【MOOC】臨床藥學(xué)英語(yǔ)-南京醫(yī)科大學(xué) 中國(guó)大學(xué)慕課MOOC答案

【MOOC】臨床藥學(xué)英語(yǔ)-南京醫(yī)科大學(xué)中國(guó)大學(xué)慕課MOOC答案單元作業(yè)1單元測(cè)試11、【單選題】Whatwouldyourecommendtothispatientatthistime?本題答案：【Fulvestrant+PI3K/AKT/mTORinhibitorinaclinicaltrial】2、【多選題】WhydoweneedtolearnClinicalPharmacyEnglish?本題答案：【Increaseinternationalmedicalandpharmacyknowledge#Improveglobalhealthawarenessandcross-culturalcommunicationability#Broadenstudents’internationalvisionandcultivatestudents’globalcompetence#Layfoundationforfollow-upscientificresearch】單元作業(yè)2單元測(cè)試21、【單選題】2.Whichoneisfaster,thenormalrateofimpulseinitiationortheSAnode?本題答案：【theSAnode】2、【判斷題】HeartTheheartactsasapumpandmaintainscirculationofthebloodbyalternateconcentrationandrelaxationofcardiacmuscle(themyocardium).Itgenerallycontractsatarateof70to75beats/minuteinahealthy70-kgpersonatrest.Thenormalheartrhythm,knownassinusrhythm,originatesinspecializedcardiaccells,calledpacemakercells,inthesino-atrial(SA)orsinusnodeandhasbeendefinedasasinusnoderateof60to100beats/minute.EachheartbeatorcontractionisinitiatedbygenerationofanactionpotentialintheSAnode;theelectricalimpulsespreadsoverbothatria,causingthemtocontract,andontotheatrioventricular(AV)node.FromtheAVnodeitspreadsthroughthebundleofHisanddownthePurkinjefiberstotheventricles,causingthemtocontract.Itisthemovementofionsacrossthecardiaccellmembranethatgeneratestheactionpotential.Theelectricalchangesinvolvedcanberecordedonanelectrocardiogram(ECG).Othercardiaccellsthatarelocatedoutsidethesinusnodearealsocapableofinitiatingimpulses.Thesecells,termedectopicpacemakers,canbefoundintheatriovertricularjunctionandintheHis-Purkinjesystem.Thenormalrateofimpulseinitiationbytheseectopicpacemakersislessthanthatofthesinusnodeandthereforetheydonotnormallyinitiatetheheartbeat.However,theymaybecomedominantincertaincircumstancessuchas:iftheintrinsicrateoftheectopicpacemakerrisesabovethatofthesinusnode;ifthesinusnoderatefallsbelowthatoftheectopicpacemaker;orwhenanormalsinusnodeimpulseispreventedfrombeingconductedthroughtheheart(heartblock)leavingtheectopicpacemakertofireatitsownintrinsicrate.Acardiacarrhythmiacanbedefinedinsimpletermsasanyabnormallyofrate,regularity,orsiteoforiginofthecardiacimpulseorasadisturbanceinconductionthatcausesanabnormalsequenceofactivation.Symptomsdependonthearrhythmiabutmayincludefatigue,dyspnoea,dizziness,andsyncope;suddendeathmayoccur.Palpitationisatermusedtodescribeanunacceptableawarenessofthebeatingheartbythepatient.Thismayoccurnormallyincircumstancessuchasemotion,exercise,orstressormayoccurinassociationwitharrhythmias.Clinically,arrhythmiasmaybeclassifiedbypresumedsiteoforigin,namelyassupraventriculararrhythmias(includingatrialarrhythmiasandatrioventricularjunctionalarrhythmias)orasventriculararrhythmias.Classificationcanalsobebasedonrateaseitherbradyarrhythmias(slow)ortachyarrhythmias(fast).Bradyarrhythmiasarecausedbysinusnodedysfunction,whicheitherdepressesimpulsegenerationordisturbstheconductionofimpulsesfromthesinusnodetotheatria.Atrioventricularblockindicatesdisturbanceofconductionoftheatrialimpulsetotheventricles.Infirst-degreeblocktheimpulseisdelayed.Itisusuallyasymptomaticbutmayprogresstosecond-orthird-degreeblock.Insecond-degreeblocktheimpulseisblockedintermittentlyandinthird-degreeblockthereisacompleteblock.Atrioventriculardissociationindicatesaconditioninwhichventricularactivityisfasterthan,andindependentof,theatrialactivity.Bradyarrhythmiasmaybetreatedwitheitheratropineorisoprenaline,althoughcardiacpacingisthetreatmentofchoice.Fortachyarrhythmiasaclassificationordiagnosisbasedontheprecisemechanismofthearrhythmiawouldalsobedesirablebutthisisnotalwaysclear.Inmanyoftheclinicallyrelevantarrhythmias,however,themechanismisoneofre-entry.Re-entryoccurswhentheinitialimpulsedoesnotdieoutbutcontinuestopropagateandreactivatetheheart.Questions1.OnlytheSAnodecaninitiatetheheartbeat,trueorfalse,why?本題答案：【錯(cuò)誤】3、【判斷題】BradyarrhythmiasarecausedbyAVnodedysfunction,trueorfalse?本題答案：【錯(cuò)誤】4、【判斷題】Kate’sdoctortoldherthatshemighthasafirst-degreeatrioventricularblockandsuggestedhertotakefurtherexamination.However,Marydoesnotfeelanyuncomfortable.Shouldshetakethedoctor’sadvice?本題答案：【正確】單元作業(yè)3單元測(cè)試31、【單選題】HypertensionHypertension,particularlyessentialorprimaryhypertension,iswidespreadandalthoughusuallyasymptomatic,isamajorriskfactorforstrokeandtosomeextentischemicheartdisease.Controlofhypertensionisthereforeamajoraspectofcardiovascularriskreduction.Nationalandinternationalguidelinesonmanagementhavebeenpublished.Definitions:Thetermbloodpressuregenerallymeansarterialbloodpressure,thepressureofthebloodonarterywalls.ItisusuallymeasuredindirectlyinthebrachialarteryjustabovetheelbowusinganappropriatelycalibratedsphygmomanometerandisexpressedinmmHg.Twomeasurementsaremade:systolicormaximumbloodpressure(achievedduringventricularcontractionoftheheart)anddiastolicorminimumbloodpressure(achievedduringventriculardilatation).Hypertensionmeansahigherthan“normal”bloodpressure;ithasbeendefinedasthelevelofbloodpressureabovewhichinterventionhasbeenshowntoreducetheassociatedcardiovascularrisk.Manyfactorsinfluencebloodpressure,resultinginabell-shapeddistributioncurveinthegeneralpopulation,andinconsequenceitisdifficulttodefineanabsolutenorm.Normaladultbloodpressurehasbeenarbitrarilydefinedasasystolicpressurebelow130mmHgtogetherwithadiastolicpressurebelow85mmHg(i.e.below130/85mmHg),butmorerecentstudieshavesuggestedthatoptimalbloodpressure,intermsofcardiovascularrisk,maybelowerthanthis.USguidelinesnowdefinenormalbloodpressureasbelow120/80mmHg,whileEuropeanandBritishguidelinesclassifythisasoptimal.Bloodpressureof130~139/85~89mmHgareregardedashighnormalorareincludedintheclassificationofprehypertension.Althoughhypertensionwasformerlydefinedintermsofdiastolicbloodpressurealone,itisnowrecognizedthatsystolicpressureisalsoimportantindeterminingrisk,andcurrentguidelinesgiveequalemphasistoboth.Bloodpressureabove140mmHgsystolic,and/or90mmHgdiastolicisgenerallyconsideredtorepresenthypertension.Althoughclassificationsofmild,moderate,andseverehypertensionhavebeenwidelyused,thesetermsmaybemisleadingsinceabsolutecardiovascularriskismoreimportantindeterminingtheneedfortreatmentanddependsonotherfactorsinadditiontobloodpressure.Mostguidelinesthereforeuseagradingsystemtoclassifyhypertension,asfollows:grade1:140~159/90~99mmHg;grade2:160~179/100~109mmHg;grade3:≥180/≥110mmHg.IntheUSguidelines,stage1hypertensioncorrespondstograde1,whereasstage2includesbothgrades2and3.Whensystolicanddiastolicpressuresfallintodifferentcategoriesthehighervaluesisusedforclassificationpurposes.Classificationandsubsequenttreatmentdecisionsshouldbebasedonbloodpressuremeasurementstakenonseveraloccasionsoveraperiodthatvariesaccordingtotheseverityofhypertension.Ambulatorybloodpressuremonitoringmaybeusedinsomecases.However,readingstendtobelowerwithambulatorymonitoringthanwithconventionalmeasurementandnormalandabnormalvaluesarenotyetclearlyestablished,althoughrecommendationshavebeenmade.Inmalignantoracceleratedhypertensionrapidlyprogressingseverehypertensionisassociatedwithretinopathyandoftenrenalimpairment.Isolatedsystolichypertensionoccursmainlyintheelderlyandhasbeendefinedassystolicpressureof140mmHgormoreanddiastolicpressureunder90mmHg.1.What’stheshapeofbloodpressuredistribution?本題答案：【Bell-shaped】2、【單選題】Ifthesystolicpressureis144andthediastolicpressureis105,whichgradedoeshypertensioncorrespondto?本題答案：【Grade2】3、【單選題】Whichoneusuallyhasalargerreading,ambulatorymonitoringorconventionalmeasurement?本題答案：【Conventionalmeasurement】4、【單選題】Allyhasabloodpressureof145/85Hg.Whatisthegivennameforthishypertension?本題答案：【Isolatedsystolichypertension】5、【判斷題】Chrishasacardiovascularrelateddisease.Thisyear,hisbloodpressuremeasuredinannualexaminationwas130/85Hg.Hethoughtthattheresultwasveryoptimal.Whatdoyouthinkaboutit,ifyouarehisphysician?本題答案：【錯(cuò)誤】單元作業(yè)4單元測(cè)試41、【單選題】PaclitaxelTradeNamesAbraxane-Injection,lyophilizedpowderforsuspension(albuminbound)100mgPaclitaxel-Injection,solution,concentrate6mg/mLApo-PaclitaxelInjectable(Canada)PharmacologyPaclitaxelisanovelantimicrotubuleagentthatpromotestheassemblyofmicrotubulesfromtubulindimersandstabilizesmicrotubulesbypreventingdepolymerization.Thisstabilityinhibitsthenormaldynamicreorganizationofthemicrotubulenetworkthatisessentialforvitalinterphaseandmitoticcellularfunctions.Inaddition,paclitaxelinducesabnormalarraysorbundlesofmicrotubulesthroughoutthecellcycleandmultipleastersofmicrotubulesduringmitosis,furtherdisruptingcellfunction.PharmacokineticsAbsorptionAbraxaneCmaxis18,741ng/mL.PaclitaxelinjectionsolutionFollowing3-and24-hinfusions,Cmaxis195to3,650ng/mLandAUCis6,300to15,007ng?h/mL.Distribution89%to98%proteinbound.Extensiveextravasculardistributionand/ortissuebinding.AbraxaneVdis632L/m2.PaclitaxelinjectionsolutionVdis227to688L/m2atsteadystatewith24-hinfusion.MetabolismPaclitaxelismetabolizedprimarilyto6-alpha-hydroxypaclitaxelbyisoenzymesCYP2C8andto2minormetabolites,3′-p-hydroxypaclitaxeland6-alpha,3′-p-dihyroxypaclitaxelbyCYP3A4.EliminationAbraxaneExcretedintheurine(4%)andinthefeces(20%).Terminalhalf-lifeisapproximately27handtotalbodyClis15L/h/m2.PaclitaxelinjectionsolutionExcretedintheurine(14%)andinthefeces(71%).Following3-and24-hinfusions,thehalf-lifeis13.1to52.7handtotalbodyClis12.2to23.8L/h/m2.SpecialPopulationsRenalFunctionImpairmentTheeffectofrenaldysfunctiononthedispositionofpaclitaxelhasnotbeeninvestigated.HepaticFunctionImpairmentPlasmapaclitaxelexposureisincreased.IndicationsandUsageAbraxaneForthetreatmentofbreastcancerafterfailureofcombinationchemotherapyformetastaticdiseaseorrelapsewithin6moofadjuvantchemotherapy.PaclitaxelinjectionsolutionAsfirst-lineandsubsequenttherapyforthetreatmentofadvancedcarcinomaoftheovary;adjuvanttreatmentofnode-positivebreastcanceradministeredsequentiallytostandarddoxorubicin-containingcombinationchemotherapy;treatmentofbreastcancerafterfailureofcombinationchemotherapyformetastaticdiseaseorrelapsewithin6moofadjuvantchemotherapy;incombinationwithcisplatin,forthefirst-linetreatmentofnon–smallcelllungcancer(NSCLC)inpatientswhoarenotcandidatesforpotentiallycurativesurgeryand/orradiationtherapy;forthesecond-linetreatmentofAIDS-relatedKaposisarcoma.UnlabeledUsesPaclitaxelinjectionsolutionhasbeenusedforsquamouscellheadandneckcancer,smallcelllungcancer,bladdercancer,esophagealcancer,testicularcancer,endometrialcancer,prostatecancer,gastriccancer,germcelltumors,andrefractoryleukemiaandrecurrentWilmstumorinchildren.AbraxanehasbeenusedforNSCLC,metastaticmelanoma,andsquamouscellcancerofthetongue,headandneck,oranalcanal.ContraindicationsHypersensitivityreactionstopaclitaxelorotherdrugsformulatedinCremophorEL(polyoxyethylatedcastoroil)(paclitaxelinjectionsolutiononly);patientswithsolidtumorswhohavebaselineneutrophilcountoffewerthan1,500cells/mm3orinpatientswithAIDS-relatedKaposisarcomawithbaselineneutrophilcountsoflessthan1,000cells/mm3.DosageandAdministrationAbraxaneAdultsBreastcancerIV260mg/m2over30minevery3wk.Forpatientsexperiencingsevereneutropenia(neutrophilcountlessthan500cells/mm3for1wkorlonger)orseveresensoryneuropathy,reducedoseto220mg/m2forsubsequentcourses.Forrecurrenceofsevereneutropeniaorseveresensoryneuropathy,reducedoseto180mg/m2.Forgrade3sensoryneuropathy,holdtreatmentuntilresolutiontograde1or2,andreducethedoseforallsubsequentcoursesoftreatment.PaclitaxelinjectionsolutionAdultsReducedoseby20%forallsubsequentcoursesinpatientsw