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Musculoskeletal System > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

Alpha Motor Neurones: Receives input from what? (3)

A

Upper neurones from the brain
Sensory inputs from muscle spindles
Spinal interneurones

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2
Q

Alpha Motor Neurones: Function

A

Responsible for the generation of force by muscle

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3
Q

Neuromuscular Junction

A

Large chemical synapse that bridges the spinal motor neurone and skeletal muscle fibre

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4
Q

Neuromuscular Junction: End plate

A

Point of contact between the spinal motor neurone and skeletal muscle fibre

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5
Q

Neuromuscular Junction: Synaptic Bouton

A

Point where the axon of the motor neurone bifurcates at the skeletal muscle to produce branches with a swelling

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6
Q

Neuromuscular Junction: Where do the key events of neurotransmission occur?

A

Synaptic bouton

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7
Q

Synaptic Transmission

A

Mechanism by which cells communicate with one another across the synaptic cleft

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8
Q

Neuromuscular Junction: Electrical Synapses - Each gap junction consists of two what?

A

Hemichannels

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9
Q

Neuromuscular Junction: Electrical Synapses - Junctions enable the passage of what?

A

Small molecules <1kDa

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10
Q

Neuromuscular Junction: Electrical Synapses -

A
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10
Q

Neuromuscular Junction: Electrical Synapses - Gating mechanisms (2)

A

Vj Gating
Slow Transitions

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11
Q

Neuromuscular Junction: Electrical Synapses - Vj Gating

A

Junctional voltage gating

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12
Q

Neuromuscular Junction: Electrical Synapses - Slow Transition Gating

A

Gating via Calcium voltage control or pH docking and undocking

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13
Q

Neuromuscular Junction: Chemical Synapses

A

Synapses at which the neurotransmitter release bridges the pre- and post-synaptic cells in a uni-directional manner

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14
Q

Neuromuscular Junction: Chemical Synapses - MEPPs

A

Miniature End Plate Potentials

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15
Q

Neuromuscular Junction: Chemical Synapses - EPPs

A

End Plate Potentials

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16
Q

Neuromuscular Junction: Chemical Synapses - Miniature End Plate Potentials

A

Spontaneous release of neurotransmitters cause small amplitude depolarisations at the end plate

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17
Q

Neuromuscular Junction: Chemical Synapses - End Plate Potentials

A

An action potential in the pre-synaptic cell triggers neurotransmitter release to cause large amplitude depolarisations in the end plate

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18
Q

Quanta

A

Vesicular packets of ACh that protect ACh from degradation

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19
Q

Neuromuscular Junction: Recording - What approach is used?

A

Patch Clamp

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20
Q

Quantal Content

A

Number of vesicles released per stimuli

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21
Q

Quantal Content (QC)=

A

Mean EPP Amplitude/Mean MEPP Amplitude

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22
Q

Neuromuscular Junction: How does each Quanta induce a MEPP?

A

Activation of Nicotinic ACh receptors on the post-synaptic cell at the motor end plate

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23
Q

Neuromuscular Junction: EPPs require what to occur?

A

Motor nerve stimulation

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24
Q

Impact of Hemicholinium-3

A

Inhibits the Na+ dependent reuptake of Choline into the pre-synaptic cell to limit the re-synthesis of ACh

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25
Q

Impact of Vesamicol

A

Inhibits the packaging of ACh into vesicles by inhibiting the ACh transporter

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26
Q

Impact of Alpha Latrotoxin

A

Causes emptying of ACh vesicles from the pre-synaptic cell to induce muscular spasms

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27
Q

Source of Alpha Latrotoxin

A

Black widow spider venom

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28
Q

Impact of Tetrodotoxin

A

Blocks Na+Channels therefore no action potential to stimulate ACh Release

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29
Q

Impact of Conotoxin

A

Blocks voltage-gated Calcium Channels to prevent exocytosis of ACh-containing synaptic vesicles

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30
Q

Impact of Botulinum

A

Cleaves a protein in synaptic vesicles that is necessary for exocytosis

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31
Q

Impact of Tubocurarine

A

Competes with ACh for the binding site on nAChR

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32
Q

How can we reverse the actions of Tubocurarine?

A

Neostigmine

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33
Q

Impact of Suxamethonium

A

Mimics ACh to bind to nAChR to cause depolarisation with delayed degradation causing a blockade of the junction

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34
Q

Impact of Alpha-Bungarotoxin

A

Antagonises ACh at the nAChR irreversibly

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35
Q

Pharmacology of Arthritis: First stage for pain control

A

Non-Opioid - Aspirin/Paracetemol/NSAID
May be with an adjuvant

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36
Q

Pharmacology of Arthritis: Paracetamol Dose

A

If >60kg - 1g up to 4x per day

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37
Q

Pharmacology of Arthritis: Second stage for mild pain relief

A

Weak Opioid (Codeine)
+ Non-Opioid
+ Adjuvant

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38
Q

Pharmacology of Arthritis: Third stage for moderate to severe pain relief

A

Strong Opioid (Morphine)
+ Non-Opioid
+ Adjuvant

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39
Q

Pharmacology of Arthritis: Examples of NSAIDs (6)

A

Ibuprofen
Naproxen
Diclofenac
Indometacin
Etodolac
Celecoxib

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40
Q

Pharmacology of Arthritis: Indications for NSAIDs (3)

A

Inflammatory arthritis
Mechanical musculoskeletal pain
Pleuritic or Pericardial Pain

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41
Q

Pharmacology of Arthritis: Side Effects of NSAIDs (8)

A

Peptic or Bowel Ulceration
Renal impairment
Dyspepsia
Oesophagitis
Gastritis
Fluid retention
Wheeze
Rash

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42
Q

DMARDs

A

Disease Modifying Anti-Rheumatic Drugs

43
Q

Pharmacology of Arthritis: DMARDs - Is action fast/slow?

A

Slow - takes weeks to months to act

44
Q

Pharmacology of Arthritis: DMARDs - Mechanism of Action

A

Anti-inflammatory impact with no direct analgesic effect

45
Q

Pharmacology of Arthritis: DMARDs - Why is this used in Arthritis?

A

Reduces rate of joint damage

46
Q

Pharmacology of Arthritis: DMARDs - Combination therapy should be used for what patients?

A

In patients with an initial inadequate response to DMARD therapy

47
Q

Pharmacology of Arthritis: DMARDs - Two most favourable examples

A

Methotrexate
Sulfasalazine

48
Q

Pharmacology of Arthritis: DMARDs - Sodium Aurothiomalate - Administration route

A

Intramuscular

49
Q

Pharmacology of Arthritis: DMARDs - Sodium Aurothiomalate - Side effects (4)

A

Bone marrow suppression
Glomerulonephritis
Rash
Oral ulcers

50
Q

Pharmacology of Arthritis: DMARDs - Sodium Aurothiomalate - Must monitor what?

A

FBC
Urine for proteinuria

51
Q

Pharmacology of Arthritis: DMARDs - Penicillamine - Administration Route

A

Oral

52
Q

Pharmacology of Arthritis: DMARDs - Methotrexate - Mechanism of action

A

Folate antagonist

53
Q

Pharmacology of Arthritis: DMARDs - Methotrexate - Route of administration (2)

A

Oral
Subcutaneous

54
Q

Pharmacology of Arthritis: DMARDs - Methotrexate - Indications (4)

A

Rheumatoid Arthritis
Psoriatic Arthritis
Connective tissue disease
Vasculitis

55
Q

Pharmacology of Arthritis: DMARDs - Methotrexate - Must monitor what? (2)

A

FBC
Liver Function Tests

56
Q

Pharmacology of Arthritis: DMARDs - Methotrexate - Side effects in the blood (2)

A

Leucopenia
Thrombocytopenia

57
Q

Pharmacology of Arthritis: DMARDs - Methotrexate - Side effects on the liver (2) and caution to take

A

Hepatitis
Cirrhosis
Limit alcohol intake

58
Q

Pharmacology of Arthritis: DMARDs - Methotrexate - Side effect on the lungs

A

Pneumonitis

59
Q

Pharmacology of Arthritis: DMARDs - Methotrexate - Side effects on the GIT (3)

A

Oral ulcers
Nausea
Diarrhoea

60
Q

Pharmacology of Arthritis: DMARDs - Methotrexate - Side effects during pregnancy and impact to make

A

Teratogenic - stop at least 3 months prior to conception

61
Q

Pharmacology of Arthritis: DMARDs - Leflunomide - Is the half life short or long?

A

Long - requires wash out

62
Q

Pharmacology of Arthritis: DMARDs - Leflunomide - Side effect during pregnancy

A

Teratogenic

63
Q

Pharmacology of Arthritis: DMARDs - Sulfasalazine - When is this used?

A

Used in combination with Methotrexate in early inflammatory arthritis

64
Q

Pharmacology of Arthritis: DMARDs - Sulfasalazine - Must monitor what? (2)

A

FBC
Liver Function Tests

65
Q

Pharmacology of Arthritis: DMARDs - Sulfasalazine - Side Effects on the GIT (2)

A

Nausea
Oral Ulcers

66
Q

Pharmacology of Arthritis: DMARDs - Sulfasalazine - Side effect on the blood

A

Neutropenia

67
Q

Pharmacology of Arthritis: DMARDs - Sulfasalazine - Side effect on the liver

A

Hepatitis

68
Q

Pharmacology of Arthritis: DMARDs - Sulfasalazine - Side effect on the reproductive system

A

Reversible Oligozoospermia

69
Q

Pharmacology of Arthritis: DMARDs - Hydroxychloroquine - Has no effect on what?

A

Joint damage

70
Q

Pharmacology of Arthritis: DMARDs - Hydroxychloroquine - Indications

A

Connective tissue disease (SLE/Sjogren’s Syndrome/RA)

71
Q

Pharmacology of Arthritis: DMARDs - Hydroxychloroquine - Side effects

A

Retinopathy

72
Q

Pharmacology of Arthritis: DMARDs - Hydroxychloroquine - Indication for Rheumatoid Arthritis

A

Patients with early disease to control the signs and symptoms

73
Q

Pharmacology of Arthritis: Biological Therapeutics

A

Drugs designed to target specific aspects of the immune system

74
Q

Pharmacology of Arthritis: Anti-TNF Therapy - Administration route

A

Subcutaneous

75
Q

Pharmacology of Arthritis: Anti-TNF Therapy - More effective when?

A

In combination with DMARDs

76
Q

Pharmacology of Arthritis: Anti-TNF Therapy - Indications (3)

A

Rheumatoid Arthritis
Psoriatic Arthritis
Ankylosing Spondylitis

77
Q

Pharmacology of Arthritis: Anti-TNF Therapy - What type is used in pregnancy and breast feeding?

A

Certolizumab

78
Q

Pharmacology of Arthritis: Anti-TNF Therapy - Why is Certolizumab used in pregnancy and breast feeding?

A

Doesn’t cross the placental barrier due to the pergolated component

79
Q

Pharmacology of Arthritis: Anti-TNF Therapy - Examples (3)

A

Etanercept
Adalimumab
Certolizumab

80
Q

Pharmacology of Arthritis: Anti-TNF Therapy - Indication

A

High Disease Activity Score for RA

81
Q

Pharmacology of Arthritis: Anti-TNF Therapy - Side effects

A

Risk of infection - can reactivate TB

82
Q

Pharmacology of Arthritis: Anti-TNF Therapy - Contraindications (2)

A

Pulmonary fibrosis
Heart failure

83
Q

Mode of Action - Rituximab

A

Monoclonal Antibody against B CD-20 Lymphocytes

84
Q

Mode of Action - Tocilizumab

A

Inhibits IL-6

85
Q

Mode of Action - Abatacept

A

CTLA-4 Ig blocks the full activation of T Lymphocytes

86
Q

Mode of Action - Ustenkinumab

A

Inhibits IL-12 and IL-23

87
Q

Mode of Action - Secukinimab

A

Inhibits IL-17

88
Q

Mode of Action - Tofacitinib or Baricitinib

A

Janus Kinase Inhibitors

89
Q

Pharmacology of Arthritis: Allopurinol - Mechanism of Action

A

Xanthine Oxidase Inhibitor

90
Q

Allopurinol - What is the main caution?

A

A rapid reduction in uric acid can result in an exacerbation of gout

91
Q

Allopurinol - Side Effects (2)

A

Rash vasculitis - more common in the elderly and in renal impairment patients
Marrow aplasia

92
Q

Allopurinol - Interacts with what drug?

A

Azathioprine

93
Q

Allopurinol - Indication

A

Gout - after an acute attack

94
Q

Febuxostat - Mechanism of Action

A

Xanthine Oxidase Inhibitor

95
Q

Febuxostat - Indication

A

Patients that cannot tolerate Allopurinol in Gout

96
Q

Febuxostat - Side effect

A

Renal impairment

97
Q

Febuxostat - Contraindications

A

Ischaemic Heart Disease

98
Q

Examples of Uricosurics (4)

A

Probenecid
Sulphinpyrazone
Azapropazone
Benzbromarone

99
Q

Corticosteroids - Indications (3)

A

Inflammatory Arthritis
Polymyalgia Rheumatica
Vasculitis

100
Q

Corticosteroids - Side Effects on the Musculoskeletal System (2)

A

Osteoporosis
Muscle Wasting

101
Q

Corticosteroids - Biochemical Side Effects (2)

A

Increased risk of diabetes
Increase body fat - centripetal obesity

102
Q

Corticosteroids - Side Effects on the Cardiovascular System

A

Hypertension
Fluid Retention
Avascular necrosis of the femoral head

103
Q

Corticosteroids - Side Effects on the Skin

A

Skin Atrophy

104
Q

Corticosteroids - Side Effects on the Eyes (2)

A

Cataracts
Glaucoma

105
Q

Corticosteroids - Side Effects on the Hormones

A

Adrenal suppression

106
Q

Corticosteroids - Side Effects on the blood counts

A

Immunosuppression

Musculoskeletal System (9 decks)

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