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STEP > General Principles > Flashcards

General Principles Flashcards

1
Q

Which is a Type A drug reaction?

A

Predictable reaction

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2
Q

What is a predictable drug reaction?

A
  • Type A drug reaction

- It is due to known pharmacologic properties of the drug

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3
Q

Give two examples of a predictable drug reaction

A
  • Gastritis associated with NSAIDs

- Nephrotoxicity due to aminoglycosides

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4
Q

What is an exaggerated sensitivity reaction reaction?

A
  • Type B drug reaction

- Predictable reaction occurs at lower than expected exposure

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5
Q

Give an example of an exaggerated sensitivity drug reaction?

A
  • Tinnitus after a single aspirin dose
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6
Q

What is an idiosyncratic drug reaction?

A
  • Type B drug reaction

- Unpredictable reaction in certain patients

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7
Q

Give an example of an idiosyncratic drug reaction

A
  • Nonimmune hemolytic anemia with primaquine in G6PD
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8
Q

What is an immunologic drug reaction and give examples of each type?

A
  • Unpredictable, specific immunologic reaction
  • Examples
    1. Rapid Urticaria (Type I)
    2. Drug-induced hemolysis (Type II)
    3. Serum sickness (Type III)
    4. Contact dermatitis (Type IV)
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9
Q

What is the endoderm and what does it give rise to?

A 
Innermost layer
Gives rise to:
- Primitive gut
- Mucous membranes
- Glands
- Lung buds
- Urinary tract
- Yolk sac
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10
Q

What is the ectoderm and what does it give rise to?

A 
Outermost layer
Gives rise to:
- Epidermis
- Hair
- Sebaceous glands
- Sweat glands
- Nervous system
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11
Q

What is the mesoderm and what does it give rise to?

A 
The middle layer
Gives rise to:
- Heart
- Vascular system
- Subcutaneous tissue
- Muscles
- Skeleton
- Sex glands
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12
Q

Type 1 Collagen

A
  • Bones, Skin, Tendons (non cartilage)
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13
Q

Type 2 Collagen

A
  • Cartilage and Vitreous Humor
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14
Q

Type 3 Collagen

A
  • Extensible Connective Tissue (Skin, Lungs, Vascular System, Arteries)
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15
Q

Type 4 Collagen

A
  • Basement Membranes
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16
Q

What is the rate limiting enzyme in gluconeogenesis? What is its cofactor? What medication blocks this?

A
  • Pyruvate carboxylase
  • Biotin is the cofactor
  • Metformin inhibits gluconeogensis
17
Q

Polymerase Chain Reaction

A

-Used to amplify small fragments of DNA (genes, exons, noncoding regions) by repeated replication
- Requires the following
1. DNA template that includes the target region to be amplified (Ex. BCRA1 Exon 11)
2. Flanking sequences adjacent to the target region
3. The sequence of the flanking regions must be known in order to make the primers necessary to start PCR
4. Target region does not to be known so long flanking sequences are known
5. Thermostable DNA polymerase is used to replicate DNA template from pool of supplied DNA triphosphates
- Steps are:
1. Denaturing
> By exposing the sample to high temperatures
2. Annealing
>Primers combine with denatured, single stranded flanking ends of the target region when the temperature is lowered
3. Elongation
>DNA polymerase forms new daughter strands in 5’ to 3’ direction, starting from 3’ end of each primer

18
Q

What are the three ways in which down syndrome can be inherited?

A
  1. Meiotic Nondisjunction
    - 95% of cases
    - Extra copy of chromosome 21 present in every cell
    - Increased with maternal age
  2. Unbalanced Robertsonian Translocation
    - 2-3% of cases
    - All or part of additional chromosome 21 is attached to another chromosome (usually 14)
    - Higher risk if unbalanced translocation is present in one parent
  3. Mosaicism
    - 1% of cases
    - Only some cells have an extra copy of chromosome 21
    - No association with maternal nondisjunction
    - Nondisjunction event post fertilization, early in embryonic life
19
Q

Autosomal Dominant Inheritance

A
  • Due to defects in structural genes
  • Persists over many generations
  • Both males and females are affected
  • Pleiotrophic (multiple unrelated effects)
  • Variable (different between individuals)
  • Family history is crucial to diagnosis
  • If one parent heterozygoes, half the children can get disease
20
Q

Autosomal Recessive Inheritance

A
  • Due to enzyme deficiencies
  • Usually seen in only one generation
  • More severe than dominant disorders
  • Patients usually present with disease in childhood
  • Increased risk in consanguineous families
  • If 2 heterozygous parents, 1/4 of children affected (homozygoes), 1/2 will be carriers and 1/4th will be normal
21
Q

X-linked Recessive Inheritance

A
  • Males of Heterozygous mothers have 50% chance of being affected
  • No male to male transmission, because male only passes the Y chromosome to sons
  • It skips generations
  • Can only happen in females if homozygoes, known as Lyonization, depends on the pattern of innactivation of the X chromosome carrying mutant vs normal gene
22
Q

What are the most common X linked recessive disorders?

A

Oblivious Females Will Often Give Her Boys Her X-Linked Disorders

  1. Ornithine transcarbamylase deficiency
  2. Fabrys Disease
  3. Wiskott-Aldrich syndrome
  4. Ocular Albinism
  5. G6PD Deficiency
  6. Hunter Syndrome
  7. Bruton agammaglobulinemia
  8. Hemophilia A and B
  9. Lesch-Nyhan Syndrome
  10. Duchenne and Becker Muscular Dystrophy
23
Q

Competitive Antagonist

A
  • Bind to the exact same receptor binding sites as endogenous or exogenous agonists
  • They prevent agonist binding and activation of the receptor
  • Can be reversible (ionic bond) or irreversible (covalent bond)
  • Reversible competitive antagonists can be overcome by high concentrations of agonist
  • This causes displacement of the antagonist from the receptor by mass action.
  • Shifts curve to the right, decreases potency of the agonist, no change efficacy.
    Ex. Flumazenil (competitive antagonist) + Diazepam (agonist) on GABA receptor.
24
Q

Noncompetitive Antagonists

A
  • Bind to receptors at the site other than the primary agonist binding site
  • Cause conformational (allosteric) change in the receptor protein that modifies the agonist binding site and prevents agonist binding
  • Because they bind to a different site than the agonist, they are able to remain bound to the receptor even when high concentrations of agonist are present
  • This is because the agonist is unable to displace noncompetitive agonists from the receptor
  • Shifts curve down, decreases efficacy
  • Ex. Phenoxybenzamine (noncompetitive antagonist) + Noreepinephrine (agonist) on alpha receptors
25
Q

Partial Agonists (Alone)

A
  • Acts at same site as full agonist
  • But has lower maximal effect, lower efficacy
  • Potency is independant
  • Ex. Morphine (full agonist) vs Buprenorphone (partial agonist) at opiod Mu- receptors
26
Q

What is the most common inherited and second most common congenital cause of intellectual disability?

A

Fragile X Syndrome

27
Q

Fragile X Syndrome

A
  • X linked disorder
  • Loss of function mutation in fragile x mental retardation 1 (FMR1) gene on the long arm of the X chromosome
  • Males who inherit full mutation will manifest features
  • Females with one abnormal chromosome will have milder and variable features
  • Clinical features become most aparent in puberty
  • Long, narrow face, prominent forehead and chin, large testes
  • Hyperlaxity of the joints on the hand
  • Developmental delay (speech and motor) is common in infancy
  • Neuropsychiatric features present in childhood (anxiety, attention deficit-hyperactivity disorder, autism)
28
Q

What is the most common cause of congenital intellectual disability?

A

Downs syndrome

29
Q

Precision Vs Accuracy

A

Precision
- Reliability
- Ability of a test to reproduce identical or similar results with repeated measurements
Accuracy
- Validity
- Ability of a test to measure what its supposed to measure
- Its results should be equivalent to the results of a gold standard test

STEP (28 decks)

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