Clinical Medicine Exam I 9/14/11 part 2

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Clinical Medicine Exam I 9/14/11 part 2
2011-09-12 15:00:56
14 substance abuse environmental hazards immune system

Part 2 of Study guide for Clinical Medicine Exam I
Show Answers:

  1. Chemical Dependency/Substance Abuse
    • Inappropriate use of drugs or chemicals
    • Impairs function in some way/extent
    • May cause euphoria ("high")
  2. Abuse of Chemicals (prescribed or illicit) leads to...
    • Changes in behavior
    • Changes in sleep patters
    • Changes in interpersonal relationships
    • Problems with employment
    • Serious health problems
    • Death
  3. Habit
    Practice of using substances at regular & frequent intervals

    --like a ritual--
  4. Dependence
    Physiologic and phychological craving for substance
  5. Physiologic Dependence
    Discontinuance of substance leads to withdrawal (physical)
  6. Phychological Dependence
    Continuing desire to take substance to function (mental)
  7. Tolerance
    • Body has adapted to substance
    • More must be taken to achieve same effect
  8. Addiction
    Used for the most serious form of substance abuse
  9. Central Nervous Sytem (CNS) Depressents
    Tranquilizers, alcohol, cannabis (marajuana)
  10. Narcotics (also CNS depressors)
  11. Stimulants
    Coffee, amphetamines (ridelin & aderol)
  12. Psychedelics
    Hallucinogens (LSD)
  13. Legally Prescribed Medications
    • Tranquilizers or sedatives
    • Medication shared w/ others
    • Prescriptions obtained from several sources
    • Medications combines w/ other substances
  14. Readily Available w/o Restrictions
    • Sleep-inducing or wake-up pills
    • Cough syrups and decongestants
    • Spray paints, alcohol-based hair lotions, glued, nail polish removers, aerosols, solvents, ect.
  15. Illegal or Street Drugs
    • Costly & Dangerous (content unpredictable)
    • Increased use leads to overdose
    • Known by common names rather than medical/chemical names
    • Can be sniffed, injected, smoked, or taken orally
    • Increased criminal activity and violence associated w/ drug trafficking
    • Many manufactured from inexpensive chemicals
    • Often diluted w/ contaminants (may be toxic)
  16. Predisposing Facors to Abuse
    • Heredity/genetics
    • Family systems & practices
    • Disease
    • Increased availabilty of drugs
    • Stress
    • Increased medical use of mood-altering and analgesic agents
    • Acceptance of alcohol or marijuana as a recreational tool in all age groups
  17. Anabolic Steroids
    • Abused by some athletes and body builders (competetive sports)
  18. Date-Rape Drugs
    • Illegal and premeditated assault
    • Mixed with alcohol causes CNS depression and deep sleep
    • No memory of events after administration
    • Difficult to bring charges against abuser
  19. Recognition of Abuse
    • Pattern of consumption varies (frequent/ large periodical doses)
    • Some individuals are affected by small amounts
    • Other individuals can function well with high intake
    • Combinations of chemicals usually exert more marked effects
    • Depressants decrease level of CNS function and social inhibitions
    • Stimulants increase CNS activity
  20. Potential Complications- OVERDOSE
    • Common and acute problem
    • Relatively small safety margin for some drugs
    • Stret drugs may be contaminatd and dosage not known accurately
    • Synergism-drug combinations= stronger reaction
  21. Potential Complication- WITHDRAWAL
    • Discontinuation of drug use
    • Withdrawal symptoms due to physiological dependency
    • May be mild to serious depending on drug
    • --Irratibility
    • --Tremors
    • --Nausae, vomiting, stomach cramps
    • --High blood pressure
    • --Psychotic behavior
    • --Convulsions

  22. Potential Complication- PREGNANCY
    • Fear of detection prevents seeking prenatal care
    • Fetus may have congenital defects, respiratoratory depression at birth/ drug dependency at birth
    • No SAFE alcohol consumption
    • Cigarette smoking & second-hand smoke leads to...
    • Increased rate of stillbirth & spontaneous miscarrage, low birth weight
  23. Potential Complication- CARDIOVASCULAR PROBLEMS
    -Cocain, amphetamines & other stimulants
    • Irregular heartbeat
    • Increased blood pressure
    • May lead to heart attacks
    • Strokes
    • Heart failure at a young age
  24. Potential Complication- PSYCHEDELIC EXPERIENCES
    -Hallucinogenic Drugs
    • Increased, unreal, distorted interpretation of sensory inputs
    • May have unpleasant episode with combinations of fear, panic, depression, increased risk of suicide
    • Physical effects:
    • Increased BP, nausea, tremors
    • "Ecstasy" can lead to cardiac arrest or death by dehydration
    • Memory impairment, distorted judgment, and high risk behavior
  25. Potential Complication- INFECTION
    • Malnutrition reduces host resistance
    • Common in drug users who share needles (Hepatitis B, HIV infection)
  26. Potential Complications of ALCOHOL
    • Cirrhosis
    • Nervous System Damage of Wernicke Syndrome or Korsakoff Psychosis
    • Alcohol backs up the fat which accumulates in the liver so there is lack of oxygen resulting in lack of liver function
    • -Persons with chronic alcoholism
    • Long-term or acute excessive alcohol intake--lipid accumulation, alcoholic hepatitis and fibrosis--
  28. Nervous System Damage
    • Wernicke Syndrome--confusion, disorientation, loss of motor coordination
    • Korsakoff Psychosis--Altered personality and amnesia
  29. Wernicke Syndrome
    Confusion, disorientation, loss of motor coordination
  30. Korsakoff Psychosis
    Altered personaity and amnesia
  31. Assistance with Substance Abuse
    Treat immediately in emergency room
  32. Assistance with Substance Abuse
    Should be handled in medical facility
  33. Assistance with Substance Abuse
    Required to prevent complications
  34. Assistance with Substance Abuse
    • overdose/toxic effect
    • Withdrawal
    • Supportive Care
    • Therapy
    • Counseling and behavior modifications
    • Support groups (e.g. AA)
  35. Environmental Hazards of AGENTS
    • Can cause damage to cells and organs of the human body at time of exposure or after repeated exposure- safe level hasn't been decided
    • -based on total life exposure
  36. Damage of Environmental AGENTS
    • Becomes more apparent with age (age reduces the physiologic reserves of tissues)
    • Increase in childhood cancers and hypersensitivities
    • Hypersensitivities to new chemical substances have increased--chemicals in food processing, synthetic materials in buildings and furnishings, cosmetics and toiletries, microbes in water and food supply--
  37. Safety Procedures
    • Occupational Safety & Health Administration (USA) and similar International agencies establish protocos for:
    • --Safety procedures in workplace
    • --Safety procedures in the environment
    • --Infection control
    • --Protective equipment
    • --Exposure to harmful substances and hazardous material
  38. Hazardous chemicals
    Tissue Damage from large Chemical dose in single incident or from repeated exposure to small amounts

    Unwanted Chemicals ingested in contaminated food, water, or toys and household objects, inhaled, absorbed through the skin
  39. Examples of Chemicals
    • heachlorophene
    • Exposure to Plastics
  40. Hexachlorophene
    • Was widely used in hospitals as an eseptic in soaps and powders
    • Absorbed through the skin (eventually leads to brain damage)
    • use now restricted
  41. Exposure to Plastics
    • Phalates used to soften plastics and prevents shattering
    • Toys, bottle nipples, ect.- withdrawn from U.S. and Canadian markets
  42. Chemicals found in Heavy Metals such as Lead & Mercury
    • Can accumulate in tissues with long-term exporsure
    • Lead can be...
    • --Ingested in food or water
    • --Inhaled
    • --Found in lead pipes and batteries
    • --Lead-based pain (toys, furniture)
    • --Common childhood poison
  43. Toxic Effects of Lead
    • Hemolytic Anemia
    • Infammation and ulceration of the digestive tract
    • Inflammation of the kidney tubules
    • Damage to the nervous sytem (neuritis, encephalopathy, seizures or convulsions, delayed development and intellectual impairment, irreversible brain damage
  44. Chemicals- Inhalants
    • Particulate (asbestos, silica)
    • Gaseous (sulfur dioxide, ozone)
    • Solvents (benzene, acetone)
  45. Sources of Toxic Inhalants
    • Factories, laboratories, mines, artists' workshops
    • Insecticides, aerosols
    • Paints, glues
    • Furniture, floor coverings
    • Poorly maintained heating systems
    • Smog --hydrogen sulfide, particles from dust and smoke, carbon monoxide--
  46. Examples of Toxic Inhalants
    • Asbestos, iron oxide, silica (inhaled particles, lung damage in workers in mines and other industries)
    • Cigarette Smoking (lung disease including cancer, bladder cancer, cardiovascular disease, predisposition to numerous other diseases
  47. Physical Agents- Hyperthermia
    • Excessive elevation of body temperature
    • Syndromes include
    • heat cramps with skeltal muscle spasms due to loss of elecrolytes
    • heat exhaustion--sweating, heacache, nausea, dizziness, fainting
    • Heat stroke (shock, coma, very high core body temperature)
  48. Heat Cramps
    w/ skeletal muscle spasms due to loss of elecrolytes
  49. Heat Exhaustion
    Sweating, headache, nausea, dizziness, fainting
  50. Heat Stroke
    • Shock
    • Coma
    • Very high core body temperature
  51. Physical Agents-Hypothermia
    • Exposure to cold temperatures
    • Localized frostbite (fingers, toes, ears, exposed part of face)
    • Systemic exposure--due to submersion in cold water, lack of adequate clothing, wet slothing, core body temperature drops, capillaries and cell membranes are damaged
    • --abnormal shift of fluid and sodium
    • --Hypovolemic shock and cell necrosis
  52. Hypovolemic Shock
    Severe blood and fluid loss which makes the heart unable to pump enough blood to the body
  53. Cell Necrosis
    cell death due to unexpected and accidental cell damage
  54. Physical Agents- Radiation
    • X-rays, gamma rays, protons, neutrons
    • Rays differ in energy levels and ability to penetrate the body tissue, clothing, or lead
    • Amount of radiating absorbed by the body is measured in rads (radiation, absorbed doses)
    • Natural Sources (sun and radioactive materials in soil)
    • Other Sources (radon gas--homes, industry, nuclear reactors, diagnostic procedures)
  55. Physical Agents- Noise
    • Single loud noise may rupture the tympanic membrane or damage nerve cells in the inner ear
    • Noise in the workplace--cumulative damage, ear protection is now required in most noisy work envrionments)
  56. Biological Agents- Bites & Stings
    • Direct injection of animal toxin into the body (neurotoxins by spiders or snakes, vasular agents in jellyfish)
    • Transmission of infectious agents through animal or insect vectors (rabies, malaria, lyme disease)
    • Allergic reaction to insect proteins (bee or wasp stings)
  57. Biological Agents- Food Poisening
    • Contaminated food and water
    • May be the result of heat-labile toxins produced in contaminated food (Botulism poisening)
    • May be the result of heat-stable toxins produced in contaminated food (staph contamination)
    • My be the result of infection with microbe( most common oubreaks are caused by strains of E. coli or Salmonella)
  58. Immunology
    the study of the mechanisms that allow the body to recognize materials as foreign and to neutralize & eliminate them
  59. A normal immune response consists of...
    • Recognizing a foreign antigen
    • mobilizing forces against it & attacking it
  60. 2 Types of Immunity
    • Innate (natural) Immunity
    • Acquired (adaptive) Immunity
  61. Innate Immunity
    • 1st line of defense
    • Non-specific & non-adaptive
    • Invloves the skin and mucus membranes as well as the non-specific immune response to inflammation
  62. Acquired Immunity
    • Specific line of defense
    • Specific response to a pathogen taht has entered the body
  63. Active Aquired Immunity
    • Occurs via introduction of an antigen into a responsive host
    • Host develops antibodies to the antigen
    • Vaccines are based on the idea of acquired immunity
  64. Passive Acquired Immunity
    Antibodies that are transferred from on person to another (mother-->fetus, injection of antibodies (gamma globulin-boosts immune system w/ antibodies)
  65. Components of the Immune System
    • Lymphoid Structures
    • Immune Cells
    • Tissues
    • --These structures produce the necessary cells, trap microorganisms and assist in the production of specific immune responses
    • There are many chemical mediators in the body that have significant roles in the immune process
  66. Antigens
    • Any foreign substance that is capable of eliciting an immune response
    • Does not have the cell surface marker unique to that individual
    • Body recognizes the difference between self and non-self allowing it to initiate the appropriate immune response
  67. Innate Immunity
    • Exterior Defenses (skin, digestive tract)
    • Inflammatory Response (first line of defense)
    • Phagocytes (neutrophils, monocytes)
  68. Aquired Immunity
    • When pathogens overwhelm the natural/innate immune system acquired immunity serves the purpose of preventing/managing infections
    • --Humoral Immunity: antibodies that are present in the body fluids such as blood and saliva
    • --Cell Mediated Immunity: T-Cells recognize hidden antigens inside cells and destroy them on cell to cell basis
  69. Humoral Immunity
    Antibodies that are presesnt in the body fluids such as blood and saliva
  70. Cell Mediated Immunity
    T-Cells recognize hidden antigens inside cells and destroy them on a cell to cell basis