Podcast
Questions and Answers
Which practice accelerates tooth decay by increasing the acidity of the mouth?
Which practice accelerates tooth decay by increasing the acidity of the mouth?
What is an effective method to disrupt plaque below the gum line and between the teeth?
What is an effective method to disrupt plaque below the gum line and between the teeth?
Which factor is essential in protecting enamel and aiding in remineralization?
Which factor is essential in protecting enamel and aiding in remineralization?
What is a comparable preventive step to using fluoride toothpaste for oral health?
What is a comparable preventive step to using fluoride toothpaste for oral health?
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Which option provides an effective alternative for people with dental appliances or dexterity issues for plaque removal?
Which option provides an effective alternative for people with dental appliances or dexterity issues for plaque removal?
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What is the principal bacteria responsible for the initiation of dental caries?
What is the principal bacteria responsible for the initiation of dental caries?
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Which of the following surfaces are the most frequent sites of early decay for dental caries?
Which of the following surfaces are the most frequent sites of early decay for dental caries?
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What happens if dental caries extend to the underlying dentin without management?
What happens if dental caries extend to the underlying dentin without management?
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Which action can help prevent demineralization of enamel caused by bacterial acids?
Which action can help prevent demineralization of enamel caused by bacterial acids?
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What protective action does saliva provide in preventing dental caries?
What protective action does saliva provide in preventing dental caries?
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What is one of the key benefits of fluoride in preventing dental caries?
What is one of the key benefits of fluoride in preventing dental caries?
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What is one of the main mechanisms of action of fluoride?
What is one of the main mechanisms of action of fluoride?
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Which of the following is NOT a recommended protective factor for enamel remineralization?
Which of the following is NOT a recommended protective factor for enamel remineralization?
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How can carious lesions be stopped or reversed if identified early?
How can carious lesions be stopped or reversed if identified early?
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Which of the following practices can help minimize the impact of oral diseases?
Which of the following practices can help minimize the impact of oral diseases?
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What factor plays a significant role in promoting enamel remineralization?
What factor plays a significant role in promoting enamel remineralization?
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What is the recommended frequency for flossing according to the text?
What is the recommended frequency for flossing according to the text?
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What is the primary function of Mean Corpuscular Hemoglobin (MCH)?
What is the primary function of Mean Corpuscular Hemoglobin (MCH)?
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What is the reference range for Mean Corpuscular Hemoglobin Content (MCHC)?
What is the reference range for Mean Corpuscular Hemoglobin Content (MCHC)?
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What does RBC Distribution Width (RDW) measure?
What does RBC Distribution Width (RDW) measure?
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Which condition is commonly associated with neutrophil hyposegmentation?
Which condition is commonly associated with neutrophil hyposegmentation?
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How is Mean Corpuscular Hemoglobin Content (MCHC) calculated?
How is Mean Corpuscular Hemoglobin Content (MCHC) calculated?
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What is the main function of Reactive Lymphocytes?
What is the main function of Reactive Lymphocytes?
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What is the primary function of hemoglobin in the blood?
What is the primary function of hemoglobin in the blood?
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What is the role of platelets in the blood?
What is the role of platelets in the blood?
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What is the reference range for Mean Corpuscular Volume (MCV)?
What is the reference range for Mean Corpuscular Volume (MCV)?
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What is the primary cause of macrocytic anemia?
What is the primary cause of macrocytic anemia?
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What is the primary cause of microcytic anemia?
What is the primary cause of microcytic anemia?
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What is the normal range for hematocrit in women?
What is the normal range for hematocrit in women?
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What is the primary cause of polycythemia vera?
What is the primary cause of polycythemia vera?
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What is the main function of white blood cells?
What is the main function of white blood cells?
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What is the main function of red blood cells?
What is the main function of red blood cells?
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What is the main difference between anemia and polycythemia?
What is the main difference between anemia and polycythemia?
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What is the mechanism of action of PD-1/PD-L1 inhibitors in cancer treatment?
What is the mechanism of action of PD-1/PD-L1 inhibitors in cancer treatment?
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Which of the following genes is associated with non-small cell lung cancer and is targeted by ALK TKIs?
Which of the following genes is associated with non-small cell lung cancer and is targeted by ALK TKIs?
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What is the response rate of ALK TKIs in patients with ALK gene mutations?
What is the response rate of ALK TKIs in patients with ALK gene mutations?
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What is the role of epidermal growth factor (EGF) in cell growth?
What is the role of epidermal growth factor (EGF) in cell growth?
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Which of the following is a common adverse effect of tyrosine kinase inhibitors?
Which of the following is a common adverse effect of tyrosine kinase inhibitors?
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What is the role of primary care, urgent care, EM, and IM PAs in cancer treatment decisions?
What is the role of primary care, urgent care, EM, and IM PAs in cancer treatment decisions?
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What is the mechanism of action of EGFR TKIs in cancer treatment?
What is the mechanism of action of EGFR TKIs in cancer treatment?
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What is the response rate of EGFR TKIs in patients with EGFR gene mutations?
What is the response rate of EGFR TKIs in patients with EGFR gene mutations?
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What is the primary mechanism by which platinum-based chemotherapy agents, such as cisplatin, carboplatin, and oxaliplatin, work?
What is the primary mechanism by which platinum-based chemotherapy agents, such as cisplatin, carboplatin, and oxaliplatin, work?
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What is the primary function of checkpoint inhibitors, such as nivolumab, in the treatment of lung cancer?
What is the primary function of checkpoint inhibitors, such as nivolumab, in the treatment of lung cancer?
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What is the primary mechanism of resistance to cisplatin in cancer cells?
What is the primary mechanism of resistance to cisplatin in cancer cells?
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What is the primary adverse effect of oxaliplatin in the treatment of lung cancer?
What is the primary adverse effect of oxaliplatin in the treatment of lung cancer?
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What is the primary function of major histocompatibility complex (MHC) on antigen-presenting cells (APCs) in the immune response?
What is the primary function of major histocompatibility complex (MHC) on antigen-presenting cells (APCs) in the immune response?
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What is the primary mechanism by which cancer cells evade the immune system?
What is the primary mechanism by which cancer cells evade the immune system?
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What is the primary benefit of neoadjuvant therapy in the treatment of lung cancer?
What is the primary benefit of neoadjuvant therapy in the treatment of lung cancer?
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What is the primary mechanism of action of chemotherapy in the treatment of lung cancer?
What is the primary mechanism of action of chemotherapy in the treatment of lung cancer?
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What is the primary role of CTLA-4 and PD-1 in the immune response?
What is the primary role of CTLA-4 and PD-1 in the immune response?
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What is the primary basis for the development of resistance to carboplatin in cancer cells?
What is the primary basis for the development of resistance to carboplatin in cancer cells?
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Study Notes
What is Cancer?
- Cancer is when cells grow uncontrollably due to genetic alterations.
- These alterations affect genes, which are the instruction manual for cell behavior.
- Cancerous cells can invade or damage nearby tissues or travel to other locations.
Treatment Strategies
- Neoadjuvant therapy: giving drugs before surgery or radiation.
- Adjuvant therapy: giving drugs after surgery or radiation.
- Combination therapies can include chemotherapy, checkpoint inhibitors, and targeted therapies.
Traditional Treatment of Lung Cancer
- Platinum-based chemotherapy: Cisplatin, Carboplatin, and Oxaliplatin.
- Platinum moieties bind to DNA, interfering with synthesis, leading to cellular apoptosis.
Cisplatin Resistance
- Decreasing drug uptake
- Increasing drug efflux
- Inducing drug detoxification
- DNA repair mechanisms
Adverse Effects of Lung Cancer Treatment
- Severe N/V: managed with 5-HT3 receptor antagonists (like ondansetron)
- Nephrotoxic: more important with cisplatin, mitigated by aggressive IV hydration
- Myelosuppression: more important with carboplatin and oxaliplatin
- Neurotoxic: cold-induced and cumulative neuropathy with oxaliplatin
- Ototoxic, hypomagnesemia, hypocalcemia, and hypokalemia
Immunology Refresher
- MHC on antigen-presenting cells (APCs) presents antigens to T-cell receptor (TCR)
- 2nd signal often required for T-cell activation, like CD80 from APC to CD28 on T-cell
- Activated T-cells bring CTLA-4 and PD-1 to their surface to prevent excessive inflammation
How Cancer Subverts Immunology
- Cancer cells can bind to inhibitory receptors on T-cells and deactivate them
- Immune checkpoint inhibitors (ICIs) target these receptors to prevent deactivation
Immune Checkpoint Inhibitors
- 2011: first approval for ICIs
- Over 80 FDA-approved uses for over 17 concerns
- Considered the standard of care in modern oncology
- AE: autoimmune response to normal tissues, treated with corticosteroids
PD-1/PD-L1 Inhibitors
- Nivolumab (Opdivo), PD-1
- Pembrolizumab (Keytruda), PD-1
- Cemiplimab (Libtayo), PD-1
- Atezolizumab (Tecentriq), PD-L1
- Durvalumab (Imfinzi), PD-L1
CTLA-4 Inhibitors
- Ipilimumab (Yervoy)
- Tremelimumab (Imjudo)
Tyrosine Kinase Inhibitors
- Gene mutations cause abnormal cell behaviors
- Tyrosine kinases are involved in cell growth processes
- Each has their own adverse effects, monitoring parameters, and contraindications
ALK Tyrosine Kinase Inhibitors
- ALK gene codes for anaplastic lymphoma kinase (ALK), involved in cell growth
- Mutated forms of ALK gene and protein found in non-small cell lung cancer
- ALK TKIs recommended as first-line therapy in patients with ALK gene mutations, with response rates between 47-83%
EGFR Tyrosine Kinase Inhibitors
- EGF-R gene codes for Epidermal Growth Factor (EGF) Receptor on cell surface
- Mutations in the gene can cause EGF-R upregulation on cancer cells
- EGFR TKIs recommended as first-line therapy in patients with EGFR gene mutations, with response rates of at least 70%
Final Thoughts
- Decisions on cancer treatments are ultimately not up to primary care, urgent care, EM, or IM PAs
- Recognize these drugs and their potential adverse effects, which can be acute symptoms seen in patients
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Description
Test your knowledge about preventive steps for maintaining good oral health, including brushing and flossing techniques, avoiding sugary foods, using fluoride toothpaste, and more. Learn how to protect your teeth and gums by following these oral hygiene tips.