FR Review 10 - Spring Block 4 Material Other Than AAs

Question 1

Differentiate osteoblasts from osteoclasts.

Answer 1

Osteoblasts: build bone
Osteoclasts: break down bone

Question 2

List some non-pharmacologic interventions indicated for osteoporosis patients.

Answer 2

Smoke and alcohol cessation, fall prevention, regular weight bearing exercise, adequate intake of calcium and vitamin D

Question 3

Describe the mechanism of action of vitamin D supplementation as it relates to osteoporosis.

Answer 3

Vitamin D is required for the intestinal absorption of calcium

Question 4

What is the mainstay of osteoporosis therapy?

Answer 4

Bisphosphonates

Question 5

Describe the mechanism of action of bisphosphonates.

Answer 5

Incorporated into bone in areas of active bone remodeling. There they decrease activity of osteoclasts allowing osteoblast activity to prevail

Question 6

Describe the 30 minute rule of bisphosphonates and describe how Ibandronate is different.

Answer 6

Patients must take most bisphosphonates 30 minutes before eating and remain standing for 30 minutes after to allow the drug to travel easily down the esophagus and into the stomach –> risk for esophageal ulcers. Ibandronate requires 60 minutes standing.

Question 7

What is the primary AE associated with bisphosphonates?

Answer 7

Long bone pain

Question 8

Describe the mechanism of action of selective estrogen receptor modulators (SERM).

Answer 8

Agonize estrogen receptors on bone but antagonize estrogen receptors on uterine and breast tissue

Question 9

What is the broad-view explanation as to why agonizing estrogen in bone helps osteoporosis?

Answer 9

Estrogen decreases osteoclast activity

Question 10

Describe the mechanism of action of RANK-L inhibitors.

Answer 10

RANK binding to RANK-L receptors activates osteoclasts. Blocking RANK-L decreases bone breakdown.

Question 11

Differentiate skeletal muscle relaxers from neuromuscular blockers.

Answer 11

Direct muscle relaxers: blocks release of Ca within the cell and thus blocking contraction
Indirect muscle relaxers: hyperpolarize neurons that innervate muscle groups to decrease spasm
Neuromuscular blockers: block Ach receptors in skeletal muscle system thereby preventing contraction

Question 12

What acetylcholinesterase inhibitor drugs are used to reverse paralytics and what other disease are they used to treat?

Answer 12

Stigmines - neostigmine, ex –> also used to treat myasthenia gravis

Question 13

What is an alternative to administering gasses for anesthesia?

Answer 13

Total propofol anesthesia usually administered with an opioid –> usually causes less N/V

Question 14

Are anesthetic agents lipophilic or hydrophilic? State why.

Answer 14

Lipophilic –> need to get into the CNS

Question 15

Describe the minimum alveolar concentration (MAC).

Answer 15

Minimum dose of a gas required to make 50% of the population not respond the pain. The lower the MAC, the more potent the drug.

Question 16

What is propofol’s claim to fame?

Answer 16

Rapid on and rapid off

Question 17

What is the major AE of propofol?

Answer 17

Hypotension –> reduces vascular tone by 10-20%

Question 18

Why is propofol colored white and what are three reasons this is clinically significant?

Answer 18

The drug is not lipophilic so it is mixed with a soy-based lipid emulsion
Clinical - has egg so must be cautious in patients with egg allergies
Clinical - strict aseptic technique required because fat makes it more prone to bacteria
Clinical - the fat means it has calories that must be accounted for when calculating a patient’s nutrition administration

Question 19

How can the duration of action of a local anesthetic be prolonged?

Answer 19

Add a vasoconstrictor to the local anesthetic –> epinephrine

Question 20

In what areas of the body should local anesthetics with vasoconstrictors not be used?

Answer 20

Fingers, nose, penis, toes, and ears

Question 21

What is the most preferred local anesthetic?

Answer 21

Lidocaine

Question 22

Name and describe a rare life threatening AE of anesthetic gasses and state how it is treated.

Answer 22

Malignant hyperthermia –> sudden release of intracellular calcium results in muscle contraction, hyperkalemia, and hyperthermia.
Treated with dantrolene, insulin, and D5W –> future anesthesia must exclude gasses

Question 23

What are the ways nicotine replacement can be administered?

Answer 23

Many methods –> gum, patch, nasal spray, inhaler, lozenges

Question 24

How is the nicotine patch dose and how is it used?

Answer 24

21mg, 14mg, or 7mg. Wherever you start (based on how many cigarettes they smoke), have them on it for 3-4 weeks then taper down for 2 weeks at each lower dose.

Question 25

What is the mechanism of action of bupropion?

Answer 25

Dopamine agonist –> it gives the reward so the patient doesn’t need cigarettes for the reward

Question 26

What patients should not be prescribed bupropion?

Answer 26

Seizure patients and eating disorders –> hyponatremia decreases seizure threshold

Question 27

What is the mechanism of action of varenicline?

Answer 27

Antagonist and partial agonist of the nicotine receptor –> relieves withdrawal symptoms but provides little dopamine reward

Question 28

What are the two AEs of varenicline?

Answer 28

Weird dreams and SI

Question 29

What effect will smoking cessation have on a patient’s prescription medication doses?

Answer 29

Cigarette smoke is an inducer of CP 450. When a smoker suddenly stops, any drug that goes through CP 450 will require a lower dose

Question 30

In what type of vitamins do we worry about toxicity?

Answer 30

Fat soluble - A, D, E, K

Question 31

What AE associated with vitamin A supplementation do we need to know?

Answer 31

alopecia

Question 32

List and name the B vitamins discussed in class and describe what they are primarily known for.

Answer 32

B1: Thiamine - deficiency in chronic alcoholics
B3: Niacin - increase HDL
B6: Pyridoxine - supplemented in patients taking isoniazid for TB
B9: Folate - deficiency causes anemia
B12: Cyanocobalamin - deficiency causes pernicious anemia

Question 33

What drug can mask signs and symptoms of B12 deficiency/pernicious anemia?

Answer 33

Folate –> can return CBC values to normal but still result in further neuronal destruction and misdiagnosis. Pernicious anemia requires replacement of B12.

Question 34

Deficiency of what vitamin (other than B9) can ultimately lead to folate deficiency anemia and why?

Answer 34

Vitamin C protects stores of tetrahydrofolic acid (active form of folate). Vitamin C deficiency can lead to depletion of active folate and ultimately folate deficiency anemia.