Pharmacology Flashcards
What is pharmacodynamics?
How the drug affects the body
What is pharmacokinetics?
How the body affects the drug
What is first line anti-hypertensive in a patient who is under 55 or has diabetes?
ACE inhibitor
What is your first line anti-hypertensive medication in a patient over 55 yrs old and of Black or Afro Caribbean descent?
CCB
What is illness behaviour?
How an individual responds to illness. Highly variable
Where are two places that opioids work?
Pre-synapses and 4th ventricle
What are 3 ways that tolerances to opioids occur?
Increased metabolism of opioids
Downregulation of opiod receptors
Neuroplasticity of CNS target areas
What fibres are involved in chronic pain?
Small unmyelinated C fibres
Give an example of a drug that works on cytoplasmic receptors?
Steroids
Give an example of a drug that works on nuclear receptors?
Thyroid receptor hormone
Oestrogen
Vit D
Vit A
Describe the 4 Hypersensitivity reactions..
- IgE mediated
- Cytotoxic Reactions complement activation
- Deposition of immune complexes
- Delayed hypersensitivity i.e. T cell mediated so Steven Johnson syndrome
Define the following different types of pain:
- Nociceptive
- Neuropathic
- Nociplastic:
- Nociceptive: Pain in response to actual or threatened damage
- Neuropathic: pain causes by lesion or disease of the somatosensory nervous system.
- Nociplastic: pain that arises from altered nociception despite having no actual threatened tissue damage.
What is allodynia?
Pain due to a stimulus that doe not normally provoke a pain response.
Describe the 4 parts of the pain pathway:
- You cut yourself
- Stimulate peripheral nociceptors and pain mediators
- Travels to the dorsal ganglion to the ipslateral spinothalmic tract
- Thalamus -> cerebrum (Broadman’s area 3,2,1)
Describe what type of pain travels along the following also if they are myelinated or unmyelinated:
Large C fibres
A delta fibres
A beta fibres
A alpha fibres
Large C fibres: unmyelinated and things travel slowly. Transport mechanical, chemical and thermal pain.
A alpha fibres : myelinated transport proprioception
A beta fibres: myelinated and transport touch
A delta fibres: myelinated and transport mechanical and thermal pain
Is pain transported via the dorsal or ventral ganglion?
Dorsal
What is noticed in the insular cortex?
The degree of pain
What is noticed in the cingulate cortex?
Emotional content that relates to pain
What triggers the amygdala?
Emotions and stress
Where is the descending inhibitory pathway found?
Peri aqueductal Grey area
How can we treat pain? How does pain relief work?
Stimulates the descending inhibitory pathway.
Found in the periaqueductal grey area that releases noradrenaline and serotonin.
What is a calculation that you can use to work out a
Males idea body weight IBW
Female IBW
Male: 0.9H -88
Female: 0.9H-92
What is the % fluid intracellular vs extra cellular?
%intracellular 2/3rd
%extracellular: 1/3rd
What are the following fluid requirements in these groups of people?
A. Adults
B. Children
C. Neonates
A. Adults 70mls/kg remember via the average 70kg male
B. Children 80mls/kg
C. Neonates 90mls/kg
Describe what you would see in the following WHO dehydration criteria:
No dehydration
Some dehydration
Severe dehydration
No dehydration: not enough signs
Some dehydration: restless, irritable, sunken eyes, thirsty, eager drinker, slight reduced skin turgur
Severe dehydration: lethargy, sunken eyes, unable to drink, significant skin pinch
What is normal urine output in an adult?
> 0.5 ml/kg/hour
What are the issues associated with having a full stomach when going to surgery?
Increased risk of Aspiration and thus aspiration pneumonia
If a patient does have a full stomach. What anaesthetic method would you have to do to put them to sleep?
Rapid Sequence Induction
What medications should be avoided pre operative?
- ACE inhibitor
- Aspirin, Clopidogrel, DOACs
- NSAIDs
- Metformin.
- COCP
What system does anaesthetic work on?
The reticulocytes activating system
What are the two steps involved in anaesthetising a patient?
- IV injection propofol to induce anaesthesia
2. Continued inhalation with desflurane
How do muscle relaxants work?
They have a short rapid onset
They work by mimicking acetylcholine
How can you reverse muscle relaxants?
By using an acetylcholinesterase like Sugammadex
Give an example of a depolarising and a non depolarising muscle relaxant.
- Depolarising: Suxmeathonium
2. Non depolarising: Rocuronium this is a competitive inhibitor. No fasculations. takes a while to work.
What is the sequence start to finish of putting someone to sleep under anaesthetics?
- Oxygen
- Propofol (anaesthetic)
- Suxmeathonium (muscle relaxant)
- Intubate and ventilate. Put cricoid pressure to obstruct the larynx
- Keep under with: desflurane, morphine and muscle relaxant rocuronium.
- Wake up using sugammadex
Are inhaled medications hydrophilic or hydrophobic?
Hydrophobic
