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HIT 135 - ch 21-22, HIT 135 - 20, HIT 135 - CH 18-19, HIT 135- CH 16, 17, HIT 135 - ch 14-15, HIT 135 - CH 12-13 Lymphatic and Immune Systems /, HIT 135 - CH 10-11 : Cardio/ Hematology, HIT 135 CH 9, HIT 135 - 7,8, 9, HIT 135 - CH 6, HIT 135 - CH 5

Terms in this set (1909)

Conventional external-beam radiation therapy consists of a single beam of radiation delivered to the tumor from several directions. The concern is the effect of the radiation on the healthy tissues close to the tumor being irradiated. For complex reasons, large tumors respond less well to radiation than small tumors. Strategies to overcome this include surgical resection prior to chemotherapy (as in the treatment of breast cancer), chemotherapy to shrink the tumor prior to radiation therapy, and the administration of radiosensitizing drugs during radiation therapy. Examples are cisplatin (Platinol) and cetuximab (Erbitux).

Stereotactic radiation is a specialized form of external-beam radiation therapy. It focuses radiation beams by using detailed imaging scans. In stereotactic radiosurgery (SRS), radiation is applied to the tumor with multiple (as many as 200), separate narrow beams, so that the tumor receives a very high dose of radiation in one treatment, yet the surrounding tissues are minimally irradiated. In areas of the body where there is motion by breathing or blood flow, a combination of continuous imaging, motion detection, and robotic guidance enable the beams to remain focused on the tumor. Stereotactic body radiation treatment (SBRT) refers to the use of these techniques in such areas as the lungs. A technique called hypofractionation is the giving of a much higher dose of radiation per session with greater accuracy and the sparing of normal surrounding tissue. Brand names for these stereotactic radiation therapies include Gamma Knife, Cyberknife, Tomotherapy, and Truebeam.

3-dimensional conformal radiation therapy (3DCRT) is the result of being able to delineate tumors and surrounding normal tissues in three dimensions using CT or MRI scanners and planning software. The profile of each radiation beam and the treatment volume conform to the shape of the tumor, allowing a higher dose of radiation to be delivered to the tumor with a reduced toxicity to the surrounding normal tissues.

Intensity-modulated radiation therapy (IMRT) is the next generation of 3DCRT in which, if the tumor is wrapped around a vulnerable structure such as a blood vessel or major organ, the pattern of radiation delivery can avoid the normal structure.

Proton beam therapy has the advantage that the proton only gives up its energy when it hits the tumor and does not continue on through the tumor to hit normal tissue on the far side. Very high doses of radiation can be given without adjacent normal tissue damage. Prostate cancer is the most common cancer to be treated by proton beam therapy.
also called talk therapy, explores with a trained mental health professional thoughts, feelings, and behaviors on the assumption that the cure for a person's suffering lies within that person. The therapist's roles are to generate emotional awareness and insight to help the person identify the source of the problems and consider alternatives for dealing with them. There are six types of psychotherapy:

Supportive psychotherapy, in which the expression of feelings is encouraged and the therapist provides help with problem solving.

Psychoanalysis, which is the oldest form of psychotherapy, developed by Sigmund Freud in the early 20th century. It encourages the person to say whatever comes to mind and helps the person develop an understanding of how the past affects the present, enabling the person to develop new and more adaptive ways of functioning.

Psychodynamic psychotherapy, which is similar to psychoanalysis and focuses on identifying unconscious patterns in current thoughts, feelings, and behaviors.

Cognitive therapy, which helps people identify distortions in interpreting experiences and learn to think in different ways about the experiences, which leads to an improvement in behavior and feelings.

Behavioral therapy, which is similar to cognitive therapy. A combination of the two—cognitive behavioral therapy (CBT)—is often used. Behavioral therapy believes that abnormal behaviors are due to faulty learning, and these maladaptive behaviors can be unlearned and corrected.

Interpersonal therapy involves treatment for depression and focuses on unresolved grief and conflicts that arise when people have to fill roles that differ from their expectations both at work and in the family.
Conjunctivitis is the infectious, contagious condition. It can be caused by viruses, many different bacteria, and organisms that cause sexually transmitted diseases. It is a cause of "bloodshot" eyes.

Allergic conjunctivitis can be part of seasonal hay fever or be produced by year-round allergens such as animal dander and dust mites. Irritant conjunctivitis can be caused by air pollutants (smoke and fumes) and by chemicals such as chlorine and those found in soaps and cosmetics

Neonatal conjunctivitis (ophthalmia neonatorum) can be caused by a blocked tear duct in the baby, by the antibiotic eyedrops given routinely at birth, or by sexually transmitted bacteria in an infected mother's birth canal.

Dry eyes are a common and chronic condition which over 75 million Americans suffer from. It is due to the tears losing water and becoming too salty so that the eyes sting and burn and vision becomes blurry.

Corneal abrasions can be caused by foreign bodies, direct trauma (such as being poked by a fingernail), or badly fitting contact lenses. The abrasion can grow into an ulcer

Scleritis, inflammation of the sclera (the white outer covering of the eyeball), can affect one or both eyes. It causes dull pain and intense redness, and is often associated with rheumatoid arthritis and the digestive disorder Crohn's disease

Uveitis, inflammation of the iris, ciliary body, and choroid, produces pain, intense photophobia, blurred vision, and constriction of the pupil. There is usually an underlying disease, such as rheumatoid arthritis.
Mydriatics are drugs that cause the pupil to dilate and are mainly used to examine the eye fundus. Mydriacil (Tropicamide) takes 15 minutes for the eye to fully dilate and can last for 3 to 6 hours with blurred vision. Other dilating drops, for example, atropine and homatropine, are long acting, lasting 7 to 10 days.

Miotics are drugs that constrict the pupil (miosis); for example pilocarpine, which can be part of a regimen for treating glaucoma.

Ocular topical anesthetics temporarily block nerve conduction in the conjunctiva and cornea. They have a quick onset of 10 to 20 seconds and last for 10 to 20 minutes. They are used to assist with eye examinations and visual acuity testing and to help treat chemical burns, welding flash, and foreign bodies. Examples are amethocaine, 0.5% and 1%, and oxybupricaine, 0.4%.

Ocular diagnostic drops stain conjunctival cells to improve diagnostic capabilities; for example, the presence of a foreign body or a corneal abrasion. Examples are fluorescein and Lissamine Green. The drops do not interfere with vision but are taken up by soft contact lenses, which should be removed prior to instillation of the drops.

Ocular lubricant drops are used to replace tears, treat dry eyes, moisten hard contact lenses, protect the eye during eye surgical procedures, and help treat keratitis. Examples are Visine, Refresh Optive, and Retaine.

Anti-infective eye medications, both drops and ointments, can be antibacterial, for example, glatifloxacin (Zymaxid) and sulfacetamide (Klaron, Ovace); antifungal, such as natamycin (Natacyn); and antiviral, for example, idoxuridine (Herplex) and trifluridine (Viroptic).

Anti-inflammatory eye medications are used in allergic disorders, to prevent scarring and visual loss in inflammation of the eye, and to decrease postoperative eye inflammation and scarring. Examples are corticosteroids such as dexamethasone (Decadron) and nonsteroidal anti-inflammatory agents such as flurbiprofen (Ocufen) and suprofen (Profenal).

In glaucoma, numerous eye medications are available and are used individually, in combinations, and/or with surgery (see previous section on eye therapeutic procedures). Miotics decrease the size of the pupil and widen the trabecular network to enable fluid to escape more easily. Beta-adrenergic blockers decrease production of aqueous humor; examples are timolol maleate (Timoptic) and betaxolol (Betoptic). Carbonic anhydrase inhibitors reduce production of aqueous humor; examples are acetazolamide sodium (Diamox) and dichlorphenamide (Daranide); alpha-adrenergic agents increase the outflow of aqueous humor by unknown mechanisms; examples are epinephrine (Epifrin) and phenylephrine (Neo-synephrine).
characterized by hyperglycemia resulting from an absolute or relative impairment of insulin secretion and/or insulin action.

This leads to a disruption of carbohydrate, fat, and protein metabolism. It is the world's most prevalent metabolic disease and the leading cause of blindness, renal failure, and gangrene. There are four categories of diabetes mellitus:

Type 1 diabetes, also called insulin-dependent diabetes mellitus (IDDM), accounts for 10% to 15% of all cases of DM but is the predominant type of DM under the age of 30. When symptoms become apparent, 90% of the pancreatic insulin-producing cells have been destroyed by autoantibodies. The incidence of type 1 diabetes is increased in patients with Graves disease, Hashimoto disease, and Addison disease.

Type 2 diabetes, also called non-insulin-dependent diabetes mellitus (NIDDM), accounts for 85% to 90% of all cases of DM. Almost 7% of U.S. residents are diagnosed with type 2 diabetes, and the incidence is increasing rapidly. Not only is there some impairment of insulin response, but there is decreased insulin effectiveness in stimulating glucose uptake by tissues and in restraining hepatic glucose production. This is called insulin resistance. In addition to type 2 diabetes, insulin resistance leads to other common disorders such as obesity, hypertension, hyperlipidemia, and coronary artery disease. Type 2 diabetes can be secondary to Cushing syndrome, acromegaly, pheochromocytoma, and aldosteronism.

Gestational diabetes is seen in the latter half of 5% of pregnancies. While most cases of gestational diabetes resolve after the pregnancy, a woman who has this complication of pregnancy has a 30% chance of developing type 2 diabetes within 10 years.

Mature-onset diabetes of youth (MODY) is genetically inherited, occurs in thin individuals who are in their teens and twenties, and is comparable to type 2 diabetes in its severity.
NSAIDs inhibit the two cyclooxygenase (COX) enzymes that are involved in producing the inflammatory process. They have analgesic and antipyretic effects and are used for treatment of tissue injury, pyrexia, rheumatoid arthritis, osteoarthritis, gout, and nonspecific joint and tissue pains. The three major NSAIDs, each of which is available OTC, are:

--Acetylsalicylic acid (aspirin), which, in addition to the above effects and uses, also has an antiplatelet effect due to its inhibition of one of the COX enzymes; thus, it is often used in the prevention of heart attacks.

--Ibuprofen (Advil, Motrin, and several other trade names), which acts by inhibiting both the COX enzymes, essential elements in the enzyme pathways involved in pain, inflammation, and fever. It is taken orally, but in 2009 an injectable form of ibuprofen (Caldolor) was approved for use. In some studies, ibuprofen has been associated with the prevention of Alzheimer and Parkinson diseases, but further studies are needed.

--Naproxen (Aleve and many other trade names), which is taken orally once a day and also inhibits both the COX enzymes.

Indomethacin, an NSAID that inhibits both COX enzymes, is a potent drug with many serious side effects. It is not used as an analgesic for minor aches and pains or for fever.

Paracetamol (acetaminophen), an active metabolite of phenacetin (not an NSAID), is a widely used OTC analgesic and antipyretic. It is used for the relief of minor aches and pains and is an ingredient in many cold and flu remedies.

Skeletal muscle relaxants are FDA-approved for spasticity (baclofen, dantrolene, tizanidine) or for muscular conditions like multiple sclerosis (carisoprodol, chlorzoxazone, cyclobenzaprine, metaxalone, methocarbamol, orphenadrine). The only drug with available evidence of efficacy in spasticity is tizanidine (Zanaflex, Sirdalud), but cyclobenzaprine (Amrix) appears to be somewhat effective.

Anabolic steroids are related to testosterone but have been altered so that their main effect is to cause skeletal muscle to hypertrophy. They are used illegally in many sports to increase muscle strength. They have marked, often irreversible, side effects, including stunting the height of growing adolescents, shrinking testes and sperm counts, masculinizing women, and causing delusions and paranoid jealousy. In the long term, there are increased risks of heart attacks and strokes, kidney failure, and liver tumors.
T lymphocytes (T cells). The "T" stands for thymus, where they mature.

T lymphocytes make up 75% to 85% of body lymphocytes. There are several types of T cells:

Cytotoxic or "killer" T cells destroy target cells. Their cell membrane holds a coreceptor that can recognize a specific antigen. Coreceptors are named with the letters "CD" (cluster of differentiation) followed by a number, for these cells, CD8.

Helper T cells contain the CD4 coreceptor and are called CD4 cells. They begin the defensive response against a specific antigen.

Memory T cells arise from cytotoxic T lymphocytes that have previously destroyed a foreign cell. If they encounter the same antigen, they can now quickly kill it without initiation by a helper T cell.

Suppressor T cells suppress activation of the immune system. Failure of these cells to function properly may result in autoimmune diseases.

B lymphocytes (B cells). These cells mature in the bone marrow. B lymphocytes make up 15% to 25% of lymphocytes. They are activated by helper T cells, respond to a specific antigen, and cause the production of antibodies called immunoglobulins (Ig). The mature B cells are called plasma cells and secrete large quantities of antibodies that immobilize, neutralize, and prepare the specific antigen for destruction.

Null cells. These are large granular lymphocytes that are natural killer cells but lack the specific surface markers of the T and B lymphocytes.

Macrophages. These cells develop from monocytes that have migrated from blood. They ingest and destroy tissue debris, bacteria, and other foreign matter (phagocytosis).
Death of cardiac muscle due to ischemia

The most immediate need in the treatment of MI is to provide perfusion to get blood and oxygen to the affected myocardium. This can be attempted in several ways:

Clot-busting drugs (thrombolysis). Streptokinase or tissue plasminogen activator (tPA) are injected within a few hours of the MI to dissolve the thrombus.

Artery-cleaning angioplasty also called percutaneous transluminal coronary angioplasty (PTCA). A balloon-tipped catheter is guided to the site of the blockage and inflated to expand the artery from the inside by compressing the plaque against the walls of the artery.

Stent placement. To reduce the likelihood that the artery will close up again (occlude), a wire mesh tube, or stent (Figure 10.22), is placed inside the vessel. Some stents (drug-eluting stents) are covered with a special medication to help keep the artery open.

Coronary artery bypass graft (CABG). In this procedure, mostly used for people with extensive disease in several arteries, healthy blood vessels harvested from the leg, chest, or arm detour blood around blocked coronary arteries. The procedure is performed by using a heart-lung machine that pumps the recipient's blood through the machine to oxygenate it while surgery is performed. More recently, the procedure is being performed "off-pump" with the heart still beating.

Rotational atherectomy. A high-speed rotational device is used to "sand" away plaque. This procedure has limited acceptance.

Heart transplant, in which the heart of a recently deceased person (donor) is transplanted to the recipient after the recipient's diseased heart has been removed. The immune characteristics of the donor and recipient have to be a close match.