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Final > Primary > Flashcards

Primary Flashcards

1
Q

CSHT

A

Time taken for the plasma concentration of a drug to fall by half, when an infusion (designed to maintain a constant plasma concentration) is stopped

Context refers to the duration of the infusion

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2
Q

3 causes of calcified CXR lesions

A

Asbestosis
Mitral valve disease
Chicken pox

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3
Q

Visual symptoms of papilloedema

A

Enlargement of blind spot
Blurring of vision

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4
Q

Mapleson A minimum flow (2)

A

SV: 0.8-1x MV
CV: 2-3x MV

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5
Q

Mapleson B minimum flow (2)

A

SV: 1.5-2x MV
MV: 2-3x MV

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6
Q

Mapleson C minimum flow (2)

A

SV: 1.5-2x MV
MV: 2-3x MV

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7
Q

Mapleson D minimum flow

A

SV: 2-3x MV
CV: 0.8-1x MV

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8
Q

Mapleson F minimum flow

A

2-3x MV

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9
Q

Mapleson E minimum flow

A

2-3x MV

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10
Q

Lack system

A

Co-axial Mapleson A

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11
Q

Bain system

A

Co-axial Mapleson D

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12
Q

Bain system FGF is carried through…

A

The inner tube

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13
Q

Closing capacity = FRC when?

A

Age 44 supine
Age 66 upright

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14
Q

Identify the structures of the descending tracts

A

Medial longitudinal fasciculus
Lissaur’s tract
Lateral corticospinal Tract
Rubrospinal tract
Pontine reticulospinal tract
Medullary reticulospional
Lateral vestibulospinal
Tectospinal
Ventral corticospinal

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15
Q

Identify the structures of the ascending tracts

A

Fasciculus gracilis
Fasciculus cuneatus
Dorsal spinocerebellar tract
Ventral spinocerebellar tract
Spinothalamic tract

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16
Q

Anion Gap (2)

A

[Na] + [K] - [HCO3] - [Cl]
Range 8 - 16 mEq/L

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17
Q

Causes of a high anion gap metabolic acidosis (3)

A

High unmeasured anions:
- Lactic acidosis
- DKA
- Alcohol, methanol, ethylene glycol

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18
Q

Clearance

A

Volume of plasma from whicha drug is completely removedina given time(mL/min)
Commonly indexed against body mass (mL/kg/min)

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19
Q

Clearance (formulas)

A

Cl = Vd / T
Since T = 1 / K
Cl = K.Vd

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20
Q

Pharmacokinetics

A

Absorption
Distribution
Metabolism
Excretion

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21
Q

Bioavailability

A

Fraction of a drug available to the systemic circulation compared with IV administration
Calculated by area under the curve

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22
Q

First pass metabolism

A

Metabolism by the gut wall or liver prior to reaching systemic circulation
PR, SL, TD, inhalational, IV etc - bypass 1st pass metabolism

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23
Q

First order kinetics

A

Rate of elimination of a drug is directly proportional to drug concentration

24
Q

Time to reach steady state (first order kinetics)

A

5 half lives

25
Q

Elimination profile in a single compartment.

A

C = C0.e-kt
where:
C = concentration at time = t
C0= concentration at time = 0
k = rate constant
t = time
-kt is a dimensionless term

26
Q

Describe C0

A

The concentration of a drug at time = 0
C0= dose / Vd

27
Q

What is the time constant (t)?

A

Time taken for plasma conc to fall to 1/e of it’s current value
Or the time taken to fall to 37% of initial value
Or the time taken for a drug to be completely eliminated, had the original rate of decline continued

The inverse of the rate constant.

28
Q

Half life

A

The time taken for plasma concentration to reach half its starting value

29
Q

Relationship between half life and the time constant (T)

A

T½ = T.ln2

30
Q

Which is bigger? the time constant or half life?

A

Time constant > half life
T is time taken to fall to 37% which is longer than t1/2 time taken to fall to 50%
ALWAYS

31
Q

Why do you wake up quickly following a propofol infusion at steady state?

A

Conductancebetween the peripheral and central compartments islow. The terminal elimination take a long time, butplasma concentrations fall rapidlyand you wake

32
Q

Michaelis constant

A

The concentration of a substrate at which an enzyme system is working at half its maximal capacity

33
Q

What factors affect hepatic extraction of a drug? (3)

A

Protein binding
Blood flow
Michaelis constant

34
Q

Volume of distribution

A

The theoretical volume into which a drug disperses to produce the observed plasma concentration
Vd = Dose / C0

35
Q

Seddon-Sunderland Classification

A

Classifcation of peripheral nerve injury
1. Neuropraxia - temporary interruption of conduction without loss of axonal continuity
2. Axonotmesis - loss of relative axon continuity and myelin covering, but preservation of the connective tissue framework
3. Neurotmesis - axon + endoneurium transection (preserved perineurium + epineurium)
4. Neurotmesis - axon + endoneurium + perineurium transection (preserved epineurium)
5. Neurotmesis with complete transection of nerve trunk

36
Q

Isomer

A

Molecules that have the same molecular formula but whose atoms are arranged differently

37
Q

Structural isomer

A

Molecules with the same molecular formula but different chemical structure

38
Q

Colloid

A

A substance that has large insoluble particles of one substance suspended/dispersed through a second substance

39
Q

Blood:gas coefficient

A

Ratio of amount of anaesthetic gas in blood to that in gas when the two phases are equal volume + pressure + in equilibrium at 37°C

Describes the relative solubility of a gas in blood (water)

Lower blood:gas coefficient → more in gas than in blood → faster onset/offset

40
Q

What is the embryological origin of the adrenal medulla?

A

Chromaffin cells derived from the ectodermal cells of the neural crest

41
Q

What is the embryological origin of the adrenal cortex?

A

Mesoderm

42
Q

What does the adrenal cortex secrete?

A

Steroid hormones:
Glomerulosa: glucocorticoids (cortisol)
Fasciculata: mineralocorticoids (aldosterone)
Reticularis: androgens

43
Q

What are glucocorticoids? (1)

A

Steroid hormones that affect the metabolism ofcarbs, fats + proteins
Important in mediating the response to fasting and stress

44
Q

What are the primary effects of glucocorticoids?

A

Cardiovascular
- Maintenance of response to catecholamines
Liver
- Protein catabolism
- Gluconeogenesis
Kidney
- Weak mineralocorticoid activity
Immune
- Immunosuppresion
- Slowed healing

45
Q

What are the primary effects of mineralocorticoids?

A

Cardiovascular - none
Liver - none
Kidney
- Resorbs Na⁺in the Distal Convoluted Tubule at the expense of loss of K⁺and H⁺lost into the urine
- Expansion of the intravascular compartment (water follows Na⁺)
Immune - none

46
Q

Cardiovascular - none

A

Aldosterone is released in response to:
- Decreased Na⁺
- Decreased plasma volume
- Increased K⁺
- Activation of the RAAS

The final common pathway is thebinding of angiotensin IIto receptors in thezona glomerulosa - This acts viaG-proteinto activatephospholipase C
It facilitates the conversion ofcorticosterone → aldosterone

47
Q

What is hyperaldosteronism?

A

Excess circulating aldosterone:
Primary causes
- Conn’s Syndrome - adrenal adenoma (60%)
- Bilateral adrenal hyperplasia (30%)
- Carcinoma

Secondary causes
- Increased activation of the RAAS e.g. CCF or liver cirrhosis

48
Q

What are the core features of hyperaldosteronism?

A

Hypertension (coz retention of water)
Hypokalaemia (coz loss of H⁺ in kidneys)
Metabolic alkalosis (coz loss of H⁺ in kidneys)

49
Q

What is SVR?

A

SVR = 80 x (MAP - CVP)/CO
1000 - 1500 dyne/s/cm5

50
Q

What factors cause a right shift of the oxyhaemoglobin dissociation curve?

A

CADET:
CO₂
Acidosis / anaemia / altitude
DPG (raised) - e.g. in pregnancy
Exercise
Temperature

51
Q

Which components in PRC help prevent depletion of 2,3-DPG?

A

Adenosine
Phosphate
Glucose
NB, mannitol helps prevent oxidative stress to RBC, but has no impact upon 2,3-DPG

52
Q

What are the “classical” anti-inflammatory cytokines?

A

IL4
IL-10
IL-13
IFN-α
TGF-β

53
Q

Define osmolarity

A

Number of osmoles perlitreof solvent

2x (Na⁺ + K⁺) + urea + glucose
* Na⁺ + K⁺ are doubled because each has an associated anion (usually Cl⁻)

Affected by temperature + pressure

54
Q

Define osmolality

A

Number of osmoles perkgof solvent

55
Q

Maximum concentrating capacity of the kidneys

A

1200 mOsm/L

56
Q

Minimum mandatory renal solute excretion

A

500-600 ml / day

Final (21 decks)

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