Extra Qs

Question 1

What receptor type mediates the sympathetic system (ligand gated, nuclear, G protein or enzyme)

Answer 1

G protein

Question 2

What might anticholinergic poisoning result in

Answer 2

confusion, tachycardia, dry skin, pupil dilation

Question 3

What are the main inhaled and IV general anaesthetics

Answer 3

• IV: propofol, etomidate, thiopental, ketamine

- Inhaled: nitrous oxide, halothane, enflurane, isoflurane

Question 4

What do local, and general anaesthetics act on

Answer 4

Local = voltage gated Na channels 
General = ligand gated ion channel (GABA, glycine, NMDA etc.)

Question 5

volume of distribution is 300l. Fraction unbound in plasma is 0.06. What is the plasma concentration when 30mg of drug is given.

Answer 5

-Ignore the plasma bond value
-Vd = dose/ plasma conc
= 30/300
= 0.1

Question 6

Which antagonists or agonists are needed to treat inflammation for the substances: glucocorticoids, H1, COX

Answer 6

• 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

Question 7

What does hypokalaemia mean and symptoms

Answer 7

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.

Question 8

In patients with tremors and palpitations rather than anxiety what 2 drug classes should be used

Answer 8

• beta adrenoreceptor antagonists (eg. propanolol)
• 5HT agonist (eg. buspirone) - target inhibitory serotonin transporters so inhibits release

(-Benzodiazepines are anxiolytics )

Question 9

Interaction between BDZ and alcohol

Answer 9

Alcohol is a CNS depressant so causes severe sedative effects with BDZ

Question 10

Are short or long lasting BDZ better for old patients and why

Answer 10

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.

Question 11

What type of receptor is a nicotinic acetylcholine receptor

Answer 11

Ligand gated ion channel

Question 12

Which carrier proteins use ATP to transport drugs against a concentration gradient

Answer 12

p glycoproteins

Multidrug resistance protein 2

Question 13

Name drugs that can be hydrolysed in the plasma, and in the liver

Answer 13

• eryhthorcytes - aspirin

- Butrylcholinesterase can hydrolyse enzymes in the plasma

Question 14

what are the opioid neutrotransmitters

Answer 14

enkephalins, endorphins, dynorphins

Question 15

what are the monoamine neurotransmitters. What drugs target each of them

Answer 15

• 5HT - anxiolytics and antidepressants
• DA - antipsychotics
• NA - anxiolytics, antidepressants, many adrenoreceptors antagonists and agonists

Question 16

What are the catecholamine hormones. Where are they made

Answer 16

DA, adrenaline, norepinephrine

-adrenal gland

Question 17

What drugs are used for anxiolytics

Answer 17

• Benzodiazepines: bind to GABA, hyperpolarisation
• B1 & 2 adrenoreceptor antagonists: inhibit somatic and autonomic responses
• 5HT agonists: tagets inhibitory auto receptor

Question 18

why benzodiazepines tend to have longer lasting effects in older people

Answer 18

-rate of oxidation (phase 1 metabolism) in older people is reduced so less metabolism. Longer half life

Question 19

Why is duration of local aneasthetics limited. In what way can it be prolonged. How can onset of drug be accelerated.

Answer 19

• 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)

Question 20

Which adrenoreceptors and choline receptors regulate salivary flow

Answer 20

• Muscarinic (M3) = increases flow

- A1, B1, B2 = decreases flow

Question 21

which adrenoreceptors and choline receptors are G protein coupled and which are ligand gated

Answer 21

• G protein = muscarinic ACh, adrenoreceptors

- Ligand = nicotinic ACh (muscle and neuronal type)

Question 22

decline of a drug to what level in the body is likely to have no pharmacological effect

Answer 22

Generally a decline to 6.25% will be far below therapeutic threshold. For this reason a drug is said to have no pharmacological effect

Question 23

Which 4 key measures are used to establish if the adverse reaction is linked to the prescribed drug

Answer 23

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

Question 24

risk factors for oral candida

Answer 24

-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.

Question 25

what is a secondary adverse reaction

Answer 25

Indirect causation, secondary to the drug,
e.g. opportunistic infection due to glucocorticoid
therapy lowering immune function of the patient.

Question 26

Why does warfarin take between 1-2 days to achieve its clinical effects

Answer 26

• Existing clotting factors need to be degraded and removed from the body before anticoagulation effects of Warfarin are seen.
• highly bound to plasma proteins