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Файл:Перевод медицинского текста. Учебное пособие для подготовки к практическим занятиям по дисциплине «Иностранный язык»
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Text 7. Alkylating agents
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Picture 7. DNA alkylating agents
Alkylating agents are a class of antineoplastic or anticancer drugs
which act by inhibiting the transcription of DNA into RNA and thereby
stopping the protein synthesis.
Some examples of alkylating agents are nitrogen mustards (chlorambucil and cyclophosphamide), cisplatin, nitrosoureas (carmustine, lomustine, and semustine), alkylsulfonates (busulfan), ethyleneimines (thiotepa), and triazines (dacarbazine).
Cyclophosphamide — the most widely used alkylating agent of modern times.
Alkylating agents prevent cell division primarily by cross-linking
strands of DNA. Because of continued synthesis of other cell constituents,
such as RNA and protein, growth is unbalanced, and the cell dies. Activity
of alkylating agents does not depend on DNA synthesis in the target cells.
Alkylating agents are used in treating various forms of cancer, but they tend
to work best in slow-growing cancers, such as: brain tumors, breast cancer,
leukemia.
Alkylating and Alkylating-Like Agents
Cyclophosphamide, used in the treatment of breast cancer and hematologic malignancies, is typically well tolerated. At higher dosages,
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greater than 100 mg/kg, there have been case reports of hemorrhagic myocarditis, tachyarrhythmias, HF, and pericardial disease. Platinum-based
agents, often considered alkylating-like agents, are commonly used in
germ-cell testicular cancer, as well as ovarian, lung, and breast cancers and
other solid tumors. Platinum cardiotoxicity has been perhaps most well
studied in the testicular cancer population. Testicular cancer has high cure
rates, and survivors often live 30 to 50 years after treatment, but they suffer
from an increased long-term risk of CV events believed to be related to
platinum therapy exposure. One epidemiologic study with a median observation time of 19 years reported a 5.7-fold increased risk of coronary artery
disease and 2.3-fold increased risk of atherosclerotic disease as defined by
coronary disease, cerebrovascular disease, and peripheral arterial disease
in patients receiving platinum-based chemotherapy regimens compared
with patients receiving no chemotherapy. These effects were worsened in
patients who received concomitant RT, and patients also had abnormal androgen levels. Some studies have also suggested that platinum is associated with endothelial damage, because plasma platinum levels remain detectable in patients up to 20 years after therapeutic exposure.
Adverse Effects
Most alkylating agents cause gastrointestinal side effects and doselimiting toxicity to bone marrow. Most of the alkylating agents produce an
acute suppression of the bone marrow, with the major effect being a decreased granulocyte count. Busulfan depresses all blood elements, particularly stem cells. Because both cellular and humoral immunity are suppressed by alkylating agents some are used for the treatment of autoimmune disease. In addition to the effect on the bone marrow, alkylating
agents are highly toxic to mucosal cells resulting in oral mucosal ulceration
and effects on the intestinal mucosa. Other organ systems affected by some
alkylating agents include the lungs (pulmonary fibrosis) and the liver. Cyclophosphamide and ifosfamide cause a severe hemorrhagic cystitis due to
their release of acrolein, a metabolite. This condition is manageable with
thiol flushing agents. Because the more unstable alkylating agents, such as
nitrogen mustard and the nitrosoureas, have strong vesicant properties
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they damage veins with repeated use and produce ulceration if extravasated. Alkylating agents cause alopecia and have immunosuppressive effects.
Task 1. Answer the following questions
1. How do we calla class of antineoplastic or anticancer drugs which
act by inhibiting the transcription of DNA into RNA and thereby stopping
the protein synthesis?
2. Namesome examples of alkylating agents.
3. Do alkylating agents prevent cell division primarily by cross-linking
strands of DNA?
4. What for are alkylating agents used?
5. Are there any adverse effects of the alkylating agents?
Task 2. Read and translate the following statement and say if it is
true or false
1. Some examples of alkylating agents are barbiturates, benzodiazepines, gamma-hydroxybutyrate (GHB) and opioids .
2. Cyclophosphamide isthe most widely used alkylating agent of
modern times.
3. Cyclophosphamide is not used in the treatment of breast cancer
and hematologic malignancies.
4. Platinum-based agents, often considered alkylating-like agents, are
commonly used in germ-cell testicular cancer, as well as ovarian, lung, and
breast cancers and other solid tumors.
5. Most alkylating agents cause pulmonary side effects.
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Text 8. Anticoagulants
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Picture 8. Anticoagulant medication and the process of preventing blood clot
Anticoagulants are medicines that help prevent blood clots. They're
given to people at a high risk of getting clots, to reduce their chances of
developing serious conditions such as strokes and heart attacks.
A blood clot is a seal created by the blood to stop bleeding from
wounds. While they're useful in stopping bleeding, they can block blood
vessels and stop blood flowing to organs such as the brain, heart or lungs if
they form in the wrong place.
Anticoagulants work by interrupting the process involved in the formation of blood clots. They're sometimes called "blood-thinning" medicines, although they don't actually make the blood thinner.
Although they're used for similar purposes, anticoagulants are different to antiplatelet medicines, such as low-dose aspirin and clopidogrel.
Types of anticoagulants
The most commonly prescribed anticoagulant is warfarin.
Newer types of anticoagulants are also available and are becoming
increasingly common. These include:
• rivaroxaban (Xarelto);
• dabigatran (Pradaxa);
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• apixaban (Eliquis);
• edoxaban (Lixiana).
Warfarin and the newer alternatives are taken as tablets or capsules.
There's also an anticoagulant called heparin that can be given by injection.
Read more about heparin on the Electronic Medicines Compendium (EMC)
website.
When anticoagulants are used
If a blood clot blocks the flow of blood through a blood vessel, the affected part of the body will become starved of oxygen and will stop working properly.
Depending on where the clot forms, this can lead to serious problems
such as:
• strokes or transient ischaemic attacks ("mini-strokes")
• heart attacks;
• deep vein thrombosis (DVT);
• pulmonary embolism.
Treatment with anticoagulants may be recommended if your doctor
feels you're at an increased risk of developing one of these problems. This
may be because you've had blood clots in the past or you've been diagnosed with a condition such as atrial fibrillation that can cause blood clots
to form.
You may also be prescribed an anticoagulant if you've recently had
surgery, as the period of rest and inactivity you need during your recovery
can increase your risk of developing a blood clot.
How to take anticoagulants
Your doctor or nurse should tell you how much of your anticoagulant
medicine to take and when to take it.
Most people need to take their tablets or capsules once or twice a
day with water or food.
The length of time you need to keep taking your medicine for depends on why it's been prescribed. In many cases, treatment will be lifelong.
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If you're unsure how to take your medicine, or are worried that you
missed a dose or have taken too much, check the patient information leaflet that comes with it or ask your GP, anticoagulant clinic or pharmacist
what to do.
Things to consider when taking anticoagulants
There are several things you need to be aware of when taking anticoagulant medicines.
If you're going to have surgery or a test such as an endoscopy, make
sure your doctor or surgeon is aware that you're taking anticoagulants, as
you may have to stop taking them for a short time.
Speak to your GP, anticoagulant clinic or pharmacist before taking
any other medicines, including prescription and over-the-counter medicines, as some medicines can affect how your anticoagulant works.
If you're taking warfarin, you'll also need to avoid making significant
changes to what you normally eat and drink, as this can affect your medicine.
Most anticoagulant medicines aren't suitable for pregnant women.
Speak to your GP or anticoagulant clinic if you become pregnant or are
planning to try for a baby while taking anticoagulants.
Side effects of anticoagulants
Like all medicines, there's a risk of experiencing side effects while taking anticoagulants.
The main side effect is that you can bleed too easily, which can cause
problems such as:
• passing blood in your urine;
• severe bruising;
• prolonged nosebleeds;
• bleeding gums;
• vomiting blood or coughing up blood;
• heavy periods in women.
For most people, the benefits of taking anticoagulants will outweigh
the risk of excessive bleeding.
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Task 1. Answer the following questions
1. How do we call medicines that help prevent blood clots?
2). When are they prescribed and given to people?
3. The most commonly prescribed anticoagulant is warfarin, isn’t it?
4. Are anticoagulants different to antiplatelet medicines?
5. Do anticoagulants have side effects? What are they?
Task 2. Read and translate the following statement and say if it is
true or false
1. Rivaroxaban (Xarelto), dabigatran (Pradaxa), apixaban (Eliquis) are
newer types of anticoagulants that available and becoming increasingly
common nowadays.
2. Depending on where the clot forms, this can lead to serious problems such as strokes or transient ischaemic attacks ("mini-strokes"), heart
attacks, deep vein thrombosis (DVT), pulmonary embolism.
3. Most people need to take their tablets or capsules once a week
with hot tea and lemon.
4. If you're unsure how to take your medicine, or are worried that you
missed a dose or have taken too much, ask your cardiologist and follow his
recommendations.
5. There's no risk of experiencing side effects while taking anticoagulants.
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Text 9. Antifungal medicines
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Picture 9. Different antifungial medication forms
Antifungal medicines are used to treat fungal infections, which most
commonly affect your skin, hair and nails.
You can get some antifungal medicines from a pharmacy without
needing a GP prescription.
Infections antifungals can treat
Fungal infections commonly treated with antifungals include:
• ringworm;
• athlete's foot;
• fungal nail infection;
• vaginal thrush;
• some types of severe dandruff.
Some fungal infections can grow inside the body and need to be
treated in hospital.
Examples include:
• aspergillosis, which affects the lungs;
• fungal meningitis, which affects the brain.
You're more at risk of getting one of these more serious fungal infections if you have a weakened immune system – for example, if you're taking
medicines to suppress your immune system.
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Types of antifungal medicines
You can get antifungal medicines as:
• a cream, gel, ointment or spray;
• a capsule, tablet or liquid;
• an injection;
• a pessary: a small and soft tablet you put inside the vagina.
Common names for antifungal medicines include:
• clotrimazole (Canesten);
• econazole;
• miconazole;
• terbinafine (Lamisil);
• fluconazole (Diflucan);
• ketoconazole (Daktarin);
• nystatin (Nystan);
• amphotericin.
How antifungal medicines work
Antifungal medicines work by either:
• killing the fungus;
• preventing the fungus from growing.
When to see a pharmacist or GP
See a pharmacist or GP if you think you have a fungal infection. They
can advise you on which antifungal medicine is best for you.
If you take too much antifungal medicine, call 111 or speak to a
pharmacist or GP.
If you're advised to go to hospital, take the medicine's packaging with
you so the healthcare professionals who treat you know what you've taken.
Things to consider when using antifungal medicines
Before taking antifungal medicines, speak to a pharmacist or GP about:
• any existing conditions or allergies that may affect your treatment
for fungal infection
• the possible side effects of antifungal medicines;
;
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• whether the antifungal medicine may interact with other medicines
you may already be taking
• whether your antifungal medicine is suitable to take during preg-
;
nancy or while breastfeeding – many are not suitable.
You can also check the patient information leaflet that comes with
your antifungal medicine for more information.
Side effects of antifungal medicines
Antifungal medicines may cause side effects. These are usually mild
and do not last long.
They can include:
• itching or burning;
• redness;
• feeling sick;
• tummy (abdominal) pain;
• diarrhoea;
• a rash.
Occasionally, antifungal medicines may cause a more severe reaction,
such as:
• an allergic reaction – your face, neck or tongue may swell and you
may have difficulty breathing
• a severe skin reaction – such as peeling or blistering skin;
• liver damage (very rarely) – you may have loss of appetite, vomit-
;
ing, nausea, jaundice, dark pee or pale poo, tiredness or weakness.
Stop using the medicine if you have these severe side effects, and see
a GP or pharmacist to find an alternative.
Antifungal medicines for children
Some antifungal medicines can be used to treat children and babies –
for example, miconazole oral gel can be used for oral thrush in babies.
But different doses are usually needed for children of different ages.
Speak to a pharmacist or GP for more advice.
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