1
Q
Mechanism of action of hormonal contraceptives (3 diff ways)
A
Inhibit hormone release, inhibit sperm migration or inhibit ovum implantation
2
Q
Inhibition of hormone release- contraceptives
A
inhibits the release of gonadotropin releasing hormone from the hypothalamus
results in the pituitary gland not being stimulated to release follicle stimulating hormones and luteinizing hormones
- results in no follicular maturation and the inhibition of ovulation
3
Q
Gonadotropin
A
Hormone that stimulates the pituitary gland
4
Q
Inhibition of sperm migration- contraceptives
A
Progestins alter the secretions of the endocervical gland into a scant thick fluid that makes sperm migration difficult
5
Q
Progestins
A
Progesterone like hormones
- sometimes has androgenic properties
6
Q
Inhibition of ovum implantation- contraceptives
A
Hormonal contraceptives cause the endometrium to not fully develop making it unsuitable for a fertilized ovum
7
Q
Oral contraceptives
A
One of the most effective
- fixed combination, multiphasic and progestin only
- convenient, cheaper non invasive and self administered but absorption varies in individuals and is subject to first pass effect
8
Q
Fixed combination oral contraceptives
A
Type of oral contraceptive
- fixed combination of estrogen and progestin
- take for 21 out of 28 days of a cycle ( many pill menstruate in the week off it)
- some people fully eliminate menstruation
-99.7 percent effective with perfect use and 92 percent with typical use
9
Q
Multiphasic oral contraception
A
Oral contraception
- Fixed amount of estrogen and variable
amounts of progestin increasing week to week
- reduces the hormonal dose , adverse effects and mimic bodies natural cycle more closely
10
Q
Progestin only oral contraceptive and effetiveness
A
A daily low dose of progestin that’s taken for as long as the patient needs
- less excepted by all patients,
- breakthrough bleeding can occur
- slightly less effective 98 percent perfect use 92 typical
11
Q
Mild adverse affects of oral contraceptives
A
Nausea, Edema, headache HEN
-Nausea is caused by estrogen but usually stops after 1 or 2 cycles
Edema- swelling in the bodies tissue, often in feet, legs, hands, face and abdomen
Headache- drug will be stopped if severe
12
Q
Moderate effects of oral contraceptives
A
WG,BB,A,PH,I
Weight gain, breakthrough bleeding, increased skin pigmentation from estrogen, acne from progestin
Hirsutism- abnormal growth of hair on the face or body due to progestin
Increased Utis and vaginal infections
- sometimes lose period (amenorrhea)
13
Q
Serious adverse effects of combined pill contraceptives
A
BHSCH
Blood clots- estrogens induce production of some factors for blood coagulation changes from 1/1000 chance to 3/1000 chance
Heart attack- Mix of estrogen and progestin increases risk mostly in smokers and obese patients- this is associated with progestin
Stroke- increased risk esp in those over 35
Hypertension- Cardiovascular disease more prevalent esp over 35
cancer- endometrial, colorectal and ovarian risk is REDUCED
14
Q
When can you not take combined oral contraceptives
A
Thromboembolic disease, blood clotting, cerebrovascular disease, impaired liver function, liver disease, estrogen dependent neoplasia, pregnancy (congenital effects on child, limb deformities masculization or undescended testes aka cryptor chidism), undiagnosed bleeding, carcinoma of breast
15
Q
Non contraceptive benefits of oral contraceptives
A
- Reduced risk of ovarian cysts
- reduced incident of ectopic pregnancy (egg implanted outside of uterus often in fallopian tubes)
- reduced risk of ovarian and endometrial cancer
- less iron deficiency or anemia
- less acne and hirsutism (specifically with newer progestins without androgenic effects )
16
Q
DEPOT contraceptive
A
Intramuscular shot
- A slows release formulation contraceptive injection
- progestin dose is injected every 3 months with contraception in that time
PRO: dose not controlled by patients, steady supply, avoids first past effect
CONS: more invasive, volume od drug is limited
99.7 pervcent perfect use, 97 typical use
17
Q
Adverse effects of depot contraceptives
A
Similar to the progestin only pill
- breakthrough bleeding, alter profile of plasma lipids, increase low density lipid proteins and decrease high density
- small increase in risk of coronary vascular cancer in older versions
-
18
Q
IUD- intrauterine devices
A
Implanted into the uterus
- the most common type releases levonorgestrel which is a progestin
- sometimes effective up to 8yrs
- long term and reversible
99.9 percent effective rate for typical and perfect use
19
Q
Adverse effects of IUDS
A
Heaving menstrual flow(often resolves within a couple of months)
- pelvic discomfort
- increased risk of UTIs
20
Q
Transdermal Contraceptive patch
- pros, cons and how effective is it
A
Estrogen and progestin patch that’s applied to the skin
- the drug is delivered at a constant rate for 7 days (3 patches per cycle)
- same mechanism of action as other estrogen-progestin contraceptives
PROS: convenient, steady drug supply avoiding first pass effect
CONS: expensive and can cause irritation to skin
99.7 percent perfect use, 92 percent perfect use
21
Q
Male contraceptives
A
- Attempts to inhibit sperm development (spermatogenesis) have been unsuccessful, mostly permanently alter fertility, increase sex expression, ineffective or adverse effects
- results in low potassium (hypokalemia)
22
Q
Spermatogenesis
A
Hypothalamus releases gonadotropin which stimulates anterior pituitary gland to release follicle stimulating hormone seminiferous tubules that make sperm and luteinizing hormone Ludwig cells that produce testosterone
testosterone is responsible for male sex characteristics and the prescene of it in the body prevents hypothalamus from releasing more gonadotropin preventing overpdouction of testosterone
this is why male attemptd at contraceptives lead to decreased testosterone and decrease sex drive
23
Q
Androgen based potential male contraceptives
A
Androgen can inhibit the release if gonadotropin and spermatogenesis
Injectable form
2 main problems: only eighty percent responded with lowering of less than 4 millimeter
- excess androgen led to increased sex characteristics including aggression
24
Q
Estrogen based male contraceptive
A
Suppress GNRH release and spermatogenesis
issue: decrease in testosterone, sex drive and feminine characteristics were observed
attempted to add androgens
- only 60 percent of people responded and became infertile, many adverse effects
25
progestin and androgen based male contraceptive
Used to inhibit gnrh resulting in loss of spermatogenesis and testosterone production which decreased male sex characteristics
attempted to add androgen to counteract that but it was hard to find an appropriate dose of exogenous androgen
26
Gossypol based male contraceptive
compound from cottonseed
destroys parts of seminiferous tubules decreasing sperm production
- doesn't alter sex drive or testosterones
99 percent effective but no guarantee that's its reversible
- leads to hypokalemia- low potassium
- study was abandoned
27
Classification of medicinal/herbal products
Allopathic medicine, herbal medicine, phytopharmaceuticals, allopathic phytopharmaceuticals
28
Allopathic medicine
Drugs used in mainstream medicine
- Have received a drug identification number from health Canada and undergone full safety and efficacy testing
29
Herbal medicine
Plant products sold to treat conditions with no drug identification number (DIN)
often unpurified and lack clinical trials
30
Phytopharmaceuticals
Drugs obtained by plants that are purified
- are used at therapeutic doses with scientific evidence of efficacy and documented toxicity
31
Allopathic phytopharmaceuticals
Drugs obtained and purified from plants that meet all the requirements of a drug (DIN, full safety and efficacy evaluation) and have full status as a drug
32
Over the counter drugs
Non- prescription drugs
- based on the premise that the general public can diagnose mild symptoms and select appropriate agents of treatment
33
What guidelines should be followed when using an over the counter drug
Illness/symptoms- One should be familiar with their symptoms and they should be mind
Adverse effects- Drug should be stopped if serious adverse effects occur to stop serious toxicities or drug interactions
consultation- Pharmacists can help, drug use should not exceed 2 weeks without consultation
SAC- Slap ayazs cock
34
Safety and efficacy of over the counter drugs
Controlled by the safety food and drugs act that controls safety, efficacy, advertising and sale
- All new ones need rigorous testing and post market surveillance often come from previous prescription drugs with many clinical trials
- issue is some are available without these trials because they have been on the market and used for decades
- only way to measure is through randomized control(grandparenting)
ex.) Acetaminophen wouldn't be approved today due to toxicities
35
How to select the appropriate over the counter drug
BDSP- Brody doesn't suck penis
Brand vs generic, Dose, Simplicity, Proof
Brand vs generic- the brand name isn't always better often just more expensive
Dose- the best over the counter drug will come in an appropriate dosage (ex.) liquid form for children) it will have a therapeutically effective dose
Simplicity- simple formulations and ingredients, multiple ingredients often questionable
- Proven efficacy and toxicity
36
Common over the counter drugs
Internal analgesics, antihistamines, drugs for excess stomach acid, decongestants, cough suppressants, sleeping aids, laxatives,, antidiarrheals, hydrocortisone cream and iron supplements
37
Internal analgesics
Drugs that provide the relief of pain
- acetylsalicylic acid
- acetaminophen
- Nsaids
38
Acetylsalicylic acid (ASA)
- Aspirin
- Analgesic: relieves pain
- antipyretic (relieves fever) and anti-inflammatory
- low doses can prevent stroke and heart attack by inhibiting platelet aggregation/blood clots
39
Adverse effects of acetylsalicylic
Gastric irritation, tinnitus, Reyes syndrome, Allergic reactions
GART
Gastric irritation- ASA breaks down the mucosal protective barrier in the stomach leading to irritation and increases bleeding
Tinnitus- ringing in the ears
Reyes syndrome- affects CNS (swelling in liver and brain)
Allergic reactions- sometimes due to yellow food coloring
40
Acetaminophen
- Tylenol
- Analgesic: the most widely used
- Analgesic and antipyretic equally effective to aspirin but isn't an anti-inflammatory
- available in liquid making it good for kids
- Good when aspirin causes stomach problems or fever and is good for kids due to Reyes syndrome
41
Acetylsalicylic acid MOA
- works by inhibiting the synthesis of prostaglandins- endogenous substances that enhance mediation of pain fever and inflammation
42
Mechanism of action for acetaminophen
Inhibits prostaglandin (enhance pain and fever) synthesis which blocks formation of prostaglandins
- ex.) cyclooxygenase enzyme
43
Adverse effects of acetaminophen
- well tolerate at therapeutic dose but overdose can cause liver toxicity (about 20 tablets)
- if you have alcohol use disorder or liver disease you are more susceptible
- some people think large doses can cause liver injury after long time
- Found in a lot of products sometimes people overdose by taking different drugs
44
NSAIDS- non steroidal anti-inflammatory drugs
- another analgesic
ex.) ibuprofen and naproxen
analgesic, antipyretic and anti-inflammatory
- most effective anti inflame
- more efficacious than ASA (200mg vs 325) in dental and menstrual pain
45
Adverse effects of NSAIDS
- Gastric infection- less likely than ASA
- skin rash
- dizziness
- blurred vision
- fluid retention
46
Internal vs topical analgesics
Most pain is best treated internally but topical is good for minor sprains or joint pain
ex.) DICLOFENAC/VOLTAREN
47
Mechanism of action of internal analgesics
When tissue is damaged arachidonic acid is released
- the acid is converted by cox2 or cox1 enzymes that produce prostaglandins
- cox1 enzymes produce protective prostaglandins that lead to renal protection, gastroprotection, platelet aggression, vasodilation and bronchodilation
- Cox2 produces inflammatory prostaglandins that lead to inflammation, pain, fever, and decreased platelet aggression
- Internal analgesics block 1 or both paths decreasing prostaglandin production which is beneficial but can also block protective affects resulting in adverse effects
48
Antihistamines
Used to treat allergy symptoms such as hay fever
- act by blocking histamine receptors and inhibiting binding of histamine(substance released in allergies) to its receptors decreasing allergy symptoms
classified into first and second generation agents due to its pharmacology
49
First and second gen antihistamines
First- Diphenhydramine- cause sedation and drowsiness
2nd Gen- cetirizine- less sedating and preffered
50
Drugs for excessive stomach acid
Either neutralize stomach acid or decrease its secretion
- antiacids
- h2 receptor
antagonists
- proton pump inhibitors
51
Acid secretion
Active process where protons are transferred into stomach in exchange for potassium
- this is carried out potassium pump
52
Antacids- systemic vs nonsyetmic
- how can they be dangerous
systemic and non systemic
- hold the PH of gastric stomach contents at around 4
- neutralize the gastric acid with acid-base chemical reactions
Systemic- taken orally and absorbed by the GI tract (ex.)TUMS/calcium carbonate), large amounts can cause hypercalcemia and systemic alkalosis
Non systemic- taken orally but not dissolved into the Gi tract, doesn't cause alkalosis
ex.) aluminum hydroxide coats mucosal lining but can decrease phosphate absorption, absorption of other drugs and cause constipation
53
H2 receptor antagonists - how they work, adverse effects
Histamine is involved in the release of stomach acid
- when histamine receptors 9different than allergy inducing) in the acid secreting cells in the stomach are activated, the proton pump is turned on and acid secretion is increased
- with the h2 receptor antagonist: it blocks the h2 receptors reducing the amount of acid secreted
- is more effective than other antacids and has little adverse effects other than a skin rash headache or rare confusion
-
54
Cause of congestion
Congestion is caused by the dilation of small blood vessels which allows fluid to leak from the vessels into the spaces between the cells
- congestion is caused by fluid build up in the nasal cavity
-
55
Decongestants- what are they, MOA and adverse effects
Cause constriction of blood vessels preventing the accumulation of fluid and reducing congestion
- often use nose drop containing 0.5 percent phenylephrine or an oral tablet of pseudoephedrine
Adverse affects- long term use can lead to irritation or chronic rhinitis (chronic congestion) , rebound congestion and potential alteration of blood pressure
56
Cough cause and types of suppressants( 2 types of coughs)
Coughing involves signals from bronchioles which is processed by the cough center in the brain/medulla
- Productive coughs- clears airways of mucus and should not be suppressed
- Non productive coughs (dry and phlegm free) should be suppressed
- centrally active cough suppressants and peripheral cough suppressants
57
Centrally acting cough suppressants
Block processing on information in the brain reducing the frequency of cough
- contains codeine or dextromethorphan hydrobromide(20-30 mg every 6 hours)
- some contain therapeutic doses some have less (Benylin used to be 6.5mg per dose now it is 30
- codeine can lead to opioid use disorder
58
Peripheral cough suppressants
Block nerve endings in the throat and bronchioles which inhibits stimulus to cough
camphor and menthol either added to vaporizers or rubbed on throat and chest
ex.)VAPORUB
- efficacy is questionable, could be slightly effective but likely placebo
59
Sleep aids
Relive sleepiness or help an individual fall asleep
ex.) melatonin: combats jet lag, adjusts sleep-wake cycle
- night time preparations of OTC drugs like NyQuil
- Don't treat clinical insomnia
60
Laxatives
increase excretion of soft formed stool by increasing gut mobility or stool hydration
- To relieve constipation or used before procedures like bowel surgery
- Stimulant laxatives and bulk farming+ osmotic
61
Stimulant laxatives and adverse effects
Increase motor activity of the intestine and increase secretion of water and electrolytes into intestine
ex.) bisacodyl
adverse effects: cramping, water and electrolyte disturbances,
long term use could lead to functional disturbances in the Gi tract
62
Bulk forming and osmotic laxatives and adverse effects
Bulk forming: Swell in water to for emollient gel or viscous solution that maintains soft stool
indigestible so may stimulate peristalsis (food moving through digestive tract)
Osmotic: Draws water into the stool
takes 2-3 days to work
ex.) methylcellulose(bulk forming) Polyethylene glycol (osmotic)
adverse effects: water and electrolyte disturbances
63
Antidiarrheal agents
Diarrhea leads to dehydration concerns
- cannot use antidiarrheals if there is a fever over 38.5 degrees or if there is blood/mucus in the stool
Absorbents and loperamide synthetic opioids
Absorbents- add bulk to the Gi tract and absorb toxins, controls acute self limiting diarrhea that may resolve on their own
ex.) Pepto bismol
Loperamide synthetic opioid- drug of choice. Doesn't penetrate into the cns instead inhibits gut mobility by acting on receptors in the gi tract reducing parasitic activity
- inhibits cramps and is affective for mild-moderate non infectious travelers diarrhea (without a fever of blood )
64
Hydrocortisone cream
0.5-0.1 percent topical anti-inflammatory
- treats poison ivy, oak poison, poison sumac and insect bites
- calamine lotion is also used but it isn't anti-inflammatory
65
Iron supplementation
Iron deficiency is the most common deficiency and metabolic disease
- most common in children and women( blood loss, poor absorption or inadequate intake)
- essential for growth
- iron supplements combat this
adverse effects: nausea, vomiting, diarrhea
66
Antihistamines and CNS depressants interaction
antihistamines interact with other cns depressants like opioids, alcohol and sedative hypnotics
can cause too severe depression slowed cognition respiratory depression
67
ASA and oral anticoagulant interaction
When ASA is given with anticoagulants orally, like blood thinners, it may produce bleeding as ASA prevents platelets from adhering to each other which is necessary to stop bleeding
68
Herbal drugs
Plants or plant parts that are used to prevent or treat illness or improve health
- have been used by 80 percent of population
69
What 2 factors have pushed the use of herbal drugs
General public and manufacturers and retailer
General public- has a growing desire to use "natural products" due to believing they are safer
Manufacturers and retailers- promote herbal products for financial gain
- herbals make over 2billio dollars in sales annually
70
History of herbal drugs
prior to the 1940s they were a huge part of medicine including opioids, slowed down and morphine replaced opium and many synthetic drugs were developed
71
Value of plants for pharmaceuticals
Have many uses for herbal and allopathic drugs
- a direct source of some therapeutic agents
- provide a source of raw material for the manufacture of modified semi synthetic compounds with altered properties like increased efficacy
72
Problems associated with herbals (6)
- Lack of randomized control trials evaluating efficacy and safety- only completed in a few herbals, in 2004 stricter regulations began
- The literature overstates the efficacy of herbal preparations
- Lack of standardization- There is a lack of standardization among similar products during manufacture, standards depend on extent of health Canada inspections
Intentional adulteration- addition of substances other than the herbal like inactive dyes, allopathic drugs to inc efficacy etc (Cocaine, Nsaids, viagra, estrogens have all been found in herbals marketed as pure substances
Differing global standard across countries
Drug interactions with allopathic meds
LAGITS
73
St Johns wort
classified as effective
- supposed to treat mild to moderate depression and heal wounds
active ingredients: Hypericin, hyperforin(containing true antidepressant activity)
- less effective than other antidepressants but proven to be better than the placebo
74
St johns Wart toxicities
syndrome that manifests as confusion, agitation, shivering, fever, sweating, diarrhea, muscle spasms,, terror
Phototoxicity- a rash that forms by drug breaking down into the skin
- Can increase the risk of adverse effects like serotonin syndrome if taken with other antidepressants
- if contain ephedra can lead to additive CNS excitation
75
Aloe vera
Classified as possible effective
- supposed to treat cold sores and minor skin irritation
help with burns and wounds
active ingredient: Mannans and anthraquinones
- thought to increase microcirculation in skin
- if ingested can lead to severe diarrhea
76
Devils Claw
"Possibly effective"
- for osteoarthritis's and back pain
insufficient evidence for other suggested indications herbalists recommend it for issues from migraine to kidney disease and it's mainly used for inflammatory conditions
active ingredient : class iridoid glycosides evidence for anti-inflammatory properties but studies show inactivated in stomach acid
toxicities include diarrhea and many others
77
Panax ginseng
"possible effective"
- thinking, memory, erectile dysfunction, multiple sclerosis fatigue, sexual arousal and decreased flu risk
- supposed to reduce blood sugar
Active ingredient: ginsenosides and panaxosides
- lacks proper randomized control trials
toxicities: headache, high blood pressure, bleeding, increase insulin level in blood(bad for diabetics taking insulin)
78
Echinacea
"possibly effective"
- for colds
- insufficient evidence for anything else
Herbalists say it prevents and treats colds heal wounds is anti-inflammatory
Active ingredient: Echinacea, cichoric acid, caffeic acid
- extracts and stimulates t-lymphocytes the cells responsible for immunity
Toxicities: possible allergic reaction but very rare
- not good for those with autoimmune disease
79
Valerian
"possible effective" for mild insomnia insufficient for anything else
- herbalists say treats anxiety and panic attacks
ACTIVE INGREDIENT: group of compounds Calle valepotriates
toxicities- liver toxicity, cns depressant properties can impair ability to operate motor vehicles
80
What is a vitamin
A substance essential for the maintenance of normal metabolic functions that is not made in the body and must be found in outside sources like food
- exception K and D are naturally produced
- Fat soluble and water-soluble types
- knowledge came from disease states
- Vitamins food through aren't a drug but when taken as a tablet they are
- A, D ,E, b12, C
81
Water soluble and fat soluble vitamins
Water soluble- vitamin c and eleven vitamins in the b group
Fat soluble- A,D,E and K
82
Nutritional approach to vitamin therapy
When an individual selects a diet that aims to supply the recommended dietary allowance(RDA- sufficient for 97 percent of population) for each vitamin or a multivitamin preparation that supports the rda of each vitamin
82
When are Vitamins mainly used (3)
Need for increased nutrition, absorption disturbances and inadequate nutritional intake
Need for increased nutrition- during periods of growth, hard physical work, pregnancy, chest feeding, menstruation and stress or things like hyperthyroidism, fever, wasting disorder or immobilization
Absorption disturbances- due to things like diarrhea, liver disease or surgery
could be due to antibiotics that alter intestinal bacteria since vit K + biotin- require synthesis by intestinal bacteria to be used
Inadequate nutritional intake - due to things like poverty geography substance use disorder or restricted diets
83
Megavitamin approach of vitamin therapy + consequences
When someone ingests vitamins in excess of the RDA ( recommended dietary allowance)
- excess of water soluble vitamins are excreted through urine so people believed it was safe no matter the dose however overdose in overdose in vitamin b6 can cause nerve injury
- High doses of fat soluble vitamins A,D and E can accumulate in body fat and cause toxic effects
84
Vitamin A sources , function and therapeutic uses
- Fat soluble
Sources: Liver, milk, fat, egg yolk and carotene in carrots is converted into it
Function: required for growth and development for normal structure of mucus membrane and epithelial cells and as a constituent of a complex molecule in the eye rhodopsin (for night vision) 2
- administered in periods of increased requirement like infancy pregnancy and lactation
- derivatives used in treating acne, skin cancer and psoriasis
85
vitamin A deficiency and excessive intake
Deficiency- results in delay or growth and development, night blindness, and drying of the surface of the eye
- changes cells in bronchioles in lungs which enhances the opportunity for respiratory infection and dry itchy horny skin
Excessive intake- Dry itchy skin, vomiting, headache, enlarged liver and spleen
86
Retinoids
Retinoids are derived from vitamin A to regulate cell growth and treat acne
87
Vitamin d source function and therapeutic uses
- fat soluble
Source: Meat, fish, mushrooms, sun and milk
Function: increases the absorption of calcium and phosphate from intestine needed for new bone formation
- involved in regulation of blood calcium levels and removal of calcium from older bones
therapeutic uses- prevents osteoporosis: often taken with calcium for those at risk
88
Vitamin D deficiency and excessive intake
deficiency- removal of calcium from the bone to maintain calcium levels
- defective bone growth in children leading to or rickets or bowleggedness (soft weak bones)
Excessive intake: elevated calcium levels in the blood that are deposited in the kidney, heart,, lungs, blood vessels and skin
- feti will suffer, risk of kidney and heart disease, removal of calcium from the bone, fatigue, nausea, vomiting diarrhea and impaired kidney function
89
Vitamin E sources, function and therapeutic uses
- fat soluble
Sources- naturally occurring tocopherols, vegetable oils, green leafy vegetables
Function- essential for many biochemical reactions, is an antioxidant, protects cells in cardiovascular system and other tissues from damaging effects if free radicals
Therapeutic uses- Treats an uncommon type of hemolytic anemia in premature babies(aybe due to antioxidant effect)
90
Vitamin E deficiency and excessive intake
Deficiency- rare but can occur in malabsorption syndrome or chrons disorder
Excessive intake- inhibit platelet aggregation and contribute to anticoagulant effect of warfarin
91
Vitamin b12 and Folic acid sources, function and therapeutic uses
Sources: meats and dairy products b12, sometimes in mushrooms or foods fortified with it]
- all food groups are rich in folate but green fresh vegetables liver and yeast are the highest
Function: synthesis of red blood cells
Therapeutic uses- taken b4 and during pregnancy to reduced neural tube defects on kid, absorption decreases with age so elderly often take it4
92
deficiency and excessive intake of b12 and folate
Deficiency- pernicious anemia
excessive intake- still be studied but as of right now no significant toxic effects but can mask pernicious anemia and lead to delayed treatment
93
Vitamin c source , function and therapeutic use
Source- fruits and veggies
function- holds cells together and absorbs iron
- antioxidant and helps formation of teeth and bones
Therapeutic use- prevents and treats scurvy
- there is no evidence in it helping w colds, the antioxidant activity may reduce cancer risk
94
Deficiency and excessive intake of vitamin c
Deficiency- leads to scurvy symptoms manifest as weakness. bruising, anemia, loss of teeth and bleeding gyms
excessive intake- diarrhea, formation of kidney stones and rebound scurvy due to increase metabolism and stropping use
95
Food additives
Substances added to food to improve the appearance, texture and storage of them
- includes substances added during processing of food or added to improve nutritional value
- can be intentional or unintentional
96
Intentional food additives
Added to improve storage, texture or appearance of a food
ex.) colors, vitamins and minerals, flavors, texture agents, preservatives
97
Unintentional food additives
Added inadvertently as a result of the growing manufacturing and storage processes of food
- often called contaminants and are limited by regulations
ex.) fertilizers, pesticides, heavy metals, biohazard contamination (animal by products, microorganisms, hair)
98
Food additive regulations in Canada
- under authority of health Canada
- Food additives and conditions are listed and
if additive that isn't on the list, manufacturer must submit information on proposed use, evidence of safety, information on effectiveness
- the submission is evaluated by health Canada
99
Why are food additive regulations strict
- They are consumed without knowledge
- healthcare professionals cant get advice on them and aren't involved
- young kids are exposed during vulnerable periods
- they are not essential
100
How do we determine toxicity of a food additive
- The efficacy is easily determined but the toxicity is difficult
- risk/benefit ratios are carefully determined
- we study on animals then extrapolate results to people with the assumption high doses in animals mimic low dose lifetime exposure in humans
- highest no effect dose is calculated
- take 1/100 o- 1/1000 of maximum no dose in humans
101
Issues with determining toxicity of food additives
- it is difficult to replicate humans exposure to additives in animals
- animals are only exposed for one or two years while humans are exposed their whole life
- there is a lot of assumption made such as that high doses in animals equates to low dose lifetime exposure in humans
- can overestimate actual risk
102
Food additives as carcinogens
Food additives are carefully tested for carcicongy and if a positive response is observed they are not allowed as food additives
103
Factors considered for rational use of food additives (5)
Function, quantity, purity, toxicological evaluation, special populations
FQPTS
Function- the use of additives must be justified if they enhance or maintain quality or acceptability
quantity- should only be used in quantities sufficient to obtain stated ends
Purity- Should be pure
toxicological evaluation- information from evaluation should be gathered and and utilized to determine potential risk of the food additive and whether further study is needed
Special groups- should be taken into consideration
104
Cobalt chloride
A compound that was added to beer to control foam, it inhibited heart muscles from functioning
- cardiac deaths
105
What are humans current concerns with food additives
they mistrust the use and prefer food without additives due to substances that were never tested and ended up being toxic
however natural additives are also harmful
- Concern that exposure to children will cause ADHD or hyperactivity
106
Classes of food additives
Flavoring, colours, texture agents, preservatives, sweeteners
107
Flavoring and types
- Found in potato chips, ramen and sauces
- quite prevalent
- doesn't have very thorough testing
types: agents, enhancers, essence of smoke, synthetic flavors
108
Flavoring evaluation and toxicity
- Difficult to evaluate as there is 4-5 thousand in use, most weren't adequately tested but approved due to experience obtained over years of use
Toxicity: Very few toxicities
-monosodium glutamate (msg) can cause tightening of muscles in face and neck, headache, nausea and grogginess
109
Colors
Organic dyestuffs
- give food an appetizing appearance
- most well evaluated additive
- some allergic reactions can occur esp. to yellow tartrazine (paired with aspirin allergy)
- in Canada only 10 are allowed to be used 11 in the US and more in other countries
- Canada banned red dye no2 that produced cancer in high doses in animals
110
Texture agents+ types
- added to improve or impart a specific texture to a product
- often in high concentration: up to 1-3 percent of the product
Silicates- added to flower to keep it from free flowing
Emulsifying +thickening- added to frozen foods (ice-cream) gums and agar
111
Preservatives - 2 types of
Preserves quality of food
- allows for delivery to distant destination in proper quality
- benefit often outweighs risk
- antibacterials and antioxidants
112
Antibacterial as a food additive- 3 types
Smoke- an old method used on meat to preserve and flavour- can have carcinogenic risk
antibiotics- most effective but can cause antibiotic resistance ( not used in Canada)
Sodium nitrate- controversial
added to meat to make it appear red, inhibits the growth of clostridium botulinum
can form nitrosamines which are carcinogens
113
Antioxidants as a food additive
- Prevent oxidation and rancidity of foods
- improve the storage and quality
water and lipid soluble antioxidants
114
Water soluble antioxidants as additive
reduce oxidation of carbs/ browning
- browning of fruit
- ascorbic and citric acid used
115
Lipid soluble antioxidant as additive
Prevent fats from oxidizing or becoming rancid
- used in potato chips, cookies and cakes
- some cause liver damage
- vitamin e/tocopherols sometimes used as an antioxidant (less effective but less toxic)
116
Sweeteners- 2 main types
saccharin and aspartame
- aspartame: possible carcinogen according to WHO
safety threshold: 40mg per kg of body weight per day
mpost diet pops contain 200-300 mg
- people with phenyketavria (cannot tolerate pehnylalanine- an amino acid in aspartame) should avoid it as it can cause brain and nerve damage
117
What is an antibiotic and its purpose
A chemical substance that suppresses the growth of bacteria and may eventually destroy them
- purpose is to stop a bacterial infection through bacteriostatic (inhibiting the growth and reproduction) or bactericidal (directly killing the bacteria
- prevents growth or directly kills bacteria
118
Structure of bacterial cells
Rigid outer layer- cell wall surrounding the cytoplasmic membrane
cell wall contains peptidoglycan layer
119
Peptidoglycan layer
Complex cross linked polymer of polysaccharides and polypeptides that give the cell wall structural rigidity
- responsible for maintaining the cells shape and integrity and preventing cell lysis (breaking down of cell membrane) from high osmotic pressure
120
Gram positive and gram negative bacteria
Gram positive contains a thick peptidoglycan layer and no outer membrane
Gram negative contains thing peptidoglycan layer and an outer membrane
121
Two ways of classifying antibiotics
By cell wall composition: gram negative and gram positive
or
based on selective toxicity by targeting and interfering with essential components of biochemical reactions- killing he bacteria (by mechanism of action)
- Cell wall synthesis inhibitors, protein synthesis inhibitors, metabolic inhibitors, DNA synthesis inhibitors
122
Cell wall synthesis inhibitors- basic description+2 classes
Stop the proper formation of bacterial cell wall/membrane influencing structural integrity
2 classes: penicillin's and cephalosporins
123
Protein synthesis inhibitors- basic description+ two classes
Inhibit protein translation within bacteria and protein synthesis
2 classes: tetracyclines and macrolides
124
Metabolic inhibitors
block formation of key bacterial metabolic substrates that are needed for bacteria to survive and reproduce
- antifolate
125
DNA synthesis inhibitors
Inhibit DNA replication in bacteria preventing bacterial growth
- fluroquinolones
126
Penicillin's
- cell wall synthesis inhibitor
discovered by alexander Fleming in 1929
Two types: natural(penicillin g) and semisynthetic(modified version)
- penicillin g, methicillin, ampicillin + amoxycillin and amoxicillin+ clavulanic acid
127
Penicillin G and what it destroys and what it treats
Type of penicillin
Extracted and purified from penicillium mold
- mainly destroys gamma positive bacteria
-treats: pneumonia, middle ear infections, skin infection, meningitis, syphilis
128
Methicillin-
type of penicillin
resistant to attack from penicillinase- cannot be broken down by it
129
Penicillinase
Enzyme that breaks down penicillin and makes people resistant to penicillin G
130
Ampicillin and amoxicillin
Type of penicillin
- have a broader spectrum of antibiotic activity than penicillin G
- useful against range of infections, cause by gram - and gram +
131
Amoxicillin and clavulanic acid
Combo of semisynthetic penicillin and an inhibitor of
penicillinase that was introduced to combat penicillin- producing strands of bacteria
132
Mechanism of action of penicillin and cephalosporin
d alanine- the drug connects the two glycopeptide chains together to form the cell wall of bacteria by binding to tripeptidase
- penicillin and cephalosporin resembled d-alanine and bind to its receptor preventing the formation of cell wall
- cells without cells walls are called protoplasts- they are fragile and burst easily
- humans don't have cell walls which is why it is only toxic to bacteria
133
Adverse effects of penicillin
GI DISTRESS- nausea/diarrhea due to disturbance of healthy gut flora
PENICILLIN ALLERGY- 1- 10 percent of people allergic often if allergic to one will be allergic to others: results in a rash, fever, face and tongue swelling and itchy hives
can result in anaphylactic shock with severe difficulty breathing and a fall in blood pressure
134
Cephalosporin and its adverse effects
Cell wall synthesis inhibitor
- chemically similar to penicillin but more resistant to penicillinase
- divided into 5 generations depending on spectrum of activity
adverse effects: Similar to penicillin, GI side effects, uncommon to be allergic to it
135
Fluroquinolones
DNA synthesis inhibitor
- chemically distinct class
inhibit dna synthesis
ex.) ciprofloxacin
- gram positive and gram negatovbe
136
Tetracycline- what is it, and mechanism of action
Protein synthesis inhibitor
- one of the first antibiotics developed
- has been used for so long that some bacteria have become resistant
Mechanism of action: binds to the 30's subunit of Mrna ribosome complex and prevents the addition of amino acids to the protein chain inhibiting protein synthesis
137
Adverse effects, use in special populations and storage of tetracycline
Adverse effects- Gi effects, discoloration of teeth and diminished bone growth
use in special populations- Can interact with calcium therefore most be used carefully in kids and pregnant women
storage: if stored to long it can deteriorate into toxic degradation products
- old products must be discarded
138
Macrolides- what is it, mechanism of action, adverse effects
Protein synthesis inhibitor- antibiotic
- active against several bacterial infections cause by gram positive microorganisms, one type called erythromycin is affective in treating some gram negative
- good for those with a penicillin allergy
- binds to 50s subunit and prevents protein synthesis
adverse effects: nausea, vomiting diarrhea
139
Metabolic inhibitors- how do they work
Tetrahydro folic acid is a folate essential for the bacteria to synthesize DNA and protein
- if its not formed, bacteria growth with slow
antifolates like sulfonamide and trimethoprim inhibit folate metabolism.
140
Sulfonamide
Metabolic inhibitor
- inhibits step in formation of tetrahydrofolic acid by inhibiting PABA (para-aminobenzoic acid) incorporation into dihydropteroic acid
- tetra must be synthesized from paba in bacteria, in humans it naturally occurs which is why it is selectively toxic to bacteria
141
Trimethoprim
Metabolic inhibitor
Inhibits the enzyme dihydrofolic acid reductose which inhibits terahydrofolic acid formation
- greater inhibitory actions on bacteria than humans= selective toxicity
142
Combination antifolates
By inhibiting sequential steps in the metabolic pathway a synergestic antibacterial effect isproduced
- therefore a combo product containing sulfomethoxalwe and -trimethorpim was developed
-sulfamethoxazde-trimethoprim/cotrimoxale
- treats UTI's, respiratory tract infections and GI tract infections
143
Antibiotic combinations
Soemtimes combined for
- therapy of severe infection where the microorganism responsible is unknown or its so dangerous you cant wait to determine lab tests
- treatment of infection with different types of bacteria that cant be treated by one antibiotic
- treating tuburculosis: emergence of resistant myobacterium is an important hazard treatment is akso carried out with antitubercular drugs
- infections treated by 2 antibiotics that act synergestically
DDT's
144
Disadvantages of combining antibitoics
- unecessary additonal cost if 1 is effective on its own
- increased chance of toxicity
- enhanced opportunity for resistant bacteria to arise when combo is used especially if its not effective
- decreased number of normal populations of different bacteria removing inhibutory infkuence on poentially dangerous bacteria
145
Antimicrobial resistance
Emergence of resistant strains in antibiotics, antifungals and antivirals
- during replication bavteria can mutate and evolve to have different properties, becomiing resistant to antibiotics
- some infections are now untreatabke through antibiotics
146
2 main Factors associated with antibiotic resistance
Evolution of bacteria and clinical and environmental factors (like misuse)
147
Explain how evolution of bacteria is assicuiated with antibitpoic resistance
evolution of bacteria- in an infection the intiial bacteria population is composed of a diverse array of bacteria with different traits from mutations some traits make them reistant to antibiotics
- after antibiotics are taken, the bacteria sensitive to the effects die iff and the bacteria reistant ones stay, ovetime reistant bacteria replicates forming new population trait thats common ion new population and reisstant to antibitoics
148
Causes of antibiotic reisistsance
Over prescription, inapproproate use, use in agriculture,discovery of new antibiotics/lack of incentive
PIA
over prescription- due to lack iof diagnostic equiptment or pressure from drug companies and patients
Inappropriate use- using drugs that belong to others or stopping dose before its over
use in agriculture- animals exposed unecesarily increasing risk
- mcr1- gene found in pigs that is resistant to antibiotic collistin, reistance probably devloped from the pigs
149
4 ways organisms become reisistant
UTIE-
Uptake, target, inactivation, efflux pumos
Uptake-Small molecules gain access to the inside of the microorganism by moving through pores in the membranes. Mutation or laxk of pores makes organisms resistant
Target- a mutation in the target for the antibitoic can reduce the binding of the drug to its target abd be ineffective
Inactivation- Microorganisms develop an enzyme that inasctivates the anibitoic
ex.) penicillinase
efflux pumps- some microorganisms will over express transporters tgat pump the drug out of the microorganisms before the cell can be injured
150
Antifungal drugs
Only a few that are effective
two types:echinocandins- cell wall inhibitors:micafungan, caspofungin
imidazoles- ergosterol synthesis inibitors
-ketoconazole - fluconazole
151
Echnidocandins +MOA
Anti fungal drug- cell wall inhibitor
- newer class and commonly used
- Inhibit synthesis of a component of the cell wall reuslting in disrutpion of cell wall and fungal death
- micafungin and cospofungin
- very well tolerate in patients and only avilable for intravenous administration
152
Imidazole/azole+ MOA
ergosterol synthesis inhibitor
- ketoconazole -fluconazole
- effective when taken orally or iontravenosuly for systemic fungal infections
MOA: Inhibit fungal cytochrome p450 inhibiting ergosterol synthesis
- ergosterol is important for cell wall function and survival
- selective toxicity lies in higher affinity for fiungal p450 than human p450
- many available over the counter or as treatment for yeast infections
153
Virus
A small infectious agent that is only able to multiply within the living cells of other organisms: plants, animals and bacteria
154
Viral cycle
attachment, entry, replication, biosynthesis, assembly, release
1.) Attatchment- Viral DNA attatches to the receptors on host cell,
2.) Entry- virus enters the cell through fusion or endocytosis
3.) Replication- genome is copied using host or viral enzymes,
4.) Biosynthesis- viral Mrna is transcribed and translated producing viral proteins
5.) assembly- new genomes and proteins are packaged to from complete viral particles
6.) release- viruses exit the host cell damaging the host of effecting other cells
AERBAR
The virus binds to specific receptors on the host cell and injects genetic material, the DNA is then transcribed into RNA, and the host cell replicates the viral genome into new virus particles. These new viruses then exit the host cell, often killing it; however, some viruses retain parts of the host cell and form an envelope protecting the virus from the immune system.
155
Antivirals- what are the 2 types
2 main types: focus on different points of the viral cycle
Oseltamivir (tamiflu)and Acyclovir
156
Oseltamivir (tamiflu)
Inhibits neuraminidase which is an enzyme that allows to spread of a virus from cell to cell
- treats the flu and prevents other cells from getting infected
157
Acyclovir
Taken up into infected cells and virus activates it
- inhibits dna replication
- slective for cells infected with the virus
- long term use decreases frequency of reoccurence of genitsl herpes
- stoos infections that cause chicken pox and shingles
158
Antibiotics and the flu
You shouldn’t take antibiotics for the flu because the flu is caused by a virus, and antibiotics only work against bacteria. Using antibiotics when they aren’t needed won’t help you recover, and it can actually cause harm by:
Not treating the illness (they don’t kill viruses).
Increasing antibiotic resistance — bacteria can adapt, making future infections harder to treat.
Causing side effects like stomach upset, diarrhea, or allergic reactions.
159
environmental toxicants
A chemical that is released into the environment and can produce adverse effects on living organisms
ex.) air pulltion, tobacco smoke, pesticides, lead, mercury, BPA
160
Acute toxicity of environmental toxicants
Associated with single exposure to a chemical and often a large dose of it
ex.) chemical spill
161
Chronic toxicity of environmental toxicants
Associated with repeated exposure to small doses of a chemical over a long period of time
ex.) eating contaminated food
162
Acute vs chronic toxicity of environmental toxicants
- aflatoxin B
Acute toxicity is single exposure while chronic is multiple exposures over a long period of time
acute is typically a large dose(not always) while chronic is often a bunch of small doses
Toxic effects present differently
Aflatoxin B- acute= liver necrosis, liver failure and death
chronic= liver cancer
163
3 main environmental toxins learned
Air pollution, tobacco smoke, pesticides
164
2 categories of air pollutants
Particulayte matter and gaseous air pollutants
Particulate matter- mix of tiny particles composed of non gaseous pollutants (biological materials)
- can be solid or liquid droplets
Gasepous air pollutants- Carbon monoxide, carbon dioxide, nitrogen oxides, sulfur oxides, hydrogen sulfide, ozone
165
Sources of air pollutants
Natural sources- volcanoes, forest fires, praire fires, dust storms
Anthropogenic/man made- heating and power automobiles and industrial processes
166
Heating and power impact on air pollutants
Combustion of fossil fuels releases co2, carbon monoxide and nitrogen oxide
coal is the largest contributer to the human made increase of co2 in the air
167
Automobiles impact on air pollutants
Automobile exhaust releases smoke, lead parts, carbon monoxide, and nitrogen oxide
- regulations have forced a decrease in the 20th century
- now more "green vehicles"
168
Industrial processes impact on air pollutants
Some manufacturing processes release pollutants
acids (sulfuric acid, acetic acid)
Solvents (dissolve other substances-ethanol), chlorine, ammonia gas, metals (coppwr, lead and zinc)
169
Human health and air pollutants
- can chemically irritate the respiratory tract
- certain populations like children, older adults and those with cardiorespiratory disease are more susceptible
- the risks are often dye ti the combined action of particulates and sulfure oxides not just one pollutant
170
Tobacco smoke and second hand exposure
environmental smoke and second hand tobacco smoke is a combination of mainstream smoke thats exhaled and sidestream smoke that comes from burning the end of a cigarette
- second hand smoke can cause lung cancer and has the same risks as smoking
- because of involuntary exposure bylaws have been put in place
171
Pesticides - 2 types
used to intentionally kill organisms
- insecticides and herbicides
172
Insecticides- 2 types
Used to kill insects or make them unable to reproduce/develop naurally
organochlorine insecticides and organophosphorus insecticides
173
Organochlorine insecticides + how do they work and an example
Work by increasing sensitivity of nuerons resulting in increased CNS stimulation
- manifests as tremors convulsions and death
- residues in humans animals and environment may present long term effects but they arent yet fully understood
ex.) DDT- was used to treat maleria and was effective until insects devloped resistance and the bird and fish population decreased as well as soil and water concentration
- increased amount in food
174
Organophosphorus - what is it and its effects
First synthesized in ww2 as potential warfare agents fo things like nerve gas
- require metabolic action to work which occiurs rapidly in insects
- unstable and breaks down in the environment ( has a small impact overall)
very toxic to humans when absorbved in the skin, lead cause of posioning
175
Organophosphorus insecticides mechanism of action
Irreverisbly inhibit acetylcholinesterase that responsible for breaking down acetylcholine in the synaptic cleft
- leads to increased acetylcboline nueronn firing decreased heart rate, leading to diffuclty breathing, fecal and urinary incontinence blurree vision or death due to respiratory failure
176
Herbicides- 2 types
Pesticides that are capable of killing plants
- agent orange and paraquat
177
Agent orange - what is it how does it work
A herbicide that was used in the veitnam war to make it easier to spot targets hidden by trees
- mimics plant growth hormones causing uncontrolled unsustainable growth and death
178
Agent orange toxicirty
Chemical in agent orange TCDD (2,3,7,8 tetrachloridebenzodioxin) binds to aryl hydrocarbon receptor involved in expression for genes required for nomal cell functioning
Toxicity manifests as: chloroacne, impairment of liver and cns function, increased occurence of certain cancers can cause birth defects and still births
ukraine presidenr victor: got jaundice acne
179
Paraquat
The most widely used herbicide
- is oxic when ingested causes burns to stomach and mouth
- effects lungs, cell damage results in development of fibrous tissue that inhibits the ability to breath
- less than 2 tsps can cause lung damage
180
Lead and its 2 main toxic compounds
chemical lelading to several toxic effects
- unbiquitos naturally occuring
- present in the environment and different chemical compounds
2 main toxic compounds: lead oxide and tetraethyl lead
181
Lead exposure sources
Old paint, industry, leaded gasoline
old paint- used to make paint dry quicker, riksk of children accidently inegesting it
kids absorb 30-50 percent while adukts on absorb 10 deadly if in children mouths
Industry- lead car batteries
- i8ndustries that use lead release emissions in the workplace and surrounding area, some can end uip in soil and contaminate food and children can be exposed if they eat dirt
Leaded gasoline- tetraethyl lead was used in gasoline to increase engine compression and fuel economy. during combustion lead oxide is released into the environment
- now most gas is lead free
182
Lead toxicity (4)
CNS, PNS, Kidneys, blood
CNS- eszpecially in kids, decrease in apetitie, iritability, fatigue, if lead poisoning is not detected it can turn into permanent brain damage(encephalopaty) can lead to learniing defiicts, epilesp and blindness
PNS- degeneration of motor nerves, loss of coordination and clumsiness
Kidneys- Lead induced dysfunction due to impairment of energy metabolism invokved with mitochondrian kidney
-e ffects are reverisble if lead exposure stops
Blood- decreases biosynthesis of heme leasing to anemia and decreased lifespan of red blood cells
CPKB
183
Mercury plus its 2 sources and 2 types
Naturally occuring
- found in water and air
industry and ingesting fish
industry- used in preparation of chlorine and sodium hydroxide as an electrode,
can be exposed through the air from mercury vapour if throguh food
- ingesting fish from mervury contained water that has accumukated mervury through concentration by the aqautic food chain
- mercuric mercury abd methyl mercury
184
Mercuric mercury and its toxicity
Exposure occurs thorugh inhalation of vapours
- only 15 percent is absorbed into the body but it accumulates in the kidneys andis toxic to those organs
185
Methyl mercury and its toxicity
mercury is converted into this by bacteria and fish in water
- the most toxic form
- 90 percent is absorbed from food after eating
- targets the cns, enters the brain, binds to nerve cell proteiins and leads to nerve cell death
acute toxicity- irritability, numbness, tingling vision, hearing loss,tremor, paralysis
chronic toxicity- coma and death
186
Treatment for mercury toxicity
Chelating agents-are effective for terating merucric mercruy posioning but not methyl
- methyl mercury can be treated with charcoal i it has been ingested recently as it prevents methyl mercury from being absorbed intp the body, wont work if its alreeady asborbed and irreverisble
- Ligand that binds tightly to metal ions and can be used to remove toxic metals from blood
187
Minimato disease
In Japan cause by industraial mercury pollution
- mervcury enetered the food chain through fish and shellfish
- lead to nuerological disorders and over 2000 deaths
188
Bisphenol A (BPA) and main source of exposure
Industrial chemical used to make hard clear plastic (polycarbonate)
- used in many consumer products like baby bottles and reusable water bottles
- found in epoxy resins (protective lining on metal based cans)
main source of exposure- through diet where BPA leaches into water out of containers into food- rate increases with heating which is why you shouldnt microwave it
189
BPA toxicity
EGIE
estrogen based activity, general population, infants, environment
Estrogen based activity- bind to estrogen receptors and mimic its effects, could play a role is respiratory cancers(breast, testicular and ovarian and fertility problems. altered brain development in infants
General population- controversy around its toxicity- supposedly wont cause issues according to health Canada
Infants- no expected health risk but they are more at risk so its banned in baby bottles
environment- in the water, harming fish
- max concentration is limited through protocols
190
Pharmaceuticals in the environment
Relevant environment pollutants in surface water (rivers, streams, lakes) ground water and soils
- currently very low to low levels but adverse effects in the environment are observed in aquatic species and birds
191
Adverse effects of pharmaceuticals in the environment
Adverse effects are well known due to preclinical and clinical studies establishing the beneficial and toxic effects on humans before marketing
- possible to predict adverse effects in drinking water on humans but more difficult to predict impact on aquatic and plant life
192
6 main ways pharmaceuticals enter the environment
DAM APP
Use in agriculutre, treatment of pets, prescription, aquaculture, manufacturing processes, Disposal i=of med
193
how does use of pharmaceuticals in agriculture enter into environment
Antibiotics are used to treat farm animals, agent is excreted and manure is spread on fields for fertilizer,
use of agriculture to storage of manure to manure spreading into soil into receiving water
194
How does use of pharmaceuticals in treatment of pets and disposal get into environment
pets: metabolize and excrete like humans, find its way into surface and groundwater
Disposal: 25 percent of unused drugs are poured down he sink or flushed down the the toilet finding their way into sewer discharge ]30 percent are thrown into the garbage and disposed of in a landfill which contaminates groundwater
195
How does aquaculture contribute to pharmaceuticals in the environment
Use of antibiotics in fish or other animals especially in enclosed spaces
- used to prevent disease and promote growth to maturity
leads to high concentration of antibiotics
196
How do manufacturing processes and human prescriptions lead to pharmaceuticals in the environment
Manufacturing process- discharge from manufacturing plants effects local surface and groundwater
- impact on environment increases as chemical facilities move into developing countries with less environmental standards
Human prescriptions- Administration and excretion of prescription drugs can be excreted unchanged or as active metabolites, then passed into municipal waste water systems and sometimes not removed through sewage treatment prior TO entry
197
Major classes of pharmaceuticals in the environment
Neuroactive drugs, steroid hormones, antibiotics, antihypertensive drugs, analgesics
NASAA
198
Neuroactive drugs in the environment
Neuroactive drugs- antiepileptics, antidepressants, ssris, antipsychotics, detected in surface water, ground water and soil
- sewage treatment plants reduce but dont efficiently remove these
exposure to humans is usually minimal but messes with reproduction and development of fish
199
Steroid hormones in the environment
Biggest concern as they are estrogenic compounds
- from oral contraceptives and natural excretion
- in drinking water: below negligible level with little effects
- additive effect of human exposure to estrogens and endocrine disturbing agents like BPA
Reproduction and maturation effected in fish with tiny amounts
200
Antibitoics in the environemnt
Lead to antibiotic resistance and biomagnification in edible plants and animals
201
Antihypertensive drugs in the environment
30 percent of people in canada have been treated for hypertension it is in surface water but below ng/l range
- unsure of if there is biomagnification in food chain and what concentration is present in our seafood
202
Analgesics in the environment
Ibuprofen, naproxen acetylsalicylic acid have very high frequency of use
- doesn't pose a risk is very low in human water and minimal for aquatic species
203
Two sources of human exposure to pharmaceuticals in the environment and factors
Drinking water and bioaccumulation in food sources
- standards for permissible levels but not regulations
Factors- extent of use, dose administered persistence in environment/half-life, ability of sewage and treatment to remove agent
204
Reducing risk of pharmaceuticals in environment
- reduce discharge from factories by altering the manufacture regulations to protect the environment
- consider effect of pharmaceurticals on environemnt as apart of the drug liscencing process
- municipal sewage treatment plants are designed to remove or destroy pharmaceuticals in wastewater priot to discharge modern treatment plants
- expanding "take back" programs at pharmacies to ensure proper disposal
205
which vitamins are more toxic
Fat soluble as they cannot be brokem down in ht kidneys and excreted through urine
A,D,E,K
206
Cancer
disease primarily effecting those 50 and older, 45 percent of males and 43 percent of females develop cancer at some point
- 30 percent of all canadian deaths are due to cancer
Most common cancers: lung, breast, colorectal, prostate
207
Features of cancer cells
Generic term for a large number of diseases involving abnormal groups of cells
CIM
Cell growth and division- the ability to proliferate indefinitely
Invasion- The ability to invade surrounding tissue
Metastosis- The ability to spread throughout the body
208
2 main causes of cancer
Genetics and environmental factors
Genetics- genetic makeup contributes to variation in response to carcinogens
- xeroderma pigmentosum- gentically based deficiency in DNA repair maybe people prone to mutations and high incidence of skin cancer
Environmental factors- environmental chemicals, diet, infections
- are all modifiable
209
Environmental factors involved in cancer risk
Tobacco use, diet, occupation, viruses
- varies throughout countries due top vaccination availability regulations and food
210
Tobacco use and cancer risk
smoking causes many cancers like lung, esopjagael, bladder and pancreatic
- influenced also by gentics and frequency
smokers are 8 times more likely to develop lung cancer than non smokers
- passive smoke contributes to risk
211
Diet and cancer risk
Saturated animal fat and red meat in excess can lead to colon, rectum and prostate cancer
high intake of salt can lead to stomach cancer
lack of fruits and vegetables- fruits and begtables have constutuents that block cancer- indcing chemicals in your body
212
Viruses and cancer
Bacterial and viral disease can contribute
Bacterials like helicobacter pylori can be responsible for stomach ulcers and cancer
viral- hepatitis B and C can cause liver cancer
- eighty percent of liver cancer is caused by hepatitis
HPV can cause cervical cancer
213
abestos and benzene- cancer
Abestos- can cause lung cancer and people exposed aee brake liners, shipyard, insulation and demolition workers
Benzene- can cause leukemia
exposed: painterssm furniture finsihers, rubber workers, petrochemical workers
214
Formaldehyde and ionizing radiation - cancer risk
Formaldehyde- can cause nose cancer
exposed: hospital and lab workers, manufacturers of wood, paper and textile products
Ionizing radiation- can cause bone marrow cancer-
exposed: through nuclear material, medicinal products and procedures
215
Soot cancer risk
Can cause skin cancer
exposed: people workinmg in chimneya sweeps, cleaners, firefighters and bricklayers
216
6 main ways to prevent cancer
Avoid excessive sunlight- 75 percent of skin cancer from suns UV radiation, use sunscreen- reuces risk by forty to fifty percent UVA and UVB
Monitor alcohol intake- alcohol can increase risk of mouth and liver cancer
Eliminate tobacco use- decrease risk of lung and other cancers
Eat healthy- red meat and fruit vitamins
Be active- ensures the body is in its best shape to combat carcinogens
Vaccination- for hepatitis and HBV
SAT FAV
217
4 goals of cancer treatment
Cure the cancer, prevent the cancer, control the cancer or relieve symptoms
218
Curing the cancer
The primary goal of caner treatment
- only achieved in some cancers like childhood leukemia and testicular cancer
219
Preventing cancer
doctors aim to prevent cancer cell growth or remove precancerous cells that could lead to cancer
220
Controlling cancer
When a cure is not possile doctors aim to control and prevent the spreading of cancer to prolong survival
221
Relieving symptoms of cancer
When curing and controlling cancer symptoms is not possible, aim to make the patient as comfortable as possible through analgesics and antipyretics
222
Drugs used for the treatment of cancer and principles of treatment
Chemotherapy, radiotherapy, targeted therapy, immunotherapy
Benefit risk assesment- each situation benfits and risks must be weighed, cell lining is often harmed from continous dividing leading to nausea vomiting andf ulceration hair roots are harmed leading to hair loss
- benfits and risks are reevaluated prior to each treatment
223
Chemotherapeutic drugs
Attempt to slow growth of rapidly dissolving cells
- inhibit DNA synthesis, protein synthesis or cell divsion through many ways
- newer ones act directly sgsindt abnormal proteins in cancer cells and are more targeted
Alyklating agents-
Mitotic inhibitors
Hormone and hormone antagonsits
biologicals
- mostly dont have selctive toxicity
-
224
Alkylating agents and mitotic inhibitors
Cancer treating drugs- chemotherapy
Alyklating agents- bind to and interfere with DNA replication
Mitotic inhibitors- affect microtubule function and formation of mitotic spindle preventing cell divison
225
Hormones and hormone antagonists and biologicals
Chemotherapy technique
Hormones and hormones antagonsists- Treat hormone sensitice tumours by supressing cell division
Biologicals- Derived through molecular biological techniques
- inhibit cell replication by blocking cytokines that usually control cell growth some drugs are antibopdies to cytokines
226
Why do we often combine different chemotherapy drugs
Development of resitstance and occurence of toxicites
Development of resistance- Cancer cells can devlop resistancd to chemo drugs, this is less liekly to occur if its attacked by a variety of drugs in different ways
Occurence of toxicities-Chemotherapy drugs have a low therapeutic index if one drug is used its not possible to increase the dose beyond certain level due to toxicities
- using combination allows for selection of chemotherapeutics with different, dose schedyke and toxicities that are carefully evaluated and mazimize effects and toxicity
Phar 100 Final
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