203 final Flashcards
1
Q
Which general anesthetic has a small therapeutic margin (IV)
A
thiopental
2
Q
Which IV GA is used for preoperative sedation
A
midazolam
3
Q
a higher blood gas coefficient means
A
higher solubility = slower equilibrium within alveoli
4
Q
a higher oil;gas partition means
A
higher potency, slower recovery
5
Q
where are local anesthetics injected when it’s parenteral
A
peripheral nerve endings
near major nerve trunks
into epidural or subarachnoid spaces
6
Q
components of a local anesthetic
A
aromatic ring- ester or amide bond - amine base
7
Q
what kind of drugs are weak bases
A
local anesthetics
8
Q
GA act on ___ while LA block ___
A
general: GABAa, 2 pore K+ channels, NMDA block
LA: NA (increases excitability threshold + decreases conduction)
9
Q
what kind of drugs cause severe toxicity if absorbed systemically
A
local anesthetics
10
Q
all opioid receptors are _____
A
GPCR- Gi/Go
11
Q
2 analgesics used for neuropathic pain
A
TCAs and antiepileptic drugs
12
Q
opioids act on which channels
A
neuronal K+ and VG Ca2+
13
Q
antiepileptics act on which chanels
A
Na+ and Ca2+
14
Q
what analgesic inhibits amine uptake and blocks sodium channels
A
nefopam
15
Q
TCAs act within the
A
CNS
16
Q
what reduces expression of VG Ca2+ channel + blocks Na+
A
antiepileptics (analgesics)
17
Q
postsynaptic 5HT are highly expressed in parts of the brain implicated in
A
emotional behaviour (limbic)
18
Q
benzodiazapines structure
A
benzene ring fused to diazepine ring
19
Q
-lap/pam are
A
BZs
20
Q
flumazenil
A
BZ antagonist
21
Q
PD is associated with a loss of DA neurons in the ____ and _____ of the _____
A
substantia nigra
corpus striatum
of the basal ganglia
22
Q
levodopa is given with
A
carbidopa/benserazide
entacapone/tolcapone
23
Q
carbidopa/benserazide are
A
peripheral DOPA decarboxylase inhibitors that don’t cross the BBB
24
Q
entacapone and tolcapone are
A
COMT inhibitors
25
amantadine actions
increases DA release, decreases uptake, acts on DA receptors
26
5 PD drugs
```
levodopa
DA receptor agonists
MAO-B inhibitors
amantadine
mAChR antagonists
```
27
GABAergic neurons have _______ decarboxylase
glutamic acid
28
Huntingtons drugs
tetrabenazine
chloropromazine
baclofen
29
what in AZ activates NMDA to cause excitotoxicity
beta amyloid
30
AZ drugs
anticholinesterases
| NMDA blockers- memantine
31
HT causes neuronal loss in ___ and _____
cortex
| striatum
32
AZ sees neuronal loss in ____ and ____
hippocampus
| frontal cortex
33
mephedrone action
inhibits 5HT and DAT reuptake + stimulates release
34
methylphenidate action
inhibits SERT, DAT, and NET reuptake
| used for narcolepsy and ADHD
35
modafinil action and treats
inhibits DAT
| treats narcolepsy
36
do you know that you're on LSD when you're on LSD
yes, retained insight into the fact that disturbances are drug induced
37
can LSD cause long lasting psychopathological changes
yes
38
with MDMA, inhibition of DAT and NET = ___, while SERT causes
euphoria and rebound dysphoria
| psychomimetic effects
39
what psychometics causes hyponatremia and acute hyperthermia
MDMA
40
list of stimulants
```
amphetamines
mephedrone
methylphenidate
modafil
cocaine
```
41
list of psychomemetics
```
LSD
psilocybin
MDMA
mescaline
ketamine and phencyclidine
```
42
PCP causes ____ and ____
psychotic episodes and schizophrenic attacks
43
what part of amphetamines actions result in their rewarding effect
more DA
44
schizophrenia's root cause is what receptor
NMDA receptor hypofunction
45
NMDA receptor hypofunction on ____ GABAergic interneurons alter cortical processing = cognitive impairment
cortical
46
what happens if you block D2 in cortex
worsening of negative symptoms
47
what happens if you block D2 in nigrostriatal pathway
dystonia (sim to PD) and dyskinesia
48
what happens if you block D2 in mesolimbic pathway
enhanced prolactin secretion + galactorrhea
49
where would you use a mAchR block for schizophrenia
for motor disturbances
on neuron downstream from cholinergic
on dopaminergic neuron = secretes more dopamine
50
blocking 5HT2a in mesocortical results in
improved negative symptoms
51
in the mesolimbic pathway, combined __ and __ receptor antagonism may counteract the increased dopamine function
D2
| 5HT2a
52
what receptors do antipsychotics block besides D
H1
mAchR
alpha-adrenoceptor
53
to relieve antipsychotic motor effects, you would block mAChR in the
striatum
on post ACh neuron
on DOPA neuron
54
sodium channel blockers for seizures are use dependent, they preferentially bind to
inactivated state of the channel
55
focal seizure drugs
carbamazepine, lamotrigine, levetriacetam, phenytoin
56
SARI stands for
serotonin-2 antagonists/ 5ht reuptake inhibits
57
NaSSA stands for
noradrenergic/ specific serotonergic agent
58
inhibitors of monoamine uptake
```
SSRIs
TCA
SNRIs
NDRIs
St. John's wort
```
59
2 classes of MAOIs
irreversible, noncompetitive, nonselective inhibitors
both MAOA and MAOB
reversible, MAOA selective inhibitors
60
antidepressant effect
tremors, tachycardia, HT, sweating, insomnia, erectile and ejaculation problems
caused by ____ block
NE reuptake blockade
61
antidepressant, antianxiety, antipanic, antiobsessional, antiaggressive caused by ______ block or agonism
5HT reuptake blockade or 5HT receptor agonism
62
what blockade mitigates against prolactin elevation but aggravates psychosis
DA reuptake blockade
63
5HT2A blockade causes
antipsychotic
64
dry mouth, blurred vision, constipation, urinary retension, sinus tachy, glaucoma are caused by ___ block
M1
65
what blockade would potentiate drugs with anticholinergic properties
M1
66
alpha 2 blockade effect
possible decrease in depressive symptoms
67
order of TCA action
H1 block
M1 block
NE reuptake block
5HT reuptake block
68
MAOA prefers
5HT and NE degradation
69
MAOB prefers
phenylethylamine and dopamine
70
hypertensive crisis occurs when
MAOI inhibits the inactivation of tyramine with MAO
71
contractile state is controlled by (3)
endothelium
circulating hormones
sympathetic nerves
72
major vasoconstrictors produced by endothelial cells
endothelin
TXA2
angiotensin II
73
endothelin acts by
acting on ETa receptors to cause Ca2+ release via IP3
74
captopril is a vasodilator. what does it inhibit
RAS inhibitor
75
nicorandil action
Katp channel open
prevent VGCC
donates NO
76
what acts on V1 receptors
ADH
77
MOA of -olol
decreased cardiac output
decreased renin
reduce sympathetic activity
78
-dipine are
Ca2+ antagonists
| dihydropyridines
79
-sartans act on what receptors
AT1
80
-pril are
ACE inhibitors
81
treatment starts with either a ____ (young white) or a ________ (older or african)
RAS inhibitor
| thiazide diuretic/ Ca2+ antagonist
82
treatment for a old white man for hypertension usually starts with a
thiazide diuretic/ Ca2+ antagonist
83
there is a young african needing a antihypertensive drug, what are your choices
thiazide diuretic
| Ca2+ antagonist
84
what to use in hypertensive emergencies
nitroprusside
85
2 actions of nitroprusside
cGMP signaling increase
| NO donor
86
what does carvedilol target
beta and alpha 1
87
negative inotropics ___
weaken contraction force
88
isosorbide mononitrate is an
organic nitrate
89
what reduces preload by relaxing veins through NO
isosorbide mononitrate
90
hydralazine MOA
inhibits IP mediated intracellular Ca2+ increase
| results in a fall in BP
91
in heart failure, there is ____ CO
insufficient
92
digoxin MOA
inhibits Na+/K+ ATPase
93
digoxin ___ contraction force, ___ HR, ____ ventricular filling
increases contration forces
decreases HR
increases ventricular filling
94
-one are
aldosterone receptor antagonists
95
does spironolactone directly inhibit electrolyte transporter activity?
no
| inhibits expression of transporters
96
furosemide is a
loop diuretic
97
furosemide MOA
inhibits Na+/K+/2Cl- transporter at loop of henle
98
isosorbide mononitrate is an
organic nitrate
99
-prost-
prostacyclin and analogues
100
in PAH, the __ ventricle gets larger
right
101
familial PAH is caused by mutations in the
Bmpr2 gene
102
riocuguat is a
sGC stimulator = increased cGMP
103
inhaled NO is used for
acute vasodilator testing of PAH
| pulmonary hypertensive crisis in newborns
104
-etan- are
endothelin antagonists
105
what drugs cause the largest reductions in pulmonary artery pressure
prostacyclin
106
dobutamine is
beta1 effects to increase CO during cardiogenic shock
107
competitive inhibitors of HMG CoA reductase
statins
108
fibrates bind to
PPARalpha
109
ezetimibe inhibits
luminal cholesterol uptak eby inhibiting NPC1L1 = reduction of incorp of cholesterole into chylomicron
110
water soluble B3 complex vitamine for increasing HDL-C
niacin (nictontinic acid)- nicotinamide
111
disorders of lipoprotein metabolism that reuslt in abnormalities in plasma cholesterol, TGs, LDL-C and/or HDL-C levels
hypercholesterolemia and dyslipidemia
112
lipoprotein density ranking
chylomicron, VLDL, LDL, IDL, LDL
113
what drug inhibits dietary cholesterol uptake
ezetimibe
114
6 cholesterol drugs
```
statins
fibrates
ezetimibe
bile acid sequestrants
nacin
PCSK9 inhibitors
```
115
what inhibits the absorption of ezetimibe
bile acid sequestrants
116
- grel are
thienopyridines
117
ASA is often combined with ____ for dual antiplatelet therapy
P2Y12 inhibitors
118
dipyridamole actions
PDE inhibitor
blocks adenosine uptake
inhibits TXA2 and increases PGI2
used with ASA_ not effective alone
119
is dipyridamole effective alone
no- use with ASA
120
what is responsible for heparin's MOA
pentasaccharide sequence
121
are aldosterone antagonists competitive or noncompetitive
competitive
122
in HF, you want to ___ ventricular filling
increase
123
flurosemide is a diuretic at ____, while thazides are ____ (and ions involved)
loop- Na/K/Cl
| DCT- Na/Cl-
124
what is the danger with K+ blockers (class 3)
extends ventricular ERP = higher changes of TDP arrhythmias
125
what gene encodes pore forming subunit of rapidly activating delayed rectifier cardiac K+ channel
hERG
126
what class blocks VGCC (L type) and slows conduction at SA and AV nodes = slow HR
4 (CC blockers)
127
L type calcium channels are found at
pacemaker cells, myocytes, and vasculature
128
T type calcium channels are found at
pacemaker cells
129
calcium channel blockers prevent Ca2+ entry via _____ channels
L type calcium
130
NDHP are used on the ___ while ___ are used on vasculature
```
heart = NDHP
vasculature = DHP
```
131
electrical activity in pacemaker cells
funny sodium channels
T type Ca2+ channels
L type Ca2+ channels
K+ channels
132
sympathetic activity at pacemaker cells on what channels? what receptors
funny sodium and calcium
| beta1
133
parasympathetic activity at pacemaker cells on what channels? what receptors
K+ channels increase open, close calcium
| mAChR
134
contractile cell AP process
0: rapid depolarization Na
1: small repolarization Na close
2. plateau L type Ca open
3. repolarization K+ open, Ca2+ close
4: resting K+ open-
135
if stimulus occurs during phase ___ of AP (repolarization K+), what happens
premature AP is slower and smmaller
136
QT segment
ventricular systole
137
what causes torsades de points
blocking of K+ channels (hERG) = prolonged ventricular repolarization = tachycardia and ventricular fibrillation
138
general classification of arrhythmias
site of origin
| rate increase or decrease
139
classes of antiarrhythmic drugs and their actions
```
1 = Na+
2 = beta blockers
3 = K+
4 = Ca2+
```
140
class 1A drug
procainamide
141
class 1c drugs
flecainide, propafenone
142
what class has a weak effect on prolonging phase 0 and shortens the ERP
class 1B
143
class 1 Na+ blockers work on phase ___
```
0
and 3 (a and b)
```
144
class 1 antiarrhytmics are ___ dependent block
use
145
beta 1 is ___ coupled, beta 2 __ beta 3 ___
Gs
Gs/Gi
Gs/Gi
146
what beta receptor is on the heart
beta1
147
first generation beta blockers
noncardioselective 1 and 2
148
second generation beta blockers
cardioselective- only beta1
149
third generation beta blockers
vasodilatory properties-NO or alpha adrenergic blockade
150
beta blockers affect what channels
Ca+ L type
| funny sodium
151
class 3 antiarrhythmics increase
ERP
152
amiodarone, dronedarone, sotalol, dofetilide/ ibutilide are
class 3 K+ channel blockers
153
class 4 are ___ inotropy, dromotropy, and chronotropy
negative
154
what is used for treating torsades de points and digoxin induced arrhythmias
magnesium sulphate
155
organic nitrates action besides donating NO is
activate sGC = increases cGMP = increases MLCP = muscle relaxation
156
3 types of organic nitrates
eNOS by sheer force
those that release NO spontaneously- nitroprusside
those that require enzymes to release NO- organic nitrates
157
do you use nitrates or dipyridamols to dilate collaterals
nitrates
158
nicorandil is contraindicated with
PDE51
159
ranolazine inhibits
cardiac ion fluxes
| preferentially late sodium current
