-1-MEDICAL PHARMACOLOGY STUDY GUIDE AND TOPIC SUMMARYFOR EXAM 32/22/12Lectures #31 & #33 Gases Solvents Household PoisonsASPHYXIANTS - interfere with cell’s ability to obtain or use oxygenPhysical (N2, CO2)ChemicalCarbon Monoxide (CO) - Mechanism of toxicity, treatmentCyanide(CN) - Mechanism of toxicity, treatmentIRRITANTSUpper Respiratory Tract (HCl, SO2 ) Deep Lung (O3, NO2)chemical propertiestype of damageSOLVENTSAliphatic (gasoline, kerosene, etc)effects on lung, aspirationAromatic (Benzene, Toluene, Xylenes)additional effects on liver, bone marrowAlcohols, (Methanol, Ethylene Glycol)specialized toxicity resulting from metabolism, ethanol as antidoteHOUSEHOLD POISONSDetergent, BleachCorrosive substances, especially bases (Lye, drain cleaners)Dangers of emesisLecture # 32 Heavy Metal Toxicity1. 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-2-Iron: Deferoxamine (IM, slow IV, Oral-under rare circumstance)2. Know the routes of absorption.Skin, Inhalation, GI3. Know the mechanisms of toxicityLead: Inhibits Heme Biosynthesis- Aminolevulonic acid and Protoporphyrin IXincreases in plasma and urine (Diagnosis); Children ingested large quantities of paintcontaining lead is called "Pica"Cadmium: Inhibits ∀1-antitrypsin B(emphysema), nephrotoxicityMercury: Mercury salts precipitates proteins, necrosis, inhibits sulfhydryl (-SH) groupcontaining enzymes; plastic industry-Minimata diseaseArsenic: Increases vascular permeability, Inhibits anaerobic and oxidativephosphorylation; (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 level6. Know how to treat copper poison (Wilson’s disease)Penicillamine; N-acetyl-penicillamineAllergic to penicilline B Trientine (triethylenetetramine HCl)Lecture #33 PesticidesA. Organophosphorus Insecticides1. General structure2. Mechanism of action3. Metabolism4. Signs/ symptoms of toxicity5. Sites of effects6. Treatment7. OPIDNB. Carbamate Insecticides1. General Structure2. Mechanism of action3. Signs/ symptoms of toxicity4. TreatmentC. Chlorophenoxy Herbicides e.g. 24D; 245T1. Mechanism of action2. TCDD ContaminantD. Bipyridyl Herbicidese.g. Paraquat1. Toxicity2. Mechanism of actionE. Warfarin Rodenticide1. Toxicity2. Mechanism of action-3-Gonadal Hormones - Androgens and Estrogens Lecture 54Describe the pharmacology of testosterone esters and synthetic derivatives as well as anabolicandrogens with respect to route of administration and rates of absorption and metabolism.Recognize agents that block their biosynthesis and/or androgenic activityDescribe the pharmacology of estrogens and synthetic derivativesRecognize agents that block their biosynthesis and/or estrogenic activityDescribe the therapeutic use and mechanism of action of estrogen antagonists (or partialagonists) and progesterone antagonists, and explain how a selective estrogen receptormodulator(SERM) can act as an estrogen agonist in one tissue or cell type, while acting as an estrogenantagonist in another tissue or cell type.Be familiar with effects of raloxifene and tamoxifenCompare and contrast the different formulations for hormonal replacement therapy.Know the symptoms of the menopause period and which symptoms have beenshown through clinical trials to benefit from HRTUnderstand the difference between ERT ( estrogen replacement therapy) andHRT (hormone replacement therapy).Know the various estrogenic agents that may be used to treat menopausalsymptoms.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 36Describe the physiological and/or pathological consequences of normal, exaggerated, and insufficientlevels of the following hormones:Growth HormoneProlactinGnRH Gonadotropins (LH, FSH, hCG)Thyroid Stimulating HormoneDesmopressinVasopressinOxytocinReferring to lecture notes and reading assignment, recognize pharmacological agents that are usedto stimulate, mimic, or oppose these hormones, and the clinical situations in which they are useful.Oral Contraceptives and Profertility Agents Lecture 37Describe the primary mechanism of action of combination oral contraceptivepills (OCP) and of progesterone-only contraceptive pills.-4-Describe the two types of combination contraceptive pills(monophasic, multiphasic).What are the 2 possible estrogenic components of combination oral contraceptivepills?Define how OCPs are divided into groups based on dose of estrogeniccomponent.Describe how classes of progestins differ by progestational,androgenic, antiestrogenic and estrogenic activity.Describe what factors are important in determining the final estrogenicand progestational activity of a combination oral contraceptive pill.Describe factors that govern the initiation of oral contraceptive therapy. Whatare 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 infertilityUnderstand the principal pharmacological approaches to treating infertilityUnderstand 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 381. Be able to describe the different types of DiabetesMellitus; 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 anddiabetic patients3. Know the types of insulin therapies employed in type 1 DM and their rationale. (singlevs. mixed vs pump, different insulin formulations)4. Know the mechanism of action of insulin5. Know the major differences between hypoglycemic vs. antihyperglycemic drugs. What are thetherapeutic advantages of each class?6. Know the mechanisms of action
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