Environmental and Nutritional Diseases III

Question 1

HRT

Answer 1

hormone replacement therapy
-often post-menopausal women

estrogen with progesterone

Question 2

negative effects of HRT

Answer 2

cancer risk
-breast, endometrial, ovarian

also increased thromboembolsim

Question 3

HRT and breast cancer

Answer 3

increases risk after 5-8 years of use

Question 4

HRT and atherosclerosis and coronary disease

Answer 4

beneficial in women under age 60

Question 5

HRT and thromboembolism

Answer 5

increased risk

• DVT and PEs
• during first 2 years of treatment
• those who are hypercoagulable
• factor V and PT mutations

Question 6

risks of oral contraceptives

Answer 6

synthetic estradiol and progestin

-currently - lower estrogens and safer

Question 7

OC and thromboembolism

Answer 7

3x increase in venous thrombosis and pulmonary thromboembolism

increased further with factor V leiden and PT mutations

• consequence if acute-phase response - increased C reactive proteins and coag factors
• also, reduction in anticoag - protein S and antithrombin III

Question 8

OC and cardiovascular disease

Answer 8

increased risk of MI in smoking women all ages and nonsmoking women over age 35

Question 9

OC and cancer

Answer 9

reduce endometrial and ovarian cancer

increase in hepatic adenoma**

Question 10

older women who have used OC for long time

Answer 10

increased risk for hepatic adenoma**

large , solitary, well encapsulated masses

Question 11

anabolic steroids

Answer 11

synthetic testosterone

inhibit release of LH and FSH

increase amount of estrogens

Question 12

adverse effects of steroids

Answer 12

stunted growth in adolescent
acne
gynecomastia
testicular atrophy in males
facial hair and menstrual changes in females

Question 13

asthma from drug rxns

Answer 13

salicylates

Question 14

acute pneumonitis from drug rxns

Answer 14

nitrofurantoin

Question 15

interstitial fibrosis from drug rxns

Answer 15

bleomycin**
nitrofurantoin
busulfan

Question 16

tinnitus and dizziness and drug rxns

Answer 16

salicylates

Question 17

acute dystonic rxns and parkinsonian syndrome and drug rxns

Answer 17

phenothiazine antipsychotics

Question 18

respiratory depression and drug rxns

Answer 18

sedatives

Question 19

fatty liver change and drug rxns

Answer 19

tetracycline

Question 20

acetaminophen

Answer 20

most commonly used analgesic in US

Question 21

LD-50

Answer 21

dosage at which 50% of people die

-large for acetominophen

Question 22

therapeutic doses of acetaminophen

Answer 22

detox in liver - phase 2 enzymes and excreted in urine

-5% to NAPQI (by CYP2E)-conjugated with glutathione (GSH)

Question 23

larger dose of acetaminophen

Answer 23

excess NAPQI not conjugated with glutathione

-accumulates and causes hepatocellular injury leading to centrilobular necrosis

-mechanism:
covalent binding to hepatic proteins
depletion of GSH - more susceptible to ROS

Question 24

chronic alcoholics and acetaminophen

Answer 24

injury to liver can occur at lower doses

Question 25

N-acetyl cysteine

Answer 25

Tx for acetaminophen overdose

-restores GSH levels

Question 26

acetylsalicylic acid

Answer 26

aspirin

alkalosis by stimulation of resp center in medulla
-followed by metabolic acidosis

-acidosis leads to non-ionized forms reaching brain - nausea and coma

Question 27

fatal dose of aspirin

Answer 27

children 2-4g

adult 10-30g

Question 28

salicylism

Answer 28

chronic aspirin toxicity
-3g or more daily

HAs, dizzy, ringing ears (tinnitus), hearing impairment, mental confusion, drowsiness, nausea, vomiting, diarrhea

Question 29

morph of chronic salicylism

Answer 29

acute erosive gastritis
-GI bleeds and ulcers

bleeding tendencdy - block TxA2 formation

Question 30

analgesic nephropathy

Answer 30

from taking aspirin with acetaminophen over several years

can cause tubulointerstitial nephritis with renal papillary necrosis

Question 31

cocaine

Answer 31

from coca plant
-in nugget - crack

very addictive

sympathomimetic
-often leads to hyperpyrexia

Question 32

cardiovascular and cocaine

Answer 32

sympathomimetic
-blocks reuptake of dopamine as well as NE and E

-tachycardia, HTN, periphearl vasoconstriction

myocardial ischemia - from coronary a constriction
-smoking increases the coronary constriction

Question 33

cocaine and neurotransmission

Answer 33

CNS synapse - block reuptake of dopamine
-leads to euphoria, paranoia, hyperthermia

sympathetic neuron synapse - block reuptake of NE and E
-leads to HTN, arrhythmias, MI, cerebral hemorrhage, and infarct

Question 34

heroin

Answer 34

addictive opiod
-related to morphine

-euphoria, hallucinations, somnolence, sedation

Question 35

cut with heroin

Answer 35

talc or quinine

talc can cause pulmonary injury

quinine is neuro, renal, auditory toxicity

Question 36

most common infection of addicted heroin users

Answer 36

viral hepatitis

-from sharing needles

Question 37

Staph aureus and heroin

Answer 37

common infection causing endocarditis

right sided heart valves - particularly the tricuspid

Question 38

methadone

Answer 38

treatment of heroin addiction

currently used as painkiller

Question 39

cutaneous lesion

Answer 39

telltale sign of heroin addiction

Question 40

methamphetamine

Answer 40

speed or meth

• addicitve
• releases dopamine into brain
• slows glutamate release

euphoria followed by crash

Question 41

MDMA

Answer 41

ecstacy
-euphoria and hallucinogens

-increase release of serotonin in CNS

Question 42

marijuana

Answer 42

THC is psychoactive

benefits - treat nausea, chronic pain, glaucoma, weight issues, cancer cachexia

3x as much tar as cigarettes

Question 43

endogenous cannabinoid receptors

Answer 43

CB1 and CB2

lipid ligands - endocannabinoids

regulation of hypothalamic pituitary axis
-modulates appetite, food intake, energy balance, fertility, sexual behavior

Question 44

start at

Answer 44

injury by physical agents

page 420