week 9 Flashcards
(64 cards)
1
Q
Sty
A
skin infection like a pimple on eyelid-mostly external
2
Q
eye and ear cancers
A
- basal and squamous cell carcinomas of eyelid—usually slow growing
- melanoma-varying colors and potentially aggressive—usually occurs in older people
3
Q
glaucoma basics
A
high intraocular pressure in anterior chamber: Increased pressure within eye due to increased production or decreased outflow of aqueous humor (replaced every 2 hours; supplies nutrients and removes waste). Can damage optic nerve and cause blindness
4
Q
closed angle glaucoma
A
iris fused to cornea
• •
5
Q
open angle glaucoma
A
wide space between iris and cornea • most common-90% • slow clogging of drainage canals • symptoms subtle and often undetected • 3 million cases in US • African Americans especially vulnerable • Increased risk with diabetes and HP??
6
Q
gonioscopy
A
measures anterior chamber angle
7
Q
tonometry
A
measure intraocular pressure
8
Q
pilocarpine
A
glaucoma- cholinomimetic-contract ciliary muscle and increases outflow of aqueous humor.
9
Q
timolol
A
beta blocker-decreases aqueous humor secretion (popular for open angle glaucoma)
10
Q
non selective alpha agonist
A
epi- glaucoma
11
Q
lantanoprost
A
prostaglandin-increase outflow of aqueous humor (popular for Open angle glaucoma)
12
Q
drugs bad for glaucoma
A
anticholinergics and stimulants (amphetamines)
13
Q
carbonic anhydrase inhibitors and glaucoma
A
reduces acqueous humor production- worsens glaucoma
14
Q
cataracts
A
opacification of lens • Causes include: -diabetes -UV exposure -aging • Treatment is typically surgical removal
15
Q
background diabetic retinipathy
A
associated with hemorrhaging and ischemic spots (expressed as cottonwool spots)
-hypertension causes similar retinopathies as diabetes
16
Q
age related macular degeneration
A
- > 10% of patients > 80 years old
- Most common cause of severe loss of sight in 60+ pts.
- Almost never occurs in individuals
17
Q
bevacizumab
A
monoclonal AB (anti-angiogenic Ab). inject into vitreous humor 1-2x per month for wet age related macular degeneration
18
Q
retinal detachment
A
trauma
19
Q
retinoblastoma
A
most common tumor in children
20
Q
ear pain
A
often involved with dental referred pain due to both being innervated by trigeminal complex
21
Q
meniere disease
A
inner ear disorder a. Symptoms: vertigo, hearing loss, nausea, sometimes migraine headaches, hearing loss, swimming feeling, tinnitus, balance problems b. Pathology: endolymphatic hydrops—swelling/excess fluid in labyrinth • Risks- Improper inner ear fluid drainage Allergies Viral infections Head trauma Migraines c. Diagnostic tests: • Hearing and balance assessments d. Some surgical interventions, but extreme
22
Q
meclizine
A
meniere disease- H1 blocker, anticholinergic, CNS depressant-antimotion sickness medication, xerostomia
23
Q
diazapam
A
anxiety and muscle spasm and now meniere
24
Q
promethazine
A
meniere- H1 blocker, anticholinergic, antinausea and motion sickness, xerostomia
25
hydrochlorothiazide
meniere- diuretic-regulate fluid volume and pressure in inner ear
26
dexamethasone
meniere diesease- long-acting steroid/inject into the ear—it reduces fluid.
27
otitis media
• Typically associated with blockage of the Eustachian tube
• Often associated with infections by strep. Pneum. Or Haemophilus influe.
a. Symptoms: pain, ear discharge, headache, hearing loss, tinnitus, vertigo, immobile eardrum (swollen and inflamed), fever
b. Pharmacology: Amoxicillin or Amoxicillin + clavulanate or cefaclor for acute OM
Second level drugs include: trimethoprim (sulfa), or macrolides
28
cancer intro
• 2nd leading cause of death in US
• Caused by accumulation of DNA mutations in cells acquired spontaneously or induced-usually multiple mutations
• Properties:
Non-responsive to normal physiologic cues (unregulated)
Lack of response to growth inhibitory signals
Avoid normal cell cycle mediated death
Develops own angiogenesis
Evades immune detection
29
neoplasm
1. Uncontrolled growth of cells, progeny of a single cell
2. Names usually end in –oma
3. Benign epithelial tumor is adenoma (if glandular), a papilloma (if papillary)
4. Malignant tumor (metastasizes)
Epithelial= carcinoma
Mesenchymal= sarcoma
Lymphoid= lymphoma
Melanocytic tumor=melanoma
Hematopoietic= leukemia
-know example (more detail later)
• Squamous cell carcinomas
• Adenosarcomas-grandular epithelium
• Lipoma-benign
• Liposarcoma-malignant
• Osteosarcoma-malignant bone cancer
• Rhabdomyosarcoma-malignant skeletal muscles, usually kids
• Rhabdomyoma-benign
• Leiomyosarcoma-malignant tumor of smooth muscle
• Leiomyoma- benign tumor of smooth muscle
30
non neoplastic
* Granulomas are an inflammatory mass-not a neoplasm
* Hemartoma: mal-developed tissue native to site (e.g., nodular tongue)
* Choristoma: mal-developed tissue in other organs
31
cancer features
1. Lung cancer is leading cause of cancer death in US, followed by prostate in men and breast in females
2. Environment most common cause of sporadic cancers; a subset are hereditary
3. Solid tumor mutation panels are next generation sequencing used for solid tumor tissue and assessed for multiple potential targets for therapeutic responses-sometimes can predict prognosis
4. Common for success response not to kill “all” of the cells (e.g., 99.9% kill)-may lead to recurrence months to years later
5. Chromosomal changes associated with cancers include:
Deletions
Translocations
Duplications
Amplifications
Abnormal number of chromosomes
a. Cytogenetics used to look for the abnormalities listed above. E.g. there is a 9:22 translocation on chromosome 22, called the Philadelphia chromosome, that leads to chronic myelocytic leukemia
-use molecular strategies such as PCR and microarrays to detect.
32
what must a malignant tumor do to grow
* Develop a signal to proliferate
* Avoid apoptosis
* Invade stroma (if carcinoma)
* Metastasize
* Induce angiogenesis
* Alter DNA in order to allow continued mitosis (normally cells stop dividing after 15X doubling)
* Develop telomerase to prevent cellular senescence
33
genetic targets for tumors include:
• Oncogenes (promote proliferation)-e.g. growth factors or corresponding receptors- potential to cause cancer
• Tumor suppressor genes (inhibit tumor growth-e.g., BRCA-1 and BRCA-2 (breast and ovary)
P53 gene is most common suppressor gene mutation (lost in 50% of malignancies)
WT-1 gene- regulates apoptosis such as in Wilms tumor
APC-adenomatous polyposis coli-tumors in bowel and pancreas
• Apoptosis regulating genes (P53 gene also affects apoptosis)
• DNA repair genes
• Mismatched repair genes- e.g., HNPCC gene (hereditary nonpolyposis colon cancer)
• Angioneogenesis (tumors release vascular endothelial growth factor)
• Develop properties for invasiveness
34
chemo
targets proliferating cells
Consequently, good for killing fast growing tumors, not so good for slow or non-growing tumor cells
Injure rapidly proliferating normal cells such as bone marrow, intestinal mucosa, hair
35
metastic patterns
vary between tumors
36
mutation causes
e.g., chemical carcinogens-alkylating agents or nitrosamines in food, UV light-skin cancers, radiation)-
Ames test measures if a chemical alters genetic changes in bacteria and would be a carcinogen- tests if something causes cancer
37
tumor viruses
* HPV-human papilloma virus-carcinoma of cervix and oropharyngeal
* Epstein-Barr: mononucleosis
* Hep B & C viruses: hepatocellular carcinoma
* HHV 8 herpes virus- Kaposi sarcoma (often linked with AIDS)
38
bacteria and inflammation
H. pylori [gastric adenocarcinoma], and asbestosis [lung cancer])
39
chemical carcinogens
* Reactive chemical (e.g., free radicals) alter DNA
* Alkylating agents—some of which are used to tx cancer
* Polycarbon aromatics: e.g., benzopyrene in smoke and cooked meat
* Aflatoxin- fungus on peanuts and other foods- not so much in US
* Nitrosamine/nitates in foods
* Metal ions: nickel, arsenic
40
hormonal cancer activation
sex hormones
41
lack of immune responses cause cancer
., immunocompromised)
- altered host response to tumor can interfere with natural defense mechanisms
- immunosuppressed children have 200X increased risk for cancer
42
other cancer causes
```
• Genetic predisposition
• Variation in hepatic susceptibility of CYP1A1 and glutathione activity
• Radiation:
-skin cancer caused by UV rays
• X-rays/gamma radiation
-leukemias
-papillary thyroid and breast cancers
```
43
how cancers kill
a. Growth and metastasis
b. Involve vital organs
c. Get a flood of cytokines that shut down organ functions
d. Cachexia- inflammatory related cytokines from tumor rev up metabolic rate
44
carcinoid syndrome
tumor secretes things into blood
• Metastasis of intestinal carcinoid
• Flushing and diarrhea
• Right heart fibrosis
45
Carcinoma
epithelium/endothelium
• Most common type of malignancy
a. Most often metastasizes to regional lymph nodes, but can spread through blood-dependent on type
46
Squamous cell Carcinoma
similar appearance regardless of primary site
usually slow growing in the skin
associated with lips or lung more dangerous
can form keratin whirls
47
adenocarcinoma
eg, colon or breast adenocarcinoma)
forms glands/fused with gland or makes mucin
tumors of cuboidal or columnar cells
types include:
colon
prostate-fairly innocuous (not harmful) looking
breast-many positive for estrogen receptors
lung-small cell carcinomas are aggressive with poor prognosis
-large cell carcinomas are slower with better prognosis
48
neuroendocrine tumors
carcinoids of GI tract and lungs
49
mesenchymal tumors
sarcomas-Kaposi’s sarcoma [linked with AIDS],
angiosarcoma, malignant tumor of endothelial tissue (vessels); can result from radiation therapy
chondrosarcoma-malignant tumor of cartilage (chondrocytes).
osteosarcoma,
leiomyosarcoma (vs. benign leiomyoma) - malignant tumor of smooth muscle
liposarcoma
• Pushing, rather than an invasive cancer
50
lymphomas
Hodgkins lymphoma
-younger patients
-usually good prognosis
-sometimes characterized by Reed Sternberg cells (large, multinucleated B lymphocytes)
Non-Hodgkin’s lymphoma
-various levels of aggressiveness/sometimes poor prognosis
- Burkitt’s Lymphoma- a type of non-Hodgkin’s lymphoma; very aggressive from B lymphocytes. Prognosis can be poor.
51
cancer terms
* Incidence: newly diagnosed cases/time
* Mortality: death/time period
* Prevalence: # new and pre-existing cases at one moment
52
tumor grading
• TNM grading
- T, size and extent of primary tumor
- N, presence and number of lymph node metastases
- M, presence of distant mestatses
53
serological tests
most useful for assessing cancer recurrence after treatment
- PSA: prostate specific antigen
- CBA: carcinoembryonic antigen-colon carcinoma
- CA-125: serous ovarian carcinoma
- HCG: choriocarcinoma
54
epidemiology
a. 1.5 million new cancers diagnosed in 2011
~600,000
b. Lung cancer leading cause of cancer deaths in US followed by prostate for men and breast cancer for women
c. Japanese risk of gastric cancer 7X that in US
d.Breast cancer more common in US and Europe than in other countries
e. Liver cell carcinoma most common in Africa due to link with viral hepatitis.
f. The environment seems to be more important in causing cancer than genetics
g. Genetic risks, example:
• Familial adenomatous polyposis/colon cancer linked to APC gene
• Some breast and ovarian cancers linked to BRCA 1 & 2 genes
55
types of cancer tx
a. Surgical removal
b. Radiation therapy-maximize exposure of tumor and minimize exposure of normal tissue
c. Chemotherapy
most damage to rapidly proliferating cells
treats whole body
tumor can develop resistance
often multiple drugs required
can cause cancer later
56
cancer therapeutics intro
1. 1/3 patients cured with local treatment (surgery, radiotherapy)
2. Chemotherapy used for advanced disease or as an adjuvant
3. Anticancer drugs usually exert action on cells in cell cycle
4. Typically requires combination of drugs
5. Need maximal cell kill within the range of toxicity tolerated by host
6. Adjust scheduling and overlapping toxicities to protect the patient.
57
drug resistant cancer
P53 is a mutation that occurs in up to 50% of all human tumors-leads to resistance to radiation therapy and anticancer agents
58
new tx strategies
* Imatinib (Gleevec) tyrosine hydroxylase inhibitor used for multiple types of cancers such as myelogenous leukemia
* Hormones for breast and prostate cancers
* Retinoic acid-induced differentiation of some leukemias (e.g., promyelocytic leukemia)
59
alkylating agents
```
1. E.g, Cyclophosphamide
Hodgkin’s lymphoma
Leukemia
Breast cancer
2. Transfer their alkyl groups to various cell constituents such as DNA
3. Adverse effects:
Nausea, vomiting
Damage to rapidly growing tissues
Carcinogenic in nature
```
60
nitrosoureas
1. Procarbazine- used for combination regimens for Hodgkin’s lymphoma
61
platinum analogs
cisplatin
62
antimetabolites
1. Acts on intermediary metabolism of proliferating cells
2. E.g., methyltrexate-folic analog
Interferes with formation of DNA, key proteins
Treats head and neck cancers, breast cancer
63
natural product cancer, chemo drugs
1. Vinblastine or vincristine (Vinca Alkaploids)
| 2. Inhibits tubulin polymerization-cytoskeleton component
64
antitumor abx
1. Anthracyclines (e.g., doxorubicin-treat breast cancer)
