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FirstAID > Micro and Neuro part 2 > Flashcards

Micro and Neuro part 2 Flashcards

1
Q

Inhaled anesthetic that may cause nephrotoxicity?

A

–>Methoxyflurane

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2
Q

inhaled anesthetic that may cause seizures?

A

Enflurane

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3
Q

Most common drug used for anesthesia during endoscopy?

A

Midazolam (benzo, given by IV)

–>may cause amnesia; so, in case pt wakes up during procedure, won’t remember!

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4
Q

Which opiates may be used for general anesthesia?

A

–>Morphine and Fentanyl

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5
Q

Ketamines: (Arylcyclohexylamines)

A
  • ->PCP analogs; can be used for anesthesia
  • blocks NMDA (glutamate) receptors
  • can cause bad dreams and hallucinations; generally only given to pre-pubertal kids
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6
Q

Drug used for rapid anesthesia induction and short procedures (drug that killed Michael Jackson)?

A
  • ->Propofol
  • aka “milk of anesthesia”, b/c high TG-content, so looks milky
  • Potentiates GABA
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7
Q

2 classes of local anesthetic drugs:

-Mechanism of local anesthetics?

A
  • ->Block Na+ channels
  • Esters: procain, cocaine, tetracaine
  • Amides: lidocaine, mepivacaine, bupivacaine
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8
Q

Why are local anesthetics sometimes given with epinephrine?

A

b/c epinephrine = vasoconstrictor –> will make sure drug stays local, doesn’t flow elsewhere!

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9
Q

In local anesthesia: which type of fibers get nerve blockade the fastest/first? Small vs Large, Myelinated vs Unmyelinated fibers:

A
  • Small fibers > Large fibers
  • Myelinated > Non-myelinated fibers

***Size matters more - So:

Small Myelinated > Small Unmyelinated > Large Myelinated > Large Unmyelinated

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10
Q

In local anesthesia, which senses are lost first/fastest?

A

Pain (lost first) > Temp > Touch > Pressure (lost last)

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11
Q

Dantrolene:

  • mechansim?
  • uses?
A

–>blocks Ca release from sarcoplasmic reticulum of skeletal muscle

  • uses:
  • Malignant hyperthermia (a rare side effect of inhaled anesthetics and Succinylcholine, a NM-blocking drug)
  • Neuroleptic Malignant Syndrome (side effect of antipsychotic drugs)
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12
Q

Succinylcholine:

  • class of drug?
  • uses?
  • mechanism?
  • onset time and how long it lasts?
  • toxicities?
  • antidote?
A
  • Neuromuscular-blocking drug
  • Induces muscle relaxation –> used for muscle paralysis or mechanical ventilation (ie to do a tracheal intubation)

–>it’s a depolarizing neuro-muscular blocking drug; acts on nicotinic receptors to have prolonged depolarization

*Mechanism: 2 phases:
Phase 1 = Depolarizing Phase:
–>may get muscular fasciculations while fibers are getting depolarized
Phase 2 = Desensitizing phase:
–>after enough depolarization of fibers, muscle is no longer responsive to acetylcholine released by motor neurones; At this point, full neuromuscular block has been achieved

*Rapid onset (about 30 seconds); short duration (about 5-10 minutes)

  • Reversal of blockade:
  • Phase 1: cannot be reversed; no antidote (if give anti-cholinesterase drugs, can prolong depolarization!)
  • Phase 2: can be reversed with cholinesterase inhibitors (like Neostigmine, which stimulates release of endogenous ACh)
  • Toxicities:
  • Hyperkalemia
  • Hypercalcemia
  • Malignant hyperthermia (can be treated with Dantrolene)
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13
Q

Depolarizing Neuromuscular-blocking drug?

A

–>Succinylcholine

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14
Q

Nondepolarizing Neuromuscular-blocking drugs:

  • ->common suffix?
  • ->uses?
  • ->mechanism?
  • ->reversal of blockade?
A

*all end in “-curarine, -crurium, -curonium”
(Tubocurarine, Atracurium, Mivacurium, Pancuronium, Vecuronium, Rocuronium) –> think CURRY!

  • Uses: muscle relaxation–> muscle paralysis during surgery, mechanical ventilation (intubations)
  • Mechanism: Competitively compete with ACh receptors (so, block ACh at NMJ)
  • Reversal of blockade: Cholinesterase inhibitors (increase amount of ACh in junction to overcome competitive inhibition)–> ie Neostigmine, Endrophonium, or others.
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15
Q

Bromocriptine

  • use?
  • mechanism?
A

Dopamine-agonist (agonist for dopamine receptors)

–>used to treat Parkinson’s

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16
Q

Pramipexole

  • use?
  • mechanism?
A

Dopamine agonist; used to treat Parkinson’s

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17
Q

Ropinirole

  • use?
  • mechanism?
A

Dopamine agonist, used to treat Parkinson’s

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18
Q

Amantadine

  • use?
  • mechanism?
A

antiviral drug; can be used in Parkinson’s to increased dopamine release

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19
Q

L-Dopa/Carbidopa: mechanism?

A

Parkinson’s drugs
–>converted to dopamine in CNS (L-Dopa can cross BBB, unlike dopamine; Carbidoma prevents peripheral conversaion of L-dopa to dopamine)

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20
Q

Selegiline:

  • use?
  • mechanism?
A
  • treatment of Parkinson’s
  • mechanism:
  • selective MAO type B inhibitor; prevents dopamine breakdown
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21
Q

Entacapone, Tolcapone:

  • use?
  • mechanism?
A
  • used in treatment of Parkinson’s

- COMT inhibitors–> prevent degradation of L-Dopa, so increase dopamine availability

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22
Q

Benztropine

  • use?
  • mechanism?
A
  • used to treat parkinsons’
  • is an anti-muscarinic (anti-cholinergic) –> helps with the excess ACh in Parkinson’s; improves tremor and rigidity; but not effect on bradykinesia
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23
Q

Dopamine drugs: mnemonic?

A

“BALSA”

  • Bromocriptine (agonizes dopamine receptors)
  • Amantadine (increases dopamine release)
  • L-Dopa (increases dopamine)
  • Selegiline (prevents dopamine breakdown)
  • Antimuscarinics (like Benztropine)
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24
Q

Memantine:

  • uses?
  • mechanism?
A
  • Alzheimer drug

- NMDA (glutamate) receptor antagonist

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25
Q

Donepezil

  • use?
  • mechanism?
A

treatment of Alzheimers

-anti-cholinesterase

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26
Q

Galantamine:

  • use?
  • mechanism?
A
  • Alzheimer’s

- anti-cholinesterase

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27
Q

Rivastigmine:

A
  • ->can be used to treat Alzheimers

- ->anti-cholinesterase

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28
Q

Toxicity of Triptans?

A

–>Vasospasm

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29
Q

Galantamine:

  • use?
  • mechanism?
A
  • Alzheimer’s

- anti-cholinesterase

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30
Q

Rivastigmine:

A
  • ->can be used to treat Alzheimers

- ->anti-cholinesterase

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31
Q

Rivastigmine:

A
  • ->can be used to treat Alzheimers

- ->anti-cholinesterase

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32
Q

Toxicity of Triptans?

A

–>Vasospasm

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33
Q

Toxicity of Triptans?

A

–>Vasospasm

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34
Q

Aminoglycosides: (use mnemonic)

A

“Mean GNATS canNOT kill anaerobes”

  • Gentamicin
  • Neomycin
  • Amikacin
  • Tobramycin
  • Streptomycin
  • Toxicities:
  • Nephrotoxicity (esp when used with cephalosporins)
  • Ototoxicity (esp when used with loop diuretics)
  • Teratogenic

*Require O2 for uptake; so can’t be used to treat anaerobes

–>main clinical use is gram (-) rod infections

*Aminoglycosides are 30S ribosome/protein synthesis inhibitors

35
Q

Neomycin:

A

–>Aminoglycoside; used for bowel surgery

36
Q

Demeclocycline:

A
  • Tetracycline

- ->ADH-blocker; can be used to treat SIADH (acts as a diuretic)

37
Q

Doxycycline:

A
  • ->Tetracycline

- fecally-eliminated, so can be used in pts with renal failure

38
Q

Clinical uses of Tetracyclines:

A

“VACUUM THe BedRoom”

  • Vibrio cholera
  • Acne
  • Chlamydia
  • Ureaplasma Urealyticum
  • Mycoplasma pneumonia
  • Tularemia
  • H. pylori
  • Borrelia burgdorferi
  • Rickettsia
39
Q

Contraindication with tetracyclines?

A

–>Don’t take with milk, antacids, or iron-containing preparations! b/c divalent cations inhibit absorption of tetracyclines in gut

*Also, teratogenic –> don’t take during pregnancy

40
Q

Treatment for atypical pneumonias (chlamydia, legionella, mycoplasma)?

A

–>Macrolides (Erythromycin, Azithromycin, Clarithromycin)

41
Q

Toxicity of Erythromycin?

A

–>prolonged QT interval

42
Q

Toxicity/main cause of noncompliance of Tetracyclines?

A

–> GI discomfort

43
Q

Treatment of meningitis (H. influenza, N. meningitidis, Strep pneumonia)?

A

–>Chloramphenicol

44
Q

Toxicities associated with Chloramphenicol:

A
  • Aplastic anemia

- Gray baby syndrome (in preemies, b/c they lack UDP-glucuronyl transferase, so can’t get rid of bilirubin)

45
Q

Treatment for anaerobic infections (Bacteroides, Clostridium perfringens) in aspiration pneumonia or lung abscesses?

A

–>Clindamycin
(for anaerobic infections above the diaphragm)

***toxicity = pseudomembranous colitis!

(note: use Metronidazole for anaerobic infections below the diaphragm)

46
Q

TMP-SMX

A

cause sequential block of folate synthesis (so, block nucleotide synthesis)

  • Sulfas –> block Dihyropteroate synthase
  • Trimethoprim –> blocks Dihydrofolate reductase (like methotrexate!)

*TMP = “Treats Marrow Poorly” –> side effects of Trimethorpim: megaloblastic anemia, leukopenia, granulocytopenia

47
Q

Fluoroquinolones mechanism:

A

–> inhibit DNA gyrase = Topoisomerase II

48
Q

One case in which use fluoroquinolones in kids?

A

–>CF

49
Q

Metronidazole mechanism:

A
  • -> Damages DNA

- forms free radical toxic metabolites in the bacterial cell that damage DNA

50
Q

Metronidazole uses:

A

“GET GAP”

  • Giardia
  • Entamoeba
  • Trichomonas
  • Gardnerella
  • Anaerobes (Bacteroides, C. diff)
  • H. Pylori (used with bismuth and amoxicillin (or tetracycline) for “triple therapy” against H. pylori)
51
Q

Side effects of Metronidazole?

A
  • -> Disulfiram-like rxn with alcohol (also get a disulfirum rxn when take cephalosporins with alcohol!)
  • metallic taste
52
Q

4 drugs used to treat Myco. TB:

A
  • Rifampin
  • Isoniazid (+ Pyridoxine/B6)
  • Pyrazinamide
  • Ethambutol
53
Q

Dapsone:

A

–> treats Mycobacterium leprae

54
Q

Isoniazid mechanism:

A

Decreases synthesis of Mycolic acids (so, specific to mycobacteria)
–> used as solo prophylaxis against TB (but not used alone in treatment of TB)

55
Q

Isoniazid toxicities:

A
  • drug-induced lupus
  • P-450 inhibitor
  • Hepatotoxicity
  • Neurotoxicity

***Give Pyrodixine (Vitamin B6) with Isoniazid to prevent neurotoxicity and lupus side effects…

56
Q

Rifampin mechanism:

A

–> Blocks mRNA synthesis by inhibiting DNA-dependent RNA polymerase (RNA-Polymerase inhibitor)

***Used to treat M Tb (RIPE) and for meningococcal prophylaxis (ciprofloxacin is also used for prophylaxis…)

57
Q

Rifampin side effects:

A
  • ->Orange body fluids! (not toxic, just happens)

- ->P-450 inducer

58
Q

Pyrazinamide:

  • use?
  • mechanism?
A
  • ->Treatment for M Tb (RIPE)
  • ->inhibits mycolic acid production; effective in acidic environemnts –> acidic pH of phagolysosomes: best drug for reaching Tb organisms within macrophages!
59
Q

Ethambutol:

  • use?
  • mechanism?
  • Toxicity?
A
  • ->treats M Tb (RIPE)
  • ->decreases carbohydrate polymerization of mycobacterium (blocks enzyme)

***Toxicity: Red/Green color blindness = Optic neuropathy (Reversible!)

60
Q

Prophylaxis against meningococcal infection?

A
  • -> Ciprofloxacin (1st choice)

- -> Rifampin

61
Q

prophylaxis against gonorrhea?

A

ceftriaxone

62
Q

prophylaxis against syphilis?

A

penicillin G

63
Q

prophylaxis in pts with recurrent UTIs?

A

–>TMP-SMX

64
Q

prophylaxis for pts with endocarditis undergoing dental procedures?

A

Penicillins

65
Q

Prophylaxis for HIV pt with CD4 <200? why?

A
  • -> TMP-SMX

- -> prophylaxisx against PCP

66
Q

Prophylaxis for HIV pt with CD4 < 100? why?

A
  • -> TMP-SMX

- -> prophylaxis against PCP and Toxoplasmosis

67
Q

Prophylaxis for HIV pt with CD4 < 50? why?

A
  • -> Azithromycin

- -> prophylaxis against MAC

68
Q

Amphotericin mechanism?

A
  • -> Disrupts membrane function

- Binds ergosterol; forms pores in membrane allowing leakage of elecrolytes

69
Q

Nystatin: mechanism? use?

A

–> like Amphotericin; binds ergosterol, forms membrane pores and causes leakage of electrolytes

  • Very toxic, so only used topically
  • Uses: Candidiasis
  • swish-and-swallow for oral thrush
  • topical for diaper rash or vaginal candidiasis
70
Q
  • azoles (Fluconazole, Ketoconazole, etc):

- ->Mechansim?

A

Inhibits egrosterol synthesis (by binding P-450 enzyme that converts lanosterol –> ergosterol)

71
Q

Caspofungin:

  • mechanism?
  • use?
A

–>inhibits fungal cell wall synthesis by inhibiting synthesis of Beta-glucan

*Used to treat Invasive Aspergillosis

72
Q

Terbinafine:

  • mechanism?
  • uses?
A

Inhibits fungal enzyme Squalene Epoxidase
–>indirectly blocking ergosterol synthesis

  • Uses:
  • toe nail fungus; other skin fungal infections
73
Q

Griseofulvin:

  • mecanism
  • uses
A
  • -> Interferes with fungal microtubule function; disrupts metosis; deposits in keratin-containing tissues (like nails)
  • ->Treatment of Dermatophytes (like tinea, ringworm; also can be used for toe nail fungal infections)
74
Q

Amantadine:

  • mechanism?
  • uses?
A
  • Blocks viral penetration/uncoating (M2 protein)
  • Causes release of dopamine from intact nerve terminals
  • Uses:
  • Influenza A (though most strains are resistant)
  • Parkinson’s
75
Q

Oseltamivir:

  • mechanism?
  • use?
A
  • Inhibits influenza NA (Neuraminidase), decreasing release of progeny virus
  • Treats influenza A and B
76
Q

Zanamivir

A
  • Inhibits influenza NA (Neuraminidase), decreasing release of progeny virus
  • Treats influenza A and B

***like oseltamivir

77
Q

Ribavirin:

  • mechanism?
  • uses?
  • toxicities?
A

-Inhibits synthesis of guanine nucleotides by inhibiting IMP dehydrogenase

  • Uses:
  • RSV
  • chronic hepatitis C
  • Toxicity:
  • hemolytic anemia
  • Teratogenic
  • **Only use in adults; except if severe case of RSV, can give to kids/infants… but, normally contraindicated
78
Q

Acyclovir:

  • mechanism?
  • main uses?
A

Guanosine analog, so incorporates into newly replicated viral DNA, and inhibits viral DNA polymerase by chain termination
–> it’s monophosphorylated by HSV/VZV thymidine kinase

  • Uses:
  • HSV, VZV, EBV
79
Q

Valacylcovir:

A

similar to Acyclovir, but better oral availability

80
Q

Famciclovir:

A

similar to Acyclovir; but, drug of choice for herpes zoster (shingles)

81
Q

Gangciclovir:

  • mechanism?
  • uses?
A

Guanosine analog; inhibits viral DNA polymerase

  • Uses:
  • CMV, especially in imm-compromised pts
  • **#1 choice for CMV retinitis (if fails, then use foscarnet)
82
Q

Foscarnet:

  • mechanism?
  • use?
A

Viral DNA polymerase inhibitor (does not require activation by a viral kinase, unlike acyclovir and gangciclovir)

  • Use:
  • CMV retinitis in immunocompromised pts when Gangciclovir fails
83
Q

Cidofovir:

A

Inhibits viral DNA polymerase
–>treats CMV retinitis in imm-compromised pts

***does not require phosphorylation by viral kinase (like foscarnet; unlike acyclovir and ganciclovir)

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