2. Cancer

Question 1

plasma protein and receptor binding

Answer 1

drug’s efficiency; less bound = more active. Common blood proteins that drugs bind to are albumin, lipoprotein, glycoprotein, and α, β‚ and γ globulins.
drug either bound or unbound. Depending drug’s affinity for plasma protein, only a proportion may be bound to plas. prot., If binding reversible:
Protein + drug ⇌ Protein-drug complex
unbound fraction exhibits pharmacologic effects and is metabolized/excreted= “fraction bound”
Protein binding influence the drug’s half-life. bound bit= reservoir, slowly released as the unbound form to maintain =m
Since albumin is alkalotic, acidic and neutral drugs will primarily bind to albumin. If albumin becomes saturated, then these drugs will bind to lipoprotein. Basic drugs will bind to the acidic alpha-1 acid glycoprotein. medical conditions affect levels of albumin, alpha-1 acid glycoprotein, and lipoproteins.
For the drugs which rapidly undergo metabolism, clearance is dependent on the hepatic blood flow.
Drug A + B are = protein-bound. A will bind to plasma proteins in blood. B can displace A from, increasing Drug A’s fraction unbound, increase effects of Drug A. A = more available so its total decreases, keeping free drug fraction constant

Question 2

Fat soluble drugs …

Answer 2

have a higher concentration in lipid (Eg. fat and cell membranes)

Question 3

water soluble drugs have a higher concentration …

Answer 3

have a higher concentration in aqueous solution (Eg. plasma and cytosol).

Question 4

Drugs may have … or may bind to plasma proteins

Answer 4

a specific receptor-attach to

bind to plasma proteins

Question 5

Q. How much of the drug warfarin is bound to plasma proteins and how much is freely dissolved in plasma?

Answer 5

99% of warfarin is bound to plasma proteins and 1% is free in plasma.

Question 6

Q Is it the protein bound warfarin or the free plasma warfarin which is responsible for the action of the drug?

Answer 6

free plasma warfarin

Question 7

Q What happens if tamoxifen is given to a patient taking warfarin?

Answer 7

Tamoxifen increases the effects of warfarin and so increases the risk of bleeding by an unknown mechanism

Question 8

Q iv) The active metabolite of tamoxifen, 4-hydroxytamoxifen, competitively binds to the intracellular oestrogen receptor. What is meant by ‘competitive binding’?

Answer 8

Competitive binding means that both the and oestrogen bind to the same oestrogen receptor. They compete with each other for the receptor. If 4-hydroxytamoxifen is bound to the receptor it prevents oestrogen from binding to it and so reducing oestrogen effects

Question 9

GP Understand the principles of screening - Wilson and Jungner NHS complaints procedure

Answer 9

Wilson and Jungner

1. The condition being screened for should be an important health problem
2. The natural history of the condition should be well understood
3. There should be a detectable early stage
4. Treatment at an early stage should be of more benefit than at a later stage
5. A suitable test should be devised for the early stage
6. The test should be acceptable
7. Intervals for repeating the test should be determined
8. Adequate health service provision should be made for the extra clinical workload resulting from screening
9. The risks, both physical and psychological, should be less than the benefits
10. The costs should be balanced against the benefits

Question 10

GP Have an awareness of the NHS Bowel cancer screening program and other cancer screening programs.

Answer 10

55 automatically invited -one-off bowel scope if available in area-look for and remove any small growths called polyps-2 week wait for results
60 to 74, automatically invited to do home testing (faecal occult blood (FOB)) kit every 2 years- 2week results
75 or over, you can ask for home testing kit /2yr by calling free bowel cancer screening helpline

Question 11

GP red flag symptoms for suspected bowel cancer+

referral processes

Answer 11

o Blood in stool
o Change in bowel habit (more frequent and looser stools)
o Abdominal pain , bloating +/or discomfort
contact GP: simple
1. examination tummy and bottom for lumps
2. arrange for a simple blood test to check for iron deficiency anaemia – indicate bleeding
3. simple test in hospital for serious cause of your symptoms
UCR- 2 week wait max for appt

Question 12

GP issues affecting cancer survivors.

Answer 12

late diagnosis

Question 13

GP NHS complaints procedure

Answer 13

Significant event audit
The seven stages of SEA:
1. Awareness and prioritisation of a significant event
2. Information gathering
3. The facilitated team-based meeting
4. Analysis of the significant event
5. Agree, implement and monitor change
6. Write it up
7. Report, share and review
You have the right to make a complaint about any aspect of NHS care, treatment or service, and this is firmly written into the NHS Constitution.
Complaints should normally be made within 12 months of an incident or of the matter coming to your attention. This time limit can be extended provided you have good reasons for not making the complaint sooner and it’s possible to complete a fair investigation.
But consent isn’t required if you’re making a complaint in the name of:
• a deceased person
• someone who lacks the capacity to make their own decisions
• a non-Gillick competent child

Question 14

Bowel cancer risk factors

Answer 14

age, diet, weight, exercies, alcohol/smoki, family history, other disease affecting bowel (chrons, ulverus colitus)

Question 15

grades of bowel cancer

Answer 15

grades of bowel cancer
o 1: cancer that grows slowly and has a low chance of spreading beyond the bowel
o 2: cancer that grows more moderately and has a medium chance of spreading beyond the bowel
o 3: Cancer that grows rapidly and has a high chance of spreading beyond the bowel

Question 16

TNM staging

Answer 16

T=Tumour, N=Node, M=Metasteses