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MBBS - Year 1 > Physiology - Pharmacology and Patient Safety > Flashcards

Physiology - Pharmacology and Patient Safety Flashcards

1
Q

Facts about nicotine

A

Naturally occurring plant alkaloid
Found primarily in solanasceous plants
Principal source was tobacco and replacement therapy
Pure nicotine is a clear liquid w/ characteristic odour, turns brown on exposure to air

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2
Q

Absorption of nicotine

A

Nicotine is a wek base (pKa = 8.0)

Absorption through mucous membrane is pH dependent and increases as pH increases

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3
Q

Where can nicotine be absorbed through

A 
Oral cavity (absorption poor)
Skin 
Lung 
Urinary bladder 
GI tract (poor absorption due to low pH)
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4
Q

Main absorption of nicotine in cigarette smoke

A

Through funds

pH of alveoli is 7.4 so nicotine from cigar smoke is unchanged and easily crosses alveolar membrane into blood

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5
Q

Exposure to nicotine

A

Bad breath
Stained teeth
Smoker’s cough
Increased heart rate and bp

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6
Q

Bad breath - exposure to nicotine

A

Nicotine and other chemicals in tobacco gets deposited in oral cavity

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7
Q

Stained teeth - exposure to nicotine

A

Sticky substances in the smoke get deposited on teeth and thus causes stains

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8
Q

Smoker’s cough - exposure to nicotine

A

Coughing is a protective physiological mechanism to remove irritants from the body, esp from the respiratory tract

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9
Q

Increased heart rate and bp - exposure to nicotine

A

Short term effect

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10
Q

Nicotine metabolism

A

Occurs in liver within 1-2hrs in humans
70-80% gets oxidised to cotinine by oxidation
50% is excreted in urine
Nicotine can also be excreted via faeces, bile, saliva, sweat

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11
Q

Cotinine

A

Inactive metabolite of nicotine

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12
Q

Nicotine effects on whole organism

A 
Increased hr 
Cardiac contractility 
Increased bp 
Decreased blood temp 
Mobilisation of b mood sugar 
Increase in FFA in blood
Increase catecholamines levels in blood 
Arousal or relaxation
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13
Q

FFA

A

Free fatty acids

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14
Q

Catecholamines

A

Adrenaline

Noradrenaline

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15
Q

Nicotine effects on cellular level

A

Increased synthesis and release of hormones
Activation of tyrosine hydroxylase
Activation of several transcription factors
Induction of heath shock proteins
Effects of apoptosis
Induction of chromosome aberrations
Induction of sister chromatid exchange

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16
Q

Effects of nicotine on the autonomic nervous system

A

Reduces/ inhibits effects of parasympathetic activation

Tends to increase/ activate sympathetic activation

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17
Q

Why does nicotine effect the autonomic nervous system in the way it does

A

Parasympathetic endings release Ach and sympathetic endings relate NA (NE)

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18
Q

Ach

A

Acetylcholine

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19
Q

NA

A

Noradrenaline

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20
Q

NE

A

Norepinephrine

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21
Q

Cholinergic receptors

A

Receptors on the surface of cells that get activated when they bind to a type of acetylcholine

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22
Q

AChR

A

Ligand-gated ion channels and are present at the neuromuscular junction and signal muscular contraction with stimulation

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23
Q

Structure of nAChR

A

Composed of 5 subunits, 2 alpha, and one each of beta, delta and gamma subunits
All subunits arranges in barrel or cylindrical shape around a central pore
Each alpha subunit has a Ach binding site

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24
Q

How do nAChR’s work

A

Each of two alpha subunits have to be bound to Ach to allow influx of Ca2+ and Na+ intracellularly and efflux of K out of cell

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25
Types of cholinergic receptors
Nicotinic (nAChR) Muscarinic (mAChR) Named after drugs that work on them
26
Nicotinic acetylcholine receptors
Pentameric ligand-gated ion channels
27
Muscarinic acetylcholine receptors
Seven-helix G-protein coupled membrane protein
28
Peripheral effects of nicotinic receptor activation
Increase in heart rate (HR), cardiac output (CO) and arterial pressure Reduction in GI motility Sweating
29
What does the peripheral effects of nicotinic receptor activation result from
Stimulation of autonomic ganglia and peripheral sensory receptors mainly in heart and lungs
30
What does nicotine act on
Nn receptors (alpha4) 2(beta2)3 - brain cortex & hippocampus - role in cognitive function (alpha3) 2(beta4)3 – ganglion (alpha1) 2beta1deltaepsilon - muscle
31
What does smoking increase the risk of
Coronary heart disease (Myocardial Infarct) Peripheral vascular disease (hypertension) Lung cancer (carcinogens, tar & CO) Chronic Obstructive Pulmonary Disease Abnormal foetal development (low birth weight
32
COPD
Chronic obstructive Pulmonary Disease | Incl chronic bronchitis and emphysema
33
What conc do we see minimal effects of ethanol at
10mmol/L (46mg/ 100ml)
34
What conc leads to severe intoxication
150mg/ 100ml
35
What conc of ethanol is lethal
500mg/ 100ml - respiratory failure
36
1 unit
``` 8g ethanol (amount in ½ pint, 1 measure of spirit, 1 glass wine) Strength (ABV) x volume (ml) / 1000 = units ```
37
UK recommendation for alcohol intake
14 units a week for men and women
38
Where does ethanol metabolic occur
Liver
39
Ethanol absorption
Ethan ol is rapidly absorbed via stomach 90% of ethanol is metabolised, 5-10% is excreted unchanged in expired air and urine, basis of police breath & urine tests
40
Ethanol effects on body
``` Cardiovascular system Endocrine system GI tract Liver - most serious long term consequence Foetal development ```
41
Ethanol effects on cardiovascular system
Cutaneous vasodilation, causes warm feeling but actually increases heat loss
42
Ethanol effects on endocrine system
Diuresis – caused by inhibition of release of ADH (hormone) from the pituitary
43
Ethanol effects on GI tract
Increased salivary and gastric excretion
44
Ethanol effects on liver
Increased fat accumulation ---> hepatitis and finally hepatic necrosis and fibrosis Effects on lipid metabolism, platelet function & atherosclerosis
45
Ethanol effects on foetal development
Foetal alcohol syndrome (FAS) | Alcohol-related neurodevelopmental disorder (ARND)
46
Ethanol effects on CNS - acute ethanol intoxication
Slurred speech Motor incoordination Increased self confidence Euphoria Effect on mood can vary, loud and outgoing or morose and withdrawn Intellectual and motor performance and sensory discrimination all show uniform impairment
47
Ethanol effects of CNS - chronic ethanol intoxication
Irreversible neurological effects (e.g. dementia, peripheral neuropathy) May be due to ethanol, but also its metabolites (e.g. acetaldehyde, FA esters) Some effects are due to thiamine deficiency (Wernicke’s-Korsakoff syndrome)
48
Mechanism of action of alcohol on CNS
Enhancement of GABA-mediated inhibition, similar to action to benzodiazepines Effect smaller and less consistent though Inhibits transmitter release in response to nerve terminal depolarisation by inhibiting opening of voltage dependent calcium channels in neurons
49
Flumazenil
Benzodiazepine antagonist Reverses central depressant effects of ethanol Not used in alcohol dependence - side effect is to increase seizures
50
What does alcohol increase the risk of
``` CNS atrophy Cardiomyopathy Peptic ulcers Pancreatitis Liver damage Varices Testicular atrophy ```
51
Tolerance
Decrease in pharmacological effect on repeated administration of drug – dose has to be increased to get same effect
52
Dependence
State when drug-taking becomes compulsive (taking precedence over other needs
53
Withdrawal (abstinence) syndrome
Adverse effects, both physical and psychological, occurring after stopping taking drug
54
Craving
Intense desire for a drug that long outlasts the withdrawal (abstinence) syndrome
55
Reward pathway
Mesolimbic/ mesocortical dopaminergic pathway | Activated by virtually all dependence-producing drug
56
Nicotine and dopamine
Nicotine enhances synthesis and release of dopamine | Acts on cholinergic receptors on dopamine cell bodies in the ventral tegmental area (VTA)
57
What does alcohol decreases the activity of
GABAergic interneurons Alcoholics have hypofunction of mesolimbic system Severity is dependent on amount consumed
58
Mesocortical pathway
Starts in VTA and travels to prefrontal cortex, passes through nucleus accumbens
59
Mesolimbic pathway
Begins in VTA and passes through nucleus accumbens and ends at hippocampus nucleus and amygdaloid
60
Abstinence Syndrome in response to nicotine withdrawal
Increased irritability, impaired psychomotor tasks, aggressiveness, sleep disturbance Last 2-3 weeks, although craving for cigarettes lasts much longer
61
Main dopaminergic pathways
Mesolimbic Mesocrtical Nigrostriatal Tubero-hypophyseal
62
Abstinence syndrome in repose to ethanol withdrawal
Has 3 stages
63
1st stage of absence syndrome (ethanol)
Main symptoms are tremor, nausea, sweating, fever & sometimes hallucinations Lasts about 24hrs
64
2nd stage of absence syndrome (ethanol)
Epilepsy-like seizures
65
3rd stage of absence syndrome (ethanol)
'Delirium tremens’ – results in confusion, agitation, aggression & more severe hallucinations Develops over a few days
66
Mechansims for treating drug dependence
``` Substitution, to alleviate withdrawal symptoms Long-term substitution Blocking response Aversive therapies Modification of cravings ```
67
Examples of substitution to alleviate withdrawal symptoms
Benzodiazepines, to blunt alcohol withdrawal
68
Examples of long-term substitution
Nicotine patches, chewing gum, spray, inhaler, lozenge
69
Examples of blocking response
Varenicline spp antagonist for nAChR
70
Examples of aversive therapies
Disulfiram to induce unpleasant response to alcohol
71
Examples of modification of craving
Bupropion (antidepressant)
72
Effects of smoking and drinking relating to having an operation
Increased risk of DVT Withdrawal symptoms Chest infections

MBBS - Year 1 (93 decks)

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