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MSK 2.0 > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

describe the structure of the alpha motor neurone

A

it is myelinated

cell bodies are located in the spinal cord and brainstem

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2
Q

what happens to the alpha motor neurone as it nears the muscle?

A

it divides into unmyelinated branches which end in a terminal bouton (NMJ)

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3
Q

synaptic vesicles containing ACh in the NMJ are located where?

A

active zones

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4
Q

where are nAChR located?

A

junctional folds that face active zones

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5
Q

pre-synaptic processes

A
  • choline is transported into the terminal by choline transporter (symport with Na+)
  • ACh is synthesised in the cytosol with acetyl coenzyme A by choline acetyltransferase
  • ACh is concentrated in vesicles by vesicular ACh transporter
  • AP causes depolarisation and Ca2+ enters and causes vesicles in active zones to undergo exocytosis
  • ACh diffuses into the synaptic cleft and activates nAChR in endplate region
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6
Q

post-synaptic processes

A
  • two ACh molecules activate each nAChR (pentamers of glycoprotein subunits surrounding central cation pore with a gate that only opens when ACh binds)
  • channel is equally permeable to Na+ and K+, but does not conduct anions
  • when the gate is open Na+ influxes at a faster rate than K+ effluxes
  • causes simultaneous opening of many nAChR
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7
Q

what terminates ACh

A

hydrolysis by acetylcholinesterase (enzymes associated with the endplate membrane).

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8
Q

five examples of the clinical relevance of the NMJ

A 
neuromyotonia 
Lambert-Eaton Myasthenia Syndrome
Myasthenia gravis
botulinum toxin
curare-like compounds
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9
Q

describe neuromyotonia

A

autoantibodies to K+ channels leading to excitability

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10
Q

presentation of neuromyotonia

A

cramps
stiffness
slow relaxation
twitches

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11
Q

management of neuromyotonia

A

carbamazepine and phenytoin block Na+ channels

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12
Q

describe Lambert-Eaton myasthenic syndrome

A

autoantibodies to Ca2+ channels leading to reduced Ca2+ entry

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13
Q

presentation of LEMS (small cell lung carcinoma association)

A

muscle weakness

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14
Q

management of LEMS

A

anticholinesterases e.g. pyridostigmine

K+ channel blockers e.g. 3,4-diaminopyridine

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15
Q

describe myasthenia gravis

A

progressive muscle weakness during periods of activity, eye and eyelids

autoantibodies against nAChR in endplate region reducing functional challenges and AP

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16
Q

management of myasthenia gravis

A

anticholinesterases e.g. edrophonium

immunosuppressants e.g. azathioprine

17
Q

describe botulinum toxin

A

exotoxin that irreversibly inhibits ACh release. it modifies proteins involved in vesicles preventing exocytosis (used in botox)

18
Q

role of curare-like compounds (muscle relaxant)

A

competitive antagonist of ACh

19
Q

three classes of drugs involved in inflammatory arthritis management

A
  • NSAIDs
  • DMARDs
  • biologics
20
Q

examples of NSAIDs used in inflammatory arthritis management

A

ibuprofen
naproxen
diclofenac

21
Q

describe NSAIDs

A

anti-inflammatory with analgesic properties

22
Q

indications for NSAIDs

A

inflammatory arthritis
mechanical MSK pain
pleuritic/pericardial pain

23
Q

adverse of NSAIDs

A

peptic ulceration

increased risk of cardiovascular problems

24
Q

when should DMARDs be started in inflammatory arthritis?

A 
within 3 months of symptom onset
slow onset (weeks-months)
25
Q

examples of DMARDs

A
  • methotrexate
  • leflunomide
  • sulfasalazine
  • hydroxycholorquine
  • others e.g. sodium aurothiomalate and penicillamine
26
Q

what is methotrexate used in?

A

RA
psoriatic arthritis
CT disease
vasculitis

27
Q

adverse of methotrexate

A 
leukopenia
thrombocytopenia
cirrhosis
pneumonitis
rash/mouth ulcers
nausea
diarrhoea
teratogenic- stop 3 months before conception
need FBC and LFTs monitoring
28
Q

what is often used in combination with methotrexate?

A

sulfasalazine

29
Q

adverse of sulfasalazine

A 
nausea
mouth ulcers
low sperm count
hepatitis
monitoring of FBC and LFTs required
30
Q

what is hydroxychloroquine used in?

A

all connective tissue diseases

31
Q

describe biologics

A

they are drugs designed to target specific aspects of the immune system

32
Q

what scoring system is used to determine the need for biologics?

A

DAS28

33
Q

examples of biologics

A

anti-TNF e.g. infliximab, adalimumab, etanercept
rituximab (B cells)
tocilizumab (IL-6)
secukinimab (IL-17)

34
Q

when is anti-TNF used?

A

RA
psoriatic arthritis
ankylosing spondylitis

35
Q

adverse of anti-TNF

A

risk of infection (TB)
malignancy (skin)
contradicted in pulmonary fibrosis and HF

36
Q

acute management of gout

A

colchicine (diarrhoea)
NSAIDs
steroids

37
Q

prophylaxis of gout

A

allopurinol (xanthine oxidase inhibitor reducing uric acid levels)
febuxostat (used in those who cannot tolerate allopurinol)
uricosurics

MSK 2.0 (10 decks)

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