Pharmacology Flashcards

Question

Side effects of vasopressin

Answer 1

Local irritation Tissue necrosis Increased liver and TBil enzymes Reduced platelets Low sodium Anaphylaxis Bronchospasm Water intoxication

Answer 2

180/120(>140)

Answer 3

Cushings Hepatic diseases DM Chromocytomas EPO Anaemia

Answer 4

Inhibit the conversion of ATI > ATII increasing bradykinin and reducing plasma volume They induce arterial and veno dilation Reduce aldosterone release so sodium and water excretion increased Used for all forms of hypertension but can reduce it too much I.e. enalipril, benazipril, ramipril and lisonopril

Answer 5

May be a safer antihyprtensive for those experiencing renal insufficiency Dose-dependant fall in BP with minimal effects on HR and CO I.e. Losartan, irbesartan, telmisartan

Answer 6

Block A and/or B I.e. propranolol, atenolol, prazosin B blockade = decreased renin, decreased HR, decreased adrenergy and decreased contractility A blockade = antagonise contriction Used when other anti hypertensives fail or in tachydysrhythmias, may also decrease bladder sphincter tone

Answer 7

I.e spironalactone DCT and collecting ducts and decrease sodium reabsorption and decrease K excretion Weak diuretic effect If used with other hypertensives may induce renal insufficiency

Answer 8

I.e. amlodipine, diltiazem Reduce the Ca influx into smooth muscle cells reduces peripheral VR Used in hypertensive crisis (arterial vasodilators may also be preferable) #1 choice in CKD Tachycardia, constipation, vomiting and weakness not uncommon

Answer 9

Usually used in hypertensive crisis because they are very fast acting Dilate arteries and relax resistance I.e. hydralazine, sodium nitroprusside and fenoldopam

Answer 10

Aim to reduce BP 25% in first hour Aim to reduce BP to 160/110-100 in the next 2-6h I.e. sodium nitroprusside, hydralazine (may elect amlopidine) * ischaemia will occur if done too rapidly

Answer 11

Correct water and electrolyte excess Act on the nephron to block the reabsorption of water and solute I.e. Na increasing there urinary excretion Kidneys: regulate the absorption and excretion of water and solutes and rely on ADH to do so

Answer 12

A functional tubular system otherwise there is inappropriate increase in ADH that requires therapeutic diuretics for water and solute excretion

Answer 13

Na highest in the PCT and LOH therefore diuretics such as mannitol, acetazolamide and furosemide better for dieresis and spironalactone and thiazides weaker as act on the more distal convoluted tubule area

Answer 14

Osmotic diuretic that increases the osmolality of the ECF so fluid moves into this compartment and into IVS Freely filtered by the glomerulus No tubular reabsorption Increasing fluid dieresis Decrease renal vascular resistance Decreases cerebral oedema 0.25-1g/kg

Answer 15

Decreases proximal reabsorption resulting in a self-limiting metabolic acidosis Increases distal Na reabsorption Used in glaucoma

Answer 16

Inhibits Na-K-Cl at the loop of Henle Marked natriuesis and dieresis and causes an osmotic gradient shift Increases renal O2 parenchymal supply and decreases renal resistance Increases ECF fluid removal Used in CHF and fluid overload as well as Oliguria

Answer 17

Act in V2 receptors to promote solute free water clearance Treat FW retention in hypervolaemic and hyponateaemic patients (HF, liver failure, SIADH)

Answer 18

I.e. mannitol or furosemide Converts Oliguria Will increase dieresis but not improve renal function

Answer 19

Combination of LOH and DCT diuretics particularly if not fully responsive to furosemide alone

Answer 20

Try to reduce portal hypertension and oedema

Answer 21

Anoxia to the gastrointestinal mucosa such as in hypovolaemic shock and drugs such as NSAIDS. Stress also (SIRS, masses etc) H2RA, PPI, prostaglandin analogs are some options for treatment

Answer 22

Cimeditine, ranitidine Work at gastric parietal cells and compete for gastric acid secretion > reduce gastric acid secretion P450 metabolism Work rapidly

Answer 23

Irreversible inhibit H-K ATP in luminal parietal cells > stopping gastric secretion and reducing gastric reflux and duodenal ulcers I.e. omeprazole, pantoprazole, esomeprazole First pass metabolism Peak effect after 2-5 days More effective than H2RA

Answer 24

Viscous and binds tightly to epithelial cells creating a physical barrier whilst adhered to gastric ulcer or erosion Signals PG to promote mucosal repair Can absorb some drugs I.e. enro

Answer 25

PG analog that has mucosal protective and antacid properties Acts on parietal cells to reduce gastric acid Helpful in NSAID toxicity

Answer 26

More susceptible to bacterial infections

Answer 27

Maropitant Reduces substance P in CNS and NK-1 in the gut Must be over 11 weeks to avoid bone marrow suppression Good for visceral pain First-pass metabolism in the liver

Answer 28

Ondanserron, granisetron, dolasteron Block serotonin receptors (5HT3) both peripherally and centrally to reduce vomiting Liver metabolism Eliminated in urine and bile

Answer 29

Both antidopaminergic and 5HT3 blocker reducing nausea and vomiting (block CRTZ) Less effective in cats as lower dopaminergic receptors Gastric prokinetic when given as CRI (increases transit time and reduces reflux) * don’t give if GI obstruction

Answer 30

Centrally act I.e. chlorpromazine and acepromazine Travel sickness Cardiovascular changes so caution to be used Avoid if substantial liver disease

Answer 31

Cisapride as stronger effects than most other prokinetics I.e. metoclopramide and erythromycin Increases gastric emptying Increases lower oesophageal sphincter tone Not helpful in megaoesophagus as this is striated muscle Good for idiopathic constipation

Answer 32

Bethanechol/ranitidine Inhibit ACh Increase colonic motility and gastric emptying

Answer 33

Powerful prokinetic working on motilin receptors Increases lower oesophageal sphincter tone to reduce reflux Increases lower bowel peristalsis ‘Gastric hunger’

Answer 34

Have little cardiovascular effects when given within therapeutic range Have substantial effects on the respiratory system so care to be taken (pontine and medullary centres) Stereospecific receptor binding throughout CNS and the peripheral system Metabolised by the liver and excreted by the kidneys Some can induce an excitatory response particularly if given with MAOIS and other antidepressants Most increase ADH so cause urine retention Decrease GI motility

Answer 35

Release histamine inducing vasodilation and bronchoconstriction

Answer 36

Fentanyl/remifentanil = strongest Butorphanol = weakest

Answer 37

Mu opioid agonist Sedation and analgesia May cause histamine release, vomiting, diarrhoea, bradycardia Lasts 4-6h

Answer 38

Similar to morphine Some NMDA activity Sedation & analgesia Lasts 4-6h

Answer 39

Use to treat severe pain Rapid onset and short duration May induce dysphoria Available in transdermal patches

Answer 40

Kappa agonist Mild pain relief but good sedation Lasts 1-2h Partial mu reversal Ceiling effect

Answer 41

Partial agonist Mild to moderate pain Longer DOA 8-12h

Answer 42

Used as first line anticonvulsants in most patients unless HE/PSS Works on inhibitory GABA receptors to potentialities GABA and may antagonise serotonin Sedation, hypnosis, amnesia, anticonvulsant, skeletal muscle relaxation Diazepam highly protein bound whilst midazolam is water soluble Effects from sedative to excitatory and best given with an opioid to combat this Midazolam at 0.005-0.4mg/kg may stimulate the appetite

Answer 43

Used for sedation and analgesia Decrease autonomic responses by reducing norepinephrine release Inhibit ADH/insulin (Diuresis and increased glucose) Potentiate opioid analgesia even at low doses Can decrease anaesthetic drug requirements <80% Cardiovascular response is biphasic Arrhythmia associate with bradycardia and reduced CO warrants reversal and +- anticholinergic

Answer 44

Initially increased BP and SVR, decrease HR and CO Then… decreased BP, HR and CO may remain reduced, variable SVR. * watch whole body perfusion, core organs usually remain perfused but other tissues may not