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Pharm 2 > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

A delta fibers release which neurotransmitter?

A

glutamate

which binds to the NMDA receptor

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2
Q

C fibers release what at the nerve terminal?

A

substance P

which will bind to substance P receptors on the paleo neurons

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3
Q

Which fibers are faster? A delta fibers or C fibers?

A

A-delta fibers are faster since they are myelinated (saltatory conduction)

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4
Q

How do NSAIDs work?

A

inhibit the production of PGs by blocking COX2 in proflammatory cells –decreases sensitization of C and A-delta fibers

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5
Q

What is TTX?

A

tetrodotoxin
produced by bacteria in blowfish
blocks Na+ channels regardless of which state the channel is in

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6
Q

High solubility vs low solubility in regards to general anesthesia

A

Low solubility in blood = quick equilibrium and faster induction

High solubility in blood = slow equilibrium and is not useful for rapid induction

Speed of induction is inversely proportional to the solubility of the agent in blood (Blood:gas partition)

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7
Q

Halothane

A

General anesthetic

Relatively high blood:gas = slow induction

Soluble in fat

SE: halothane hepatitis - immune response

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8
Q

Enflurane

A

General anesthetic

Blood:gas relatively high = slow induction

SE: cardiovascualr depression, seizures

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9
Q

Isofurane

A

Most commonly used inhalation anesthetic in the US

1 MAC = 1.4%
Blood: gas 1.4 (relatively low) = somewhat fast induction

(+)

  • cardiac output maintained
  • systemic vessels dilate causing small decrease in BP
  • potent coronary vasodilator

(-)

  • more pungent than halothane
  • progressive respiratory depression
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10
Q

What are the 4 main categories of IV Anesthetics?

A

Barbiturates
Propofol
Etomidate
Ketamine

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11
Q

Pancuronium

A

A muscle relaxant that facilitates intubation

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12
Q

Preanesthetic medications

A 
Benzodiazepines
Antihistamines
Antiemetics
Opioids
Antimuscarinics
Muscle relaxants
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13
Q

Midazolam

A

Benzodiazepine
Reduce anxiety
Induces amnesia

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14
Q

Ester LAs

A

cocaine
procaine
tetracaine
benzocaine

short duration (t1/2 = minutes)
most common LA to cause allergies
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15
Q

Amide LAs

A

lidocaine
ropivacaine
mepivacaine
prilocaine

longer duration (t1/2 = hours) 
P450 metabolism
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16
Q

What fiber characteristics are more easily affected by LAs?

A

small diameter
myelinated (A delta)
firing frequency (use-dependent phenomenon)
fiber position

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17
Q

Bier Block

A

regional anesthesia via injecting LA into the VASCULATURE of an ARM with a TOURNIQUET on for local, fast, procedures

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18
Q

Rank the common LA areas from highest vasculature to lowest vasculature

A

intercostal > caudal > epidural > brachial plexus > sciatic nerve

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19
Q

What can be done to prevent (decrease) the likelihood that LAs will enter systemic circulation and reach the heart?

A

Co-administer Epi to activate alpha 1 receptors –constriction and thus decrease LA absorption and increase LA half life

lipid emulsions act as sponges

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20
Q

What happens if there is a low systemic absorption of LAs?

A

disruption of sensory perception

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21
Q

What happens if there is a high systemic absorption of LAs?

A

Brain - anxiety, confusion, tremors, convulsions (d/t blocking GABAa receptors, reducing the inhibition –tx: diazepam)

CV - depressed contractility, bradycardia, vasodilation, hypotension (except cocaine! –the opposite effect)

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22
Q

What happens if you inject LA directly into the bloodstream?

A

temporary blindness, aphasia, hemiparesis, convulsions, respiratory depression, coma, cardiac arrest

lipid emulsions –act as sponges

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23
Q

What is the MOA of epi and its use in LA administration?

A

activates alpha 1 adrenergic receptors on smooth muscle to case vasoconstriction and thus decrease systemic absorption of LA

vasoconstriction can potentially cause tissue necrosis

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24
Q

What is the MOA of Clonidine and what’s it’s clinical use?

A

alpha 2 agonist –activates alpha 2 on C and A delta fibers to block neurotransmitter release

used in adjunct with other LA

epidural and spinal administration

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25
Q

What other drug has similar effects to clonidine but different MOA?

A

Morphine works similarly on C fibers but instead of alpha 2 receptors it activates mu opioid receptors

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26
Q

What are the ways to treat peptic acid disease?

A

Reduce gastric acid secretion
Neutralize gastric acid
Enhance mucosal defenses
Eradicate H. pylori

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27
Q

How do H2 receptor antagonists work?

A

block H2 on parietal cells and thus decrease gastric acid secretion

28
Q

Cimetidine

A

first H2 antagonist

global CYP inhibitor

29
Q

Famotidine

A

H2 antagonist

less CYP drug-drug interactions compared to cimetidine (almost no drug-drug interactions)

30
Q

MOA of PPIs

A

IRREVERSIBLE inhibition of parietal cell proton pump leading to prolonged inhibition of gastric acid secretion

only works in parietal cells of cells actively producing gastric acid (not all are working at all times)

31
Q

PPI ADME

A

short half life
BUT since it is irreversible
if you take 1 dose it should work for 2-3 days

can cross the placenta

32
Q

What are possible side effects of PPIs?

A

decrease absorption of B12
possible increase risk of bone fx
cross placenta

33
Q

Omeprazole

A

PPI

34
Q

What is the first choice for Zollinger-Ellison Syndrome?

A

PPIs

35
Q

How do antacids work?

A

they are weak bases that are poorly absorbed so they stay in the GI lumen longer and thus directly neutralize stomach acid

36
Q

Why do we often give two antacids together?

A

Mg(OH)2 alone = diarrhea

Al(OH)3 = constipation

37
Q

What is the MOA for mucosal protective agents?

A

Taken before a meal to form past-like gel at low pH that adheres to positively charged proteins of epithelial cells as well as ulcer craters

38
Q

What is the problem with Sucralfate?

A

Mucosal protective agent

forms a paste that can absorb other drugs so wait 2hrs before admin

39
Q

Bismuth subsalicylate

A

mucosal protective agent

warn pts that they might have blacken stool and tongue because of the medal (bismuth)

40
Q

Misoprostol

A

PG analog

Mucosal protective agent

41
Q

Ondansetron

A

selective 5-HT3 receptor antagonist (anti-emetic)

42
Q

Metoclopramide

A

anti-emetic

centrally acting dopamine receptor antagonists

43
Q

What is the BBW for Metoclopramide?

A

long term use can result in irreversible muscle spasms (dyskinesia)

44
Q

What does fiber do?

A

improves bulk and consistency of feces

45
Q

Lubiprostone

A

approved for tx of IBS and idiopathic constipation

46
Q

What is the MOA for lubiprostate?

A

ClC2 Cl channel activator: increases intestinal fluid secretion
results in increased number of bowel movements

47
Q

Linaclotide

A

approved for treatment of IBS and idiopathic chronic constipation

48
Q

What is the MOA for linaclotide?

A

activation of the cystic fibrosis transmembrane conductance regulator (CFTR) – increases intestinal fluid secretion –increased number of bowel movements

49
Q

How does linaclotide differ from lubiprostone?

A

Linaclotide activates CFTR

lubiprostone activates ClC2 CL channels

50
Q

Mg(OH)2

A

saline laxative

when combined with Al(OH)3 it is an antacid

51
Q

What is the risk of saline laxatives?

A

caution with pts with renal insufficiency –risk of hypermagnesemia

this is the highest class of laxatives –watery evacuation

52
Q

Loperamide

A

antidiarrheal agent

this is an opioid

53
Q

What is the MOA of antidiarrheal agents?

A

slows intestinal transit due to stimulation of mu opioid receptors in intestinal smooth muscle

54
Q

Alosetron

A

restricted use drug for IBD with diarrhea

FDA approved for WOMEN only

55
Q

What is the serious possible side effect for alosetron?

A

ischemic colitis which has been fatal

56
Q

What is the first line treatment for ulcerative colitis?

A

Sulfasalazine

SE: up to 40% of pts cannot tolerate

57
Q

What is responsible for eliminating ethanol?

A

Alcohol dehydrogenase (ADH) found in liver and gut when blood ethanol is <0.1%

58
Q

Microsomal Ethanol Oxidizing System

A

breaks down ethanol when blood levels are >0.1%

59
Q

What is disulfiram?

A

a drug that directly inhibits ALDH (aldehyde dehydrogenase) directly

60
Q

Sxs of acetaminophen poisoning

A

N/V flu like sxs in first 24 hours
next 24 hours the pt starts to feel better
elevation of liver enzymes after latent period (>48 hours)
can progress to liver failure

61
Q

1% BAC

A

blood alcohol concentration units

1% = 1g/100mL

62
Q

What is the volume of distribution for EtOH in males and females?

A
  1. 7 L/Kg in males

0. 6 L/kg in females

63
Q

How long does it take ADH to metabolize a single drink?

A

1.5 to 2 hours

64
Q

What is Ethanol’s MOA in the CNS?

A

increases GABAs affinity to its receptor
inhibits NMDA activation via glutamate

increase endogenous opioids

65
Q

What are the two types of tolerance for EtOH?

A

metabolic tolerance –induction of MEOS enzymes

Pharm 2 (6 decks)

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