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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
Impact of Hemicholinium-3
Inhibits the Na+ dependent reuptake of Choline into the pre-synaptic cell to limit the re-synthesis of ACh
25
Impact of Vesamicol
Inhibits the packaging of ACh into vesicles by inhibiting the ACh transporter
26
Impact of Alpha Latrotoxin
Causes emptying of ACh vesicles from the pre-synaptic cell to induce muscular spasms
27
Source of Alpha Latrotoxin
Black widow spider venom
28
Impact of Tetrodotoxin
Blocks Na+Channels therefore no action potential to stimulate ACh Release
29
Impact of Conotoxin
Blocks voltage-gated Calcium Channels to prevent exocytosis of ACh-containing synaptic vesicles
30
Impact of Botulinum
Cleaves a protein in synaptic vesicles that is necessary for exocytosis
31
Impact of Tubocurarine
Competes with ACh for the binding site on nAChR
32
How can we reverse the actions of Tubocurarine?
Neostigmine
33
Impact of Suxamethonium
Mimics ACh to bind to nAChR to cause depolarisation with delayed degradation causing a blockade of the junction
34
Impact of Alpha-Bungarotoxin
Antagonises ACh at the nAChR irreversibly
35
Pharmacology of Arthritis: First stage for pain control
Non-Opioid - Aspirin/Paracetemol/NSAID May be with an adjuvant
36
Pharmacology of Arthritis: Paracetamol Dose
If >60kg - 1g up to 4x per day
37
Pharmacology of Arthritis: Second stage for mild pain relief
Weak Opioid (Codeine) + Non-Opioid + Adjuvant
38
Pharmacology of Arthritis: Third stage for moderate to severe pain relief
Strong Opioid (Morphine) + Non-Opioid + Adjuvant
39
Pharmacology of Arthritis: Examples of NSAIDs (6)
Ibuprofen Naproxen Diclofenac Indometacin Etodolac Celecoxib
40
Pharmacology of Arthritis: Indications for NSAIDs (3)
Inflammatory arthritis Mechanical musculoskeletal pain Pleuritic or Pericardial Pain
41
Pharmacology of Arthritis: Side Effects of NSAIDs (8)
Peptic or Bowel Ulceration Renal impairment Dyspepsia Oesophagitis Gastritis Fluid retention Wheeze Rash
42
DMARDs
Disease Modifying Anti-Rheumatic Drugs
43
Pharmacology of Arthritis: DMARDs - Is action fast/slow?
Slow - takes weeks to months to act
44
Pharmacology of Arthritis: DMARDs - Mechanism of Action
Anti-inflammatory impact with no direct analgesic effect
45
Pharmacology of Arthritis: DMARDs - Why is this used in Arthritis?
Reduces rate of joint damage
46
Pharmacology of Arthritis: DMARDs - Combination therapy should be used for what patients?
In patients with an initial inadequate response to DMARD therapy
47
Pharmacology of Arthritis: DMARDs - Two most favourable examples
Methotrexate Sulfasalazine
48
Pharmacology of Arthritis: DMARDs - Sodium Aurothiomalate - Administration route
Intramuscular
49
Pharmacology of Arthritis: DMARDs - Sodium Aurothiomalate - Side effects (4)
Bone marrow suppression Glomerulonephritis Rash Oral ulcers
50
Pharmacology of Arthritis: DMARDs - Sodium Aurothiomalate - Must monitor what?
FBC Urine for proteinuria
51
Pharmacology of Arthritis: DMARDs - Penicillamine - Administration Route
Oral
52
Pharmacology of Arthritis: DMARDs - Methotrexate - Mechanism of action
Folate antagonist
53
Pharmacology of Arthritis: DMARDs - Methotrexate - Route of administration (2)
Oral Subcutaneous
54
Pharmacology of Arthritis: DMARDs - Methotrexate - Indications (4)
Rheumatoid Arthritis Psoriatic Arthritis Connective tissue disease Vasculitis
55
Pharmacology of Arthritis: DMARDs - Methotrexate - Must monitor what? (2)
FBC Liver Function Tests
56
Pharmacology of Arthritis: DMARDs - Methotrexate - Side effects in the blood (2)
Leucopenia Thrombocytopenia
57
Pharmacology of Arthritis: DMARDs - Methotrexate - Side effects on the liver (2) and caution to take
Hepatitis Cirrhosis Limit alcohol intake
58
Pharmacology of Arthritis: DMARDs - Methotrexate - Side effect on the lungs
Pneumonitis
59
Pharmacology of Arthritis: DMARDs - Methotrexate - Side effects on the GIT (3)
Oral ulcers Nausea Diarrhoea
60
Pharmacology of Arthritis: DMARDs - Methotrexate - Side effects during pregnancy and impact to make
Teratogenic - stop at least 3 months prior to conception
61
Pharmacology of Arthritis: DMARDs - Leflunomide - Is the half life short or long?
Long - requires wash out
62
Pharmacology of Arthritis: DMARDs - Leflunomide - Side effect during pregnancy
Teratogenic
63
Pharmacology of Arthritis: DMARDs - Sulfasalazine - When is this used?
Used in combination with Methotrexate in early inflammatory arthritis
64
Pharmacology of Arthritis: DMARDs - Sulfasalazine - Must monitor what? (2)
FBC Liver Function Tests
65
Pharmacology of Arthritis: DMARDs - Sulfasalazine - Side Effects on the GIT (2)
Nausea Oral Ulcers
66
Pharmacology of Arthritis: DMARDs - Sulfasalazine - Side effect on the blood
Neutropenia
67
Pharmacology of Arthritis: DMARDs - Sulfasalazine - Side effect on the liver
Hepatitis
68
Pharmacology of Arthritis: DMARDs - Sulfasalazine - Side effect on the reproductive system
Reversible Oligozoospermia
69
Pharmacology of Arthritis: DMARDs - Hydroxychloroquine - Has no effect on what?
Joint damage
70
Pharmacology of Arthritis: DMARDs - Hydroxychloroquine - Indications
Connective tissue disease (SLE/Sjogren's Syndrome/RA)
71
Pharmacology of Arthritis: DMARDs - Hydroxychloroquine - Side effects
Retinopathy
72
Pharmacology of Arthritis: DMARDs - Hydroxychloroquine - Indication for Rheumatoid Arthritis
Patients with early disease to control the signs and symptoms
73
Pharmacology of Arthritis: Biological Therapeutics
Drugs designed to target specific aspects of the immune system
74
Pharmacology of Arthritis: Anti-TNF Therapy - Administration route
Subcutaneous
75
Pharmacology of Arthritis: Anti-TNF Therapy - More effective when?
In combination with DMARDs
76
Pharmacology of Arthritis: Anti-TNF Therapy - Indications (3)
Rheumatoid Arthritis Psoriatic Arthritis Ankylosing Spondylitis
77
Pharmacology of Arthritis: Anti-TNF Therapy - What type is used in pregnancy and breast feeding?
Certolizumab
78
Pharmacology of Arthritis: Anti-TNF Therapy - Why is Certolizumab used in pregnancy and breast feeding?
Doesn't cross the placental barrier due to the pergolated component
79
Pharmacology of Arthritis: Anti-TNF Therapy - Examples (3)
Etanercept Adalimumab Certolizumab
80
Pharmacology of Arthritis: Anti-TNF Therapy - Indication
High Disease Activity Score for RA
81
Pharmacology of Arthritis: Anti-TNF Therapy - Side effects
Risk of infection - can reactivate TB
82
Pharmacology of Arthritis: Anti-TNF Therapy - Contraindications (2)
Pulmonary fibrosis Heart failure
83
Mode of Action - Rituximab
Monoclonal Antibody against B CD-20 Lymphocytes
84
Mode of Action - Tocilizumab
Inhibits IL-6
85
Mode of Action - Abatacept
CTLA-4 Ig blocks the full activation of T Lymphocytes
86
Mode of Action - Ustenkinumab
Inhibits IL-12 and IL-23
87
Mode of Action - Secukinimab
Inhibits IL-17
88
Mode of Action - Tofacitinib or Baricitinib
Janus Kinase Inhibitors
89
Pharmacology of Arthritis: Allopurinol - Mechanism of Action
Xanthine Oxidase Inhibitor
90
Allopurinol - What is the main caution?
A rapid reduction in uric acid can result in an exacerbation of gout
91
Allopurinol - Side Effects (2)
Rash vasculitis - more common in the elderly and in renal impairment patients Marrow aplasia
92
Allopurinol - Interacts with what drug?
Azathioprine
93
Allopurinol - Indication
Gout - after an acute attack
94
Febuxostat - Mechanism of Action
Xanthine Oxidase Inhibitor
95
Febuxostat - Indication
Patients that cannot tolerate Allopurinol in Gout
96
Febuxostat - Side effect
Renal impairment
97
Febuxostat - Contraindications
Ischaemic Heart Disease
98
Examples of Uricosurics (4)
Probenecid Sulphinpyrazone Azapropazone Benzbromarone
99
Corticosteroids - Indications (3)
Inflammatory Arthritis Polymyalgia Rheumatica Vasculitis
100
Corticosteroids - Side Effects on the Musculoskeletal System (2)
Osteoporosis Muscle Wasting
101
Corticosteroids - Biochemical Side Effects (2)
Increased risk of diabetes Increase body fat - centripetal obesity
102
Corticosteroids - Side Effects on the Cardiovascular System
Hypertension Fluid Retention Avascular necrosis of the femoral head
103
Corticosteroids - Side Effects on the Skin
Skin Atrophy
104
Corticosteroids - Side Effects on the Eyes (2)
Cataracts Glaucoma
105
Corticosteroids - Side Effects on the Hormones
Adrenal suppression
106
Corticosteroids - Side Effects on the blood counts
Immunosuppression

Musculoskeletal System (9 decks)

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