Musculoskeletal Flashcards

Question

Mefenamic acid and meclofenamate

Answer 1

analgesic, treatment of arthritis - not recommended as initial therapy - may antagonize prostaglandin effects Higher than normal toxicity, usually used when someone responds specifically to them. They may also have some prostaglandin receptor antagnosim to them

Answer 2

Studied a lot in pediatric populations, so it is used in pediatric populations It is well-tolerated, and is used sometimes for juvenile arthritis

Answer 3

Similar to acetomenaphen, but without the liver toxicity. Doesn't due anti-inflammatory Used to treat post-op pain as alternative to opiates Can be given IM

Answer 4

very potent COX inhibitor may reduce release and/or uptake of arachidonic acid can be formulated with misoprostol to reduce GI toxicity Misoprostol is a PGE analog, which is thought to be a GI protector. It hasn't worked so well because this causes diarrhea.

Answer 5

Increasing popularity due to less GI side effects Naproxen: more potency, same side effects Ketoprofen: stabilized lysosomal membranes and antagonize bradykinin actions Oxaprozin: long half life Fenoprofen, fluribiprofen: similar to others

Answer 6

in addition to being a COX inhibitor, inhibits neutrophil activation in the presence of PGs may inhibit proteoglycanase and collagenase in cartilage long half-life - - 50 hrs Must be careful with dose, as it is eliminated slowly

Answer 7

A semi-selective COX-2 inhibitor, was replaced by celecoxib. Nambumetone is the same, but is a pro-drug Most COX-2 inhibitors have been pulled from the market. The COX-2 inhibitors lead to big problems

Answer 8

A COX-2 selective inhibitor that has no GI effects It hits the kidney hard and can cause hypertension. The COX-2 inhibitors don't have an anti-platelet effect. This lead to increased MI's, athersclerotic events, et c. Other members of class had more problems than Celecoxib Still a good drug for someone who needs chronic, long term NSAID use but who had GI trouble and who is not at risk for cardio or kidney disease

Answer 9

-Means they are derived from cholesterol and are very lipophyllic. They go through membranes and find cytoplasmic receptors. They effect gene transcription in a positive or negative manner depending on the cell/gene They are also immunosuppressive (NSAIDs aren't). Decrease IL-2,-4,-6, cell adhesion molecules (this can lead to minor increased WBC) They hit two steps of Arachidonic acid pathway, COX-2 and PLA2 Most tissues are responsive to glucocorticoids, meaning their effects are wide-felt

Answer 10

Cortisol has a short duration of action and a small anti-inflammatory effect (sodium retaining) Prednisone has an intermediate duration and 4X the anti-inflammatory effect (sodium retaining) (prednisone requires liver activation) Triamcinolone has an intermediate duration, has 5X the effect, and no sodium retaining potency Betamethasone and Dexamthasone have a long duration, 25X the anti-inflammaroty effect, and no sodium retaining potency Fludrocortisone is 125X more potent for sodium retention, used for patients lacking aldosterone (need sodium retention)

Answer 11

An acute gout drug 1. Binds to tubulin and prevents polymerization into microtubules 2. Interferes with mitotic spindle function 3. Inhibits migration and phagocytic actions of granulocytes 4. Inhibits neutrophil secretion of chemotactic factors common side effects: nausea, vomiting, diarrhea, abdominal pain affects rapidly proliferating epithelial cells in GI tract Used when NSAIDs or glucocorticoids haven't worked

Answer 12

NSAIDs are used for gout. The heavy hitters are used because they won't be used long term Ibuprofen, naproxen, indomethacin, sulindac DON'T USE ASPIRIN

Answer 13

Chronic gout drug parent drug and metabolite alloxanthine inhibit xanthine oxidase, decreases uric acid synthesis drug interaction: inhibits **metabolism** of azathioprine, 6-mercaptopurine (chemotherapeutics, need to back off the dose) Gout often affects patients undergoing chemo for cancer can be used with impaired renal function

Answer 14

Chronic gout drug Nonpurine xanthine oxidase inhibitor Liver function abnormalities, diarrhea, nausea

Answer 15

Chronic gout drug Recombinant urate oxidase Converts uric acid into soluble and inactive metabolite

Answer 16

Chronic gout drug Uricosuric agent: means it blocks reabsorption of uric acid in kidney in tubules Developed in WWII to inhibit secretion of penicillin (still blocks this, leading to increased penicillin doses) Multiple drug interactions by blocking renal secretion of other drugs

Answer 17

Previously, you would start by treating with NSAIDs, which relieve pain but don't modify disease Now, you try and modify the disease

Answer 18

Used to treat rheumatoid arthritis MOA is not extremely well known. Adverse affects: nausea and mucosal ulcers, hepatotoxicity. Can use leucovorin rescue, but lowers effect. Hepatotoxicity is such a prominent side-effect, one needs to check liver biopsy samples every 5 years.

Answer 19

DMARD for RA alkylating agents/cross link DNA toxic effects of bone marrow suppression, infertility, increased risk of infections and neoplasia

Answer 20

Azo linkage of sulfapyridine and 5-aminosalicylic acid Acts by scavenging free radicals and as COX inhibitor and dihydrofolate reductase inhibitor

Answer 21

DMARD for RA inhibits T-cell activation by binding to CD80 and 86 (on APCs) and preventing interaction with CD28 (on T cells) given by IV infusion increased risk of infection especially in combination with anti-TNF agents

Answer 22

DMARD for RA monoclonal antibody that targets CD20 (on B-cells) depletion of B lymphocytes decreases antigen presentation to T lymphocytes given by IV infusion, often combined with methotrexate main use in treatment of rheumatoid arthritis refractory to anti-TNF agents rash in 30% patients with first treatment

Answer 23

IL-6 receptor antagonist Used in RA when it hasn't responded to other drugs

Answer 24

IL-1 receptor antagonist RA drug Used when response is lacking to other DMARD therapies

Answer 25

Anti- TNF-alpha drugs Etanercept: recombinant fusion protein consisting of two soluble TNF receptor regions linked to Fc portion of human IgG Infliximab: chimeric monoclonal antibody with variable murine region linked to constant human region specific against human TNF Adalimumab: Recombinant human anti-TNF monoclonal antibody Golimumab: Recombinant human anti-TNF monoclonal antibody Certolizumab: Fab fragment conjugated to PEG, binds TNF agents must given by injection antibodies develop against these drugs but don’t appear to alter efficacy increase risk of macrophage dependent infections screen for latent or active tuberculosis

Answer 26

DMARD for RA Inhibits inosine monophosphate dehydrogenase Decreases de novo purine biosynthesis T and B cell sensitive due to lack of salvage pathway interferes with leukocyte adhesion by inhibition of E- and P-selectin expression

Answer 27

DMARD for RA converted to 6-mercaptopurine, inhibits de novo purine synthesis primary targets T and B cells toxicity - - any rapidly growing cell population

Answer 28

DMARD of RA Pro-drug that inhibits de novo ribonucleotide synthesis and triggers p53 translocation to nucleus arresting cells in G1 phase Decreases T and B cell proliferation Diarrhea as adverse effect in about 25% patients Some liver toxicity

Answer 29

DMARD of RA Inhibits calineurin phosphatase activity Decreases transcription of cytokines in T-cells (IL-2) Somewhat selective effect on T-cells, knocks out cytokine synthesis that activates T-cells Causes: renal toxicity, does not cause bone marrow supression

Answer 30

DMARD of RA Unclear mechanism of action in arthritis May decrease T-cell response to mitogens Decreases leukocyte chemotaxis Stabilizes lysosomal membranes, traps free radicals generally decreases DNA and RNA synthesis Fairly well tolerated

Answer 31

Ergocalciferol- Vitamin D₂-plant form that is cheap and works in humans Cholecalciferol- Vitamin D₃- the type made from cholesterol in mammals. The "-ols" have one hydroxyl group. The next one is put on in the liver Calcifediol- already hydroxylated, so it doesn't need to be activated by the liver. Calcitriol- fully activated, but normally don't start with this because there is no way to regulate. You would give this to a patient with kidney disease (especially ones that lead to bone trouble)

Answer 32

Salmon and human forms, salmon more potent Direct effect on osteoclast to decrease bone resorption Decreases calcium and phosphate reabsorption in kidney Don't tend to have an allergic response to this

Answer 33

Used to treat osteoporosis Act on osteoblasts to decrease osteoclast recruitment and activation It's used to upregulate osteoprotegerin, which inhibits RANKL Menopause leads to decline in estrogen. Men's androgen levels don't decline until 80's or 90's Estrogen can lead to certain cancers

Answer 34

A.K.A. PTH; Drug stimulates bone deposition Only the active part of the PTH Used intermittantly, chased with a bisphosphonate This is the only pharmacoligcal way we've discovered to help with bone reformation

Answer 35

Antagonize Vitamin D stimulated intestinal calcium absorption Stimulates renal calcium excretion block bone collagen synthesis increase PTH stimulated bone resorption

Answer 36

Can be used in women that have risk of estrogen driven cancers mimics effect of OPG

Answer 37

etidronate, pamidronate, alendronate, risedronate, tiludronate, zoledronate, ibandronate (-onate = bisphosphonate) retard formation and dissolution of hydroxyapatite imbibed by osteoclasts, leads to decreased osteoclast function in structure, close to pyrophosphate metabolized into ATP analog, accumulates in osteoclasts impairs cell function and viability, induces apoptosis (etidronate and tiludronate) ``` inhibition of protein prenylation important for osteoclast function (alendronate and ibandronate) ``` etidronate: side effect of inhibits bone mineralization gastric irritation common with all except etidronate some renal toxicity with zoledronate

Answer 38

calcium supplements: IV-calcium chloride, gluconate, gluceptate oral-calcium carbonate, citrate, lactate thiazide diuretics: reduce renal calcium excretion useful to inhibit renal calcium stone formation fluoride: accumulates in bone and teeth may stabilize hydroxyapatite increases bone volume, may increase osteoblast activity both acute and chronic toxicities limit use No good way to distribute safely

Answer 39

Used after performing surgery and radiation. Primary agent used in treatment of soft tissue and bone sarcomas Inhibits topo II Free radicals, DNA strand breaks Intercalates with DNA Myelosuppression and cardiac toxicity (free radicals), give with iron kelator

Answer 40

Used with doxorubicin to treat osteosarcoma (most common bone sarcoma) Activates when water displaces chloride group crosslinks with DNA and inhibits DNA replication Intrastrand Nephrotoxicity and ototoxicity, nausea and vomiting (worse of any chemo drug)

Answer 41

Alkylating agent Used to treat soft tissue and osteosarcomas Interstrand alkylator

Answer 42

Used to treat soft tissue and osteosarcomas Cleaved into mustard phosphoramide and acrolein (toxic metabolites) Interstrand

Answer 43

Treat soft tissue and bone sarcomas Intercalates with DNA and blocks RNA polymerases Hematopoietic suppression is most serious toxicity

Answer 44

Enhances remission duration, survival, and response rate in treatment of soft tissue sarcomas (used with doxorubicin) Alkylating agent, spontaneous cleavage in target cell yields methyl diazonium ion (active alkylator) Tumor cells that have a lot of demethylators result in resistance Inactivated by liver CYP Moderate myelosuppression

Answer 45

Forms ternary complex with topo II and DNA, blocks DNA replication Cell cycle specific for S or G2 phases Used with ifosfamide to treat osteosarcoma (they have different MOAs and no cross-reactivity) Myelosuppression, nausea, and vomiting

Answer 46

High-dose and leucovorin rescue to treat osteosarcoma Inhibits DHFR --\> indirectly inhibits thymidylate synthase and DNA synthesis Leucovorin is converted to N5, N10-methylene-tetrahydrofolate, replenishes carbon donor pool for methylation of dUMP to from TMP by TS

Answer 47

G-CSF Increases neutrophil count during chemotherapy

Answer 48

intercalates with DNA, reacts with oxygen and iron to from radicals --\> fragmentation of DNA chain Hydrolase inactivates bleomycin, present in many tissues but low in the lung --\> \*pulmonary toxicity Used in combination therapy with dactinomycin and cyclophosphamide Causes little suppression of bone marrow

Answer 49

Binds to tubulin, failure to form spindle and blocks mitosis Causes little suppression of bone marrow function Used in combination with dactinomycin and cyclophosphamide Causes predictable neurotoxicity characterized by numbness of extremities leading to loss of motor function

Answer 50

antimicrobial give before and during surgery use beyond 24hrs bad b/c of inducing resistance cephalosporins or vancomycin are drugs of choice

Answer 51

New infection during chemotheraphy of primary infection Extended use of broad spectrum antibiotics alters natural flora, one species becomes dominant and invades 3rd-generation cephalosporins and tetracyclines cause superinfections Superinfection from giving treatment for too long, developing resistance is from not taking treatment long enough

Answer 52

Debridement and resection of infected bone Fixation with pins Local antimicrobial therapy with antibiotic-impregnated polymethylmethacrylate beads, given bc of compromised blood supply to infected area systemic antimicrobial therapy

Answer 53

Organisms resistant to penicillins and cephalosporins (that are beta-lactamase-resistant) Altered PBPs for methicillin resistance Vancomycin is drug of choice to use against methicillin-resistant staphylococci (MRSA), monitor serum levels b/c of ototoxicity and nephrotoxicity Rifampin used when foreign body (pin, prosthesis) used, induces P450 Resistance caused by vanA gene that modifies cell wall (cannot bind to d-ala-d-ala anymore)

Answer 54

Developed to overcome vancomycin resistance Prevents formation of 70S ribosome complex by binding 23S subunit of 50S ribosome, blocks initiation of protein synthesis in gram (+) Mutation in 2 or more copies of 23S rRNA required to induce resistance Active against variety of resistant organisms Well absorbed, ***_can give orally_***

Answer 55

Used to overcome vancomycin resistance Given with dalfopristin, combination therapy Binds and changes conformation of 50S subunit in gram (+) Good for vancomycin-resistant strains of enterococcus faecium (infections in urinary tract, blood, and soft tissue) Inhibits P450 to slow metabolism of other drugs

Answer 56

Aka Cubicin Cyclic lipopeptide Used for antibiotic resistant gram (+) bacteria Binds to bacterial membranes and causes depolarization of membrane potential --\> inhibition of protein, DNA, and RNA synthesis Not well tolerated, hard to get correct dosing Can cause severe peripheral neuropathy, directly damages nervous system Used as last resort, resistance to all other drugs

Answer 57

First choice: Oral- \*doxycycline or amoxicillin for kids IV- ceftriaxone for late phase

Answer 58

IV Treat C. tetani Given 7-10 days to eradicate from wound Chemically activated to form hydroxylamine which degrades DNA in anaerobic organisms Some GI distress Cannot take with alcohol

Answer 59

Metronidazole and Penicillin G to eliminate C. botulinum from GI tract

Answer 60

Most effective against microfilarial forms of filarial species Treat W. bancrofti, B. malayi, and L. loa Direct effect on W. bancrofti, causes organelle damage and apoptosis Toxicity rare, can cause anorexia, nausea, headache, and vomiting at high doses Most adverse effects result from destruction of parasites

Answer 61

benzimidazole, albendazole, in combination with ivermectin Benzimidazole and albendazole inhibit microtubule polymerization by binding to parasite beta-tubulin

Answer 62

Ivermectin, causes tonic paralysis of musculuture by activation glutamate Cl channels, well tolerated

Answer 63

Mebendazole or albendazole Both inhibit microtubue polymerization by binding parasite beta-tubulin

Answer 64

S. aureus Give penicillin G Nafcillin, oxacillin, dicloxacillin to penicillin-resistant Vancomycin to methicillin-resistant

Answer 65

Synthetic penicillin, resistant to beta-lactamase Used for osteomyelitis (IM or IV)

Answer 66

Synthetic penicillin, resistant to beta-lactamase Used for osteomyelitis (IM or IV)

Answer 67

Synthetic penicillin, resistant to beta-lactamase ## Footnote Used for osteomyelitis (IM or IV)

Answer 68

Piperacillin is very broad spectrum Not beta-lactamase resistant so must be given with tazobactam which is beta-lactamase inhibitor

Answer 69

Very resistant to beta-lactamase Has additional toxicities that other beta-lactams do not have (nausea, vomiting, possible seizures) Used as last resort because of toxicities

Answer 70

Cephalosporin Cephalosporins used to treat infections of bones and joints, usually look to beta-lactamase resistant penicillins before cephalosporins Others include cephalothin, cefuroxime, ceftriaxone

Answer 71

Caused by hematogenous spread Usually caused by S. aureus and N. gonorrhoeae Treat by joint drainage and system antibiotics for 3-4 weeks (nafcillin or oxacillin for S. aureus, vancomycin for MRSA)

Answer 72

Gonococcal urethritis (N. gonorrhoeae) Ceftriaxone, ciprofloxacin, ofloxacin, cefixime

Answer 73

Muscarinic Cholinergic Antagonist Tx: Antidote for organophosphate poisoning MOA: competitive (reversible) antagonist at _all_ M receptors, thereby prevents release of IP3 & adenylyl cyclase Eye: dilation (mydriasis), cycloplegia (paralysis of ciliary muscle = loss of accommodation), reduced lacrimation, tachycardia (M2 receptors), bronchodilation Adv: Blind as a bat, mad as a hatter, red as a beet, hot as a hare, dry as a bone, the bowel and bladder lose their tone, and the heart runs alone --\> Total PNS block. Relatively safe for adults Rapidly cleared in urine \*be careful of closed angle glaucoma

Answer 74

Tertiary amine alkaloid (like atropine) Muscarinic Cholinergic Antagonist (can also block H1 receptor and cause sedation) Tx: Reduces vertigo, post-operative nausea, prevention of motion sickness (Transdermal patch) MOA: _M1 receptor_ rapid onset and primarily CNS effects Adv: Same effects as atropine + CNS: delirium , drowsiness, amnesia, excitement, hallucinations, coma

Answer 75

Choline Esters (charged; no CNS entry) Muscarinic and Nicotinic receptor agonist IV fusions of min. effective dose = vasodilation, ↓BP, reflex increase in HR Larger doses produce bradycardia and ↓atrioventricular node conduction velocity in addition to hypotension Active for 5-30secs (AChE hydrolyzed) and not well absorbed

Answer 76

partial muscarinic receptor agonist [M2 (cardiac) and M3 (smooth muscle/ glands)] used for postoperative and neurogenic ileus (atony or paralysis of the stomach or bowel following surgical manipulation) and urinary retention Longer duration of action than ACh (Active for 30 min to 2 hours) Adv: Rule out GI and urinary obstruction before use (due to possible exacerbation of problem and may cause perforation as result of increased pressure). Excessive parasympathomimetic effects, esp. bronchospasm in asthmatics. Additive with other parasympathomimetics

Answer 77

Nonselective muscarinic (all M receptors) and nicotinic agonist Tx: Glaucoma and the induction of miosis during surgery (can reverse ocular effects of atropine) Bronchospasm in asthmatics good resistance to cholinesterases

Answer 78

Parasympathomimetic alkaloid Muscarinic receptor agonist. Binds irreversibly to AChE Quaternary amine so it does not cross the BBB --\> has more peripheral effects. Tox: ↑ salivation, lacrimation, perspiration, abdominal pain, nausea, blurred vision First source of muscarine: Amanita muscaria (mushroom). Interestingly, effects mimic atropine poisoning more than muscarine excess.

Answer 79

The M2 and M3 subtypes mediate muscarinic responses at peripheral autonomic tissues. M1 and M4 subtypes are more abundant in brain and autonomic ganglia. M1, M3, M5: Gq proteins to stimulate IP3 and DAG- increase Calcium M2 M4: Gi proteins to inhibit adenylyl cyclase, which results in a decrease of intracellular concentration of cyclic adenosine monophosphate (cAMP)

Answer 80

Lipid soluble, so can be absorbed across the skin and crosses the BBB Activates autonomic postganglionic neurons (sympathetic and parasympathetic) and somatic motor because of nicotinic receptors of skeletal muscle at neuromuscular junction _NM_: Skeletal muscle - Na+/K+ depolarizing ion channel _NN:_ Postganglionic cell - Na+/K+ depolarizing ion channel

Answer 81

Tertiary Natural Cholinomimetic Alkaloid Plant derivative similar to nicotine Meth, Cocaine, Smoking cessation aid.

Answer 82

Partial Muscarinic agonist similar to Bethanechol Tx: Glaucoma; dry mouth in Sjogrens syndrome Decreases intraocular pressure by contracting ciliary body to allow outflow of aqueous humor.

Answer 83

MOA: Acetylcholinesterase (AChE) splits ACh into choline and acetate. Half life of ACh is short (fraction of a second) AChE inhibitors cause ACh to accumulate in the vicinity of cholinergic nerve terminals and increase stimulation of cholinergic receptors

Answer 84

structurally related gene to AChE; synthesized in the liver and is primarily found in plasma. MOA: Essentially the same as AChE Under development as an antidote, to scavenge the AChE inhibitor in the plasma before it reaches peripheral and central tissue sites Adv: Inhibited irreversibly by organophosphates

Answer 85

Organophosphate insecticide AChE inhibitor lipophilic (cross BBB) Irreversibly bind to AchE by phosphorylating the active site of AchE.During "aging" the bond between the organophosphate and AchE strengthens. Metabolized to inactive compounds. Safe for mammals and birds but toxic to insects and fish Prodrug - must be converted to the -phosphor-derivative before it will have effects.

Answer 86

Organophosphate insecticide AChE inhibitor Similar MOA as Malathion Adv: Not detoxified effectively in vertebrates; thus, it is considerably more dangerous than malathion to humans and livestock and is not available for general public use in the USA

Answer 87

Organophosphate AChE inhibitor _Chemical warfare agent_ --\> muscarinic excess: miosis, salivation, sweating, bronchial constriction, vomiting, and diarrhea. CNS involvement (cognitive disturbances, convulsions, and coma) follows rapidly + peripheral nicotinic effects, especially depolarizing neuromuscular blockade. Must maintain vital signs (esp. respiration), decontamination, and atropine parenterally in large doses (to control muscarinic excess), pralidoxime and benzodiazepines for seizures.

Answer 88

Organophosphate insecticide Not absorbed well by the skin like Malathion "Aging" will occur with AChE and Echothiophate Long duration of action with time (~100 hours) Adv: Brow ache, uveitis, blurred vision

Answer 89

Short-Acting AChE Inhibitor "Tensilon Test" Test for myasthenia gravis (will have improvement in muscle strength after injection), ileus, arrhythmias (rare) An alcohol (doesn't cross BBB) that electrostatically and by H bonds binds briefly to active site of AChE

Answer 90

Intermediate-Acting AChE Inhibitor Like edrophonium, but longer-acting Tx: Myasthenia gravis; postoperative and neurogenic ileus and urinary retention MOA: Forms covalent bond with AChE, but hydrolyzed and released

Answer 91

Like neostigmine, but natural alkaloid tertiary amine; enters CNS Intermediate-Acting AChE Inhibitor (Carbamate). Well absored and longer lasting (0.5-2 hours). Tx: Myasthenia gravis (MG), acute angle-closure glaucoma (initial therapy with pilocarpine), postoperative and neurogenic ileus and urinary retention. Used to treat the CNS and PNS effects of atropine, scopolamine and other anticholinergic drug overdoses. Adv: More toxic. Reverse effects with atropine. Moderate doses: Modest bradycardia and ↑BP High doses: marked bradycardia and hypotension

Answer 92

Intermediate-Acting AChE Inhibitor (Carbamate) Like neostigmine, but longer-acting (4-6 h) Tx: Myasthenia Gravis

Answer 93

Like neostigmine, but longer-acting (4-6 h). Intermediate-Acting AChE Inhibitor (Carbamate) Tx: Alternative to pyridostigmine for MG.

Answer 94

AChE Inhibitor Carbamate insecticide - very high lipid solubility --\> CNS entry rapid

Answer 95

Acetylcholinesterase Regenerator Tx: Organophosphate intoxication. Often given with atropine and diazepam. Does not cross BBB MOA: Reactivates phosphorylated AcE. Drug has a higher affinity for the phosphorous than AchE because it is a strong nucleophile. Does not work if the enzyme is carbamylated. Must be given prior to "aging." Adv: Flushing, mydriasis, tachycardia, dryness of the mouth and nose if used with too much atropine

Answer 96

Organophosphate AChE Inhibitor found in lubricating oils Neurotoxic: Causes delayed neuropathy associated with demyelination of axons and intermediate syndrome (not related to cholinergic effects)

Answer 97

Pesticide made up of six known insecticidal esters: Absorbed after inhalation or ingestion the major site of toxic action is the CNS; excitation, convulsions, and tetanic paralysis can occur. -Voltage-gated Na, Ca, and Cl channels are considered targets Adv: Highly irritating to the eyes, skin, and respiratory tree --\> irritant asthma and reactive airways dysfunction syndrome (RADS) and even anaphylaxis. Cutaneous paresthesias seen in workers spraying synthetic pyrethroids.

Answer 98

Pesticides derived from natural sources like nicotine and pyrethrum Clinical: The oral ingestion of rotenone produces gastrointestinal irritation. Conjunctivitis, dermatitis, pharyngitis, and rhinitis can also occur

Answer 99

spasmolytic GABA/B agonist induces hyperpolarization by increasing potassium efflux, reducing calcium influx and excitatory NT release in brain & spinal cord less sedative effects than diazepam and causes less reduction in muscle strength than dantrolene Adv: increased seizure activity in epileptic patients, drowsiness but patients develop a tolerance

Answer 100

spasmolytic acts at GABA/A synapses Adv: sedation when given at high enough doses to reduce muscle tone

Answer 101

Diazepam acts at GABA A synapses (causes sedation and reduces muscle spasm of almost any origin). ## Footnote Tx: Sedative, hypnotic (sleep-inducing), anxiolytic (anti-anxiety), anticonvulsant, and muscle relaxant Highly lipid-soluble benzodiazepines rapidly enter the CNS, which accounts for their rapid onset of action, followed by redistribution to inactive tissue sites and subsequent termination of the drug effect. Action can readily be terminated by administration of their selective antagonist, flumazenil.

Answer 102

Produced from Clostridum Botulinum Cosmetic uses for wrinkles injecting overactive muscles with minute quantities of botulinum toxin type-A would result in decreased muscle activity by blocking the release of acetylcholine from the neuron by preventing the vesicle

Answer 103

salicylate NSAID azo link of mesalamine with sulfapyridine Tx: IBS, rheumatoid arthritis

Answer 104

Cyclooxygenase inhibitor GI proglems (Unless COX2 selective)

Answer 105

An antibiotic that can be used to inhibit osteoclast driven bone resorption