Pharmacology

Question 1

What is pharmacodynamics?

Answer 1

How the drug affects the body

Question 2

What is pharmacokinetics?

Answer 2

How the body affects the drug

Question 3

What is first line anti-hypertensive in a patient who is under 55 or has diabetes?

Answer 3

ACE inhibitor

Question 4

What is your first line anti-hypertensive medication in a patient over 55 yrs old and of Black or Afro Caribbean descent?

Answer 4

CCB

Question 5

What is illness behaviour?

Answer 5

How an individual responds to illness. Highly variable

Question 6

Where are two places that opioids work?

Answer 6

Pre-synapses and 4th ventricle

Question 7

What are 3 ways that tolerances to opioids occur?

Answer 7

Increased metabolism of opioids

Downregulation of opiod receptors

Neuroplasticity of CNS target areas

Question 8

What fibres are involved in chronic pain?

Answer 8

Small unmyelinated C fibres

Question 9

Give an example of a drug that works on cytoplasmic receptors?

Answer 9

Steroids

Question 10

Give an example of a drug that works on nuclear receptors?

Answer 10

Thyroid receptor hormone

Oestrogen

Vit D

Vit A

Question 11

Describe the 4 Hypersensitivity reactions..

Answer 11

1. IgE mediated
2. Cytotoxic Reactions complement activation
3. Deposition of immune complexes
4. Delayed hypersensitivity i.e. T cell mediated so Steven Johnson syndrome

Question 12

Define the following different types of pain:

1. Nociceptive
2. Neuropathic
3. Nociplastic:

Answer 12

1. Nociceptive: Pain in response to actual or threatened damage
2. Neuropathic: pain causes by lesion or disease of the somatosensory nervous system.
3. Nociplastic: pain that arises from altered nociception despite having no actual threatened tissue damage.

Question 13

What is allodynia?

Answer 13

Pain due to a stimulus that doe not normally provoke a pain response.

Question 14

Describe the 4 parts of the pain pathway:

Answer 14

1. You cut yourself
2. Stimulate peripheral nociceptors and pain mediators
3. Travels to the dorsal ganglion to the ipslateral spinothalmic tract
4. Thalamus -> cerebrum (Broadman’s area 3,2,1)

Question 15

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

Answer 15

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

Question 16

Is pain transported via the dorsal or ventral ganglion?

Answer 16

Dorsal

Question 17

What is noticed in the insular cortex?

Answer 17

The degree of pain

Question 18

What is noticed in the cingulate cortex?

Answer 18

Emotional content that relates to pain

Question 19

What triggers the amygdala?

Answer 19

Emotions and stress

Question 20

Where is the descending inhibitory pathway found?

Answer 20

Peri aqueductal Grey area

Question 21

How can we treat pain? How does pain relief work?

Answer 21

Stimulates the descending inhibitory pathway.

Found in the periaqueductal grey area that releases noradrenaline and serotonin.

Question 22

What is a calculation that you can use to work out a

Males idea body weight IBW

Female IBW

Answer 22

Male: 0.9H -88

Female: 0.9H-92

Question 23

What is the % fluid intracellular vs extra cellular?

Answer 23

%intracellular 2/3rd

%extracellular: 1/3rd

Question 24

What are the following fluid requirements in these groups of people?

A. Adults

B. Children

C. Neonates

Answer 24

A. Adults 70mls/kg remember via the average 70kg male

B. Children 80mls/kg

C. Neonates 90mls/kg

Question 25

Describe what you would see in the following WHO dehydration criteria: No dehydration Some dehydration Severe dehydration

Answer 25

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

Question 26

What is normal urine output in an adult?

Answer 26

>0.5 ml/kg/hour

Question 27

What are the issues associated with having a full stomach when going to surgery?

Answer 27

Increased risk of Aspiration and thus aspiration pneumonia

Question 28

If a patient does have a full stomach. What anaesthetic method would you have to do to put them to sleep?

Answer 28

Rapid Sequence Induction

Question 29

What medications should be avoided pre operative?

Answer 29

1. ACE inhibitor 2. Aspirin, Clopidogrel, DOACs 3. NSAIDs 4. Metformin. 5. COCP

Question 30

What system does anaesthetic work on?

Answer 30

The reticulocytes activating system

Question 31

What are the two steps involved in anaesthetising a patient?

Answer 31

1. IV injection propofol to induce anaesthesia | 2. Continued inhalation with desflurane

Question 32

How do muscle relaxants work?

Answer 32

They have a short rapid onset They work by mimicking acetylcholine

Question 33

How can you reverse muscle relaxants?

Answer 33

By using an acetylcholinesterase like Sugammadex

Question 34

Give an example of a depolarising and a non depolarising muscle relaxant.

Answer 34

1. Depolarising: Suxmeathonium | 2. Non depolarising: Rocuronium this is a competitive inhibitor. No fasculations. takes a while to work.

Question 35

What is the sequence start to finish of putting someone to sleep under anaesthetics?

Answer 35

1. Oxygen 2. Propofol (anaesthetic) 3. Suxmeathonium (muscle relaxant) 4. Intubate and ventilate. Put cricoid pressure to obstruct the larynx 5. Keep under with: desflurane, morphine and muscle relaxant rocuronium. 6. Wake up using sugammadex

Question 36

Are inhaled medications hydrophilic or hydrophobic?

Answer 36

Hydrophobic