ILA

Question 1

Describe the structure of an atherosclerotic plaque

Answer 1

• Found at bifurcation points
• Lipid necrotic core
  connective tissue
  smooth muscle
  Fibrous cap

Question 2

Modifiable RF for atheroscleosis

Answer 2

High cholesterol
Smoking
HTN - shearing forces damage endothelium and increase permeability to LDLs
High cholesterol - More LDL deposited = more foam cells
BMI
Diabetes (Type 2)
Sedentary lifestyle

Question 3

Atherosclerosis non modifiable

Answer 3

Family hx -> Genetic component of DM,HTN
Male 
Gender 
Age 
Ethnicity

Question 4

How does smoking increase the risk of atherosclerosis

Answer 4

• free radicals in smoke damage endothelium
• CO and nicotine oxidise LDL
• Makes blood thicker so more easier to clot

Question 5

Secondary prevention for atherosclerosis

Answer 5

Asprin - low dose (75mg)
Anti-HTN medication
Statins - reduce cholesterol levels
DM –> Meteformin

Question 6

Define anaphalaxis

Answer 6

Severe life threatening generalised systemic hypersensitivity reaction

Question 7

Describe beta adrenergic receptor activity of adrenaline

Answer 7

Stimulation of Beta-1 adrenoceptors
+ Ionotropic
+chronotropic

Bronchodilation - Beta-2

Question 8

why might a second dose of adrenaline be required if sx do not respond or get worse

Answer 8

adrenaline has a short half life

Question 9

Tx for anaphalaxis

Answer 9

Remove percipitating cause 
- Lie flat and raise legs 
- 500micrograms of adrenaline (IM)
  if no change repeat 5mins later 
- High flow o2 
  increases alveolar o2 conc to overcome hypoxia due to bronchospasm and interstitial oedema 
-Fluids 
Help restore circulation volume --> Increase SV--> Increase CO
- Chlorphenamine - (Antihistamine)
Blocks histamine-1 receptor 
- Hydrocortisone 

A-O-F-C-H

Question 10

Blood test for anaphalaxis

Answer 10

Blood test - Mast cell tryptase

Question 11

Histamine effects in anaphalaxis

Answer 11

• Vasodilation and increased vascular permeability

- Angio-oedema and erythema to local tissues causing swelling

Question 12

Why during anaphalaxis does a patients have:

• Raises HR
• Low BP
• Slow capillary refill time

Answer 12

Vasodilation increases vascular permeability –> oedema

• less fluid in vessels –> LOW BP
• Heart compensated for low bp by increasing HR

Question 13

Anaphalaxis explain:
Raised resp rate
low o2 saturation
expiratory wheeze

Answer 13

Contraction of resp SM around trachea causes airway restricition

Question 14

Anaphalaxis:
cells involved
Ab
Mediator of blood pressure

Answer 14

Mast cells
IgE
Histamine

Question 15

Immediate treatment for anaphalaxis

Answer 15

ABCDE
Adrenaline
O2

Question 16

Inorder to induce anasthesia quickly what properties hsould a drug have in terms of its protein binding and lipid solubility

Answer 16

LOW protein binding
- Lowers free conc of drug

HIGH lipid solubility
- Readily crosses BBB

Question 17

Name 4 drug targets

Answer 17

Receptors
Ion channels
enzymes
Transporters

Question 18

Define bioavailabilty

Answer 18

The amount of a drug that reaches circulation after first pass metabolism is complete

Question 19

Explain Morphines bioavailability

Answer 19

Oral - 50% bioavailability
IV - 100%

Oral dose of morphine has to be double that of IV

Question 20

What do you do if a patient with renal failure is to be given morphine

Answer 20

- Lowe dose for longer intervals 
Morphine metabolised in to Morphine 6 glucoronide 
More potent 
Morphine is excreted via the kidneys 
Kidney failure --> Not readily excreted

Question 21

Explain the difference in presentation between an arterial thrombus and a venous thrombus

Answer 21

Arterial

• Lack of pulse
• Pale skin
• Coldness to the touch

Venous

• Red
• Hot
• Still have a pulse

Question 22

Virchows triad

Answer 22

Hypercoaguability
Endothelial injury
Blood flow stasis

Question 23

Test for DVT

Answer 23

D-Dimer

• Fibrin degredation products
• Present after DVT/PE
• Positive does not mean Dx

Question 24

Heparin MOA

Answer 24

UF - Binds to antithrombin increasing its ability to inhibit Thrombin, Factor Xa ans IXa
Monitor and adjust dose with - APTT
Acts on extrinsic pathway

LMWH - Enoxaparin
Inactivates factor Xa - but not thrombin
Accumulates in renal failure

Question 25

Warfarin MOA

Answer 25

Antagonist of Vitamin K

• Prevents synthesis of active factors: 10/9/7/2
• Acts on Intrisic pathway

Question 26

DVT complications (S+S)

Answer 26

Sx -
Breathlessness
Pleuritic chest pain
DVT S+S

Signs -
Tachycardia
Tachynopea
Pleural rub