Basic Sciences Flashcards
1
Q
First-order kinetics
A
- Rate is dependent on concentration
- Increased [ ] = increased removed per unit time
- Decreased [ ] = decreased removed per unit time
2
Q
When does the elimination phase begin
A
as soon as the first drug molecule enters the central compartment
3
Q
Elimination rate calculation
A
4
Q
Plasma concentration
A
5
Q
C0
A
initial concentration
theoretical # - needs to be back extrapolated from curve
6
Q
Volume of distribution
A
7
Q
Elimination half-time
A
8
Q
Ideal gas law
A
PV=nRT
9
Q
Phases
0-4
A
10
Q
Ion flow during
-depo
-repo
A
depo: Na & Ca in
repo: K out
11
Q
How do RMP, TP, and refractory periods correlate with the QRS?
A
12
Q
Poiseuille’s law
A
Used for laminar flow (non-turbulent)
F = (πr4ΔP)/(8ηL)
- F: volumetric flow rate (rate of fluid flow)
- r: radius
- ΔP: hydrostatic pressure gradient
- η: viscosity
- L: length
13
Q
Boyle’s law
A
PiVi = PfVf
Volume is inversely r/t the pressure it exerts
14
Q
Oxidation
A
loss of electrons
(lose H or gain O)
15
Q
Ethanol metabolism
A
16
Q
The reason I’m hungover
A
acetaldehyde
17
Q
T/F:
We can treat ethanol poisoning with methanol by saturating the enzymes and preventing its further metabolism.
A
False
Treat methanol toxicity with ethanol
Get the Meth heads drunk
18
Q
Chirality
A
molecule with a center of 3D asymmetry
Explains why some drugs don’t work on receptors even though they have the same groups attached
19
Q
chirality in drugs
A
> 50% of all drugs are chiral
(enantiomeric pairs)
20
Q
drugs with and without chiral compounds
A
chiral:
- Desflurane
- Isoflurane
- Ketamine
- Thiopental
- Etomidate
not chiral: Sevo, Prop
21
Q
Enantiomers
A
pairs of molecules existing in forms that are mirror images of each other and cannot be superimposed
D (dextrorotatory): +, rotate polarized light clockwise (R)
L (levorotatory): – , rotate polarized light counterclock. (L)
22
Q
Racemic mixture
-definition
-example
A
equal portions of D and L; cancel each other out
Ketamine (PCP analog) with a chiral compound & is a racemic mixture of S and R enantiomers
23
Q
Infrared analyzer
what can it measure?
A
Polyatomic atoms only!
CO2, N2O, volatiles (iso, des, sevo, enflurane, halothane)
NOT O2!
24
Q
Measures % concentration in gas flows
A
Infrared analyzer
25
How does the IR work?
All gases absorb radiation (light energy) at unique bands of the IR spectrum
* Inspiratory/expiratory measurements
* Expiratory is concentration in the brain
* Near real-time; continuously self-calibrates
* Can detect multiple gases in the fresh gas mixture at the same time
26
CO2 transfer from fetus to mom is facilitated by
haldane effect
## Footnote
Mom gave up her O2 to baby, now has deoxygenated hemoglobin = increased affinity for CO2
27
haldane effect
O2 [ ] influences Hgb’s CO2 affinity
A) higher O2 ➡️ O2 displaces CO2 from hgb = more O2Hgb & CO2 removal
B) Deoxygenated blood = increased ability of Hgb to carry CO
28
Bohr effect
Increased CO2 / H+ = decreased pH = decreased affinity to O2 (O2 is released from Hgb and CO2
attaches to be excreted)
* right: increased CO2, acidic, decreased Hgb affinity to O2
* left: decreased CO2, alkalotic, increased Hgb affinity to O2
## Footnote
Bohr: curve shifts d/t CO2 or pH
Haldane: O2 competes for hgb
29
Substantia Gelatinosa
* Rexed Laminae II
* processing and modulating nociceptive input from periphery
* Major site of action for opioids
30
Gate
Control Theory
* Pain is modulated by a “gate” in the cells of the substantia gelatinosa in the spinal cord
* Open (nociceptive): large, myelinated A-delta fibers & small, unmyelinated C fibers
* Close (non-nociceptive): larger A-beta fibers
31
Clonidine
-site of action
-moA
activates post synaptic alpha2 receptors in spinal cord substantia gelatinosa
32
Lymphocytes
-fxn
-the main types
Main components of adaptive immune response ii. B cells (from bone marrow)
B (bone marrow) & T (thymus)
33
**B** cells
(from **b**one marrow)
* Produce anti**b**odies; involved in humoral immune response
* Protect against **b**acteria and viruses
34
T cells
(marrow-derived; mature in the thymus)
* Able to discriminate between healthy and abnormal cells
* cell-mediated immunity
* Protect against viruses and cancer
35
Early inflammatory response
Neutrophils
36
Ingest bacteria & dead cells
Neutrophils
37
Provide defense against parasites
Eosinophils
38
Associated with asthma and allergies
Basophils
39
Monocytes
Precursors to macrophages in tissues
(macrophages help w/ wound healing)
40
activates RAAS
Renin
41
Renin
Important for regulation of BP and fluid & ____
electrolyte balance
42
Renin
released from...
the juxtaglomerular cells in the kidneys when BP is low or renal perfusion is low
43
RAAS
1. **Renin converts angiotensinogen to angiotensin I**
1. ACE: angiotensin I → II
1. Angiotensin II: vasoconstriction and aldosterone release
1. Aldosterone: increases sodium and water reabsorption in kidneys
Result: increased BP from vasoconstriction and Na+/H2O reabsorption
44
Aldosterone
**Mineralocorticoid** hormone from the adrenal **cortex** that helps regulate fluid & electrolyte balance
Increases Na & H2O reabsorption = increases BP
45
Aldosterone
moA
1. Binds to mineralocorticoid receptors = aldosterone-induced proteins (AIPs)
1. AIPs increase Na channel number/activity
2. more Na in
1. net negative luminal charge = K+ loss
46
Spironolactone
**aldosterone antagonist**/potassium sparing diuretic
47
All local anesthetics (LAs) have a pKA in range of ___. Except for...
7.6-9.0
Benzocaine is an exception with a pKa of 3.5, and thus is almost entirely unionized at physiological pH
48
All local anesthetics are ....
weak bases and may be ionized at physiological pH
49
Albumin
* carrier for drugs w/ low water solubility
* controls plasma oncotic pressure.
* Provides colloid osmotic pressure
50
Albumin effect on electrolyte balance
every 1g/dL change in Albumin = 0.8 mg/dL in Ca
Decreased serum albumin levels are associated with hypocalcemia
## Footnote
binds (90%) protein-bound calcium
51
When is albumin low?
* OB
* old
* Acute glomerulonephritis
* Nephrotic syndrome
* hypoCa
52
These two renal markers are a/w increased perioperative pulmonary morbidity
increased BUN + low albumin
53
Protein binding occurs with albumin and ____
alpha1-acid glycoprotein
54
Plasmin’s role:
Part of the ....
fibrinolytic system/tertiary hemostasis
(counterbalance system that degrades fibrin)
55
Plasminogen is broken down to plasmin, which breaks down...
fibrin into fibrin degradation products
56
retrobulbar block
what motor or sensory aspects are affected?
does not affect CN VII (facial nerve)
can close the eye with the orbicularis oculi (CN VII)
but
cannot open it with the levator muscle (CN III)
57
Facial nerve block (VII)
Role & Techniques
Prevents squinting during surgery, allows placement of a lid speculum
Techniques: van Lint (1), Atkinson (2), and O’Brien (3)
58
Facial nerve block (VII)
Complications
SQ hemorrhage, vocal cord paralysis, laryngospasm, etc
59
Blocking this CN will make the pt unable to smile
Facial nerve CN VII
60
The pharynx/base of the tongue is innervated by branches of...
1. vagus (X)
1. facial (VII)
1. glossopharyngeal (IX)
61
Innervation of the Larynx
2 branches of the vagus nerve
* SLN: Cricoid & Thyroid cartilage
* SLN internal = (S) supraglottic
* SLN external: (M) cricoid
* RLN: all intrinsic muscles of larynx except the cricothyroid
62
abolishes the gag reflex or the hemodynamic responses to
laryngoscopy
Superior laryngeal nerve block
Glossopharyngeal Nerve Block (IX)
63
sensation to posterior 1/3 of tongue and oropharynx
Glossopharyngeal Nerve (IX)
64
glossopharyngeal nerve
S&M supply
M: stylopharyngeus muscle (swallowing)
S:
* posterior 1/3 tongue
* vallecula
* anterior epiglottis (lingual branch)
* posterior & lateral walls of the pharynx (pharyngeal branch)
* tonsillar pillars (tonsillar branch)
65
Where are the SLN, RLN and Vagus?
66
innervates the vocal cords and below
RLN
67
Internal SLN branch
(above the cords)
- base of tongue
- posterior epiglottis
- aryepiglottic folds
- arytenoids
68
integrates the neurological and endocrine systems
hypothalamus
69
Hypothalamus
-location
-connection to pituitary
* Located at the base of the brain
* to anterior pituitary by portal blood vessels
* to posterior pituitary by a nerve tract (hypothalamohypophsial tract)
70
Hypothalamus produces these hormones
71
Basal ganglia
72
Basal ganglia motor syndromes
* **Parkinson’s** -loss of dopaminergic cells in the basal ganglia (Lewy Bodies)
* **Huntington’s** (chorea)-severe degeneration of the basal ganglia (caudate and putamen nuclei) and frontal cerebral cortex (Depletion of **GABA**)
73
80% of dopamine is located...
concentrated in the basal ganglia mostly in caudate nucleus and putamen
74
Medulla Oblongata (myelencephalon)
-location
-associated CNs
Lowest portion of brainstem
CN IX-XII
75
Spinal cord is an extension of the ...
medulla oblongata
76
the Spinal cord is contained within...
dural sac with an arachnoid lining that surrounds the cord and ends at conus medullaris
77
Which CN originates in the medulla oblongata
Vagus
78
Subthalamus is Part of the
diencephalon
79
This structure is part of the basal ganglia and regulates movement
subthalamus
80
ADH synthesis, storage and release
* Synthesized in nuclei of the hypothalamus
* stored and secreted by the posterior pituitary
81
ADH fxn
* Controls plasma **osmolality** via water reabsorption
* Increases blood volume by reabsorbing water from tubular fluid in the **distal tubule and collecting duct** of the nephron
82
ADH is Released from the post. pituitary when...
plasma osmolality is increased or intravascular volume is decreased
83
ADH secretion and thirst
stimulates ....
Angiotensin **II**
84
Osteocytes
* bone maintenance
* signals blasts & clasts to form and resorb
* in the lacuna
* respond to parathyroid hormone
85
most abundant cell in bone
Osteocytes
86
Osteoblasts Produce (2)
osteocalcin & osteoid
87
Osteophytes
* bone spurs in **osteo**arthritis
* as the articular cartilage erodes, these alter bone countours and joints
* enlarge until tiny pieces (joint mice) break off into synovial cavities = synovitis & joint effusion
88
osteoarthritis
* inflammatory joint disease
* degeneration and loss of articular cartilage, sclerosis of underlying bone, and formation of bone spurs (osteophytes)
* Heberden & Bouchard nodes (fingers)
89
Substances that increase gatric motility
* motilin
* gastrin
* ACh
* dopamine & 5HT3 antagonism
* 5HT4 agonism
* erythromycin (stimulates motilin)
## Footnote
glucagon decreases motility
90
Why does Erythromycin cause diarrhea?
stimulates motilin receptors
91
What can decrease gastric motility?
* Glucagon
* GLP-1's
92
GLP-1 controls glucose by...
* ↑ glucose-dependent insulin secretion
* ↑ B-cell insulin secretion
* ↓ A-cell glucagon synthesis
* ↓ gastric emptying
93
GLP-1's are __ mimetics/analogs
incretin
94
Role of calcium in cells
* second messenger
* ↑ ICF Ca: vasoconstriction
* ↓ ICF Ca: vasodilation
* G-protein cAMP & Nitric oxide cGMP: vasodilate
* Phospholipase C: Vasoconstriction
95
How do cAMP and protein kinase A (PKA) affect intracellular calcium?
↑ cAMP & protein kinase A (PKA) = ↑ ICF Ca
96
PKA affects excitation-contraction coupling by...
## Footnote
higher PKA = higher ICF Ca
* Inhibits VG Ca channels in the sarcolemma
* Inhibits Ca release from the SR
* Reduced sensitivity of the myofilaments to Ca
* Facilitates Ca reuptake into the SR via the SERCA2
97
Hormones released from the adrenal
-medulla
-cortex
-medulla: epi, NE
-cortex: cortisol, aldosterone
98
T/F:
Most NE storage is due to synthesis.
False
reuptake
99
ratio of Epi and NE secretion
80% EPI: 20% NE
100
Valerian root effects
* mild sedative, anxiolytic
* potentiates barbiturates & ANE
* May blunt BZD withdrawal
* may delay emergence in children
101
🔷
Which meds should be continued/OK to continue periop?
* valerian root
* antipsychotics
102
T/F:
H2 antagonists raise gastric pH, but do not affect volume.
False
reduces gastric volume AND acidity
103
H2 antag
moA
* competitively inhibit histamine binding to H2-receptors = less gastric acid & raise pH
* All agents are equally effective for peptic, duodenal & gastric ulcers
104
hypersecretory state of H2
Zollinger-Ellison syndrome & GERD
105
Pepcid onset
30 min- 1H
106
T/F:
Pepcid increases LES tone.
False
reglan
107
Prostaglandins are potent mast cell mediators that produce...
* vasodilation
* bronchospasm
* pulmonary HTN
* increased capillary permeability
108
the major metabolite of mast cells
Prostaglandin D2
109
PG that produces bronchospasm and
vasodilation
D2
110
T/F:
PGs directly cause pain.
False
**Peripherally** they contribute to **hyperalgesia** by sensitizing nociceptors to other mediators of pain sensation such as **histamine and bradykinin**
111
Peripherally PGs contribute to hyperalgesia by ...
sensitizing nociceptors to other mediators of pain sensation such as **histamine and bradykinin**
112
PG role in pain & how blocking them affects pain
sensitize and amplify nociceptive input
blocking their synthesis = analgesic, antipyretic, anti-inflammatory
113
Which PGs relax the ductal smooth
muscle
I2 & E2
114
two types of COX
* COX-1: widespread (gastric mucus [protective] & thromboxane A2 production [platelet aggregation])
* COX-2: induced by inflammation
115
PG's and renal system
* produced by the kidney via phospholipase A2 & cyclooxygenase
* modulates RBF & opposes ADH + RAAS
116
PGs are formed from the ___ pathway
Cycloox.
117
Carboprost tromethamine
* Hemabate; synthetic PGF2a
* uterine contractions
* 0.25 mg **IM** Q15-90 min max 2 mg
N/V, bronchoconstriction, diarrhea
**contraindicated in asthmatics**
118
T/F:
A-2 receptors are postsynaptic adrenoreceptors in smooth muscle.
False
A-1
119
Where are A1 receptors located
postsynaptic
smooth muscle (eye, lung, vessels, uterus, gut, GU)
120
A1 stimulation
* ↑ ICF Ca = smooth muscle contraction
* mydriasis
* broncho & vasoconstriction
* uterine contraction
* constriction of GI & GU sphincters
121
Phenylephrine structure
similar to epinephrine
but no hydroxyl group on the phenyl ring
122
Neo effects
* ↑ venous & arterial vasomotor tone with **no effect on B-adrenoceptors**
* Constricts venous, cutaneous, skeletal muscle, mesenteric, splenic, & renal
* ↑ LV preload & afterload
* ↑ PA & arterial pressures
123
How does Neo affect pulmonary vasculature
increases PA pressures
via PA constriction and increasing venous return
124
NE receptor activity
Direct A1
limited B2
* Intense constriction of arterial **and** venous
* Decreased renal and splanchnic flow
* increased myocardial DO2
125
Levo drip
2-20 mcg/min
short HL
126
Pheochromocytoma
* adrenal medulla Tumor that secretes both NE and epi
* Most are solitary localized to the right side of the adrenal gland
127
T/F:
Pheochromocytoma Tumors are innervated, making catecholamine release dependent on neurogenic control.
False
not innervated so catechol. release is independent of neurogenic control
128
Pheochromocytoma
what can happen?
- brain bleed, heart failure, dysrhythmias, or MI
- severe HTN if manipulated
- EKG: LVH & nonspecific T-wave changes
129
Phenoxybenzamine
long-acting Alpha-blocker (24-48H)
noncompetitive presynaptic (α2) & postsynaptic (α1)
130
Phenoxybenzamine main side effect
postural hypotension
since the baroreceptor reflex is blunted
131
Which agent has less SEs than phenoxybenzamine?
"Zosins"
selective A1
132
🔷
Manipulation of Pheochromocytoma causes severe HTN. What should you use?
- NTP, phentolamine, or other rapidly acting vasodilators
- B-blkrs
- Mag Sulfate
- A-Methyltyrosine
133
Pheochromocytoma
Diagnosis
free catecholamine and catecholamine metabolites in the 24 hour-urine
134
Antipsychotic drugs
effect on NTs
antagonize DA and ACh
## Footnote
DA antagonism = antipsychotic effects
135
Neuroleptic malignant syndrome may occur hours or weeks after giving or abruptly stopping these drugs
anti-psychotics
(DA antagonists)
136
What anesthetic drugs can cause NMS?
meperidine & reglan
137
NMS
patho
dopamine blockade in the basal ganglia and
hypothalamus & impairment of thermoregulation
138
NMS vs MH
both: rigidity, hyperT, rhabdo, ANS instability, & altered consciousness
139
Aside from MH, when is dantrolene used?
NMS
140
treatment for NMS
dantrolene & bromocriptine
stop offending agent
141
this Rx class can increase the risk of diabetes
anti-psych
"I was crazy, but now I'm sweet"
142
Anti-psychotics can cause these 2 deadly syndromes
NMS & anticholinergic crisis
## Footnote
DA antagonism & anticholinergic activity
143
Antimuscarinic compounds associated with Central Anticholinergic syndrome
* Chlorpromazine
* Thioridazine
* Haloperidol
* Droperidol
* Promethazine
144
How are O:G, potency & MAC related?
higher O:G = higher potency = lower MAC
145
O:G per agent
* Nitrous 1.4
* Des 19
* Sevo 49
* Iso 91
146
Which cholinergic receptors are
ligand gated vs G protein?
muscarinic = G
nicotinic = ligand
147
Nicotinic vs Muscarinic Crisis
S/S
nicotinic:
muscle cramps, Tachycardia, Weakness, Twitching, Fasciculations
muscarinic = SLUDGE:
Salivation, Lacrimation, Urination, Defecation, GI Cramping, Emesis
148
How do the different cholinergic stimulations affect HR?
nicotinic = tachycardiac
muscarinic = bradycardia
## Footnote
M2 = bradycardia
149
muscarinic stimulation
airway, pupillary, and GI tract constriction; bradycardia; and gland activation (ENT + sweat)
