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Pharmacology > Pharmacology final - ALL > Flashcards

Pharmacology final - ALL Flashcards

1
Q

Parasympathetic receptors and NT?

A

Nicotinic - Muscarinic

Ach - Ach

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2
Q

Sympathetic receptors and NT

A

Nicotinic - Adrenergic

Ach - NE/Epi

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3
Q

Ach synthesized from?

Enzyme?

A

Coline + Acetyl-CoA

Choline-Acetyl transferase

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4
Q

Choline uptake into presynaptic cell inhibitor?

A

Hemicholinum

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5
Q

Inhibitor of Ach exocytosis in presynaptic nerve ending?

A

Botulinum toxin

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6
Q

Major termination of synaptic Ach?

A

Acetylcholine esterase enzyme breaks it down

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7
Q

Reversible indirect acting cholinomimetic drugs?

A

Edrophonium
Physostigmine
Neostigmine

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8
Q

Irreversible indirect acting cholinomimetic drugs?

A

Malathion

Parathone

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9
Q

Function of indirect acting cholinomimetic drugs?

A

Inhibit Ach esterase causing no breakdown of Ach in synapse

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10
Q

Result of:

  1. Presynaptic cholinomimetic stimulation
  2. Direct cholinomimetic stimulation
  3. Indirect cholinomimetic stimulation
A
  1. Increase Ach
  2. Direct receptor binding increasing effect
  3. Prolonging synaptic Ach by inhibiting break down
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11
Q

Presynaptic increase of Ach ?

A

4-aminopyridin - increase Choline uptake
Increased EC calcium
Alpha-Latrotoxin stimulates Ach release in absence of Ca (Widow spider venom)

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12
Q

Difference between Ach and Carbachols?

A

Carbachols have a NH3 instead of a CH3 group

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13
Q

Carbachol T 1/2 and choline esterase resistance?

A

very resistant

long acting

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14
Q

Neostigmine administration?

A

No GI absorption must be given IV

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15
Q

Inhibitor of Ach storage?

A

Vesamicol

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16
Q

Negativ feedback of Ach release?

A

Alpha-2 receptor binding of Ach or NE
Dopamin-2 receptor binding dopamin
Block AP in NMJ by Procaine so no release

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17
Q

AB that may inhibit Ach release?

A

Tetracyclines
Aminoglycosides
Especially in Myasthenia gravis

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18
Q

Myasthenia Gravis?

A

Ab against nicotinic receptors in the NMJ causing no activation

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19
Q

Treatment og Myasthenia Gravis?

A

The -stigmines causing increase Ach in synapse
Neostigmin
Pyridostigmine
physostigmine

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20
Q

Drug used in diagnosis of Myasthenia Gravis?

A

Edrophonium since it is very short acting and can test if the patient has relife when administered
(t1/2 is 15 min)

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21
Q

Anti-Ach esterase that can pass the BBB?

A

Physostigmine

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22
Q

Drug used in Atropin overdose?

A

Physostigmine

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23
Q

SE of Ach-esterase inhibitors?

A 
Just lis what would happen if we have an overstimulation of Ach (parasympathetic)
DUMBELL
Diarrhea 
Urination 
Miosis 
Bradycardia 
Bronchospasms 
Lacrimation 
Salivation
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24
Q

Why can increased Ach lead to flaccid paralysis?

A

Nicotinic overactivation leads to inhibition (Cholinergic toxicity) like insecticide poisoning

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25
significance of anti-muscarinic drugs on the heart?
Not really of significance unless bradycardia and AV block
26
Effect of Atropin in the CNS?
DOESE DEPENDENT 1. antiemetic 2. antianxiety 1-2mg 3. Dyskinesia and tremor 10mg 4. Rage and hallucinations 10mg 5. Convulsion 6. Coma death > 150mg
27
Effect of Ipratropium?
Inhaled causing bronchodilation. Not absorbed so only local action
28
What can you give in the case of severe bradycardia?
Atropin - block parasympathetic activation increasing heart rate
29
How can you acutely reverse a hear block in patients with depressed AV nodal conduction?
IV atropin
30
M3 muscarinic antagonists?
Ipratropium | Tiotropium
31
muscarinic receptor in the CNS and its antagonist?
M1 | Scopolamide
32
Procyclidine?
Anti-muscarinic agent used in Parkinson: decrease the excitatory activity of cholinergic neurons in the striatum
33
Cyclopentolate
Non-selective anti-muscarinic agent
34
Solifenacil
M3 antagonist used in bladder spasm
35
administration of epinephrin?
IV since it is metabolized in GI
36
Indication of Epinephrin?
Anaphylaxis Angioneurotic edema with local anesthesia to increase effect
37
Location of beta-1 adrenergic receptors?
Heart SA AV Purkinje Atrial and ventricular muscle Kidney
38
Location of Alpha-1 adrenergic receptors?
Almost everywhere
39
Location of alpha-2 adrenergic receptors?
``` Almost everywhere but this is an inhibitory receptor Brain Body Platelets Pancreas ```
40
Effect of Beta-2 adrenergic receptor on SM?
ALWAYS relaxation!! The increase in cAMP inhibits action of MLCK on the
41
how can you save the kidneys during shock?
Low dose dopamin causing vasodilation in the renal artery
42
selectivity of peripheral dopamin during low and moderate dose?
low: D1 in kidney moderate: B1 high loses B1 sensitivity
43
Dobutamine
B1 selective given in cardiogenic shock together with dopamin to save the kidney
44
Alpha-1 adrenergic receptors found in?
veins and arteries so both contract!
45
Alpha-1 receptors in the eye leads?
Pupillary muscle contraction results in pupillary DILATION (mydriasis)
46
NE affinity to adrenergic receptors?
Alpha > Beta
47
Epinephrin affinity to adrenergic receptors?
Beta >> Alpha unless very high doses
48
Adrenergic receptors in the Bronchi?
Beta-2
49
What's the function of an alpha-2 antagonist?
inhibits NE negative feedback resulting in increased NE release --> goes to heart causing tachycardia
50
can out body generate new alpha reseptors in an irreversible antagonist is used?
yes, it takes 48h
51
alpha receptor in prostate?
alpha-1 A
52
what is reflex tachycardia
If blood pressure decreases, the heart beats faster in an attempt to raise it - reflex tachycardia. Can happen in response to a decrease blood volume or change in blood flow
53
what is orthostatic hypertension
Also known as postural hyertension is a medical condition where a person's BP increase when standing up or sitting down.
54
First generation beta blockers are? Second generation beta blockers are? Third generation beta blockers are?
Non-selective Beta-1 selective Selective and non-selective
55
which beta blocker can cross the BBB and is therefore also used in?
Propranolol also used as a migraine prophylaxis
56
what is the difference between propranolol and pindolol on HR?
pindolol is a partial beta agonist and will not decrease heartrate as much as propranolol
57
drug used in paroxysmal supraventricular tachycardia?
esmolol since it i very short acting
58
are second generation beta blockers always beta-1 selective?
they become non-selective in high doses
59
betablockers used in glaucoma?
Timolol + Betaxolol
60
beta blockers used in stress?
Pindolol due to no severe bradycardia
61
contraindications of beta blockers?
AV block Bradycardia DM Asthma
62
indication of beta blockers?
``` hypertension angina pectoris supraventricular tachycardias CHF glaucoma migraine stress panic disorder tremor ```
63
beta-adrenergic receptor in the kidney?
Beta-1 causing renin release, we can block this in heart failure so no renin, no angiotensin, no aldosterone and no water retention
64
what can be given in B-blocker toxicity?
Glucagon
65
beta-bloker safe in pregnancy?
Labetolol
66
Dangerous side effect of atracurium
in high doses penetrates the BBB causing seizures, also causes histamin release (bronchoconstriction and decreased BP)
67
why is Cisatracurium a better choice than atracurium?
less side effects
68
Duration of succinylcholine?
short: 5-10 min due to degradation by plasma cholinesterase (only small amount reaches NMJ)
69
When would you use depolarizing vs non-depolarizing muscle relaxants?
Depolarizing used in ventilation control and convulsion | Non-depolarizing used in anesthesia
70
how can succinylcholine cause cardiac arrest?
It increases potassium (K) release into blood
71
how does atracurium cause seizures?
it leads to production of LAUDOSINE which is neurotoxic
72
what's the 4 things that happen in astma?
1. Bronchial hypersensitivity 2. Bronchospasms 3. Increased mucous secretion 4. Cellular infiltrate causing constriction 5. Edema
73
COPD?
chronic inflammation of the airways eventually leading to emphysema (bronchial narrowing and hyperinflated alveoli) increase Co2/decreased O2
74
other drugs used in asthma and COPD?
1. IgE ab (no binding to mast cells so no histamine) 2. Ca-channel blockers (no depolarization) 3. K-channel opener (hyperpolarization) 4. NO donors causing relaxation
75
steroid in urgent asthma?
Methylprednisolone IV | prednisone oral
76
inhalation asthma corticosteroids?
Fluticasone | Budesonide
77
Name 3 leukotrienes causing inflammation?
LTB4 neutrophil chemotaxis | LTC4 and LTD4 bronchoconstriction, hypersecretion and increased reactivity
78
Drug inhibiting LT pathway?
Montelukast 10mg/day
79
When should cough not be supressed?
if productive cough suppressing it leads to mucous plug
80
opioid and a non-opioid cough suppressor?
Opioid: Codeine Non-opioid: Butamirate (They give no analgesic effect)
81
In antitussive agen Codeine does not..:
No analgesia No euphoria No resp suppression No addictiveness
82
what is the function of expectorants?
remove mucous from bronchi
83
taking AB with acetylcystein you have to...
take them 2h apart since acetylcystein inhibit function of AB
84
What is the reason of claudication in peripheral vascular disease?
ischemia causes release of adenosine which is toxic to nerve eneding causing pain
85
Drugs increasing cerebral circulation? | Indication?
Vinpocetine Nicergoline Brain circulatory disease, Alzheimer and post-stroke
86
location of migrain center in brain?
Dorsal raphe nucleus, Locus coeruleus
87
cause of migraine?
NO induces inflammatory neuropeptide release: - CGRP Substance-P Neurokinin-A Causing meningeal vasodilation and neurogenic inflammation (sterile)
88
migraine prophylaxis?
propranolol carbamazepine verapamil Galcanzumab
89
bodies response to decreased CO ?
baroreceptors in aorta and carotid senses decreased P av induces NE release which bind to Beta-1 adrenergic receptors
90
Response of increase NE due to HF on kidney?
NE bind Beta-1 adrenergic reseptors in kidney inducing renine release
91
why is the bodies response to HF not good?
increased water retention further increases strain on heart -give diuretics
92
during which phase of HF should Beta blockers be given?
from first to third, not the last phase might cause decompensation. You should rather give beta agonists at this point
93
what does beta blockers do in the heart?
``` Decrease contractility Decrease conductivity (HR) ```
94
effect of ACEI?
inhibit angiotensin conversion and increase bradykinin causing vasodilation (ACE norm degrades brady)
95
K+ sparing diuretic?
Spironolacton
96
Sodium wasting loop diuretics?
Furosamide
97
first steps in AHF
1. evaluate hypotension and determine shock state 2. oxygen if SpO2 < 90 % 3. Secure IV access 4. continue monitoring BP, SpO2. ECG 5. Patient must sit in a 45 degree position
98
What is completely contraindicated in AHF?
Beta-blockers
99
why are digoxin and digitoxin good to usen in AHF?
they have a positive inotropic effect but negative chronotropic effect
100
Mechanism of the digitalis drugs
Na/k ATPase blockers causing decreased Na/Ca antiporters leading to Ca staying in the cell and contraction
101
Cardiac glycosides (digoxin and digitoxin) on the CNS?
they increase the vagal parasympathetic tone causing decreased atrial conduction hence decrease chronotropy
102
cardiac glycosides elimination?
digitoxin liver | digoxin kidney
103
relationship between K+ and cardiac glycosides?
K+ acts as an antagonist so be carefull if patient is on K+ wasting diuretic it will potentiate the drugs and if the patient is on spironolactone it will inhibit them
104
Class IA antiarrhythmic drug Quinidine effect on HR?
It's anti-muscarinic meaning it inhibits parasympathetic tone causing increased HR
105
how can we prevent Quinidine tachycardia?
Give Digitalis before Quinidine
106
Class IA antiarrhythmic drug quinidine on Alpha-adrenergic receptors?
It's an Alpha-blocker causing vasodilation and hypotension
107
relationship between K+ and Quinidine?
K+ potentiates Quinidine
108
Quinidine vs Digoxin on excretion
competes for excretion sites therefor may cause digitalis intoxication due to decreased excretion
109
Class IA antiarrhythmics: can we use Procainamide chronic?
No due to drug induced lupus
110
Class IA antiarrhythmics: procainamide effect of autonomous nervous system?
It serves as a ganglionic blocker causing decreased sympathetic tone hende hypotension
111
penthyon is an antiarrhythmic drug but also an..
Anti-epileptic drug
112
Class II antiarrhythmic drugs? (4) | PEMS
Propranolol Esmolol - negative chrono and dromo Metoprolol - sympatomimetic Sotalol - prolong AP
113
Class III antiarrhythmics? (2)
Amiodarone | Sotalol
114
Class IV antiarrhythmics?
Verapamil
115
Class IV antiarrhythmics verapamil function?
reduce plateau by inhibiting L-type Ca-Channel
116
Class V antiarrhythmic drug adenosine function?
Opens K+ causing hyperpolarization
117
Mg+ effect as an antiarrhythmic class V?
Antagonizes digitalis, used in hypokalemia
118
Hypertension?
> 140/90
119
causes of secondary HT?
1. renal artery stenosis 2. primary hyperaldosteronism 3. aortic corotation 4. cushings syndrom 5. pheochromocytoma
120
4 classes of HT treatment?
1. diuretics 2. sympatholytic 3. direct vasodilators 4. Angiotensin inhibitors
121
what type of Ca channel is blocked by CCB?
L-type
122
most common SE of CCB?
Edema since the effect is greater on areries then veins
123
CCB with a cardiac action?
Verapamil | Diltiazem
124
Why is ACEI good to use in ischemic heart patients?
because they dont have an effect on the heart or cause reflex tachycardia (like vasodilators)
125
why is ACEI good to use post MI?
inhibits remodeling
126
why is ACEI good to use in diabetic nephropathy?
they reduce the efferent arteriole resistance lowering intraglomerular P and thereby reduce proteinuria
127
why should you not give ACEI to renal stenosis patients?
Because the HT keep the kidneys going, if you decrease blood flow then you stop renal perfusion
128
effect of ARB?
Decreased aldosterone so Na+ loss K+ retention vasodilation
129
how long does it take for ARB's to fully function?
6 weeks
130
how much occlution to get stable angina pectoris?
>70%
131
what is the bad Cholesterol and why?
LDL because it adheres to the vascular wall causing AS. Oxiation of LDL also causes an inflammatory response
132
why do we want HDL>LDL?
HDL removes LDL causing less AS
133
what is elevated in hypercholesteremia?
LDL
134
what can cause LDL clearance defect?
Apo-B defect | Low LDL receptors
135
Cause of type I hyperlipidemia?
Hyperchylomicronemia Hypertriglyceridemia Decreased clearance og Chy and VLDL APO-CII deficiency and Lipoprotein lipase deficiency
136
Cause of type II hyperlipidemia?
increased LDL
137
Cause of type III hyperlipidemia?
Dys-beta-lipoproteinemia | Accumulation of Beta-VLDL due to defect Apo-E decreasing clearance
138
Cause of type IV hyperlipidemia?
Increased TG due to increase VLDL | Very common and due to obesity and insulin restance
139
Why is thiazide a weak diuretic?
Because it works at the distal tubule and by this time almost all sodium is already absorbed
140
Spironolactone and eplerenones SE?
Gynecomastia Metabolic acidosis Hyperkalemia
141
diuretics in cerebral edema?
Mannitol | Glycerol
142
H1 receptor in lung and GI causes?
1. Vasodilation 2. Increased permeability 3. Edema 4. SM contraction
143
which non-histamin receptors do histamin also bind to?
Cholinergic, seretonin and Alpha-adrenergic receptors giving an agonistic effect
144
main difference between 1st generation and 2nd generation antihistamins?
1st generation penetrates the BBB causing sedation and decreased cognitive function
145
which antibiotic should you not give antihistamins with?
Macrolides in legionella
146
Where do we have opioid receptors?
CNS area related to pain GI Adrenal medulla
147
Endogenous opioids?
Endorphins Enkephalins Dynorphins
148
opioid receptor related to GI motility?
Kappa
149
natural opioird?
Morphine | Codeine
150
which opioides does not cause addiction?
Methadon | codein
151
alcohol with opioids causes?
serum peak concentration increases
152
opioid with muscarinic effect?
miperidine
153
opioid with NO CNS effect?
Loperamide
154
opioid used in withdrawal after addiction
Methadone | Buprenorphine
155
spinal analgesia opioid?
Nalbuphine
156
General opioid SE
1. Sedation 2. biliary colic 3. opioid induced hyperalgesia (increased nociception) 4. Pseudo-allergy (Mast cell release without IgE) 5. Constipation
157
management of aspirin overdose?
Gastric lavage activated charcoal ventilation support acid base managment
158
when can you give aspirin to children?
Kawasaki vasculitis
159
function of anti-gout medications?
1. Decreased LTB4 - decreased migration of leukocytes and granulocytes 2. decrease purin synthesis - decreased uric acid 3. Urate oxidase enzyme - removes Uric acid
160
NSAID effect on kidney?
Inhibit COX1 causing no PGE which normally dilates renal artery, decreased renal blood flow now activates RAAS causing hypertension.
161
should you take non-selective NSAIDS with aspirin?
NO, they compete with aspirin in binding to COX- 1 interfering with aspirins antiplatelet function
162
should you use aspirin in gout?
NO, it competes with uric acid in secretion so can further worsen hyperuricemia
163
Antibody nomenclature?
UMAB is human XIMAB is mixed ZUMAB - non-human but humanized
164
What are the 4 big groups of heart failure medications?
1. Diuretics 2. ACEI/ARB's 3. Direct vasodilators 4. Sympatolytics
165
what are the two classes of CCB?
Dihydropyridines (end with -dipin) | Non-dihydropyridines
166
which class of CCB have the greater effect on SM and which on the heart?
Non-dihydropyridines more on the heart | Dihydropyridines more on smooth muscle
167
Most rapid local anesthetic?
Articaine
168
Lidocaine SE
``` hypotension vasodilation excitation arrhythmia seizures ```
169
Cocaine SE
hypertension arrhythmias seizure coronary vasospasms
170
Indirect acting sympathomimetics?
Ephedrine Amphetamine Thymidine
171
Direct Alpha-1 agonist
Phenylephrine (direct Alpha-1)
172
ions enhancing or decreasing effect of local anesthetics?
IC K increases effect | EC Ca decreases effect
173
Bupivacaine SE
CV collapse | CNS toxicity
174
inhaled corticosteroids?
Fluticasone | Budesonide
175
cream corticosteroids?
fluocinolone | Mometasone
176
drug used to test adrenal function?
Metyrapone is used and it blocks cortisol synthesis
177
effect of mineralocorticoid and what is the drug?
Fludrocortisone Increased Na+ Decreased K+ and H+ overall increase in BP and increase in pH
178
three results of increased angiotensin?
ADH secretion Aldosterone secretion Vasoconstriction
179
fludrocortisone antagonist?
Spironolacton
180
locations of androgen synthesis?
ovary male testis adrenal cortex
181
why give testosterone?
``` Hypogonadism Hormone replacement Wasting syndrom for weight gain RBC production on some anemias Anabolic steroid misuse ```
182
function of finasteride and bicalutamide?
It is an anti-testosteron as it inhibits 5a-reductase conversion of testosteron to DHT in tissue
183
Goserelin and Degarelix function?
Goserelin: GnRH Agonist | Degarelix GnRH antagonist
184
Androgen sideeffect?
Remember that in males it causes feminization due to feedback mechanism Hepatocellular carcinoma Jaundice Elevated liver enzymes
185
Diuretics with anti-androgen properties?
Spironolactone is also a androgen receptor antagonist
186
when would you use and androgen antagonist and which one?
precocious puberty use Gosereli bec. of negative feedback
187
what is the function of sildenafil? when can we use it?
Phosphodiesterase 5 inhibitor causing no cGMP to GTP so increased cGMP and relaxations - vasodilation. Used in erectile dysfunction and pulmonary HT
188
why would we give estrogen replacement?
``` Post-menopausal replacement hypogonadism contraception dysmenorrhea uterine bleeding Acne ```
189
function of anastrazole?
Aromatase inhibitor
190
SERMS functions?
Tamoxifen (xbreast, +bone, +endopetrium) Raloxifene (xbeast, +bones, no endometrium) Clomiphene ( CNS antagonist causing no neg. feedback increasing FSH and LH)
191
drug having a full antiestrogenic effect in all tissues?
Fulvistrant
192
contraindications of estrogen?
History of thromboembolism Estrogen dependent neoplasm Serve liver disease
193
anti-progesterons?
Mifepristone | Ulipristal
194
causes of hypothyroidism?
``` Hashimoto Congenital Drug induced iodine deficiency Malignancy ```
195
halv life of levothyroxine?
7 days
196
what are the thee ways we can treat hyperthyroidism?
1. surgery 2. Interfere with hormone synthesis 3. Modify tissue receptors
197
function of propylthiouracil and thiamazole?
inhibit TOP causing to hormone synthesis | Also inhibit T4-T3 in tisse
198
when dues anti-thyroid drugs start to work?
takes 3 weeks because stored hormones must be used up first
199
when do we use radioactive iodine?
hyperthyroidism Ir causes destruction of gland
200
what other drugs should you give in hyperthyroidism?
beta blockers
201
GH agonist?
somatostatin SC injection
202
GH antagonist?
octreotide
203
Prolactin antagonist?
Bromcriptine binding to D2 receptor
204
Bromocriptine SE?
GI Postural HT CNS
205
Desmopressin mechanism?
Antidiuretic replacement therapy in the management of central diabetes insipidus Treatment of nocturia Used to prepare patients with mild hemophilia or von-Willebrand disease for elective surgery
206
why is desmopressin used in hemophilia A and VW disease?
Stimulate release of VW factor and factor VIII from endothelial cells
207
daily requirement of iodine?
150 ug
208
octreotide SE?
GI Steatorrhea Gallstone Cardiac Conduction abnormalities
209
rapid acting injected insulin?
Glulasin Aspart Lisprio
210
injected moderate acting insulin?
NPH insulin | Regular insulin
211
Long-acting injected insulin?
Detamer | Glargin
212
how long does Glargin insulin last?
24h
213
Dietary insulin release?
GLP and GIP already in the oral cavity so increase release
214
what is the difference between endo and exogenous insulin distribution concentration?
endogenous goes through the portal circulation where 50% is removed, exogenous is 100% what you administer
215
insulin requirements for an average person/day
30-80 U/day
216
what are the two types of insulin secretions?
1. Post prandial | 2. Basal
217
insulin administration types?
1. Sliding scale (used in very unstable patients at hospital) 2. Basal + bolus (most used method for IDDM)
218
how does sulfonylureas cause insulin secretion?
They bind potassium channels closing them causing depolarization
219
how does meglitinides cause insulin secretion?
They bind potassium channels closing them causing depolarization
220
what is very dangerous with meglitinides and sulfonylureas?
they cause insulin secretion independentof glucose level and can quickly couse severe hypoglycemia
221
Function of Liraglutide?
GLP-1 analogue (glucagon like peptide. It decreases glucagon release and gastric emptying and increases insulin release and satiety
222
Function of vildagliptin?
inhibit DPP-4 degrading of GLP-1 causing increased serum level of GLP-1
223
Acarbose function?
Inhibit Alpha-cells in Gi causing decreased glucose absorption
224
PTH function?
Increase Ca Decrease Pi Stimulate kidney to produce calcitriol
225
what is the active form of vitamin D and where is it synthesized?
Calcitriol synthesized in the kidney
226
what does vit D do?
Increase Ca2+ AND Pi absorption from GI
227
can you give cholecalciferol in vitamin D deficiency if the patient has liver failure or renal failure?
No, cholecalciferol mist be turned into calcitriol in the kidney to function
228
estrogen effect on bone?
bindes estrogen R on bone inhibiting RANK -L secretion and no activation of osteoclasts
229
DEXA scan t-score for osteoporosis?
< -2.5
230
action of bisphosphonates?
inhibit mevalonic acid pathway causing OC inhibition
231
SE of zolendronates taken IV?
osteonecrosis of the jaw
232
common SE with aspirin?
Peptic ulcers
233
Aspirins antiplatelet mechanism?
inhibit COX so no PGE and TxA2 so no platelet aggregation and activation
234
antiplatelet drug in acute coronary syndrom and PCI? | administration?
Abciximab binding to GP IIb/IIIa receptors | Must be given IV due to very short half-life (30 min)
235
when do we use Clopidogrel, Prasugrel and ticagrelor?
Transient ischemic attack Stroke Unstable angina Stent implantation
236
mechanism of heparin?
Bind fX and AT-III inhibiting thrombin formation
237
difference between HMWH and LMWH?
It's the tail that bind to AT-III and in LMWH there is a short tail so cannot bind AT-III just fX
238
Heparin tail is made up of?
Glycosaminoglycans
239
LMVH?
Daltaperin | Fondaparinux ( has no tail)
240
Clotting times normally and with heparin? when is it to long?
normal: 30-40s Heparin: 50-90s Too long: > 100s
241
Heparin SE?
prolonged bleeding Thrombocytopenia Osteoporosis
242
clotting time measured if heparin is given?
activated Partial Thromboplastin Time (aPTT)
243
what clotting factors are inhibited by warfarin?
remember the year 1972 10 9 7 2
244
how do we measure prothrombin time? and what are th values?
as standardized INR which should be: Normal: <1.1 w/warfarin: 2-3
245
Does Protamin work as an antidote for LMWH?
No, only UFH
246
Function of filgrastim in anemia?
Stimulate G-CSF receptors | Granulocyte colony stimulating factor
247
what can we see an increase of in the blood if iron deficiency anemia?
Transferrin in increased in serum and apoferritin which stores iron is decreased
248
chronic iron overload can lead to...
hemochromatosis causing damage on the heart, liver and pancreas
249
acute iron overdose can cause...
``` necrotizing gastritis abdominal pain constipation/diarrhea lethargy dyspnea ```
250
how is B12 absorbed?
binds IF secreted by the stomach and absorbed in ileum
251
anemia caused by B12 deficiency?
Megaloblastic anemia
252
where is folic acid absorbed?
Proximal Jejunum
253
anemia in folic acid deficiency?
megaloblastic anemia
254
what can folate deficiency cause in embryos?
neural tube defects
255
What does blood gass partition coefficient meand in regards to inhaled anesthetics?
Refers to solubility of the drug | The higher GPC the more soluble
256
What is the relationship between function and solubility of inhaled anesthetics?
High solubility = delayed onset | Low solubility = rapid onset
257
what is minimal alveolar concentration (MAC) referred to in inhaled anesthetics?
dose of anesthetic causing 50% of patients to become non-responders to pain
258
inhaled anesthetics effect on respiration?
respiratory depressors
259
non solubel inhaled anesthetics?
N20
260
Soluble anesthetics (several desiliters of ice)
Isoflurane Desflurane Sevoflurane
261
why does the soluble inhaled anesthetics have a slow onset?
they bind blood proteins so we must wait for saturation before they give effect which takes more time then the non-soluble
262
Ultra-short acting anesthesia?
Thiopental - surgical anesthesia within 1 min
263
which IV anesthesia should be used in CV patients?
etomidate
264
which IV anesthesia produces a dissociative state?
Ketamines, they are awake but has amnesia
265
which IV anesthesia must have an antidote due to PO respiratory depression?
Midazolam - have Flumazenil ready!!
266
which IV anesthesia should be used in head trauma eith increased IC pressure?
Thiopental
267
which IV anesthesia should not be used in asthma patients?
Thiopental causes bronchoconstriction due to histamin release
268
dose dependent effect of benzo's?
Low: sedation, anxiolytics Moderate: hyposis High: Anesthesia
269
What are the non-Benzo normally used to treat? except one of them..
Sleep disorders mostly, except Buspirone which is a serotonin agonist used in general anxiety
270
Ramelteon bindes to which receptor?
Melatonin (MT) receptors
271
function of the 5-HT1a receptor?
regulates sleep, feeding and anxiety
272
NT causing depression?
decrease in the NT serotonin, dopamin and NE
273
Indications for SSRI?
Depression to increase seretonine and remove symptomes of depression
274
seretonin syndrom?
Muscle rigidity Hyperthermia CV instability Seizures
275
SE of Ramelteon?
Testosterone depression and increased prolactine
276
5 fluorouracil specific SE?
Cardiotoxicity | Hand foot syndrom
277
5 fluorouracil indication?
COLORECTAL first line!!! | breast cancer in combination
278
chemo Cytarabine specific SE?
Liver dysfunction
279
Indication for chemo Cytarabine?
NON SOLIDS!! Leukemia (AML, ALL) Lymphoma (non-Hoskin)
280
Drug interaction between Allopurinol and 6 Mercaptopurine?
6 MP is metabolized by xanthine oxidase but this enzyme is inhibited by Allopurinol, which is often given to cancer patients due to high risk of tumor lysis syndrom in order to prevent gout. BE carefull with 6MP dose when allopurinol is also administered
281
6 mercaptopurine indication?
Acute lymphoblastic leukemia (ALL)
282
Severe SE of cyclophosphamides?
1. The toxic metabolite Acrolein causing hemorrhagic cystitis 2. Pulmonary fibrosis
283
difference between barbiturates and benzos?
Barbiturates bind GABA receptors even if there is no GABA NT
284
which Benzo's can you use if liver failure? | drink a LOT
Temazepam Oxazepam Lorazepam Can be used due to glucoronidation as metablism not in the liver
285
Why is SNRI and SSRI the first line choice in depression?
no cholinergic and adrenergic SE
286
Seizure types in epilepsy?
Tonic: freeze clonic: contract tonic-clonic freeze then contract Absence: loose conciseness for some time
287
status epilepticus?
seizures > 5 min
288
which enzyme is inhibited by vigabatrin?
GABA transaminase
289
cause of Parkinson and symptoms?
``` Loss of dopamine Bradykinesia (slow) Hypokinesia (loss of range) Dyskinesia (involuntary movement) rigidity No loss of strength ```
290
what is a tocolytic agent? | give 4 drugs?
``` used to delay labor Atosiban Terbulatine Mg Ethanol ```
291
what are the three areas affecting the vomiting center?
Vestibular Pain via GI Chemoreceptor trigger zone
292
receptor in the vomiting pathway?
Muscarinic 1 receptor
293
receptors antagonizing the vomiting center?
5-HT 3 D2 M1 NK1
294
How can blocking D2 receptors provide a pro-kinetic effect in the GI?
D2 activation inhibit cholinergic response, and by removing this we increase the cholinergic response
295
Irritant and stimulant laxatives?
Sennosides (irritates) | Bisacodyl (stimulant)
296
bulkforming laxative?
Plant fibers
297
osmotic laxatives?
MgSO | Lactulose
298
Lubricant laxatives?
Parafin oil
299
definition of constipation?
less then 3 stools a week
300
treatment of constipation?
Follow this in order: 1. first change lifestyle 2. then try osmotic laxatives 3. if not then use stimulant laxatives
301
Two drugs used in diarrhea?
Diphenoxylate Loperamide Synthetic opioids binding to u-receptor inhibiting Ach release
302
what is the function of imidazole receptors?
I1 is involved in inhibition of the sympathetic nervous system to lower blood pressure without binding to an alpha receptor
303
which of the alpha 1 receptor blocker does not cause reflex tachycardia?
Urapidil sice it has CNS effect
304
selective alpha 2 blocker?
Mirtazapine used in depression
305
Non-selective B-blockers?
Propranolol Pindolol Sotalol Timolol
306
B1 selective B-blockers?
``` BIEAM Bisprolol Esmolol atenolol Metoprolol ```
307
what the problem with high doese B1 selective b-blockers?
they become non-selective

Pharmacology (3 decks)

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