Pharmacology Synopses 3 Flashcards
can’t make hemoglobin chain, anemia, kidney makes excess EPO
iron overload
causes hematopoiesis in liver, skull and spleen, requires chelating
excess EPO
effective at binding Fe, but short half-life, requires pump
deferoxamine
genetic disease that increases Cu, causing abd pain, vomiting, convulsions, diarrhea
Wilson’s, treat with penicillamine
Mad hatter (paranoia, renal tox), Methyl, Minimata disease
inorganic mercury
what causes rebound after lead chelating?
lead stored in bone
most toxic arsenic metabolite
methylarsonous
universal methylator, needs folate to function
SAM
less toxic arsenic, renallly excreted
DMA
more folate means more methylation, means
more renal elimination, less blood arsenic
arsonous is ____, arsonic is ____
poisonous, picnic
causes skin lesions, blackfoot
arsenic toxicity
can lead penetrate blood-brain barrier?
yes
bioavailability of ingested lead
10.00%
increases Pb bioavailability by upregulating nonselective divalent metal transporter DMT
iron deficiency
toxic effects: encephalopathy, seizures, learning disabilities, chronic kidney disease
lead
organic source of Hg
Top-level predatory fish
Can Hg levels in mother effect fetus?
yes
asymptomatic mothers, physically deformed/mentally handicapped children, extremity sensory disturbance, hearing impairment, vision
methyl mercury (fetal transmission)
methyl mercury stays in
hair
found in drinking water, non-toxic version in fish
arsenic
heavy metal that causes cancers, stroke, neuropathy, MI
arsenic
lessened by selenium and folate in diet
arsenic toxicity
20 year epigenetics due to fetal transmission
arsenic toxicity
two null alleles, no enzyme for metabolizing omeprazole, a pump inhibitor. Less drug required to treat ulcers
CYP2C1923
CYP2C1923 occurs in 13-20% of
Asians
more than 2 alleles, increased metabolic activity requires higher doses of some drugs
CYP2D6*2xN
CYP2D6*2xN occurs in 30% of
Ethiopians/Saudis
deletion that effects nicotine metabolism
CYP2A6del
CYP2A6del occurs in 15% of
Asians
Warfarin, Atomoxitine, 6MP/azathioprine, Tamoxifen, Abacavir
genetic testing suggested
magnitude and effect of DDI is greater in
extensive and ultrarapid metabolizers: more enzyme to inhibit
omeprazol has ____ DDIs in Caucasians than in Asians
greater
not stored, synthesized as needed
eicosanoids
housekeeping, found in platelets
COX1
inducible by inflammation, found in endothelial cells
COX2
generated by endothelial cells, dilation, anti-platelet, GI protective
prostacyclin (PGI2)
generated in platelets, causes clotting, constriction
thromboxane (TXA2)
dilation, GI protection, inhibits inflammation, causes fever and pain
prostaglandin (PGE2)
PGE2 binds to EP3 to
cause fever
cytosolic enzymes that insert molecular oxygen into fatty acid backbone
lipoxygenase
converts arachidonic acid into LTA4 to initiate synthesis of leukotrienes
5-lipoxygenase
vasoconstrictors that activate neutrophils, inflammation, edema and asthma
leukotrienes
found in neutrophils, causes them to stick and migrate into tissues
LTB4
inhibit COX, inhibiting prostaglandins, prostacyclins, and thromboxane
NSAIDS
inhibiting prostaglandins (and capillary permeability, infiltration of leukocytes)
Anti-inflammatory
inhibiting PGE2 synthesis
Anti-pyretic
inhibiting PGs sensation effects inside and outside of CNS
Analgesic
PG inhibitition in gut prevents
EP3 activation, causes GI bleeding
PG inhibition in the kidney prevents
normal blood flow, causes acute kidney injury
associated with polyps and eosinophils, generation of leukotrienes, can cause anaphylaxis
aspirin sensitivity
what if a patient wants analgesics and anti-platelet effects?
aspirin before NSAID, or aspirin + acetominophen
rhinitis, edema, bronchial asthma, urticaria, anaphylaxis
histamine effects in immune response
exocytose histamine in response to IgE, through Ca mechanism
mast cells and basophils
in response to gastrin and vagal stimulation, histamine is release and
stimulates H+ secretion by parietal cells in the gastric epithelium
stimulates wakefulness in the hypothalamus and pain/itch at peripheral nerve endings
histamine in central and peripheral neurons
common target for antihistamines, involved in most systemic effects
H1
stimulates gastric secretion from parietal cells
H2
within the nervous system
H3
all histamine receptors are
G-protein coupled
H1 & H2 effects on vaso, BP
dilation, lower BP
H1 effects on capillary permeability
increase, leading to edema
H1 effects on bronchii and bronchial secretion
constriction and increased secretion, leading to bronchial asthma
H1 effects on cutaneous nerve endings
increase itch and pain sensation
H2 effect on parietal cells
stimulate H+ secretion by parietal cells
H1 effect in hypothalamus
increase wakefulness
H1 & H2 effects on HR and cardiac arrhythmias (at high concentrations)
increase HR and cardiac arrhythmias
H1 receptor antagonists are actually reverse agonists because
they stabilize the inactive form of the receptor
difference between first and second generation H1 antagonists
second can’t cross BBB, no CNS effects