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Step 1 11.17.12

PathologyII/Pharm I

QuestionAnswer
What is cahecia and what mediates it? loss of weight and muscle atrophy fatigue occuring in chronic disease like cancer, AIDS, HF, Tb). mediated by TNF-alpha, IFN-gamma, IL-6
What cancers are associated with Down Syndrome? ALL, AML
What cancers are associated with xeroderma pigmentosa, albinism? melanoma, basal cell carcinoma, esp squamous cell carcinoma of the skin
What cancers are associated with chronic atrophic gastritis, pernicious anemia, or post surgical gastric remnants? gastric adenocarcimnoma
What cancers are associated with tuberous sclerosis (facial angiofibroma, seizures, mental retardation)? astrocytoma, angiomyolipoma, cardiac rhabdomyoma
What cancers are associated with actinic keratosis? squamous cell carcinoma of the skin
What cancers are associated with Barrett's esophagus (chronic GI reflux)? esophageal adenocarcinoma
What cancers are associated with Plummer-Vinson syndrome ( atrophic glossitis, esophageal webs, anemia all from Fe deficiency)? squamous cell carcinoma of esophagus
What cancers are associated with Cirrhosis (alcoholic, HepB or C)? hepatocellular carcinoma
What cancers are associated with ulcerative colitis? colonic adenocarcinoma
What cancers are associated with Paget's disease of bone? secondary osteosarcoma and fibrosarcoma
What cancers are associated with immunodeficiency states? malignant lymphomas
What cancers are associated with AIDS? aggressive NHL and Kaposi's sarcoma
What cancers are associated with autoimmune diseases ( Hashimoto's thyroiditis, myasthenia gravis)? lymphoma
What cancers are associated with acanthosis nigricans ( hyperpigmentation and epidermal thickening)? viceral malignancy ( stomach, lung, brast uterus)
What cancers are associated with dysplastic nevus? malignant melanoma
What cancers are associated with radiation exposure? sarcoma, paipllary thyroid cancer
What is the mech of oncogenes? gain of function. only need damage to one allele?
What is the gene type, associated tumor, and gene product of abl? oncogene, causes CML, makes a tyrosine kinase
What is the gene type, associated tumor, and gene product of c-myc? oncogene, Burkitt's lymphoma, makes a transcription factor
What is the gene type, associated tumor, and gene product of bcl-2? oncogene, follicular and undifferentiated lymphomas (inhibits apoptosis), makes an anti-apoptotic molecule
What is the gene type, associated tumor, and gene product of erb-B2? oncogene, nreast ovarian, gastric carcinomas. makes a tyrosine kinase
What is the gene type, associated tumor, and gene product of ras? oncogene, colon carcinoma, makes a GTPase
What is the gene type, associated tumor, and gene product of L-myc? oncogene, lungtumor, makes a transcription factor
What is the gene type, associated tumor, and gene product of N-myc? oncogene, neuroblastoma, makes a transcription factor
What is the gene type, associated tumor, and gene product of ret? oncogene, multiple endocrine neoplasia (MEN) types IIA and II B, makes a tyrosine kinase
What is the gene type, associated tumor, and gene product of c-kit? oncogene, makes a gastrointestinal stromal tumor (GIST), cytokine receptor
What is the mech of tumor surpressor genes? loss of function leads to cancer, both alleles must be lost for the expression of genes
What is the gene type, associated tumor, and gene product of rb? tumor surpression, retinoblastoma, osteosarcoma, Rb product blocks G1-->S cell cycle
What is the gene type, associated tumor, and gene product of p53? tumor surpressor, most human cancers, Li-Fraumeni syndrome, p53 gene product blocks G1--->S cell cycle
What is the gene type, associated tumor, and gene product of BRCA1? tumor surpressor, breast and ovarian cancer, DNA repair protein
What is the gene type, associated tumor, and gene product of BRCA2? tumor surpressor, breast cancer, DNA repiar protein
What is the gene type, associated tumor, and gene product of p16? tumor surpressor, melanoma, unk product
What is the gene type, associated tumor, and gene product of APC ? tumor surpressor, colorectal cancer (associated with FAP, unk product
What is the gene type, associated tumor, and gene product of WT1? tumor surpressor, Wilm's tumor, ukn product
What is the gene type, associated tumor, and gene product of NF1? tumor surpressor, neurofibromatosis type 1, ukn product
What is the gene type, associated tumor, and gene product of NF2? tumor surpressor, neurofibromatosis type 2, ukn product
What is the utility of tumor marker use clinically? not used to make dx, used to confirm and monitor recurrence and tumor response to therapy
What is PSA and what can it be used for? When might it be elevated in a non cancer? Prostate-specific Ag, used to screen for prostate cancer. also elevated in BPH and prostatitis
What is prostatic acid phosphatase a marker for? prostate carcinoma
What is the screening use of CEA? carcinoembryonic Ag, non specific but produced by 70% of colorectal and pancreatic cancers; also produced by gastric, breast, and thyroid medullary carcinomas
What is the screening use of alpha fetoprotein? normally made by fetus. but also made by hepatocellular carcinomas and nonseminomatous germ cell tumors of the testis (yolk sac tumor)
What is the screening use of Beta-hCG? detects hydatidifrom moles, choriocarcinomas, and gestational trophoblastic tumors
What is the screening use of CA-125? ovarian, malignant epithelial tumors
What is the screening use of S-100? melanoma, neural tumors, astrocytomas
What is the screening use of alkaline phosphatase? metastases to bone, obstructive biliary disease, Paget's disease of bone
What is the screening use of bombesin? neuroblastoma, lung and gastric cancer
What is the screening use of TRAP? tartate resistant acid phosphatase. hairy cell leukemia which is a B cell neoplasm
What is the screening use of CA-19-9? pancreatic adenocarcinoma
What is the screening use of calcitonin? thyroid medullary carcinoma
What cancer is associated with HTLV-1? adult T cell leukemia/lymphoma
What cancer is associated with HBV, HBC? hepatocellular carcinoma
What cancer is associated with EBV? Burkitt's lymphoma, Hodgkin's lymphoma, nasopharyngeal carcinoma
What cancer is associated with HPV? carvical carcinoma (16,18), penile/anal carcinoma
What cancer is associated with HHV-8? Kaposi's sarcoma, body cavity fluid B cell lymphoma
What cancer is associated with HIV? primary CNS lymphoma
What cancer is associated with H. pylori? gastric adenocarcinoma, lymphoma
What cancer is associated with schistosoma haemotobium? squamous cell carcinoma or transitional epithelium (bladder)
What organ is affected by and what cancer is associated with aflatoxins from aspergillus? liver, hepatocellular carcinoma
What organ is affected by and what cancer is associated with vinyl chloride? liver, angiosarcoma
What organ is affected by and what cancer is associated with CCl4? liver, centrilobular necrosis, fatty change
What organ is affected by and what cancer is associated with nitrosamides (smoked foods)? stomach, gastric cancer
What organ is affected by and what cancer is associated with cigarette smoke on larynx? squamous cell carcinoma
What organ is affected by and what cancer is associated with cigarrette smoke in lungs? squamous cell carcinoma and small cell carcinoma
What organ is affected by and what cancer is associated with cigarrette smoke on the kidney? renal cell carcinoma
What organ is affected by and what cancer is associated with cigarrette smoke on bladder? transitional cell carcinoma
What organ is affected by and what cancer is associated with abestos? lung, mesothilioma, bronchogenic carcinoma
What organ is affected by and what cancer is associated with arsenic? squamous cell carcinoma on skin, angiosarcoma in liver
What organ is affected by and what cancer is associated with naphthalene (aniline) dyes? bladder, transitional cell carcinoma
What organ is affected by and what cancer is associated with alkylating agents? blood, leukemia
What is the the effect and associted paraneoplastic effects of ACTH or ACTH-like peptide? causes Cushing's syndrome, see small cell lung carcinoma
What is the the effect and associted paraneoplastic effects of of ADH? causes SIADH, see small cell lung carcinoma and intracranial neoplasms
What is the the effect and associted paraneoplastic effects ofPTH related peptide, TGF-beta, TNF, IL-1? causes hypercalcemia, see squamous cell lung carcinoma, renal cell carcinoma, breast carcinoma
What is the the effect and associted paraneoplastic effects of erythropoetin? get polycythemia, see renal cell carcinoma, hemangioblastoma, hepatocellular carcinoma, pheochromocytoma
What is the the effect and associted paraneoplastic effects of Ab against Ca++ channels at the NMJ? causes Lmbert-Eaton syndrome, see thymoma, small cell lung carcinoma
What is the the effect and associted paraneoplastic effects of hyperuricemia due to excess nucleic acid therapy as in cytotoxic therapy? causes gout, urate nephropathy. see leukemias and lymphomas
What are psammoma bodies? Where are they seen? laminated, concentric, calcific spherules seen in : 1.papillary adenocarcinoma of thyroid 2. serous papillary cystadenocarcinoma of ovary 3. meningioma 4. malignant mesothelioma (PSMM)
What are the most common male cancers by incidence? prostate (32%), lung (16%), colon/rectum (12%)
What are the most common male tumors by mortality? Lung (33%), Prostate ( 13%)
What are the most common female cancers by incidence? Breast (32%), lung (13%),colon/rectum (13%)
What are the most common female tumors by mortality? Lung (23%), Breast (18%)
What has been the pattern of lung cancer for men vs women? incidence has dropped in men but level in women
Is cqancer the #1 cause of death? no, HD still #1
Which tumors have a predilection for brain metastases? lung>breast>kidney>skin (melanoma)
What do brain metastases look like? multiple well circumscribed tumors at gray/white matter junction
Which tumors have a predilection for liver metastases? Colon>stomach>pancreas
What are the most common sites of metastases after regiona LN? liver and lungs
Which tumors have a predilection for bone metastases? prostate,breast>lung>thyroid,testes. metastatic bone tumors more common than primary.
What are lung, prostate, and breast bone mets called? lung: lytic prostate:blastic breast: lytic and blastic
What does Km for an enzyme reflect? its affinity for substrate, decr Km= incr affinity
What is V max directly proportional to? enzyme concentration
What is Km? concentration of substrate at 1/2 V max
What is the relationship between V max and the y intercept in a 1/s vs 1/v graph? incr Y intercept= decr V max
What is the relationship between the x intercept and Km in a graph of 1/s vs 1/v? further x intercept is to the right= greater Km = less affinity
What are the X and y intercepts in a 1/s vs 1/v graph? What is the slope? y intercept:1/Vmax x intercept:1/-Km slope: Km/Vmax
What is the resemblance to substrate, ability to be overcome with substrate, and binding to active site for a competitive inhibitor? resembles the substrate, can be overcome with substrate, binds the active site
What is the resemblance to substrate, ability to be overcome with substrate, and binding to active site for a noncompetitive inhibitor? does not resemble the substrate, cannot be overcome by [s], does not bind the active site
What is the effect on Vmax, Km, and pharmacodynamics of a competitive inhbitor? do not change Vmax, incr Km, decr potency
What is the effect on Vmax, Km, and pharmacodynamics of a noncompetitive inhbitor? decr Vmax, does not change Km, decr efficacy
What is volume of distrobution? How might it be altered? relates amount of drug in body to plasma conc. Vd=amt body/plasma conc. Vd of plasma protein bound drugs will incr vd due to decr protein binding in liver and kidney disease
What type of drugs have low Vd? distribute in blood, are large or charged molecules
Where do drugs with a medium Vd distribute to, what types of molecules? distribute to extracellular space or body water. small hydrophillic molecules that do not bind plasma proteins
Where do drugs with high Vds distribute to and what types of molecules? distribute to all tissues, small, lipophilic molecules that bind strongly to extravascular proteins
What is drug clearance? CL=rate of elimination of drug/plasma drug concentration
How many half lives does a drug infused at a constant rate take to reach a steady state? 4-5 half lives
How is the T 1/2 calculated? t1/2= 0.7 x vd/ Cl
What is bioavailabilty (F) and what is the diff between the IV and oral? F= fraction of adminstered drug IV=100% Orally= % that survives first pass in liver or gut
How do you calculate the loading dose? LD=CpxVd/F where Cp is the target conc
How do you calculate the maintenance dose? MD=CpxCL/F
What is the effect on maintenance and loading dose by renal or liver disease? these disease decr the MD but LD is unchanged
Which affects the frequency of dosing, T1/2 or time to steady state? frequency not affected by time to steady state, but is affected by T1/2
What is zero order drug elimination? rate of elimination is constant regardless of Cp, Cp will decr linearly with time
What is the elimination of phenytoin, ethanol, aspirin? zero order elimination
What is first order drug elimination? rate of elimination is proportional to drug concentration. constant fraction of drug eliminated per unit time. Cp decr exponentially with time
Which drugs are trapped in urine and cleared quickly? Which drugs can be reabsrobed? ionized species trapped in urine and eliminated quickly. neutral forms reabsorbed
What types of drugs are phenobarbital, methotrexate, aspirin? When are they trapped and how can OD be Tx? weak acids. trapped in basic environments. Tx overdose with bicarbonate
What types of drugs are amphetamines? When are they trapped and how can OD be Tx? weak bases. trapped in acidic environments. tx OD with ammonium chloride
What is Phase I metabolism and what enzyme does it? What are the products? PHase I = reduction oxidation, hydrolysis. usually yield slightly polar water soluble metabolites. Done by Cyt P 450
What is Phase II metabolism What are the products? glucoronidation, acetylation sulfation. yield polar inactive metabolites. conjugation
Which phase of metabolism do geriatric patients not have? often dont have phase I
What might be seen in pt who are slow acetylators? can get more SE because of decr rate of metabolism
What is efficacy? What classes of drugs have high efficacy? maximal effect a drug can produce. highe efficacy drug classes are analgesic, abtx, antihistamines, decongestant
What is potency? What classes of drugs have high potency? amount of drug needed for a given effect. incr potency, incr affinity for receptor. chemotherapeutics, antihypertensive drugs, antilipid drugs
What is the effect on an dose max effect scale by a competitive antagonist? shift curve to right, decr potency, NC in efficacy ex. diltizam + flumazenil on a GABa receptor
What is the effect on an dose max effect scale by a noncompetitive antagonist? shifts curve down= decr efficacy. ex. NE + phenoxybenzamine on alpha receptors
What is the effect on an dose max effect scale by a partial agonist? acts the same as a full agonist but with reduced maximal effect. decr efficacy. ex. morphine and buprenorphine at opioid mu recetor
What is the therapeutic index and how is it calculated? how does it relate to drug safety? LD50/ED50= median lethal dose/median effective dose. safer = higher TI
Created by: tjs2123