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Medicine Phase 2a > Patho, Pharma and Immunology bits > Flashcards

Patho, Pharma and Immunology bits Flashcards

1
Q

Define Pathology

A

The study of cause and effect of disease

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2
Q

What are causes of fluctuating cognitive function?

A

Any brain bleed/abscess or alcohol intoxication

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3
Q

What are 2 types of autopsy

A

Hospital

Medico-Legal

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4
Q

What is a Hospital autopsy for?

A

Required for audits, teaching or research

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5
Q

What is a Medico-Legal autopsy for?

A

Needed to find out cause of death and for forensic autopsies

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6
Q

Which autopsy requires a ‘cause of death’ certificate?

A

Hospital autopsy

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7
Q

When do you refer deaths to a coroner?

give examples

A

Presumed natural with cause of death unknown and have not seen dr in last 14 days
Presumed iatrogenic e.g. abortion, anaesthetic deaths and postoperative deaths
Presumed unnatural e.g. industrial death, suicide, murder

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8
Q

What is meant by iatrogenic illness

A

Illness caused by medical examination

e.g. abortion, anaesthetic deaths, postoperative deaths

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9
Q

What are the 4 main steps of an autopsy?

A

External Examination
Evisceration (Y-shaped incision)
Internal Examination
Reconstruction

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10
Q

Define inflammation

A

Local physiological response to tissue injury. Usually it is not a disease instead a manifestation of a disease.

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11
Q

Name 2 cells that are found in acute inflammation

A

Neutrophils

Endothelial cells

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12
Q

Name 3 cells that are found in chronic inflammation

A

Macrophages
Lymphocytes
Fibroblasts

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13
Q

Give the 4 different appearances of acute inflammation giving the latin translation

A
  1. Rubor (redness) due to dilation of small blood vessels within the damaged area.
  2. Calor (heat) due to increased blood flow resulting in vascular dilation
  3. Tumor (swelling) result of oedema the accumulation of fluid from the extravascular space.
  4. Pain (dolor) due to the stretching and the distortion of tissues.
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14
Q

Give two local effects of inflammation

A

Swelling and the beneficial destruction of invading microbes

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15
Q

Give 4 systemic effects of inflammation

A

Pyrexia
Constitutional symptoms
Weight loss
Haematological changes

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16
Q

Give the definition of chronic inflammation: what makes it different to acute?
Is chronic inflammation always secondary to acute inflammation?

A

Subsequent and often prolonged tissue reactions following an initial response.
Doesn’t have to start with acute inflammation. All the cells normally travel in the body by laminar flow. In inflammation this process changes. LOADS of lymphocytes and macrophages.

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17
Q

Give two examples of chronic inflammation

A

TB

Crohns

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18
Q

What drug class is used to treat inflammation? What does it do?

A

NSAIDS
NSAIDS inhibit Cyclo oxgenase (COX) which produces prostaglandins.
There are two forms of COX. COX 2 is produced in response to an inflammatory response. Whilst Cox 1 is made for basic house keeping throughout the body.

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19
Q

What is the difference between efficacy and affinity?

A

Efficacy: is the Effect! a drug has. High efficacy of a drug means it stimulates a number of responses.
Affinity: how much of the drug is required to produce 50% of the maximum product possible. Can include antagonists as well.

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20
Q

What does potency mean?

A

a measure of drug activity

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21
Q

What are the 4 forms of drug targets?

A

Enzyme
Receptor
Transport protein
Ion channel

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22
Q

Name 4 routes of drug administrations and give an example of a drug for each

A 
Oral (aspirin)
Sublingual (GTN )
Rectal (diazepam)
Subcutaneous (insulin)
IV (anything)
Intramuscular (anti-psychotics)
Inhalation (salbutamol) 
Topically (steriod)
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23
Q

Define drug

A

Any chemical substance that has a biological impact on the body

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24
Q

Define Pharmacology

A

The branch of medicine concerned with the uses, effects and modes of actions of drug

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25
Q

What is PharmacoDYNAMICS

A

how a drug affects the body

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26
Q

What is PharmacoKINETICS

A

What the drug does to the body
or a branch of pharmacology involved with the movement of drugs in the body
This includes absorption, distribution, metabolism and excretion

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27
Q

Define receptor

A

Recognition proteins of endogenous mediators i.e. a cell membrane or cell cytoplasm of a nucleus.

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28
Q

What is draggability?

A

The ability of a protein target to bind to small molecules with high affinity

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29
Q

Whta are Mediators?

A

Intracellular proteins that enhance and activate the functions of other proteins

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30
Q

What are 4 types of receptor?

A

Ligand gated ion channel
G-protein coupled receptors
Kinase linked receptors
Cytosolic/nuclear receptors

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31
Q

Give example of Ligand gated ion channel and example of G protein coupled receptor

A

Ligand gated ion channel - Nicotinic ACh receptor

G protein coupled receptors - Beta-adrenoceptors

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32
Q

How do Ligand Gated Ion Channels work?

A

Ligand binds to receptors on the ion channel, which causes the channel to open

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33
Q

How do G protein Coupled Receptors work?

A

GPCRs interact with G proteins in the plasma membrane. When an external signaling molecule binds to a GPCR, it causes a conformational change in the GPCR. This change then triggers the interaction between the GPCR and a nearby G protein. It is this change that causes there to be activation of the cellular contents caused by the attachment of a ligand to a receptor.

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34
Q

Give example of a ligand

A

Light or energy

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35
Q

Give example of a kinase linked receptor and how it works

A

Activated by growth factors. Signal dimer, bonds to the receptor (tyrosine kinase). This stimulates kinase activity. These are generally needed to modify gene transcription. The tyrosines are then phosphorylated and the intracellular proteins bind to the phospho-tyrosine docking sites.

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36
Q

What type of receptors are cytosolic/nuclear receptors and generally what is there purpose?

A

Steroid receptors

Generally needed to modify gene transcription

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37
Q

What are 4 different parts of pharmacokinetics

A

Absorption (into the blood)
Distribution (into extra or intracellular space)
Metabolism (broken down in Liver and kidney!)
Elimination (i.e. urine, faeces and bile)

38
Q

By what 4 methods can absorption happen? (e.g. GI mucosa)

A

Passive diffusion
Facilitated diffusion
Active transport
Endocytosis

39
Q

What factors can affect absorption rates?

A

pH
Vascularity (e.g. shock reduces SC absorption)
Surface area
Contact time (e.g. with food = slower gastric emptying)

40
Q

Define distribution

A

The ability for a drug to reversibly leave a blood stream and enter the extracellular fluid and tissue

41
Q

What factors affect Distribution?

A

Blood flow (e.g. brain > muscles)
Capillary permeability
Plasma protein binding (e.g. albumin)
Tissue protein binding (e.g. cyclophosphamide accumulating in bladder leading to cystitis)
Lipophilicity (ability to cross cell membranes) i.e. a lot of drugs can’t cross the blood brain barrier

42
Q

Give example of tissue protein binding (factor affecting distribution)

A

Cyclophosphamide accumulating in the bladder leading to cystitis

43
Q

What has a higher blood flow out of brain and muscles?

A

Brain

44
Q

Define metabolism of a drug

A

Breakdown of the drug to allow it to be made into active forms and also excreted through hepatic, renal and biliary routes

45
Q

Metabolism-Pharmacokinetics: What are phase 1 reactions?

A

Involves cytochrome P450 enzymes
Add functional groups i.e. OH
OR Undergo Oxidation or Reduction

46
Q

Metabolism-Pharmacokinetics: What are phase 2 reactions?

A

Conjugation

i.e. add glucuronic acid

47
Q

Give example of a drug and example of a condition that can induce Cytochrome P450 enzyme and what is the effect of this?

A

Rifampicin
St John’s Wort
Induce cytochrome P450 and thus speed up phase 1 reactions (everything sped up as this is rate determining step)

48
Q

What graph can be used to distinguish between first order and zero order kinetics in a drug’s metabolism?

A

Plasma conc (y) against Time/hours (x)

49
Q

Describe line seen on a plasma conc against time (x) graph for the metabolism of drug showing first order kinetics

A

Reverse exponential

looks like reciprocal graph shape in +ve y and +ve x quadrant

50
Q

What does first order kinetics metabolism apply to?

A

Most drugs

Drug is readily metabolised in the liver

51
Q

Describe line seen on a plasma conc against time (x) graph for the metabolism of drug showing first order kinetics

A

Reverse exponential
(looks like reciprocal graph shape in +ve y and +ve x quadrant)
(draw pic)

52
Q

What does first order kinetics metabolism apply to?

A

Most drugs

Drug is readily metabolised in the liver

53
Q

Describe line seen on a plasma conc against time (x) graph for the metabolism of drug showing zero order kinetics

A

Straight line with constant negative gradient

54
Q

What does zero order kinetics metabolism apply to?

A

Where metabolism is saturable
e.g. alcohol
OR in drug excess e.g. aspirin and phenytoin

55
Q

Where can drugs e eliminated from the body?

A 
Urine
Faeces
Bile
Lungs
Breast Milk
56
Q

Define pharmacodynamics

A

The branch of pharmacology concerned with the effects of drugs and the mechanism of their action

57
Q

Simply state the difference between pharmacokinetics and p.dynamics

A

PK - what the body does to the drug

PD - what the drug does to the body

58
Q

What are 2 aspects of pharmacodynamics?

A

Signal transduction - binding of drugs to receptors, which leads to there being an amplified down regulation of signals
Intrinsic effect - Agonist or Antagonist

59
Q

What are 2 agonist and 3 antagonist intrinsic effects?

A

Agonist:
Full (equivalent to endogenous agonist)
Partial

Antagonist:
Competitive (reversibly prevents endogenous agonist binding)
Irreversible (covalent bond)
Allosteric (binds to other site, irreversible)

60
Q

What factors affect a dose response graph?

A

Concentration
Receptor availability

Graph is measured response (y) against Dose (x) on log scale
(affect potency)
generally see sigmoid shape on this curve

61
Q

Describe differences between sympathetic and parasympathetic neurones
Sympathetic = S
Parasympathetic = PS

A

Both preganglionic neurones release Acetylcholine at end of neurone which acts on Nicotinic receptor on post ganglionic neurone.
Postganglionic neurone:
s - releases noradrenaline which acts on adrenergic receptors
ps - releases ACh which acts on muscarinic receptors

62
Q

Where do you find IgA antibodies and what are their function?

A

IgA is found in mucosal areas, such as the gut, respiratory tract and urogenital tract, and prevents colonization by pathogens, it is also found in saliva, tears, and breast milk.

63
Q

Where are IgD antibodies found?

A

IgD is found on B cells that have not been exposed to antigens.

64
Q

What is purpose of IgG?

A

IgG is the most abundant antibody and responsible for the secondary response.

65
Q

What is purpose of IgM?

A

IgM is the most primitive antibody and eliminates pathogens in the early stages of B cell-mediated (humoral) immunity (primary response) before there are sufficient IgG.

66
Q

What is purpose of IgE?

A

IgE is in response to parasites and is responsible for anaphylaxis.

67
Q

Give example of what can be given to reverse an opioid overdose

A

IV naloxone

68
Q

Give example of a drug with a wide and one with a narrow therapeutic index

A

Wide - Simvastatin

Narrow - Warfarin

69
Q

What is function of an Alpha 1 receptor?

A

Vasoconstriction
Increase blood pressure
Increases the closing of the bladder sphincter

70
Q

What are relevant conditions for Alpha 1 receptors and Alpha 2 receptors?

A

A1 - BPH (Benign prostatic hyperplasia), High Blood Pressure

A2 - Glaucoma

71
Q

What are relevant conditions for Beta 1 and Beta 2 receptors?

A

B1 or B2 - Asthma

72
Q

What is function of Alpha 2 receptors?

A

Inhibits adrenaline and Ach release.
Inhibits insulin release.
Causes Vasoconstriction

73
Q

What is function of Beta 1 receptors?

A

+ve chronotropic (increased HR)
+ve inotropic (increased heart contraction)
Promotes renin release

74
Q

Define chronotropic

A

regards Heart Rate

-ve chronotropic means reduction in HR

75
Q

Define inotropic

A

regards Heart Contraction

if something is inotropic or +ve inotropic, it increases heart contraction

76
Q

What is function of Beta 2 receptors?

A

Relaxes smooth muscle and causes bronchodilation. Promotes insulin release.

77
Q

Give example of a Beta 2 receptor drug agonist

A

SABA/LABA
Short or Long acting beta agonist

Promotes relaxation of smooth muscle, causes bronchodilation, promotes insulin release

78
Q

Give example of Alpha 1 antagonist

A

Tamsulosin

Alpha 1 receptor activation causes: Vascoconstriction, Increase blood pressure And increases the closing of the bladder sphincter

Therefore prevents vasoconstriction, decreases blood pressure and decreased closing of bladder spincter

79
Q

Give example of Beta antagonist

A

Beta Blockers e.g. Atenolol

Beta ANTAgonist causes:
Decrease HR and heart contraction and renin release (B1)
Prevents smooth muscle relaxation and bronchodilator and insulin release.

80
Q

What are 2 types of Cholinergic receptors?

A

Nicotinic (both para and sympathetic)

Muscarinic (parasympathetic)

81
Q

What are 3 types of muscarinic receptors and what do they do?

A 
M1= 1 thing (gastric juices)
M2= 2 chambers (heart and decreases heart beat)
M3 = 3 things. Bronchoconstriction, constriction of pupils, increased salivation and sweating.

M1 (found in brain and gastric glands of the stomach). Increases the secretion of gastric juice.
M2 (found in the heart) causes a decreasing nature to the heart beat. Meaning if the heart is going too slow we would use an antagonist for the M2 receptor.
M3 (found in many locations). Basically fight or flight response leads to the constriction of the pupil and increased salivation, bronchoconstriction and sweating.

82
Q

What is general function of parasympathetic NS

A

Rest and digest. But also stimulates tears, saliva and constricts the bladder and bronchi.

83
Q

What is general function of sympathetic NS

A

Flight or fight. Leads to bronchodilation and increased heart rate.

84
Q

Where are Muscarinic 1 receptors found and what do they do?

A

Found in brain and gastric glands of the stomach. Increases the secretion of gastric juice.

1 thing (gastric juices)

85
Q

Where are Muscarinic 2 receptors found and what do they do?

A

Found in the heart.
Causes a decreasing nature to the heart beat. Meaning if the heart is going too slow we would use an antagonist for the M2 receptor.

2 chambers (heart and decreases heart beat)

86
Q

Where are Muscarinic 3 receptors found and what do they do?

A

Found in many locations.
Basically fight or flight response leads to the constriction of the pupil and increased salivation, bronchoconstriction and sweating.

3 things (bronchoconstriction, pupil constriction, increased salivation/sweating)

87
Q

Muscarinic receptors:

Drying secretions used palliatively. What receptor would you inhibit?

A

Anticholinergic

specifically M3

88
Q

Muscarinic receptors:

In a patient with bradycardia, how would you speed up their heart rate?

A

M2 inhibitor

89
Q

Muscarinic receptors:

Someone with asthma, what receptor would stimulate your drug to act on?

A

M3

i.e. LAMA ipratropium bromide

90
Q

Muscarinic receptors:

How would you dilate someone’s pupil for an eye exam?

A

M3 agonist

91
Q

Muscarinic receptors:

How would you treat an overactive bladder?

A

Any anti ACh as bladder stimulation is parasympathetic (S2-4)

92
Q

Name 3 possible side effects of an anticholinergic

A

Worse memory
Drying of mouth
Constipation

Medicine Phase 2a (22 decks)

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