MEDICAL PHARMACOLOGY STUDY GUIDE AND TOPIC SUMMARY FOR EXAM 3 2 22 12 Lectures 31 33 Gases Solvents Household Poisons ASPHYXIANTS interfere with cell s ability to obtain or use oxygen Physical N2 CO2 Chemical Carbon Monoxide CO Mechanism of toxicity treatment Cyanide CN Mechanism of toxicity treatment IRRITANTS Upper Respiratory Tract HCl SO2 Deep Lung O3 NO2 chemical properties type of damage SOLVENTS Aliphatic gasoline kerosene etc effects on lung aspiration Aromatic Benzene Toluene Xylenes additional effects on liver bone marrow Alcohols Methanol Ethylene Glycol specialized toxicity resulting from metabolism ethanol as antidote HOUSEHOLD POISONS Detergent Bleach Corrosive substances especially bases Lye drain cleaners Dangers of emesis Lecture 32 Heavy Metal Toxicity 1 Know specific chelating agents for each metal and route of administration Lead Calcium disodium EDTA IV 2 3 dimercaptosuccinic acid Succimer Oral 2 3 dimercaptopropanol BAL Dimercaprol IM Penicillamine Oral Cadmium Calcium disodium EDTA IV Mercury 2 3 dimercaptosuccinic acid Succimer Oral 2 3 dimercaptopropanol BAL Dimercaprol IM Penicillamine Oral N acetyl penicillamine Oral Arsenic N acetyl penicillamine Oral Penicillamine Oral Arsine gas AsH3 hemolytic agent transfusion 1 Iron Deferoxamine IM slow IV Oral under rare circumstance 2 Know the routes of absorption Skin Inhalation GI 3 Know the mechanisms of toxicity Lead Inhibits Heme Biosynthesis Aminolevulonic acid and Protoporphyrin IX increases in plasma and urine Diagnosis Children ingested large quantities of paint containing lead is called Pica Cadmium Inhibits 1 antitrypsin B emphysema nephrotoxicity Mercury Mercury salts precipitates proteins necrosis inhibits sulfhydryl SH group containing enzymes plastic industry Minimata disease Arsenic Increases vascular permeability Inhibits anaerobic and oxidative phosphorylation semiconductors herbicides pesticides water contamination 4 Know why EDTA given IV EDTA cannot cross the cell membrane 5 Know why EDTA given as Calcium disodium salt To balance the calcium level 6 Know how to treat copper poison Wilson s disease Penicillamine N acetyl penicillamine Allergic to penicilline B Trientine triethylenetetramine HCl Lecture 33 Pesticides A Organophosphorus Insecticides 1 General structure 2 Mechanism of action 3 Metabolism 4 Signs symptoms of toxicity 5 Sites of effects 6 Treatment 7 OPIDN B Carbamate Insecticides 1 General Structure 2 Mechanism of action 3 Signs symptoms of toxicity 4 Treatment C Chlorophenoxy Herbicides e g 24D 245T 1 Mechanism of action 2 TCDD Contaminant D Bipyridyl Herbicides e g Paraquat 1 Toxicity 2 Mechanism of action E Warfarin Rodenticide 1 Toxicity 2 Mechanism of action 2 Gonadal Hormones Androgens and Estrogens Lecture 54 Describe the pharmacology of testosterone esters and synthetic derivatives as well as anabolic androgens with respect to route of administration and rates of absorption and metabolism Recognize agents that block their biosynthesis and or androgenic activity Describe the pharmacology of estrogens and synthetic derivatives Recognize agents that block their biosynthesis and or estrogenic activity Describe the therapeutic use and mechanism of action of estrogen antagonists or partial agonists and progesterone antagonists and explain how a selective estrogen receptor modulator SERM can act as an estrogen agonist in one tissue or cell type while acting as an estrogen antagonist in another tissue or cell type Be familiar with effects of raloxifene and tamoxifen Compare and contrast the different formulations for hormonal replacement therapy Know the symptoms of the menopause period and which symptoms have been shown through clinical trials to benefit from HRT Understand the difference between ERT estrogen replacement therapy and HRT hormone replacement therapy Know the various estrogenic agents that may be used to treat menopausal symptoms Be aware of different protocols and routes of administration of HRT Understand the rationale for choosing one protocol or route over another Hypothalamic and Pituitary Hormones Lecture 36 Describe the physiological and or pathological consequences of normal exaggerated and insufficient levels of the following hormones Growth Hormone Prolactin GnRH Gonadotropins LH FSH hCG Thyroid Stimulating Hormone Desmopressin Vasopressin Oxytocin Referring to lecture notes and reading assignment recognize pharmacological agents that are used to stimulate mimic or oppose these hormones and the clinical situations in which they are useful Oral Contraceptives and Profertility Agents Lecture 37 Describe the primary mechanism of action of combination oral contraceptive pills OCP and of progesterone only contraceptive pills 3 Describe the two types of combination contraceptive pills monophasic multiphasic What are the 2 possible estrogenic components of combination oral contraceptive pills Define how OCPs are divided into groups based on dose of estrogenic component Describe how classes of progestins differ by progestational androgenic antiestrogenic and estrogenic activity Describe what factors are important in determining the final estrogenic and progestational activity of a combination oral contraceptive pill Describe factors that govern the initiation of oral contraceptive therapy What are the criteria or important factors that influence choice of OCP Know the contraindications to OC therapy List the signs of excess estrogen or progesterone activity in an OCP Drugs used for infertility Understand the principal pharmacological approaches to treating infertility Understand the use of clomiphene gonadorelin short acting GnRH leuprolide long acting GnRH menotropin Pergonal and human Chorion Gonadotropin Pergnyl Insulin and Oral Hypoglycemic Drugs Lecture 38 1 Be able to describe the different types of Diabetes Mellitus what is different about each type that affects therapeutic intervention 2 Be able to define or recognize characteristic profiles of insulin and glucose levels in normal and diabetic patients 3 Know the types of insulin therapies employed in type 1 DM and their rationale single vs mixed vs pump different insulin formulations 4 Know the mechanism of action of insulin 5 Know the major differences between hypoglycemic vs antihyperglycemic drugs What are the therapeutic advantages of each class 6 Know the mechanisms of action and side effects of the major oral hypoglycemic and antihyperglycemic drugs Corticosteroids Lecture 39 Compare and contrast
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