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Year 2 Revision > Pharm Revision > Flashcards

Pharm Revision Flashcards

1
Q

How does the SS and PS regulate HR

A

SS increase cAMP which increases opening of iF and iCa to inc depolarisation
PS dec cAMP which inc opening of iK to prolong repolarisation

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2
Q

How do beta 1 receptors regulate contractility

A

inc cAMP which inc pKA to promote contraction by decreased calcium going into the SR so more is available for contraction

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3
Q

What is the class of drug that verapamil comes under

A

Phenylalkylamines

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4
Q

What is the other class of rate slowing calcium antagonists (not verapamil)

A

Benzothiazepines such as Diltiazem

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5
Q

What is the problem with dihydropyridines for dec contractility

A

No effect on the heard but profound vasodilation can cause reflex tachycardia

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6
Q

How does vasodilation and venodilation affect preload and afterload

A

vasodilation dec afterload

venodilation dec preload

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7
Q

5 key beta blocker side effects

A

Bronchoconstriction
Cold extremities + worsening of peripheral artery disease
Dec heaptic gluconeogenesis and glycogenolysis DIABETICS
Bradycardia (heart block)
Worsening of cardiac failure (reduction in CO)

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8
Q

Side effects of both type of calcium blockers

A 
Verapamil = bradycardia and AV block. Constipation 
Dihydro = ankle oedema, headache flushing, palpitations due to reflex tachy
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9
Q

Adenosine MOA and USE

A

stimulates alpha 1 in SAN and AVN to reduce cAMP and dec chronotropy and dromotopy
stimulates alpha 2 in vasc smooth muscle to inc cAMPt to relax
SVT’s short lived

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10
Q

Verapamil MOA and USE for anti arrhythmic

A

Depress SA atuoomaticity and AV
reduce ventricular responsivess to atrial arrhythmias
SVT and AF

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11
Q

Amiodarone moa use adverse

A

SVT and VT
multiple ion block
accumulates and can cause skin rash, hypo/hyper thyroidism, pulmonary fibrosis

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12
Q

effect of digoxin bc of blocking the pump
USE
Adverse effects

A

inc intracellular ca
positive ionotropic effect
vagal stimulation causes inc refractory period and reduced rate of conduction through AV node
AF and Flutter
Dysrhythmias and hypokalaemia can lower toxicity

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13
Q

M1 Receptors

A

neural tissue

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14
Q

M3 receptors

A

exocrine and smooth muscle

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15
Q

ACh enzyme to make

A

choline acetyl transferase

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16
Q

Dopamine to noradrenaline

A

Dopamine beta hydroxylase

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17
Q

COMT stands for

A

catechol-O-methyl trasnferase

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18
Q

SS vs PS response key words

A

coordinated and divergent

discrete and localised

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19
Q

why do effects of cannabis last so long

A

storage in adipocytes

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20
Q

Dronabinol

A

delta 9 thc = chemo NV

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21
Q

nabilone

A

delta 9 thc = chemo NV

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22
Q

sativex

A

delta 9 thc and cannabidiol = symptom improved for spasticity due to MS

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23
Q

rimonabant

A

CB1 antagonists = anti-obesity but depression and suicide

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24
Q

effect of enterohepatic recycling on measuring intoxication

A

11 OH THC is more potent and recycles so delta 9 thc is a bad indicator

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25
Q

what is anterior cingulate cortex function

A

performance monitoring and behavioural adjustment

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26
Q

part of brain for munchies

A

lateral hypothalamus

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27
Q

endogenous cannibinoid

A

anandamide

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28
Q

appetite neurones for pharm

A

Melanin concentrating hormone neurones

orexin

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29
Q

cannabis and hunger neurones

A

inhibits GABA on MCH so inc in MCH and orexin production so inc hunger

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30
Q

cannabis and psychomotor performance

A

depresses cerebral cortex

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31
Q

cannabis and CV system

A

TRPV1 receptor to cause calcium influx-> tachycardia

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32
Q

cannabis vasodilation

A

conjunctivae

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33
Q

cannabis memory loss

A

inhibits production of brain derived neurotrophic factor in hippocampus

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34
Q

cannabis levels in the brain

A

rise v quickly but fall v quickly bc brain is highly perfused

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35
Q

how much smoked cannabis reaches bloodstream

A

30%

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36
Q

define alkaloid

A

any class of nitrogenous compound of plant origin that has profound physiological actions on humans

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37
Q

THC =

A

tetrahydrocannabinol

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38
Q

what type of receptors is CB

A

g protein i = negative with AC

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39
Q

four types of cocaine

A

crack = precipitated with alkaline solution
cocain paste = plant mushed up
freebase= dissolve crack in a non-polar solvent
cocaine hcl = therapeutic

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40
Q

what is the cocaine plant name

A

erythroxylum coca

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41
Q

cocaine CVS risks (3 actions)

A

vasoconstriction
platelets
atherosclerosis

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42
Q

cocaine and seizures

A

vasoconstriction in brain arteries leading to inc in temp

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43
Q

why is nicotine in a cigarette so effective

A

melts the tar to make droplets
alkaloids dissolve in droplets
easily absorbed

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44
Q

why is nicotine not absorbed in the mouth

A

cigarette smoke is acidic and pKa of mouth is alkaline so ioniside

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45
Q

nicotine euphoria

A

nachr causes sodium influx so inc firing rate

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46
Q

nicotine and CVS

A

inc SS
vasoconstriction coronary arterioles
atherosclerosis
inc thromboxane A2

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47
Q

nicotine and parkinson’s and alzheimers

A

inc cyp450 which remove neurotoxins which contribute to onset of parkinson’s
diminishes some of the proteins

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48
Q

caffeine and euphoria

A

adenosine antagonist so removed inhib effect on dopamine and D1 receptor function

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49
Q

nicotine metabolism

A

CYP2A6 in liver
produces cotinine
excreted in urine

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50
Q

cocaine pKA

A

weak base so less absorbed in stomach

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51
Q

cocaine half life

A

20-90 mins

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52
Q

cocaine metabolism

A 
liver = inactive ecgonine methyl ester and benzoylecgonine
plasma = plasma cholinesterases
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53
Q

how to work out how much alcohol in g/100ml

A

ABV% x 0.78

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54
Q

how much alcohol is metabolises

A

90%

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55
Q

acetaldehyde metabolism

A

aldehyde dehydrogenase -> acetic acid

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56
Q

chronic alcohol and ataxia

A

cerebellar cortex degeneration

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57
Q

Alcohol receptor targets in CNS

A

Allopregnelone -> enhances GABA
dec NMDA
reduces Ca2+ influx so less exocytosis

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58
Q

why alcohol and cutaneous vasodilation

A

less calcium influx and more prostaglandins

acetaldehyde

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59
Q

alcohol and reward pathways

A

less dopamine bc inc gaba and reduces nmda

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60
Q

brain targets of alcohol

A 
hypothaalmus 
RAS
hippocampus
cerebellum
basal ganglia= time
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61
Q

alcohol and HR

A

dec sensitivity of baroreceptors so less baroreceptor firing so inc HR

62
Q

benefits of alcohol

A 
dec mortality from coronary artery disease
inc HDL
inc tPA
dec platelet aggregation 
POLYPHENOLS
63
Q

alcohol hepatitis

A

cytochrom p450 -> oxygen freeradicals inflammation

64
Q

alcohol cirrhosis

A

fibroblasts recruited

connective tissue laid down

65
Q

alcohol endocrine (3)

A

inc cortisol
dec DDAVP
dec testosterone

66
Q

why do u get nausea

A

gastric irritation
vagus
vomiting centre

67
Q

wernicke korsakoff

A

thiamine B1 deficiency
oxidative stress
wernicke encephalopathy = mitochondrial injury
K psychosis = apoptosis in the brain

68
Q

alcohol and liver

A 
uses up NAD+
no beta oxidation of lipids
pyruvate -> lactate
acetyl coA -> ketones 
lipids build up
69
Q

BAC limit

A

80mg/100ml

70
Q

heart contractility

A

calcium enters thru dihydropyridine receptors

ryanodine receptors on SR causing more calcium release

71
Q

SERCA2a

A

removal of calcium

rate of relaxation and contractility of next beat

72
Q

how is calcium removed from the cell

A

plasma membrane calcium ATPase
sodium calcium exchanger
SERCA2a

73
Q

why is hypokalaemia dangerous with digoxin

A

digoxin competes with potassium so if less potassium then more effect

74
Q

organic nitrates MOA

A

NO -> GC vasodilaiton

75
Q

verapamil target

A

l type calcium channel so less depolarisation

76
Q

gastric vs duodenal ulcer symptoms

A

gastric while eating, duodenal after eating 3 hours

77
Q

molecule that is protective in the stomach

A

prostaglandins

78
Q

PS and gastric acid

A

inc histamine which inc acid

79
Q

what type of transporter in parietal cells

A

H/K ATPase

80
Q

PPI’s in stomach active why

A

weak base accumulates in canaliculi

81
Q

histamine receptor antagonist side effects

A

dizziness headache

82
Q

H pylori antibiotics

A

tetracycline/quinolone
amoxicilin
clarithromycin/metronidazole

83
Q

why is ondasteron used for chemo NV

A

chemo is toxic to enterochromaffin cells
cause excessive serotonin release
antagonises receptors on NTS, VC, CTZ

84
Q

what is ondasteron given with

A

glucocorticoids to reduce free radical production

aprepitant = neurokinin 1 receptor antagonists NTS = VC

85
Q

motion sickness MOA

A

neural mismatch
vestibular sustem Machr receptors
hypothalamic histamine release into ctz
muscarinic to VC

86
Q

anti-emetic side effects

A 
histamine = drowsy
serotonin = headaches
muscarininc = dry mouth constipation
dopamine = EPS
87
Q

aldosterone sodium channel antagonist

A

amiloride

88
Q

when is mannitol used

A

major oedema

89
Q

which diueretics lead to loss of potassium recyclcing so inc loss of calcium and magnesisum

A

acetazolimide
frusemide
thiazide

90
Q

side effects of loop diuretics and thiazides

A

hypovolemia
metabolic alkalosis bc inc cl-loss
hyperuricaemia
hypokalaemia

91
Q

side effect of carbonix anhydrase inhib

A

metabolic acidosis due to inc bicarb loss

92
Q

side effect of potassium sparing

A

hyperkalaemia

93
Q

why are thiazides used in htn

A

chronic thiazides vasodilate leading to reduced tpr

94
Q

PGE2 unwanted actions

A

acute inflam
immune
tumorigenesis
inhibition of apoptosis

95
Q

what are the receptors thought to lower pain threshold with prostanoids

A

ep1 ep4

96
Q

pge2 derisable actions

A

bronchodilation
renal salt and water homeostasis
gastroprotection
vasoregulation

97
Q

how do NSAIDs cause renal toxicity

A

constriction of afferent renal arteriole
reduction in renal artery flow
reduced glomerular filtration rate

98
Q

aspirin side effects

A

gastric
bronchospasm
bleeding times
nephrotoxicity

99
Q

why is paracetamol overdose

A

NAPQI has to metabolised by glutathione-S-trasnferase

if glutathione is depleted then NAPQI oxidises thiol group of hepatic enzymes causing cell death

100
Q

antidote for paracetamol poisioning

A

add compound with SH
IV Acetylcysteine
Oral Methionine

101
Q

paracetamol laws

A

16 x 500mg
2 packs in transaction
illegal to sell more than 100

102
Q

aminosalicylates MOA

A

inhibit IL1 - TNF alpha and PAF
dec antibody secretion
reduced cell migration
localised inhibition of immune responses

103
Q

problem with anti-tnf alpha

A

anti-drug antibodies and inc drug clearance
TB
septicaemia
heart failure

104
Q

3 immunosuppressives for IBD

A

azothioprine
methotrexate
cyclosporin

105
Q

2 x aminosalicylates

A

olsalazine

mesalazine

106
Q

azothioprine side effects

A

pancreatitis
bone marrow suppression
hepatotoxicity
lymphoma and skin cancer

107
Q

Manipulation of microbiome for IBD

A

Nutrition based for UC
Faecal microbiota replacement therapies
Rifaximin - binds to RNA polymerase sustains remission in CD

108
Q

anti tnf alpha eg

A

infliximab

109
Q

new targets IBD

A

integrins
interleukins
interleukin rececptors
janus kinase cell signalling

110
Q

Type a not atenolol

A

anticholinergics and dry mouth

nsaids and peptic ulcers

111
Q

tybe c not methotrexate

A

aantimalrials and ocular toxicity

112
Q

type d

A

immunosuppressants and thalidomide

113
Q

type 2 pharm

A

methyldopa and haemolytic anaemia

114
Q

type 3 pharm

A

procainamide induced lupus

115
Q

overlapping toxicities

A

ethanola nd BDZ

116
Q

antagonistic effects

A

amitriptyline and acetylcholinesterase inhibitors

117
Q

cyp450 inducers

A
  • grapefruit
  • fluoxetine
  • cimetidine
  • erthryomycin

ketoconazole
ciprofloxacin
ritonavir

118
Q

inhibitions vs induction of cyp450

A

induction days

inhibition quick

119
Q

drug elimination reactions

A

probenecid and pencillin

lithium and thiazides

120
Q

asthma deliberate interaction

A

salbutamol and ipratropium

121
Q

nAChR in skeletal muscle structurs

A

5 subunits alpha x 2 beta gamma delta

ach opens both alpha to allow sodium influx to generate end plate potential

122
Q

example of a spasmolytic that stops propagation of AP

A

dantrolene

dec release of calcium from DR to dec force of contraction and dec spasticity

123
Q

administration of suxamethonium and metabolism

A

IV bc highly charged

pseudo-cholinesterases

124
Q

unwanted effects of suxamethonium

A

post op muscle pains
bradycardia bc stimulates M2
hyperkalaemia so avoid in soft tissue injury
inc intra-ocular pressure

125
Q

how to reverse tubocurarine

A

anticholinesterases to inc endogenous acetylcholine

126
Q

tubocurarine side effects

A

hypotension due to ganglion blockade and histamine release
reflex tachy due to blockade of vagal ganglia
bronchospasm
excessive secretions
apnoea

127
Q

side effects of ACEi ARBs

A 
Cough
hypotension
urticaria/angioedema
hyperkalaemia
fetal injury
renal failure if renal artery stenosis
128
Q

describe smooth muscle contractision

A

membrane depolarisation opens VGCC
Ca binds to calmodulin
complex binds to and activated myosin light chain kinase
phosphorylation leads to SMC

129
Q

what is in red thrombi and white thrombi

A 
red = high fibrin
white = high platelet
130
Q

three stages of cell based theory

A

initiation
amplification
propagation

131
Q

dabigatran vs rivaroxaban

A

2a vs 10a

132
Q

example of low molecular weight heparin

A

Dalteparin

133
Q

heparin route of administration

A

IV/SC

134
Q

anticoag indications

A

AF stroke

135
Q

ADP receptor name

A

P2Y12

136
Q

abciximab route

A

IV/SC

137
Q

antiplatelets indication

A

acute coronary syndormes MI

AF stroke

138
Q

thrombolytics indication

A

stroke

STEMI

139
Q

other antiplatelet that i forget

A

aspirin cox 1 thromboxane

140
Q

nucleic acid synthesis

A

paraaminobenzoate
dihydropteroate
dihydrofolate
tetrahydrofolate

141
Q

what inhibits bactoprenol

A

bacitracin

142
Q

methods of antibiotic resistance

A 
Destruction enzymes
additional target
alteration in target enzyme
inc levels of target
reduction in aquaporins and inc efflux
143
Q

polyene example

A

amphotericin

144
Q

azole moa

A

cyp450 sterol synthesis

145
Q

ribavirin moa

A

nucleoside analogue prevents viral rna synthesis

146
Q

boceprivir moa

A

protease inhibitor

147
Q

enfuvirtide target

A

HIV GP41

148
Q

zidovudine

A

nucleoSide RT inhibitor

149
Q

what encodes all viral proteins

A

Gag precursor

150
Q

HSV sturcutre

A

dsDNA with tegument and lipid bilayer

151
Q

influenza structure

A

multipartite ssRNA

Year 2 Revision (22 decks)

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