Pharm & Ototoxicity Flashcards
(95 cards)
1
Q
5 cardinal signs of inflammation
A
Redness
Vasodilation
Increased blood flow
Swelling
Edema, caused by accumulation of fluid outside blood vessels
Heat
Increased blood flow to the area
Fever is brought about by chemical mediators of inflammation and contributes to the rise in temperature at the injury site
Pain
Distortion of tissues caused by edema
Chemical mediators of inflammation such as prostaglandins
Loss of function
Because of pain or severe swelling that prevents movement
2
Q
What is a controlled substance and example
A
Drugs that have the potential for abuse or dependence & regulated by FDA
Opioids like morphine
3
Q
What is redox reaction
A
2 part reaction
reactions that are concerned with the transfer of electrons
loss of electrons = oxidation (cation)
gain of electrons = reduction (anion)
4
Q
Difference bw pharmacology & pharmacoepidemiology
A
pharmacology - basic and clinical applied science that deals with fate and actions of drugs in the body
pharmakon - poison or drugs
logos - study or discourse of
pharmacoepidemiology - study of drug outcomes
study of the use and effects of drugs in large populations
Applies the principles and methods of epidemiology to understand the patterns, causes, and effects of drug use and to evaluate the outcomes of drug therapies in the real world.
5
Q
Which chemical bonds is commonly NOT involved in drug receptor interactions?
van Der Waals bonds
lonic bonds
Hydrogen bonds
Covalent bonds
Hydrophobic bonds
A
covalent
6
Q
which is not correct
Oxidative stress is a disturbance in the balance between reactive oxygen species (ROS) and a system’s antioxidant defenses
Oxidative stress and inflamation are believed to be responsible for certain diseases such as cancers
Reactive oxygen species (ROS) is only seen in damaged/dying cells
In humans, glutathione provides protection against oxidative stress in the auditory-vestibular system v
Cell death because of oxidative stress can occur through necrosis or apoptosis depending on level of stress
A
Reactive oxygen species (ROS) is only seen in damaged/dying cells
7
Q
proteins; which is right
Amino acids content andsequence in proteins is determined by gene encoding the protein
Most enzymes, hormones, and NTs are proteins
Immune system is made of proteins
There is protein in laundry detergent
All
A
all
8
Q
Which pairing of NT/Neuromodulator and fxn is correct?
Acetylcholine - voluntary movement of the smooth muscles
Dopamine - voluntary movements, pleasure, and addiction
Norepinephrine/noradrenaline - arousal/wakefulness
Substance P - Pain
Serotonin - inflammation
A
Dopamine - voluntary movements, pleasure, and addiction
Norepinephrine/noradrenaline - arousal/wakefulness
Substance P - Pain
9
Q
Which statement of FDA’s approval process for new drugs is accurate?
If a drug causes cancer during animal trials it can still be approved for human treatment
Typically takes </= 5 yrs for new drug to market in US
Post-marketing surveillance (phase IV) occurs after FDA approval and goes for life of the drug
When no comparable alternate drug is available, extremely ill patients can have investigational drugs
Drug patents last lifetime of the drug
A
Post-marketing surveillance (phase IV) occurs after FDA approval and goes for life of the drug
When no comparable alternate drug is available, extremely ill patients can have investigational drugs
10
Q
Roles & responsibilities of FDA
Enforcement of drug laws for controlled substances
Ensuring effectiveness of nutritional supplements
Overseeing safety of medical devices
Regulating tobacco substances
A
C and d
11
Q
Which statement is correct for Dosage and Margin of safety for a drug
The effective dose of a drug (ED50) benefits 50% of total number of humans that receive it during short term toxicity testing in drug development phase
The lethal dose of a drug (LD50) kills 50% of total number of mice that receive it during short term toxicity testing in drug development phase
If LD50 of a drug is 500 and ED50 is 100 MOS = 10
Acceptable margin of drug safety in humans is </= 5
Drugs that prove to be teratogenic during clinical trials can never be marketed because they all have narrow margin of safety
A
The lethal dose of a drug (LD50) kills 50% of total number of mice that receive it during short term toxicity testing in drug development phase
12
Q
Phase 1 clinical trials required by FDA for drug approval does not include what
Evaluation of drug safety in humans
Establishing dose at which toxicity appears
Non-blinded trials on healthy participants that last several months
Study participants are patients with the condition which the drug is being tested
Determining pharmacokinetics of the drug being tested
A
Study participants are patients with the condition which the drug is being tested
13
Q
Is the substance a Hormone, Amino acid, NT, or Enzyme
Dopamine -
Tyrosine -
Estrogen -
Acetylcholinesterase -
A
NT
AA
Hormone
enzyme
14
Q
poppy seed
A
narcotic
15
Q
malaria
A
quinine
16
Q
opium
A
narcotic
17
Q
tomato for the heart ailments
A
doctrine of signatures
18
Q
mold
A
penicillin
19
Q
defines probability of population based benefits & risks
A
Pharmacoepidemiology
20
Q
Risk factor for chronic inflammation
A
smoking
21
Q
Compassionate drug use
A
Lack of availability of a comparable drug
22
Q
Prostaglandin
A
inflammation
23
Q
speeds up biochemical reactions
A
enzyme
24
Q
premature aging/cancers
A
Reactive oxygen species (ROS)
25
Factors affecting drug cost and drug development
research & devleopment costs
includes FDA approval process
complicated manufacturing process
coverage and reimbursement for the drug by 3rd party payer (insurance)
desired profit margin of manufacturer
maximizing profits prior to patent expiration
export to other countries
determined by foreign government or negotiation
usually lower over seas
26
What is anaphylaxis? How is it caused? Drug example commonly involved in causing anaphylaxis & drug used to treat it
aka anaphylactic shock
severe, progressive whole-body reaction to a chemical that has become an allergen
immune response; Triggered by an immune response involving Immunoglobulin E (IgE). When exposed to an allergen, the body's immune system produces IgE antibodies that bind to mast cells and basophils, leading to the release of histamine and other chemicals that cause the symptoms.
common causes
drugs - most common is penicillin but also anesthesia meds
food allergies - peanuts & shellfish
insect bites - bee stings & fire ants
pollen & other inhaled allergies although rare
epinephrine
27
Define Pharmacogenomics. What are SNPs? What are the role of SNPs in pharmacogenomics?
study of the role of the genome in drug responses
combo of pharmacology & genetics
studies how the genetic makeup of a PT affects their response to drugs
If one nucleotide in a specific position is exchanged with another nucleotide, the alteration is referred to as a
Single nucleotide polymorphism or SNP (pronounced “SNIP”)
SNPs or other genetic variations can affect protein amount or function by altering coding sequence of transcription or mRNA translation, which could be pharmacologically important
Cytochrome P450 (CYP) liver enzymes metabolize >30 classes of drugs
Genetic variations causing less active/inactive forms of CYP can influence drug metabolism for tons of drugs leading to overdoses
Influence on Drug Metabolism: Some SNPs may cause individuals to metabolize drugs too quickly (ultra-rapid metabolizers) or too slowly (poor metabolizers). This can result in suboptimal drug effects or increased toxicity. For example, SNPs in the gene CYP2D6 affect how people process drugs like codeine or antidepressants.
28
What is the IS and how does it work? What is an example of an antibody/immunogobulin and antigen
a constellation of responses mounted by body to attacks from outside the body
self/non-self recognition
achieved by every cell displaying a marker based on the major histocompatibility complex (MHC)
MHC - group of genes coding for cell surface proteins essential for immune system
any cell without this marker are treated as non-self & attacked
antibodies form gamma globulin part of the blood proteins
they inactivate antigens through various mechanisms
IgG - dominates secondary immune system & only antibody that crosses placental barrier to the fetus and protects newborn for 3-6mos
mediates type II reaction & type III reactions
IgA
IgM - dominates in primary immune responses
mediates type II reactions
IgD
IgE - mediates type I reactions
Antigen
Spike protein antigen
29
What is not a teratogen
Rubella
IgG immunogobulin
Alcohol
Radiation therapy
Penicillin based antibiotics
IgG immunogobulin
30
The DEA categorizes drugs with no medicinal use and high potential for abuse as ____ drugs
schedule I
31
Immunoglobulin released from mast cells & most commonly involved in anaphylaxis
ige
32
Who is most at risk for anaphylaxis reactions
12 yrs w/ childhood asthma taking meds for it
62 yrs taking the same hypertension meds for around 20 years
3 yr old that had a reaction rash to a bee sting
50 yrs who doens’t each shrim due to throwing up once as a kid for eating an excessive amount
42 yrs with allergies to pollen
3 yr old that had a reaction rash to a bee sting
33
FDA requires studies on reproduction before drug approval due to
Drugs that are teratogens can adversely affect infants and young kids
Placental membrane is permeable to most drugs which can cause fetal harm
Appropriate drug package inserts can be developed in to remove liability from manufacturer and FDA
All drugs that are teratogens prevent fertilization
Drugs that are teratogens can never be marketed
Placental membrane is permeable to most drugs which can cause fetal harm
34
Based on cost and time constraints result, which of the following would pharmacogenomics be most beneficial
Determining most effective drug to treat PTs hypertension
When 2 drugs are available for treatment and both contraindicated for that patient and no other alternative is available
Determining if PT will develop resistance to a drug treatment for lung cancer when several drugs are available
Genetic screening for common polymorphism that results in the development of an inactive form of cytochrome P450 enzyme needed for metabolizing certain drugs
Improving an existic & effective vaccine for childhood disease
Genetic screening for common polymorphism that results in the development of an inactive form of cytochrome P450 enzyme needed for metabolizing certain drugs
35
T and B cells come from bone marrow and pleuripotant hematopoietic stem cells
true
36
Conclusion of Thiesen et al study regarding ADRs for hospitalized children. List two ADRs for each of the systems listed
aud/vestib
CNS
Skin
ADRs were common in hospitalized children
Children who had undergone general anesthesia were at 6x greater risk of developing an ADR
AUD/VESTIB: HL & tinnitus
cns: dizziness, drowsiness
skin: acne, alopecia
37
What is schedule II drugs & an example
Substances with high potential for abuse but with accepted medical uses with severe restrictions
morphine & fentanyl
cocaine
methamphetamine
oxycodone
adderall & ritalin`
38
Erythema multiforme
(allergic reaction to some antibiotics, NSAIDS, & infections that causes skin lesions like bumps, plaques, blisters and can lead to Stevens-Johnson Syndrome)
39
Active artificial immunity with an example and passive natural immunity with an example
Active artificial (immunization-vaccines)
Develops slowly, lasts for several years, and is specific to the antigen for which the immunization was given
Passive natural (trans-placental mother-to-child)
Develops immediately, is temporary, and affects all antigens to which the mother has immunity
40
What is pharmacodynamics?
about what the drug does to the body.
studies the effects of drugs on the body and the mechanisms of their action. It focuses on how a drug interacts with its biological target (such as receptors, enzymes, or DNA) and the subsequent biochemical and physiological effects that result from these interactions.
41
What is pharmacokinetics? What are the main components? What are the stage & the system or structure they each act on?
what the body does to the drug after it is administered
Absorption: How the drug enters the bloodstream from the site of administration (e.g., oral, intravenous).
Distribution: How the drug spreads throughout the body's tissues and fluids.
Metabolism: How the drug is chemically altered by the body, usually in the liver, to form metabolites.
Excretion: How the drug and its metabolites are eliminated from the body, often through the kidneys (urine) or liver (bile)
42
What are the 4 physiological barriers to drug movement? What is the blood labyrinth barrier and how can it affect cochlear function
cell membrane
Blood Brain Barrier (BBB)
Blood-Placental barrier
Blood Labyrinth barrier (BLB) - homeostatic mechanism protecting IE; Disruption of BLB can disrupt ion transport system of the lateral cochlear wall, lead to disturbances of inner ear homeostasis, resulting in functional disruption of the auditory system
43
In the Article “Drug Side effects on adudiological and vestibular testing (2017) the author recommended asking the questions below for each audiology PT. For each question, state the importance in the practice of audiology.
What meds are you currently taking?
What are you taking them for?
How long have you been taking them?
44
What are agonists and antagonists? What is one difference between competitive and non ccompetitive
agonist - drug that after receptor binding results in active conformation
ligands that activate receptors
antagonist - drug that favors inactive conformation after receptor binding
inhibit action of natural agonists at receptor sites
without an agonists there is no effect of an antagonist
Competitive antagonist - reversible binding (agonist can displace antagonist) to the same active site on the receptor as an agonist; when an antagonist competes with the ligand for agonist site binding
Noncompetitive antagonist - irreversible (cannot be displaced even with high concentrations of agonists), poisonous, bond covalently; when an antagonist binds to a receptor at a site other than the agonist site & doesn’t compete directly with an agonist for receptor binding but instead alter or inhibit receptor from responding to an agonist binding
Differs in 2 ways: can bind either to active or allosteric receptor site & binds irreversibly by covalent bonding
45
graded dose response
describes the effect of various drug doses on an individual
2 parameters
potency (EC50) of a drug
concentration which the drug elicits 50% of its maximal response
potency = affinity of a drug to its receptor
efficacy (ECmax) of a drug
maximal response produced by a drug
efficacy = related to receptor occupancy by drug molecules
46
Quantal dose responsee
describes effect of various drug doses on a population
47
drug bioavailability
Quantity of drug reaching systemic circulation ÷ Quantity of drug administered
how much of the drug you took and how much of it is available
IV drugs injected into the systemic circulation = generally 1 (max) bioavailability
oral drugs = <1 bioavailability
depends on the route of administration, the chemical form of drug & PT factors (GI enzymes, pH and hepatic metabolism
concept of this is important in generic drugs - these drugs have the same molecular structure but concentration and route of administration may differ
FDA mandates generic has to have 90% of the bioavailability of the parent compound
48
compliance
degree to which a patient’s behavior matches medical advice
Noncompliance, therefore, is any behavior that does not follow medical advice
49
drug elimination half life and formula to calculate it
degree to which a patient’s behavior matches medical advice
Noncompliance, therefore, is any behavior that does not follow medical advice
50
Lock and key model of drug receptors
the receptor and the molecule (often called the ligand) have specific shapes that fit together perfectly, like a key fitting into a lock. The receptor's shape is fixed, and only a molecule with the exact matching shape can bind to it.
51
polypharmacy
Use of multiple antibiotics raise the risk of polypharmacy and adverse reactions including ototoxicity
52
The role of the human cell membrane in drug absorption
has to pass through for drug to reach intracellular target
nonpolar molecule (steroids) easily pass the cell membrane
most drugs & polar molecules - larger & not easily passed through membrane
A polar (water soluble) molecule has a partial +ve charge in one part of the molecule and complementary –ve charge in another part
factors affecting drug’s passing ability across
lipid solubility - more lipid soluble drug = easier crossing because they are water hating
degree of ionization (charge) - charged molecules cannot cross (mus use pores/channels), Hydrophobic drug molecules can generally pass through easily
molecular size - smaller = easier & larger = harder
drug shape - shape shifters can go through easier (induced-fit model)
53
Cytochrome P450 CYP Enzymes
primary machine for metabolizing drug
more CYP = faster drug metabolism
less CYP = slower drug metabolism
the specific set of CYP enzymes a person has in their livers affects how fast they can break down and process drugs - amount CYP enzymes a person has influences how fast or slow a drug is metabolized in their body
54
Situations that most likely increase risk of ototoxicity/vestibulotoxicity can include
Insufficiency of phase I and II enzymes
Accidentally taking an extra dose of prescribed med in 24 hr period
Overall increased metabolism
Polypharmacy
Decreased cardiac function
Insufficiency of phase I and II enzymes
Decreased cardiac function
55
Many statins (cholesteral lowering meds) are metabolized by cyp enzymes that grapefruit juice inhibits. Drinking too much grapefruit juice when taking this results in
Increased metabolism of statins in the liver
Increased plasma levels of statins with higher risk of adverse effects
Rapid elimination of statins by kidneys
Decreased ½ life of statins
Improved therapeutic effect of statins
Increased plasma levels of statins with higher risk of adverse effects
56
Which is correct regarding cell receptors
Drug reactions can occur if drug molecule fits into the target cell receptor
When ligand binds to a specific receptor it causes a conformational change in the cell triggering its responses
According to lock and key, only a specific substrate can fit into the active site of a receptor
Another one
All of the above
all
57
Which is incorrect regarding bioavailability
Bioavailability = quantity of a drug reaching the systemic circulation divided by the quantity of the drug administered
Drugs administered through IV have bioavailability of 1
Bioavailability is affected by hepatic metabolism regardless of route of administration
Fda mandates generic drugs have to have at least 50% bioavailability of parent compount
Drug dosage is dependent on bioavailability of a drug
Fda mandates generic drugs have to have at least 50% bioavailability of parent compount
58
Which entities cannot be provided the results of a PT hearing eval without PT written consent
Referring physician
Older son who drove them to the appt
PT’s insurance
Earmold lab that is fabricating her impression
Office manager who handles billing
Older son who drove them to the appt
59
Which regarding phase I and II drug metabolism is correct
Phase I occurs in liver and II in kidneys
Kidney disease affects I and II metabolism
Drug metabolism enhaces hydrophillic nature of drugs for easy elimination from body
After undergoing phase II if it is still lipid soluble will not be excreted by the body
Phase I and II of drugs is unaffected by presence of other drugs in the body
Drug metabolism enhaces hydrophillic nature of drugs for easy elimination from body
60
Which about first pass metabolism is incorrect
Inhalants are subhect to it
Drugs administered orally are subject to it
It inactivates a portion of the drug so drug dosage needs to be adjusted
Fxn of it is to protect body from ingested toxins
Hepatic disease affects it
Inhalants are subhect to it
61
After fitting binaural HA, PT returns stating they wore them at least 6 hours a day. A check of the tracking shows they only wore them closer to the time of the appt. This is an ex of
Noncompliance
Compliance
White coat compliance
Non persistence
white coat compliance
62
PT visits multiple physicians and shops around for the best pricing for his medicines. This is
Untreated med condition
Difficulty with drug labels
Polymorphism
Poor access to health professionals
polymorphism
63
PT is 55 yr old who has bilateral HL and case hx says he has _______ He may be at higher risk for ADR of ototoxicity and vestibulotoxicity because of
Potentially decreased rate of drug metabolism in the liver
Poor drug compliance
Decreased therapeutic drug level
Potentially decreased rate of drug metabolism in the liver
64
What can slow drug clearance from the body
Short half life of drug
Cytochrome p450 inhibition
Polycystic kidney disease
Comorbid cardiac and liver diseases
Comorbid cardiac and liver diseases?
cp450 inhibition?
polycystic kidney disease?
65
affinity of a drug to its recepto
potency
66
Maximal drug receptor occupancy by drug molecules
efficacy
67
Bypasses blood brain barrier
intrathecal route of administration
68
Administration of Oil based substances
intramuscular route of administration
69
First pass metabolism
enteral route of administration
70
_____proteins are the most abundant class of cell receptors and are involved in cell signaling
g proteins
71
The most common plasma protein that drug molecules bind to is
albumin
72
What are disease of the liver and kidney that can affect pharmacokinetics causing increased risk of ototoxicity/vestiboxicity
Liver: liver cirrhosis
Kidney: polycystic kidneys
73
Grapefruit juice in higher doses will decrease metabolism and lead to high plasma levels of these drug causing potential
true
74
inducer
barbiturates speed up metabolic process & decrease action of drugs being taken simultaneously - drug leaves the body faste
75
inhibitor
slow down the metabolic process and increase action of drugs being taken simultaneously - drug stays in the body longer
76
first order kinetics
Elimination of a constant fraction per time unit of the drug quantity present in the organism
The elimination is proportional to the drug concentration
95% of drugs are eliminated in this fashion
the more you take the more that is taken out
77
zero order kinetics
elimination isnt proportional to the amount you are taking and causes toxicity and accumulation in the body
Elimination of a constant quantity per time unit of the drug quantity present in the organism
Rather rare, mostly occurring when the elimination system is saturated
Drugs eliminated in this manner include
Salicylates, ethanol, and cisplatin
78
What are the ASHA criteria for change. What are the guidelines for monitoring before, during, and after treatment of antibiotics and chemo. Why do we monitor
ASHA criteria for clinically significant change in hearing sensitivity due to ototoxic medication
> 20 dB pure-tone threshold shift at one frequency
> 10 dB shift at two consecutive test frequencies
Threshold response shifting to "no response" at three consecutive test frequencies
significant changes in hearing need to be confirmed within 24 hrs
all threshold changes must be confirmed by retest
Baseline Eval:
Occurs before or no later than 24 hours after administration of chemotherapeutic drugs
Before or no later than 72 hours following administration of aminoglycoside antibiotics
Recheck thresholds within 24 hours of the Baseline Test to determine patient reliability
Monitoring Evals
Periodically throughout treatment, usually BEFORE each dose of chemo
1 to 2 times per week for patients receiving ototoxic antibiotics
frequency depends on
A patient's particular drug regimen, which can be determined by reviewing the patient's medical chart
Physician’s recommendations
follow-up audiograms performed after drug discontinuation can continue for up to a year, performed at
3 months, 6 months, 9 months, and 12 months
Then annually thereafter, especially for platinum-based drugs
You typically monitor for over a year in 3 month periods and if there is no change you can stop monitoring
Because ototoxic hearing loss can be progressive, occurring > 6 to 12 months after drug regimen is discontinued
79
How long do we monitor for radiation long term? What does radiation do to the inner ear?
HL can present as CHL, mixed, SNHL, or retro
⅓ PTs treated w/ this radiation experience SNHL
This radiation exacerbates HL when taking along w/ platinum-based chemotherapies
Radiation results in cochlear microvascular fibrosis, in turn causing degeneration of OHCs, IHcs, and VIII N fibers (Huang, et al., 2023).
Long-term (up to 10 years) audiologic follow-up post treatment is recommended
80
Vestibular ototoxicity treatment
vertigo, disequillibrium, oscillopsia (damage to VOR, bouncing vision), risk of falling (might need canes or walkers)
Medication
Vestib rehab therapy
Vestibular toxicity can result in compensation by central vestibular system w/ minimal long term effects but some the damage is permanent (especially bilateral peripheral vestibular damage)
81
NSAIDS stands for and uses and auditory side effect
non-steroidal anti-inflammatory analgesics
Used for pain, inflammation, fever, stroke
Reversible tinnitus & HL
82
Cinchonism and what causes it
disorder due to excessive or prolonged use of cinchona or its alkaloids and marked by temporary deafness, ringing in the ears, headache, dizziness, and rash.
83
Methotrexate
folate analog inhibitor
84
Taking an ear impression and they bleed what should they have done before doing one?
Taken med history thoroughly
85
What is the difference between non genetic amingolucoside ototoxicity and genetic
genetic: not dose dependent so a single injection can lead to profound deafness; severe to profound SNHL; mutation of 1555A>G point mutation (SNP mutation)
non genetic: dose dependent; the more you take the more likely you will have hearing loss
86
What is the difference between antibiotic synergism and antagonist
Antibiotic antagonism
One antibiotic can cancel out desired effects of the other
For e.g., if tetracycline and penicillin are given together, penicillin will not be effective
Antibiotic synergism
When combination of two antibiotics effects is greater than the sume of their individual effects.
Using more than one antibiotic increases the spectrum of kill and produces a desired effect of greater magnitude
For e.g., enterococci bacteria may not be completely eradicated by penicillin alone
But streptomycin given with penicillin, will kill the enteroccoci bacteria completely
Use of multiple antibiotics raise the risk of polypharmacy and adverse reactions including ototoxicity
87
Margin of safety equation
LD50 ÷ ED50
acceptable margin in drugs is >/= 2000
EX:
LD50 = 10 mg
ED50 = 2 mg
MoS = 5
legal dose is only 5x the effective which is low margin of safety in humans
88
What is the benefit of OAEs for monitoring and the population is benefits most
If normal, OAEs are good indicator of early ototoxic damage because they measure OHC fxn
used for those that are unable to give behavioral responses; really sick or really old individuals or children
89
What should you stop before vestib assessment
Caffeine, alcohol, smoking,, low dose of aspirin?
90
3 toxic effects of aminoglycosides and the system affected
Nephrotoxicity (20-30% incidence): This can be reversible but can also contribute to ototoxicity by causing the drug to accumulate in the body due to impaired renal clearance.
can increase both ototoxicity and vestibulotoxicity.
Neuromuscular Blockade: A rare but severe reaction that can lead to respiratory paralysis.
Ototoxicity/Vestibulotoxicity: Ototoxicity, which affects hearing, occurs in 2-20% of cases, while vestibulotoxicity, which affects balance, occurs in about 15% of cases. The exact incidence is difficult to determine due to variations in how hearing loss is defined and the sensitivity of hearing evaluations (<8 kHz)f
91
When will the FDA Approve teratogen drugs and what is an example
when the benefits outweigh the risks
ex: thalidomide used to treat morning sickness i pregnant women, Accutane used to treat acne
92
Which tumors respond to radiation and chemo and which don’t
Small rapidly dividing cells respond best (not solid tumors becuase of slow growth/divisio of cells & they need radiation/surgery as well)
Metastasize happens when tumor cells mutate
Original tumors - respond well to chemo
Metastatic lesions - less responsive & poor prognosis
93
______ exacerbates ototoxicity effects of aminoglycosides and cisplatin
94
______ is better at detecting ototoxicity before DPOAEs and conventional
95
What other system is affected by ototoxins etc.
nephrotoxocity?
