Exam questions Flashcards
What is Splanchnic Blood Flow
blood flow to the abdominal gastrointestinal organs including the stomach, liver, spleen, pancreas, small intestine, and large intestine.
What is a beta lactam drug
creates an enzymatic defense system in the body`
what is an example of a beta lactam drug
penicillins
what is chadsvasc score
most commonly utilized method to predict thromboembolic risk in atrial fibrillation
what does cha2ds2vasc score stand for
Congestive heart failure Hypertension Age>75 (2) Diabetes melitus Stroke/Thromboembolism (2) Vascular disease Age 65-74 Sex C
what does the c of chadsvasc score stand for
congestive heart failure
what does the h of chadsvasc score stand for
hypertension
what does the a2 stand for in chadsvasc
age >75 (counts for 2 points)
what does the d stand for in chadsvasc
diabetes melitus
what does the s2 stand for in chadsvasc
stroke (counts for 2 points)
what does the v stand for in chadsvasc
vascular disease
what the the a stand for in chadsvasc
65 - 74 year old
what does the Sc stand for in chadsvasc
sex catagory i.e. male or female at birth
what does a score of 0 call for in chadsvasc
Nothing
what does a score of 1 call for in chadsvasc
consideration of DOAC
what is a DOAC
‘Direct Oral AntiCoagulant’
what is an example of a direct oral anticoagulanty
apixaban
what does a score of 2 indicate for in chadsvasc
use of direct oral anticoagulant
what type of drug is lasartan
angiotensin II receptor blocker
give another type of angiotensin 2 receptor blocker other than lasartan
volsartan
what type of drug is atropine
anticholnergic
what do anticholinergic drugs do
inhibit the transmission of parasympathetic nerve impulses
reducing spasms of smooth muscle reducing bradycardia
What is fluticasone
steroidal nasal spray
What is bioavailability
the proportion of a drug or other substance which enters the circulation when introduced into the body and so is able to have an active effect.
What is EC50
Half maximal effective concentration
What is Emax
the maximum response achievable
What is Ki
The inhibitor constant, Ki,
is an indication of how potent an inhibitor is
it is the concentration required to produce half maximum inhibition.
What is IC50
indicates how much of a particular inhibitory substance (e.g. drug) is needed to inhibit, in vitro, a given biological process or biological component by 50%
What is LD50
the amount of a material, given all at once, which causes the death of 50%
What is Kd
measure of the affinity of a drug for a receptor. More simply, the strength of the ligand–receptor interaction.
What is Bmax
is the total density (concentration) of receptors in a sample of tissue.
what is pA2
a measure of the potency of an antagonist
what is Citalopram
selective serotonin reuptake inhibitors
what is tamoxifen
antiestrogens
what does tamoxifen target
oestrogen
what is COMT
Catechol-O-methyltransferase
What is adrenaline in reference to COMT
a substrate
what is the key feature of adrenaline for the comparisson to the structure of salbutamol
Catechol ring
why is the catechol ring important in the comparisson between adrenaline and salbutamol
it is important as salbutamol does not have a catechol ring so has a longer duration.
is adrenaline selective
no
is salbutamol selective
yes it is a selective beta 2 agonist that helps to relax bronchial muscle
what other receptors beside b2 receptor does adrenaline target
alpha 2 receptors in the smooth muscle and arteries leading to vasoconstriction
what causes paracetamol poisoining
a build of the toxic metabolite NAPQI
how do you treat paracetamol poisoining
activated charcoal administered within one hour of paracetamol being taken
what is pancuronium
neuromuscular blocker
what is pancuronium used for
to induce skeletal muscle relaxation during anesthesia and to facilitate the management of patients undergoing mechanical ventilation.
what is the key molecular target for pancuronium
nicotinic acetylcholine receptors
what is donepazil
reversible inhibitor of acetylcholinesterase
what is donepazil indicated for
indicated for the treatment of mild to moderate alzeheimers disease
what is alzheimers characterised by
loss in cholinergic activity
How does adrenaline work at the beta 1 receptor
beta 1 adrenergic receptor = gpcr due to g alpha subunit (gas)
it signals g causing adenylyl cyclase to convert atp to camp leading to increased levels of activity at PKA.
leading to an increase in receptor activity
how is the cAMP dependent pathway initiatied for adrenaline working at a beta 1 receptor
it is initiated through adenylyl cyclase
what effect does the initation of the cAMP dependent pathway have on the receptors function
potentiation
what is a pro drug
a drug which is broken down in the body into its active components
what is timolol
beta blocker
what is timolol used for
open angle glaucoma
what is open angle glaucoma
Glaucoma is a common eye condition where the optic nerve, which connects the eye to the brain, becomes damaged.
how does timolol help treat open angle glaucoma
it reduces the intraocular pressure, responsible for causing glaucoma, by reducing the amount of fluid entering the eye.
what type of drug is lasartan
angiotensin II receptor antagonists
what is lasartan mechanism of action
prevents angiotensin 2 binding to at1 receptors
preventing mediated vasoconstriciton and aldosterone secreting effects
what is lasartan useful for
reducing blood pressure
what do you experience a cough in ACE inhibitors
blocks the degradation of bradykinin leading to accumulation in the system
the bradykinin stimulates the vagal afferent nerve fibres in the smooth muscle of the airways
resulting in constriction then a cough
what do both acei and arb mechanism of action have in common
both affect the raas
what are the differences in the acei and arb mechanism of action
acei
blocks conversion ag1 to ag2 leading to vasodilation,
reduced sodium retention and reduced anti diuretic hormone reducing the amount of sodium and water retrieved from the collecting duct.
arb
blocks the Angiotensin II receptor, which results in vasodilation,
reduced sodium retention (Aldosterone secretion reduced)
reduced release of anti diuretic hormone from the pituitary gland which reduces the amount of sodium and water retrieved from the collecting ducts of the kidney
One advantage of sublingual route
drugs administed can bypass first pass metabolism optimising its bioavailability
they have a fast onset of action owing to the fact they are not influenced by tansit through the gi tract
one disadvantage of sublingual route
need to have small molecular weight to be able to cross the epithelium meaning only a small number of drugs can take advantage of the route
What is fast
fast
arm weakness
speach diffuculties
time to call 999
what is fast used for
stroke
what is the assessment criteria used for face and speech
can the person smile, has their mouth or eye dropped
speech is the individual able to speak normally
how does low dose aspirin protect patients from CKD
blocks thromboxane A2 Production
what beta blocker should be used in pregnent people
lebetalol
give 4 examples of lipid lowering agents
simvastatin
ezetimibe
bezafibrate
nictotinic acid/vitamin b3
how does simvastatin reduce lipid
inhibits the synthesis of cholesterol by inhibiting the hmg coA reductase inhbitor
how does ezetimibe lower lipid
blocks the absorption of cholesterol from food and bile
how do fibrates lower lipid
angonist that induce hepatic uptake and oxidation of cholesterol and tryglycerides
how does vitamin b3 lower lipids
inhibits lipolysis in adipocyrtes and thus reduce lipid synthesis in the liver
how does the activation of b1 receptors in the heart increase heart rate
beta 1 adrenergic receptor is a g protein coupled receptor (gas)
signalling Gas ATP -> cAMP via adenylyl cyclase -> increased activity at PKA
where are beta 1 receptor located
heart
if a patient has asthma what drugs can you give for the treatment of coronary events
nitrate
beta blocker or CCB
low dose aspirin
statin
what is spironolactone
potassium sparing thiazide diuretic
how does spironolactone work
cleaves small amounts of sodium from the distal convoluted tubule
leading to a lack of water being reabsorbed increasing the amount of urine passed.
how does atenolol lower cardiac output
reduces heart rate by reducing sympathetic activity
reduces the cardiac force of contraction by reducing sympathetic activity
what is first line management of a patient presenting with stroke <4 hours after the eventq
alteplase is a thrombolytic agent used to rescue the blood supply and reduce the impacts due ischaemia
what are three surgical interventions to help with plaque in carotid artery
bypass
baloon angioplasty
stent
what are two pharmacological interventions which could help reduce the risk of future stroke
anti coagulant
statins
what three major interventions may help rehabilitate from stroke
speach
physi
occupational
what are four non pharmacological interventions which could help reduce the risk of future stroke
moderate exercise
diet
stop smoking
moderate alcohol
what are the similarities between COPD and Asthma
Coughing Shortness of breath Chest tightness exercise intolerance wheezing anxiety with increased heart rate may occur in both diseases
what are the differences between asthma and COPD
asthma is reversible whereas copd is progressive
asthma can occur at any age wheras copd is usually >40
copd produces more mucus and phlegm compared to asthma
chronic cough common in copd
copd often have chronic blueness to fingernail bed and or lips
what does mart stand for
maintenance and reliever therapy
what is maintenance and reliever therapy
2 drugs given together in one inhaler
including a corticosteroid and fast acting or long acting beta 2 agonist
what is an example of a inhaler that has 2 drugs within used for mart therapy
forstair contains beclometasone and or formoterol
why would you use a ICS + LABA in asthama
benefit of using an ics and laba in combination without any increased side effects. Due to their complementary and synergistic effects.
what is chiral switching
chiral switch occurs in the pharmaceutical market when a drug made up of 2 enantiomer forms is replaced with a purified single-enantiomer version
how does salbutamol benefit from chiral switching
salbutamol is a beta 2 adrenergic receptor antagonist causing bronchial dilation
bronchodilator effect delivered by r abuterol which is 60x more potent than the pharmacodynamic effect.
what are the advantages of chiral switching
An improved (less complex, more selective) pharmacodynamic profile
A higher therapeutic index (improved safety margin)
Less complex drug interactions and relationship between plasma concentration and effect
More rational therapeutic drug monitoring
Expose the patient to less body load and thus reduce metabolic/renal/hepatic drug loa
explain the advantages of routine use of salbutamol for the managment of asthma vs adrenaline in relation to chemical structure
Adrenaline is not selective to beta2 receptor
the tertiary butyl (c-ch3-ch3-ch3) of salbutamol makes it selective for beta receptor compared to alpha
that means that adrenaline would lead to side-effects
Furthermore adrenaline has a short half-life
salbutamol has longer half-life because the change from catechol to primary alcohol
means it is no longer substrate for COMT and also increase selectivity for beta2
Salbutamol is available as tablets, however it is commonly used as Metered-Dose Inhaler (MDI). Explain why.
o A Lower dose
o A faster onset of action
o Less side effects
o When compared to administering the same drug orally.
Outline FOUR factors that need to be considered when discussing and deciding on a suitable nicotine replacement therapy (NRT) product
The decision should be patient centric
Considering the patients needs, tolerability and cost
If the patient has early morning cravings for a cigarette
A lozenge could be helpful
If the patient is pregnant
A 24 hour patch may be supportive
If the patient is willing to stop smoking immediately
A quick mist mouth spray may be helpful.
what is a common side effect of salbutamol
can influence the b2 receptors found in skeletal muscle which leads to tremor
what are two common side effect of ICS inhaled treatment (short term)
Oral thrush, if the patient does not wash their mouth out after each inhalation, this can lead to accumulation of the drug in the mouth which can make the patient susceptible to oral thrush.
Hoarse voice
what are 3 longer term side effects of ics inhaled treatment
hypertension
osteoporosis
cushing syndrome
how can we measuere airway inflamation
quantifying the fractional exhaled nitric oxide in the breath
as if there is an increase it may reflect the induction of nitric oxide synthase 2
that is found to be increased in airway epithelial cells of asthmatic patients with the presence of inflammation
how can we test the function of the lungs
peak expiratory flow
explain how we use peak expiratory flow
measure peak flow variability is typical of asthma
why is lumacaftor given to cystic fibrosis patiients
improves symptoms and underlying disease pathology by aiding the conformational stability of F508 delta mutated CFTR proteins
preventing misfolding and resulting in increased processing and trafficking of mature protein to the cell surfarce
If the patient is on ibuprofen and lanzoprazol, what would the recommendation be if he is dx with AKI
• Stop ibuprofen as it is nephrotoxic
Which drugs would you use to manage hyperkalaemia
Insulin
salbutamol
why would we use insulin in the treatment of hyperkalaemia
insulin shifts potassium into cells by stimulating the na+-h+ antiporter on cell membrane
promoting the entry of sodium into cells which leads to activation of the Na+ K+ atapase causing electrogenic influx of potassium
why would we use salbutamol in the treatment of hyperkalaemia
rapidly reduces potassium levels by shifting potassium into smooth skeletal muscle cells
mediated by the beta 2 receptors and require the intervention of cAMP
joined at the cell membrane and the subsequent stimulation of the Na K ATPase
which bring the potassium into the striated muscle cells
what are the four types or kidney stone
calcium oxolate stone
uric acid
cystine
infection stone
what are the 4 non invasive treatment options to deal with a kidney stone
increase fluid intake
alpha adrenergic receptors
penicillamine
extracorporeal shock wave lithotripsy
what is ureteroscope
small viewing telescope inserted into urethra and through the bladder to remove small stones in the lower part of the ureter
what is percutaneous nephrolithotomy
small incision into the back and a probe is inserted through the nephroscope to break the stone into small pieces
