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NMF: acute care > Pharmacology > Flashcards

Pharmacology Flashcards

1
Q

What do NSAIDs do?

A

block COX-1 or 2 which are enzymes that form prostaglandins. prostaglandins are pro-inflammatory lipids that can lead to clotting, fever and pain

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2
Q

What is the difference between COX 1 and 2?

A

COX2 is just inflammatory but COX1 has a role in stomach lining, platelet formation and kidney function

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3
Q

How does aspirin stop clotting?

A

stops production of a prostaglandin called thromboxane A2 which activates platelets to initiate blood clotting

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4
Q

How does aspirin cause gastric bleeds?

A

it decreases production of protective mucus in the stomach so the acid can burn through stomach causing ulcers and bleeds

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5
Q

How can aspirin affect asthma?

A

when cyclooxygenase is blocked there are more fatty acids available to the leukotriene pathway which cause narrowing airways and increased mucus

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6
Q

What can aspirin cause in babies and children?

A

Reye’s syndrome

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7
Q

What does an agonist do?

A

binds to the receptor and produces an effect within a cell

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8
Q

What does an antagonist do?

A

binds to receptor to block the effect of the natural agonist that binds to it

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9
Q

What is the difference between noradrenaline and adrenaline?

A

noradrenaline is the major neurotransmitter used by the sympathetic nervous system

adrenaline is a hormone released by the adrenal glands in response to metabolic changes

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10
Q

How do general anaesthetics work?

A

they enhance GABA A receptor activity through a site distinct from the benzodiazepine binding sites

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11
Q

What is the choice of IV GA?

A

propofol

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12
Q

What is the choice of inhaled GA?

A

sevoflurane

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13
Q

How do local anaesthetics work?

A

they prevent action potential propagation in neurones so that painful impulses are not conducted to higher centres

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14
Q

What can systemic deliverance of local anaesthetic cause?

A

cardiovascular collapse

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15
Q

What is the prototypical local anaesthetic?

A

lidocaine

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16
Q

What are benzodiazepines used for?

A

sedation and anxiolysis

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17
Q

How do benzodiazepines work?

A

bind to and enhance the activity of GABA A receptors which open Cl- channels causing hyperpolarisation which makes it less likely for the neurone to fire an AP

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18
Q

What reverses the action of benzodiazepines? what is it?

A

flumazenil: competitive antagonist

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19
Q

Which benzodiazepine is mainly used for anxiolysis?

A

temazepam

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20
Q

Which benzodiazepine is mainly used for sedation and amnesia?

A

midazolam

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21
Q

How does morphine work?

A

it binds to the mu opiod receptor and stimulates dopamine release in the reward pathway

22
Q

What reverses the action of morphine? what is it?

A

naloxone

competitive antagonist

23
Q

How can morphine cause nausea and vomiting?

A

causes mast cell degranulation leading to histamine release

24
Q 
How does the anti-emetic 
a) cyclizine
b) ondansetron
c) dexamethazone
d) metoclopramide
work?
A

a) H1 receptor antagonist
b) 5HT3 receptor antagonist
c) steroid
d) D2 receptor antagonist

25
Q

What are the two types of muscle relaxants?

A

non-depolarising

depolarising

26
Q

How do non-depolarising muscle relaxants work?

A

they are competitive antagonists of ACh at the neuromuscular junction

27
Q

Give an example of a non-depolarising muscle relaxant

A

rocuronium

28
Q

How can non-depolarising muscle relaxants’ action be reversed?

A

anticholinesterases eg. neostigmine

29
Q

How do depolarising muscle relaxants work?

A

partial agonist for ACh causing an inital fasciculation the paralysis

30
Q

Name the depolarising muscle relaxant

A

suxamethonium

31
Q

Why would suxamethonium be used over rocuronium?

A

it has a rapid onset which can be used for rapid sequence induction

32
Q

What gastric acid inhibitors are used before surgery?

A

ranitidine which is a H2 receptor antagonist

proton pump inhibitors eg. omeprazole, lansoprazole

33
Q

What is warfarin?

A

a synthetic coumarin derivative which inhibits the synthesis of the vitamin K dependent clotting factors in the liver

34
Q

What are the vitamin K dependent clotting factors?

A

II
VII
IX
X

35
Q

How can warfarin be reversed?

A

immediately: fresh frozen plasma

12 hours: vitamin K

36
Q

What
a) potentiates
b) inhibits
warfarin activity?

A

a) antibiotics

b) barbituates, oral contraceptives, carbamazepine

37
Q

How do ACEi work?

A

they inhibit the conversion of angiotensin I to angiotensin II by angiotensin converting enzyme

38
Q

What are ACEi used for?

A

treatment of hypertension
all grades of heart failure
prophylaxis after MI

39
Q

What needs to be checked before using ACEi?

A

renal function

may cause increase in potassium

40
Q

What should not be used with ACEi?

A

potassium sparing diuretics

41
Q

What is salbutamol?

A

a relatively selective beta adrenoceptor agonist which is used as a bronchodilator in reversible obstructive airway disease

42
Q

Which beta adrenoceptor does salbutamol have more of a pronounced effect on?

A

beta-2

43
Q

What are the side effects of salbutamol?

A

tachycardia
tremor
anxiety
hypokalaemia

44
Q

What is atenolol?

A

a relatively cardioselective beta 1 receptor antagonist

45
Q

What are beta 1 receptor antagonists used for?

A

treating angina, MI, arrhythmia, heart failure

46
Q

What happens if a non-selective beta blocker is used in an asthmatic patient?

A

bronchoconstriction

47
Q

Why should beta 2 adrenoceptors be used with cause in insulin-dependent diabetics?

A

beta 2 adrenoceptors stimulate hepatic glycogen breakdown and pancreatic release of glucagon increasing plasma glucose

so, blocking them lowers plasma glucose

48
Q

What effect do beta blockers have on the heart?

A

negative chronotropic and inotropic effect on the heart

49
Q

What is a negative chronotropic effect?

A

reduce heart rate

50
Q

What is a negative inotropic effect?

A

reduce myocardial contractility

51
Q

How does insulin work?

A

it binds to and activates a membrane bound tyrosine kinase receptor and increases the rate of glucose uptake in to cells

52
Q

What is metformin?

A

a biguanide oral hypoglycaemic

NMF: acute care (6 decks)

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