Pharmacology 4350A/B Study Guide - Panitumumab, Cetuximab, Cyp2B6

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pearhornet262

24 Apr 2012

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Allele - specific sequence variation of a gene. Haplotype - chromosomal region which groups of alleles are more frequently inherited together. Thiopurines (treat leukemia + inflammatory bowel + organ transplant) 90% tpmt*1 = wt: 1/300 tpmt*3 = low enzyme activity. Ugt1a1*1 (normal) + ugt1a1*28 (aa change in tata box) + ugt1a1*6. *28 is frequent in europeans + *6 is frequent in asians. Rtk - proliferation + inhibit apoptosis + angiogenesis. Monoclonal ab (trastuzumab + cetuximab) blocks receptor dimerization. Atp mimetics small molecules (getfitinib + erlotinib + lapatinib) blocks nucleotide binding. Getfitinib - increase response to getfitinib in lung cancer patients with kinase-domain mutation. Increase response to getfitinib in lung cancer patients with egfr mutation/amplification (lesser) Mhc molecules bind to antigen"s cell surface peptide and is recognized by t cells. Very polymorphic affecting mhc binding to antigen + t cell recognizing mhc. Hla-b*5701 + hla-dr7 + hla-dq3 linked with hypersensitivity syndrome (delayed immune response)

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1. The nurse educator for an oncology unit is preparing an in-service presentation for new nurses about the care of patients with immunodeficiencies. Patients with cancer who are receiving chemotherapy, as well as those with bone marrow transplants, are immunocompromised and require special attention to assess for signs of infection. The nurse educator focuses on special care needs of this patient population. (Learning Objective 2)

a. What is the rationale for assessing the pulse and respiratory rates for 1 full minute in a patient with immunodeficiency?

b. What special precautions about dietary restrictions and food preparation should be included in the teaching for a patient with immunodeficiency?

c. What nursing actions should be implemented to decrease the risk of infection in the patient with immunodeficiency?

2. Josh Parsons, a 36-year-old patient diagnosed with leukemia, is immunocompromised. The patientâs absolute neutrophil count is 750. The patient has a moderate risk for infection. The nurse provides patient and family education on ways to decrease the risk for infection. (Learning Objective 3)

a. What should the nurse include in the teaching session with the patient and family?

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Harvey and Deanne Gilbert were both born and raised in Kansas City, Missouri. Harvey attended the University of Missouri in Kansas City, majoring in pre-med, and then completed medical school at the University of Missouri in Columbia. Deanne graduated from the University of Missouri with a degree in elementary education and began her teaching career in Raytown, Missouri, a suburb of Kansas City. During Harveyâs junior year in college, Harvey and Deanne were married. While Harvey attended medical school, Deanne taught fifth grade in Centralia, Missouri. Following graduation from medical school, Harvey was commissioned as a lieutenant in the U.S. Navy and completed his internship at the Oakland Naval Hospital. He spent 1 year in Vietnam as a physician on a troop transport ship. On returning from Vietnam, he was stationed in Stockton and San Diego, California. While stationed in Stockton, Deanne taught sixth grade at Colonial Heights Elementary School.

Harvey had spent 4 years as a physician in the Navy. After leaving the Navy, he became a resident in radiation oncology at Mt. Zion Hospital in San Francisco. After Deanne and Harvey had their first child, Jill, Deanne gave up teaching to be a full-time stay-at-home mom to Jill and her younger brother, Jason. Harvey continued his studies, doing research at Stanford, and completed his training in radiation oncology at UCLA in 1973.

Harvey began practice at the Kaiser Hospital in Los Angeles and worked for them for about 9 years. The Gilberts firmly believed in the time value of money and the power of investing. They saved a percentage of their income from the time they were married. They always paid themselves first and invested their money, primarily in stock and mutual funds, which they selected carefully. They always invested the maximum in retirement accounts and fully funded their 401(k) and self-directed IRA.

Then Harvey entered private practice in a community hospital in Los Angeles for another 10 years as director of a regional cancer center. When Jill entered college at USC, Deanne determined that student housing in the area was rundown and not very safe, so she decided to buy a piece of property that Jill could live in while attending the university. She worked with several brokers until she found a piece of property that she really liked. When her friend Diane Futterman, another physicianâs wife, found out what she was doing, she wanted to work with Deanne and they formed a Subchapter S corporation to purchase affordable rental housing for students in the USC area. They bought houses and remodeled them to meet their own high standards; furnished them; installed security systems, including bars on the windows and security doors; and rented to students. In the first year, they bought one house; the next year, they bought three more houses. Deanne and Diane invested primarily in student housing and then gradually expanded into apartments and rental real estate. The work in the corporation was divided very carefully, with both partners doing what they were most interested in and did best. Diane specialized in contracts and the legal aspects of the business, whereas Deanne specialized in the physical maintenance, decorating, and security of the units. They prided themselves in offering safe, affordable, and secure housing for students and tenants in the Southern California area.

By 1992, both of the Gilbertsâ children had settled in the San Francisco area. Deanne and Harvey moved to northern California in 1993 to take advantage of an opportunity for Harvey to practice in the Modesto area. In 1997, Harvey and Deanne decided to go out on their own and build a cancer center in Lodi, California, where Deanne became the office manager and Harvey was the primary physician and medical director. The decision was made early on to stay in the specialty of radiation oncology with their services being used by several health plans, HMOs, and other physician groups. Between 1997 and 2004, the center grew from 4 employees to 12. In 2004, the radiation facility was sold to a national radiation oncology organization with Harvey continuing as the practicing physician and Deanne as the manager. When the center was sold, all the original investors were paid off.

Harvey and Deanne were retained by the purchasing entity to continue their roles as medical director and office manager. The acquisition agreement also provided them with the opportunity to participate in profit sharing, and as such, they have continued to participate in the revenues of the practice.

Over his years in practice, Harvey was continually asked for recommendations regarding long-term care and assisted living; thus the idea of the Gilbert Guide was developed and founded by the entire family. By this time, their daughter Jill, a graduate of USC with more than 10 years of experience in the film industry, and their son Jason, a graduate of UCLA with many years of experience in the area of strategic planning, operations, finance, and product management, were looking for a new venture. Gilbert Guide, Inc. was developed to address the dire need for comprehensive and practical consumer guides for long-term care planning in every major metropolitan area in the United States. Founded by the Gilbert familyâJill, Jason, Deanne, and Harveyâthe Gilbert Guide has grown from its inception in 2003 as a groundbreaking guidebook setting new standards and criteria for assessing the quality of the many types of long-term care available to become the biggest senior care site on the Web, offering an even wider range of resources to help families and caregivers in their time of senior care need. This is truly an entrepreneurial family venture, with their daughter Jill as president and CEO, their son Jason as COO and CFO, and Harvey as medical and policies director. The Gilbert Guide can be found on the Internet at http://www.gilbertguide.com.

1. How much of the Gilbertâs success do you attribute to their persistence?

2. How important do you believe the Gilbertâs investments and understanding of time value of money contributed to their overall success?

3. Provide a brief summary of the case study

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Tetraethylammonium (TEA) is a drug that blocks voltage-gated potassium channels. What effect would this have on an action potential?

(a)Prevent the rising phase

(b)Prevent the cell from reaching the threshold to trigger an action potential

(c)Prevent or prolong the falling phase

(d)None of the above

The hyperpolarization phase of the action potential is due to:

(a)The opening of voltage-gated Cl- channels

(b)Prolonged opening of voltage gated K+ channels

(c)The closure of resting Na+ channels

(d)Rapid inactivation of voltage-gated K+ channels

The period when it is difficult to initiate another action potential for several milliseconds due to voltage-gated sodium channel inactivation is referred to as the:

(a)Relative refractory period

(b)Absolute refractory period

(c)Resting period

(d)Hyperpolarization period

In the human central nervous system, Gap junctions are found:

(a)Only between neurons

(b)Only between astrocytes

(c)In both neurons and astrocytes

(d)In all cells

Small molecule transmitters such as acetylcholine are synthesized in:

(a)The nerve terminal

B) The cell body and transported to the nerve terminal

C) Synaptic vesicles

D) Endoplasmic reticulum

Prior to Otto Loewiâs classical experiment, which of the following was not known:

(a)stimulation of the vagus nerve slows the heart

(b)extracts of frog heart, made following vagal nerve stimulation, slow the heart

(c)some acetylcholine effects are similar to those produced by muscarine

(d)vagal nerve stimulation releases a substance which slows the heart

Which of the following is most important in determining if neurotransmission is excitatory or inhibitory?

(a)The structure of the synapse

(b)The neurotransmitter released by the presynaptic neuron

(c)The neurotransmitter receptor

(d)The strength of the stimulus

Benzodiazepines such as Valium allosterically regulate GABA receptors by:

(a)Binding at receptor sites other than the transmitter binding site

(b)Binding at the transmitter (GABA) binding site on the receptor

(c)Blocking the action of the endogenous transmitter

(d)Mimicking the action of the endogenous transmitter

GABA-A receptors are ligand-gated Cl- channels. The equilibrium potential of Cl- is -65 mV. At the neuronal resting membrane potential of -65 mV, GABA binding to the GABA-A receptor would result in the opening the Cl- channel, resulting in:

(a)no net flow of Cl- ions

(b)Cl- inflow and hyperpolarization

(c)Cl- outflow and depolarization

(d)Cl- outflow and hyperpolarization

At the mammalian neuromuscular junction, the released neurotransmitter acts on:

(a)muscarinic receptors

(b)nicotinic receptors

(c)adrenergic receptors

(d)Beta receptors

Neurotransmitters are packaged into synaptic vesicles by:

(a)endocytosis following transmitter release

(b)presynaptic membrane transporters

(c)vesicular transporters

(d)all of the above

. Which of the following are NOT types of ion channels?

Voltage-gated

(a)Ligand-gated

(b)G protein coupled receptor (GPCR)-gated

(c)Leak channels

(d)NONE of the above

NMDA receptors are unique in that their ion channel is:

(a)Ligand-gated

(b)Voltage-gated

(c)Ligand- and voltage-gated ion channels

(d)GPCR-gated

. Which of the following is INCORRECT regarding Catecholamine neurotransmitters

(a)Includes Dopamine, Norepinerphrine, and Epinephrine

(b)Contain a Catechol Ring

(c)Synthesized from Tryptophan

(d)Are produced by neurons whose cell bodies are located in the upper brainstem

The largest and most diverse group of receptors in eukaryotes is:

(a)Ligand gated receptors

(b)Glutamate receptors

(c)G-Protein coupled receptors

(d)Allosteric receptors

The most abundant G-protein coupled receptor in the brain is:

(a)Glutamate receptors

(b)Acetylcholine receptors

(c)Cannabinoid receptors

(d)Dopamine receptors

Which of the following drugs DOES NOT block voltage-gated Na+ channels

(a)Lidocaine

(b)Riluzole

(c)Reserpine

(d)Tetrodotoxin

Sarin, a nerve gas, exerts its toxicity by:

(a)blocking nicotinic receptors

(b)inhibiting choline acetyltransferase

(c)inhibiting acetylcholinesterase

(d)inhibiting voltage-gated Na+ channels

Botulinum Toxin (BoTox) interferes with transmitter release by:

(a)cleaving protein(s) involved in transmitter release

(b)blocking voltage-gated Ca2+ channels

(c)blocking voltage-gated Na+ channels

(d)blocking voltage-gated K+ channels

Atropine is:

(a)An agonist of the acetylcholine ionotropic receptor

(b)An antagonist of the acetylcholine ionotropic receptor

(c)An agonist of the acetylcholine metabotropic receptor

(d)An antagonist of the acetylcholine metabotropic receptor

Pharmacology 4350A/B Study Guide - Panitumumab, Cetuximab, Cyp2B6

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