
what are the disadvantages associated with Adenovirus as a vector in gene therapy?
|
doesn't provide long term gene expression > no integration
|
|
|
why is the herpes virus rarely used as a vector for gene therapy?
|
wil mutate quickly
infects dividing and non-dividing cells difficult to develop replicating free vector |
|
|
what are the advantages of using Liposomes as a vector for gene therapy?
|
non-pathogenic
no immunity problems no limit on size of gene |
|
|
what are the disadvantages of using liposomes as vectors for gene therapy?
|
low transfection efficacy
low rate of stable integration |
|
|
what type of liposome affords better access to host cell?
|
cationic liposomes afford better access to the host cell
entering the cell causes the liposome to be removed exposing the encoded plasmid DNA |
|
|
Cimetadine
Ranitidine Nizatidine Famotidine |
H2 receptor antagonist on parietal cells
decrease cAMP levels decrease intracellular Calcium decrease proton pump activity |
|
|
what are H2-antagonist primarily used in the treatment of?
|
PUD
Dyspepsia GERD |
|
|
side effects of Cimetadine.
|
H2-antagonist
weakly anti-androgenic in elderly men > impotence Lipophilic: can cross the BBB > slurred speech, delirium, confusion |
|
|
do H2-antagonist inhibit meal and/or basal acid secretion?
|
inhibit both meal and basal acid secretion
|
|
|
what is used in patients to inhibit acid secretion in individuals who are refractory or unresponsive to the effects of H2 antagonist?
|
Muscarinic antagonist
- Pirenzeipine - Propantheline - Dicyclomine - Trihexethyl - Glycopyrrolate |
|
|
what are the important side effects of muscarinic antagonist, which are the reason they are rarely used in the treatment of PUD?
|
multiple peripheral effects via blockade of muscarinic receptors:
increased HR decreased salivation loss of accommodation |
|
|
Name proton pump inhibitors
|
Omeprazole
Lansoprazole Rabeprozole |
|
|
what are proton pump inhibitors used to treat?
|
PUD
DOC in Zollinger-Ellison syndrome Most efficacious for treating GERD |
|
|
what is a potential side effect of proton pump inhibitors?
(Omeprazole, Lansoprazole, Rabeprazole) |
may cause gastric hyperplasia
|
|
|
why are proton pump inhibitors the most effective drug in the treatment of PUD?
|
receptor up-regulation
most effective drug to decrease H+ secretion since all secretory products increase activity |
|
|
MOA of proton pump inhibitors
|
inhibits H+/K+ ATPase pump in luminal membrane of parietal cells (decreases histamine, gastrin, ACh)
irreversible inhibition > inhibits acid secretion for 24-48 hours |
|
|
what is possible treatment for H.pylori with PPI?
|
Clarithromycin + PPI (Omeprazole, Lansoprazole, Rabeprazole)
|
|
|
what are the 5 ways that Sucralfate treats PUD?
|
Protectant:
1. complexes with protein at ulcer to form protective layer 2. stimulates PG secretion 3. decreases back diffusion of H+ 4. binds to and inactivates pepsin and bile salts 5. suppression of H.pylori infection - decreases further acid secretion |
|
|
what H2-antagonist inhibits P450 enzymes?
|
Cimetadine
|
|
|
T/F
H2 antagonist inhibit the efficacy of proton pump inhibitors |
True
|
|
|
Misoprostol
|
PGE1 agonist > decreases cAMP > inhibits acid secretion + promotes bicarbonate/mucus secretion
|
|
|
what are possible side effects of Misoprostol?
|
PGE1 may cause diarrhea and uterine stimulation
|
|
|
what would you administer Misoprostol for?
|
protectant from PUD with patients who take chronic NSAIDS for treatment of arthritis
|
|
|
what is Bismuth-subsalicylate?
|
Pepto-bismol
colloid bismuth solution |
|
|
what drugs are used to treat inflammatory bowel disease?
|
Sulfasalazine: 5-ASA
Olsalazine: 5-ASA Infliximab: TNF-a monoclonal antibody Azathioprine: cytotoxic agent Glucocorticoids: anti-inflammatory |
|
|
what is the main treatment goal in inflammatory bowel disease?
|
act to reduce inflammation
|
|
|
what is an important side effect of Sulfasalazine?
|
exhibits bone marrow suppression due to presence of sulfapyridine
|
|
|
how does Olsalazine avoid bone marrow suppression?
|
by having 2 5-ASA moieties
|
|
|
what are the desired effects of antacid treatment?
|
decrease total acid load
inhibit the activity of pepsin > proteolytic enzyme at pH 5 |
|
|
what cation found in antacids may lead to rebound acid?
|
Calcium
|
|
|
what cations have the slower onset in antacids?
|
magnesium
aluminum |
|
|
Prokinetic drugs
|
Bethanechol
Neostigmine Metoclopramide Erythromycin |
|
|
list the prokinetic drugs and their receptor action.
|
Bethanechol: M3 muscarinic agonist
Neostigmine: Cholinesterase inhibitor Metoclopramide: D2 antagonist Erythromycin: Motilin agonist |
|
|
what are prokinetic drugs used for?
|
increases gastric tone, constrict sphincters, or smooth muscle
- diabetic gastroparesis, GERD Relief of N/V due to antineoplastic therapy |
|
|
CAster oil
|
secretory/stimulant laxative
- opens Cl- channels - improves bowel movements and relieves constipation |
|
|
possible side effect of Caster oil
|
secretory stimulant agent: electrolyte imbalance
|
|
|
Milk of Magnesia
|
saline
- osmotic gradient improve bowel movements and relieves constipation |
|
|
possible side effect of milk of magnesia
|
magnesium absorption and rectal epithelial sloughing
explosive bowel movements |
|
|
Mineral oil
|
laxative
Lubricant Emollient |
|
|
possible side effects of Mineral oil
|
decreased absorption of fat-soluble vitamins and pulmonary aspiration > pneumonia
|
|
|
Psyllium
|
laxative
reduces transit time Bulk forming - safest and preferred |
|
|
Loperamide
Dephenoxylate/atropine |
Opiate
antidiarrheal drugs increase flow resistance, decreases propulsion, and secretion |
|
|
Major side effects of Diphenoxylate?
|
has some abuse potential
Atropine is added to sub-therapeutic concentrations to prevent abuse |
|
|
Bismuth subsalicylate
|
pepto-bismol
anti-secretory agent decreases net fluid secretion |
|
|
Dicyclomine
|
M3 antagonist
reduces contraction activity |
|
|
Hydrated aluminum silicate, pectin, kaolin
|
gel forming agent
increases flow resistance and increased formed stools |
|
|
Cholestyramine
|
ion exchange resin
bind water and bile salts |
|
|
Ondansetron
Granisetron |
5-HT3 antagonist
treatment of chemotherapy induced emesis |
|
|
Ondansetron
|
post operative emesis treatment
|
|
|
Metoclopramide
Prochlorperazine |
D2 dopamine antagonist
antiemetic |
|
|
Dronabinol
|
THC/Cannabinoid agonist
antiemetic |
|
|
Dimenhydrinate
Meclizine |
H1 antagonist
antiemetic motion sickness |
|
|
Scopolamine
|
muscarinic antagonist
motion sickness |
|
|
how is emesis mediated?
|
mechanism in the CTZ in the brainstem
|
