Extra Qs Flashcards
What receptor type mediates the sympathetic system (ligand gated, nuclear, G protein or enzyme)
G protein
What might anticholinergic poisoning result in
confusion, tachycardia, dry skin, pupil dilation
What are the main inhaled and IV general anaesthetics
- IV: propofol, etomidate, thiopental, ketamine
- Inhaled: nitrous oxide, halothane, enflurane, isoflurane
What do local, and general anaesthetics act on
Local = voltage gated Na channels General = ligand gated ion channel (GABA, glycine, NMDA etc.)
volume of distribution is 300l. Fraction unbound in plasma is 0.06. What is the plasma concentration when 30mg of drug is given.
-Ignore the plasma bond value
-Vd = dose/ plasma conc
= 30/300
= 0.1
Which antagonists or agonists are needed to treat inflammation for the substances: glucocorticoids, H1, COX
- Glucocorticoid agonists: they increase cortisol which supress immune system
- H1 antagonists: reduce inflammation for allergies
- Cyclooxygenase inhibitors: inhibit prostaglandin production which are produced in inflamed cells
What does hypokalaemia mean and symptoms
Low potassium levels in blood. It is key for functioning muscle and neuronal cells.
- Cause weak muscles, cramping, paralysis, abnormal heart rhythms, bradycardia.
- Causes low renal function where urination decreases.
In patients with tremors and palpitations rather than anxiety what 2 drug classes should be used
- beta adrenoreceptor antagonists (eg. propanolol)
- 5HT agonist (eg. buspirone) - target inhibitory serotonin transporters so inhibits release
(-Benzodiazepines are anxiolytics )
Interaction between BDZ and alcohol
Alcohol is a CNS depressant so causes severe sedative effects with BDZ
Are short or long lasting BDZ better for old patients and why
Short lasting have higher therapeutic advantage because they are metabolised by glucaronidation (phase 2) to inactive forms. It lacks hang over effect as active intermediate is not formed. Older patients have less oxidation so less phase 1 metabolism.
What type of receptor is a nicotinic acetylcholine receptor
Ligand gated ion channel
Which carrier proteins use ATP to transport drugs against a concentration gradient
p glycoproteins
Multidrug resistance protein 2
Name drugs that can be hydrolysed in the plasma, and in the liver
- eryhthorcytes - aspirin
- Butrylcholinesterase can hydrolyse enzymes in the plasma
what are the opioid neutrotransmitters
enkephalins, endorphins, dynorphins
what are the monoamine neurotransmitters. What drugs target each of them
- 5HT - anxiolytics and antidepressants
- DA - antipsychotics
- NA - anxiolytics, antidepressants, many adrenoreceptors antagonists and agonists
What are the catecholamine hormones. Where are they made
DA, adrenaline, norepinephrine
-adrenal gland
What drugs are used for anxiolytics
- Benzodiazepines: bind to GABA, hyperpolarisation
- B1 & 2 adrenoreceptor antagonists: inhibit somatic and autonomic responses
- 5HT agonists: tagets inhibitory auto receptor
why benzodiazepines tend to have longer lasting effects in older people
-rate of oxidation (phase 1 metabolism) in older people is reduced so less metabolism. Longer half life
Why is duration of local aneasthetics limited. In what way can it be prolonged. How can onset of drug be accelerated.
- limited by hydrolysis of the amide bond by esterases
- limited by its lipid solubility
- Prolonged by co-administration of NA which acts on a1 to vasoconstrict vessels
- Accelerated by using a slightly alkaline solution to assist its absorption into nerve tissue (makes it more lipid soluble in the pH 7.4)
Which adrenoreceptors and choline receptors regulate salivary flow
- Muscarinic (M3) = increases flow
- A1, B1, B2 = decreases flow
which adrenoreceptors and choline receptors are G protein coupled and which are ligand gated
- G protein = muscarinic ACh, adrenoreceptors
- Ligand = nicotinic ACh (muscle and neuronal type)
decline of a drug to what level in the body is likely to have no pharmacological effect
Generally a decline to 6.25% will be far below therapeutic threshold. For this reason a drug is said to have no pharmacological effect
Which 4 key measures are used to establish if the adverse reaction is linked to the prescribed drug
Time sequence between taking drug and adverse reaction
The reaction corresponds to the known pharmacology of the drug
The reaction stops on cessation of the drug
The reaction returns on restarting the drug
risk factors for oral candida
-Diabetes, anaemia, immunosuppression, haematological cancers, chemotherapy, radiotherapy, HIV infection,
- avoidable risk factors include poor dental hygiene,
and local trauma, including mucosal irritation. Lifestyle factors, in particular smoking,
-antibiotics and inhaled or oral corticosteroids.
what is a secondary adverse reaction
Indirect causation, secondary to the drug,
e.g. opportunistic infection due to glucocorticoid
therapy lowering immune function of the patient.
Why does warfarin take between 1-2 days to achieve its clinical effects
- Existing clotting factors need to be degraded and removed from the body before anticoagulation effects of Warfarin are seen.
- highly bound to plasma proteins
