Uterine Motility & Anticancer & Toxins

Front 1

Drugs that stimulate Activity (Oxytocics)

Back 1

1. Oxytocin
2. Dinoprostone
3. 15-methyl PGF2a - Carboprost Tromethamine
4. Ergonovine Maleate
5. Methylergonovine Maleate
6. Mifepristone - RU486

Front 2

Drugs that inhibit uterine Activity (tocolytic)

Back 2

1. Terbutaline sulfate
2. Magnesium Sulfate
3. Prostaglandin-synthetase Inhibitors - Indomethacin

Front 3

Therapeutic Indications for drugs that stimulate uterine motility

Back 3

1. induce labor
2. control postpartum uterine hemorrhage
3. cause uterine contraction
4. Induce abortion

Front 4

Therapeutic indications for drugs that inhibit uterine motility

Back 4

1. delay or prevent premature labor (<37 weeks)
2. slow delivery so other therapeutic measures can be performed

Front 5

Production of oxytocin

Back 5

sensory stimuli (stretching) from cervix, vagina, and breast causes the release from nerve terminals into the circulation

Front 6

MOA of Oxytocin

Back 6

binds to specific receptors, activates receptors on myometrial smooth muscle cells increases intracellular calcium and leads to contractions of smooth muscle

Front 7

Indications for use of Oxytocin for labor induction

Back 7

1. risk to mother, fetus, or both
2. erythroblastosis fetalis
3. placental insufficiency
4. prolonged pregnancy (>42 weeks)

Front 8

Other uses of Oxytocin

Back 8

1. stimulate milk ejection
2. reduce postpartum hemorrhage (USE BIG DOSE)

Front 9

Adverse Effects of Oxytocin

Back 9

1. decrease in blood pressure, increased heart rate, arrhythmias
2. Sustained uterine contractions **

Front 10

Prostaglandins for uterine motility

Back 10

1. Dinoprostone
2. 15-methyl PGF2a - Carboprost Tromethamine
3. PGE1 analog - Misoprostol

Front 11

Uses of dinoprostone

Back 11

1. cervical ripening **
2. induce contractions

Front 12

Cervical Ripening

Back 12

prostaglandins stimulate uterine contractions and cause softening and dilation of the cervix

Front 13

Application of Dinoprostone

Back 13

1. Cervical gel - Prepidil
2. Vaginal inserts - Cervidil

Front 14

ADRs and Contraindications of Dinoprostone

Back 14

1. GI disturbances
2. Uterine hyperstimulation


1. Abnormal fetal position, fetal distress

Front 15

15-methyl PGF2a - Carboprost Tromethamine

Back 15

control postpartum bleeding - given IM
OR
induce abortion in the 2nd trimester

Front 16

PGE1 analog Misoprostol

Back 16

used with the antiprogestin Mifepristone RU486 for early termination of pregnancy

Front 17

Ergot Alkaloids to stimulate uterine motility

Back 17

1. Ergonovine Maleate
2. Methylergonovine Maleate

Front 18

Ergonovine Maleate & Methylergonovine Maleate

Back 18

USE: postpartum/postabortion hemorrhage

MOA: activate alpha 1 receptors - induce intense contractions of uterus

ADRs: HTN, nausea, vomiting, diarrhea

Front 19

Mifepristone - RU486

Back 19

MOA: antiprogestin or progesterone receptor antagonist = causes detachment of the products of conception

USES: 1st trimester termination of pregnancy - restricted distribution program

ADRs: bleeding and cramping

Front 20

Terbutaline

Back 20

MOA: beta 2 receptor agonist - increase in cAMP may decrease contraction of smooth muscle

ADRs: maternal pulmonary edema and hyperglycemia

BLACK BOX WARNING: fetal and maternal tachycardia

Front 21

Magnesium Sulfate

Back 21

MOA: relaxes uterine smooth muscle - decreases levels of myometrial intracellular free calcium

ADRs: flushing, sweating, hypotension

*drug of choice for patients with contraindications for beta 2 agonists

Front 22

1. Mechlorethamine
2. Cyclophosphamide

Back 22

Alkylating Agent - Nitrogen Mustards

Front 23

1. Carmustine

Back 23

Alkylating Agent - Nitrosoureas

Front 24

1. Cisplatin

Back 24

Alkylating Agent - Platinum Complexes

Front 25

1. Methotrexate

Back 25

Antimetabolite - Folic Acid Analog

Front 26

1. Mercaptopurine

Back 26

Antimetabolite - Purine Analog

Front 27

1. Fluorouracil
2. Cytarabine

Back 27

Antimetabolite - Pyrimidine

Front 28

1. Daunorubicin HCl
2. Doxorubicin HCl

Back 28

Antibiotics - Atracycline

Front 29

1. Vinblastine Sulfate
2. Vincristine Sulfate
3. Etoposide
4. Paclitaxel

Back 29

Vinca Alkaloids, Epipodophylotoxins and Taxanes

Front 30

1. Prednisone
2. Dexamethasone

Back 30

Adrenocorticosteroids

Front 31

1. Tamoxifen

Back 31

Estrogen and Antiestrogens

Front 32

1. Imatinib Mesylate

Back 32

Tyrosine Kinase Inhibitors

Front 33

1. Trastuzumab

Back 33

Monoclonal Antibodies

Front 34

Mechanism of Action of Alkylating Agents

Back 34

*Cell Cycle Non-Specific

1. Miscode DNA strands
2. Incomplete repair of alkylated segment
3. Excessive crosslinking of DNA and inability for strand separation

Front 35

Which Alkylating Agent is most lipid soluble

Back 35

Carmustine

Front 36

ADRs of Cisplatin

Back 36

Nephrotoxicity and otoxicity

Front 37

Toxicity of Alkylating Agents, Antimetabolites

Back 37

1. Nausea and Vomiting
2. Bone Marrow Depression

Front 38

Methotrexate

Back 38

*FOLIC ACID ANALOG*

MOA: blocks the conversion of folic acid to tetrahydrofolate leads to a block in DNA, RNA, protein synthesis ; S-phase specific

ADRs: mild nausea/vomiting, bone marrow depression

Front 39

Uses of Methotrexate

Back 39

leukemia, lymphoma; breast, head, neck carcinoma; osteosarcoma; bladder, gastric AND immunosuppressant

Front 40

Part of the cell cycle affected by Mercaptopurine, Fluorouracil, and Cytarabine

Back 40

S-Phase - Antimetabolites

Front 41

MOA of Daunorubicin HCl and Doxorubicin HCl

Back 41

*Cell Cycle Non-Specific - max effect in S-phase*

Intercalates and binds DNA - uncoils DNA helix - destroys DNA template

Front 42

Toxicity of Daunorubicin HCl and Doxorubicin HCl

Back 42

Cardiotoxicity

Front 43

MOA of Vinblastine Sulfate and Vincristine Sulfate

Back 43

*Cell Cycle Specific - M phase*

binds tubulin - disrupts mitotic spindle apparatus - prevents metaphase

Front 44

Toxicity of Vinblastine Sulfate and Vincristine Sulfate

Back 44

Neurological toxicity

Front 45

MOA of Etoposide

Back 45

*G2-Phase*

forms complex with topoisomerase II and DNA - DNA breaks - cell death

Front 46

MOA of Paclitaxel

Back 46

*G2 and M Phase*

Antimicrotubule agent - inhibits microtubule assembly

Front 47

MOA of Tamoxifen

Back 47

*G1 Phase*

competes with estradiol for binding to cytoplasmatic estrogen receptors - DNA, RNA, and protein synthesis reduced

Front 48

ADRs of Tamoxifen

Back 48

SHORT: hot flashes, nausea, vomiting

LONG: visual disturbances, hypercalcemia, vaginal bleeding

Front 49

Uses of Tamoxifen

Back 49

Breast Carcinoma

Front 50

MOA of Imatinib Mesylate

Back 50

*G1 Phase*

Bcr-Abl protein tyrosine kinase inhibition - cell proliferation inhibition and induction of apoptosis

Front 51

ADRs of Imatinib Mesylate

Back 51

SHORT: ab pain, nausea, vomiting, diarrhea

LONG: fatigue, join pain, fluid retention, cramps, edema, rash

Front 52

USES of Imatinib Mesylate

Back 52

1. Philadelphia Chromosome positive chrominic myeloid leukemia

2. c-Kit (CD117) receptor positive-gastrointestinal stromal tumor

Front 53

MOA of Trastuzumab

Back 53

*G1-Phase*

binding to extracellular domain of human epidermal growth factor receptor HER-2 - downregulation of EGF receptor tyrosine kinase signaling activity

Front 54

ADRs of Trastuzumab

Back 54

SHORT: nausea, vomiting, diarrhea

LONG: anemia, neutropenia, infections, fatigue, infusion reactions, rash

Front 55

USES of Trastuzumab

Back 55

1. adjuvant breast cancer (in EGF 2 receptor positive tumor)

2. metastatic breast cancer

Front 56

Cause of Cushing's Syndrome

Back 56

1. caused by a tumor or excess growth (hyperplasia) of the pituitary gland. This gland is located at the base of the brain.

2. occurs when your body is exposed to high levels of the hormone cortisol for a long time

3. occur when your body makes too much cortisol

Front 57

Symptoms of Cushing's Syndrome

Back 57

1. Upper body obesity (above the waist) and thin arms and legs
2. Round, red, full face (moon face)
3. Purple marks, called striae, on the skin of the abdomen, thighs, and breasts
4. Thin skin with easy bruising
5. Backache, which occurs with routine activities
6. Bone pain or tenderness
WOMEN - excess hair growth on face, neck, chest
MEN - impotence, no desire for sex

Front 58

LD50 - Lethal Dose 50

Back 58

dosage of a chemical that is needed to produce death in 50% of treat animals

Front 59

LC50 - Lethal Concentration 50

Back 59

same as LD50 but applies to exposure to gasses

Front 60

NOAEL - No Observed Adverse Effect Level

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highest dose that does not produce a statistically significant toxic effect

Front 61

RfD - Reference Dose

Back 61

estimate of the daily exposure to an agent that is assumed to have no adverse health impact on the human population

NOAEL / 100

Front 62

Anticholinergic Syndrome

Back 62

*Think Atropine*

SIGNS: tachycardia, dry flushed hot skin, urinary retention

COMMON CAUSES: atropine, scopolamine, antihistamines

TREATMENT: Physostigmine

Front 63

Sympathomimetic Syndrome

Back 63

*Think Cocaine*

SIGNS: tachycardia, HTN, elevated temp, diaphoresis, mydriasis, seizures

COMMON CAUSES: cocaine, amphetamine, ephedrine, caffeine

TREATMENT: IV benzos (seizures), lidocaine(heart), beta blockers (HTN)

Front 64

Opiate Syndrome

Back 64

*Think Heroin*

SIGNS: hypotension, bradycardia, coma, resp depression, miosis

COMMON CAUSES: narcotics

TREATMENT: symptomatic and maybe naloxone

Front 65

Non-Opiate Syndrome

Back 65

*Think Alcohol*

SIGNS: hypotension, bradycardia, coma, resp depress, miosis

COMMON CAUSES: barbiturates, benzos, alcohol

TREATMENT: symptomatic, maybe flumazenil, IV saline

Front 66

Cholinergic Syndrome

Back 66

*Think insecticides, nerve agent*

SIGNS: confusion, CNS depression, muscle twitching, weakness/paralysis

COMMON CAUSES: organophosphates, carbamate insecticides

TREATMENT: atropine, 2-PAM(organophosphates)

Front 67

Non-Specific Antidotes to Ingested Toxins

Back 67

1. Activated Charcoal
2. Polyethylene Glycol PEG 3350)

Front 68

non-specific chelator, limits drug absorption, not as efficacious if drug is rapidly absorbed

Back 68

Activated Charcoal

Front 69

Whole-Bowel Irrigation - polyethylene glycol

Back 69

useful when the ingestion of a drug occurs that is poorly absorbed by activated charcoal

Front 70

Organophosphates

Back 70

*Acetylcholine esterase inhibitors*

Irreversible - organophosphate
Reversible - carbamates

Front 71

Signs and Symptoms of Organophosphate Poisoning

Back 71

HEADACHE, miosis, nausea
1. S-Salivation
2. L-Lacrimation
3. U-Urination
4. D-Defication

Front 72

Mechanism of Action of Organophophates

Back 72

extremely toxic----respiratory failure due to diaphragm muscle paralysis and central depression of respiratory centers

Front 73

Treatment of Organophosphate poisoning

Back 73

Atropine for both and 2-PAM

Front 74

Alcohols

Back 74

1. Methanol
2. Ethylene Glycol
3. Diethylene Glycol

Front 75

Methanol

Back 75

SOURCE: windshield washer solvent

S/S: CNS depression like ethanol

MOA: metabolized to formaldehyde - blindness

TREAT: metabolic acidosis - Na bicarb IV & Fomepizole(ADH inhibitor)

Front 76

Ethylene Glycol

Back 76

SOURCE: auto antifreeze

S/S: CNS depression, hypocalcemic tetany, oxalicaciduria(crystals present in the urine)

TREAT: hypocalcemia - Ca IV & Fomepizole(ADH inhibitor)

Front 77

Diethylene Glycol

Back 77

SOURCE: wrongly used as low-cost sub for glycerin and propylene glycol (toothpaste)

S/S: nausea, anuric renal failure, hepatitis, pancreatitis

TREAT: early diagnosis w/ supportive and symptomatic

Front 78

1. Arsenic
2. Lead
3. Methylmercury

Back 78

Metals

Front 79

Lead

Back 79

short T1/2 life in soft tissue, T1/2 life in bone is from years to decades

Front 80

Sources of Lead

Back 80

1. Consuming contaminated foods
2. ingestion of paint chips or dust
3. drinking contaminated water
4. toys made in other countries
5. gasoline
6. Occupation

Front 81

Signs and Symptoms of Lead Poisoning

Back 81

1. hypochromic microcytic anemia
2. weak wrist or ankle extensor muscles
3. encephalopathy with delirium, hallucinations, convulsions
4. colic
5. gout
6. stillbirths

Front 82

MOA of Lead

Back 82

1. believed to mimic and replace endogenous ions

2. inhibits hemoglobin synthesis resulting in anemia

Front 83

Treatment of Lead Poisoning

Back 83

1. eliminate source
2. metal chelators (succimer being 1st line)

Front 84

Why is lead poisoning worse in children than in adults

Back 84

absorb 40% that is ingested, blood brain barrier deteriorates which can lead to lower IQ, increased ADHD, aggressive behavior, and deliquency

Front 85

Sources of Arsenic

Back 85

1. contaminant of coal, metal ores
2. rural/municipal water supplies in the US
3. Occupational

Front 86

Signs and Symptoms of Arsenic Poisoning

Back 86

ACUTE:
1. hemorrhagic gastroenteritis (rice water diarrhea)
2. garlic odor on breath
3. dehydration

CHRONIC:
1. hyperkeratosis
2. exfoliative dermatitis
3. bone marrow depression
4. increased risk of cancer

Front 87

MOA of Arsenic poisoning

Back 87

likely causes severe oxidative stress and disrupt protein function by binding to -SH containing amino acids

Front 88

Treatment of Arsenic Poisoning

Back 88

Metal Chelator - Dimercaprol given IM

Front 89

Arsine Gas

Back 89

1. occurs in miners
2. formed when acid touches arsenic metal
3. S/S: rapid hemolysis, renal failure
4. TREAT: none- supportive

Front 90

Sources of Methylmercury

Back 90

1. Hg metal in dental labs, old thermometers, gold mining
2. inorganic salts used as medical specimen preservatives, insecticides
3. felt hats
4. consumption of contaminated fish and grain fungicide

Front 91

Signs and Symptoms of Methylmercury poisoning

Back 91

1. cerebellar ataxia
2. movement disorders
3. loss of balance
4. sensory deficits
5. loss of visual field
6. deafness
7. dysarthria
**ALL ARE IRREVERSIBLE**

Front 92

MOA of Methylmercury poisoning

Back 92

unknown, shown to increase intracellular calcium and bind to metallothionein

Front 93

Women who are nursing or pregnant

Back 93

avoid consuming all predatory fish species due to teratogenic effects of MeHg

Front 94

Metal Chelators

Back 94

1. Succimer
2. Calcium EDTA

Front 95

Calcium EDTA

Back 95

1. Given IM or IV for severe Lead Poisoning
2. Toxic to kidney at high doses
3. S/E: chills, fever, nausea, vomiting

Front 96

Succimer

Back 96

1. first orally effective metal chelator
2. more rapidly effective
3. can be used for lead, mercury, and arsenic poisoning
4. S/E: GI distress, rash, diarrhea

Front 97

Gases

Back 97

1. Carbon Monoxide
2. Cyanide

Front 98

Sources of Carbon Monoxide

Back 98

*colorless, odorless, tasteless, nonirritating, ubiquitous*

1. any burning or combustion process

Front 99

Signs and Symptoms of Carbon Monoxide Poisoning

Back 99

1. headache
2. dizziness
3. increased heart rate

Front 100

Mechanism of Carbon Monoxide

Back 100

binds to hemoglobin in place of oxygen, reduces ability of oxygen to dissociate from hemoglobin and be delivered to deep tissues needing oxygen

Front 101

Treatment of Carbon Monoxide Poisoning

Back 101

1. remove agent
2. hyperbaric oxygen

Front 102

Cyanide

Back 102

SOURCE: smoke(plastics, wool). industrial exposure, chemical warfare

S/S: bitter almond breath, headache, nausea, apnea, loss of consciousness, seizures, coma

MOA: binds to cytochrome oxidase- inhibits electron transport chain - decreased ATP synthesis

TREAT: Cyanokit (Cyanide + Hydroxocabalamin)

Front 103

Dust and Others

Back 103

1. Asbestos
2. PCBs and Dioxin
3. Bisphenol A

Front 104

Asbestos

Back 104

*filamentous silica*

SOURCE: older building materials

S/S: none right away, mesothelioma lung cancer (15-20 years later)

TREAT: no antidote, limit exposure

Front 105

PCBs and Dioxin

Back 105

SOURCE: flame retardants, plasticizers, insulating materials in electric transformers

S/S: dermal acne-like eruptions called chloracne, nausea, headache, vomiting

Front 106

Dioxin

Back 106

colorless odorless, highly lipid soluble, environmentally stable, contaminant of Agent Orange

TREAT: none

Front 107

Bisphenol A (BPA)

Back 107

SOURCE: leaching from water bottles (stamped with 7 on bottom) into water, plastic lined canned food,

S/S: unkonwn

MOA: unknown

TREAT: none

Front 108

Some concern with BPA

Back 108

exposure in utero results in neural and behavioral effects