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Integration and Consolidation > Test Review > Flashcards

Test Review Flashcards

1
Q

Describe hypokalemia on cardiac conduction

A

Decreased extracellular potassium concentration (hypokalemia) results in decreased potassium conductance, which reduces potassium current. Hypokalemia is also shown by the appearance of U waves. Hypokalemia would also account for the woman’s muscle weakness (flaccid paralysis) as it decreases the voltage-gated sodium current in nerve, skeletal muscle, and cardiac muscle. In hypokalemia, decreased sodium current in atrial myocytes would increase the duration and decrease the amplitude of the P wave. Hypokalemia would decrease delayed rectifier potassium current in the SA node, which would make the slope of phase 4 steeper and increase heart rate. Excitability of cardiac myocytes would be decreased in hypokalemia due to decreased sodium current (threshold would be shifted more positive than normal). Increased plasma potassium concentration (hyperkalemia) would increase potassium current, which would increase the rate of phase 3 repolarization. The duration of the ventricular action potential would be decreased and a spiked T wave would be seen on the ECG.

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2
Q

Describe the effects of hyperkalemia on cardiac conduction

A

In hyperkalemia, gK would be increased and EK would be less negative (more positive). The increased gK in hyperkalemia would increase potassium current, resulting in a faster phase 3 repolarization (spiked T wave). Hyperkalemia causes a resting depolarization of atrial and ventricular myocytes, which decreases the number of resting sodium channels. This would decrease the conduction velocity of the action potential through the atria and widen the P wave, and prolong the P-R interval. Hyperkalemia would increase potassium current, decreasing the duration of the ventricular action potential. This would decrease the QT interval. Hyperkalemia decreases sodium current in ventricular myocytes, which would decrease conduction velocity of the action potential. The time to fully depolarize the ventricles would be increased and seen as a wide QRS complex (with a lower amplitude and slower rate of rise than normal).

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3
Q

How do pre and post ganglionic lengths compare in sympathetic vs para sympathetic?

A

Parasympathetic - Long Pre and short post

Sympathetic - short pre and long post

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4
Q

Why does sympathetic discharge lead to increased blood flow to muscle and decreased to skin?

A

Muscle contains predominantly Beta receptors and skin has alpha

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5
Q

Miosis

A

Excessive contraction of the pupil of eye

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6
Q

Mydriasis

A

Excess dilation of the pupil

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7
Q

What is the area of integration for the autonomic nervous system?

A

Hypothalamus

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8
Q

Describe norepinephrine metabolism by MAO and COMT in respect to metabolites and location

A

MAO - Dihydroxymandelic acid and occurs within mitochondria

COMT - Normetanephrine and occurs within extra neuronal spaces

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9
Q

Pilocarpine is a muscarinic _____?

A

Alkaloid

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10
Q

Carbachol has what type of action on nicotine receptors?

A

Direct

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11
Q

How do trimethaphan and hexamethonium block ganglions?

A

Both competitively block nicotinic Ach receptor without causing depolarization

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12
Q

How do neostigmine/physostigmine inhibit AchE?

A

Act as substrates (competitive inhibition) and are slowly hydrolyzed

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13
Q

How will administering edrophonium affect symptoms of cholinergic crisis?

A

Make symptoms worse

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14
Q

How do sympathomimetic agents affect metabolism?

A

Excitation of metabolism mediated by B2 increased glycogenolysis

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15
Q

Norepinephrine can stimulate what Beta receptors?

A

B1 - increase HR and contractility

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16
Q

Eye effect: alpha 1

A

Radial muscle leading to mydriasis

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17
Q

Eye effect: M3

A

Affecting circular and ciliary muscles leading to miosis and accomidation

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18
Q

Eye effect: B2

A

ciliary body leading to aqueous humor secretion

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19
Q

Mechanism: Tyramine

A

Acts by releasing NE from cytoplasmic neuronal pool to produce tachyphylaxis

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20
Q

Pindolol/Timolol are used in the treatment of?

A

HTN and arrythmias

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21
Q

Metryosine forms a compound with what inhibiting what?

A

Tyrosine hydroxylase leading to inhibition of rate limiting step

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22
Q

Tachyphylaxis

A

Rapidly diminished effect of a drug after successive administration

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23
Q

Sweat glands are innervated by

A

Sympathetic CHOLINERGIC nervous system

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24
Q

Patients on MAO inhibitors are at increased risk for what?

A

Developing HTN crisis following ingestion of meals rich in tyramine

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25
Q

General sympathetic discharge can lead to?

A

Hyperglycemia - Beta 2

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26
Q

Ephedrine, Amphetamines and Tyramine all produce?

A

Tachyphylaxis

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27
Q

Toxic activation of nicotinic effects

A

Stimulation followed by paralysis of ganglia of skeletal muscle

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28
Q

Tubocurarine

A

Competitive antagonist at ganglia and adrenal medulla leadin to decreased BP, tachycardia, and histamine
Also blocks nicotinic receptor at NMJ producing paralysis

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29
Q

Skeletal muscles have what type of receptors?

A

Post synaptic NICOTINIC receptors

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30
Q

Epinephrine metabolis

A

Uptake

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31
Q

Phentolamine before isoproteranol would?

A

Create greater drop in BP than isoproteranol alone due to decreased sympathetic reflex following Beta receptor stimulation

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32
Q

Butoxamine

A

B2 selective antagonist

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33
Q

Why is pilocarpine resistant to AchE?

A

It is not a choline ester

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34
Q

What is the primary control of autoregulation

A

CO2 which diffuses through the BBB to decrease the pH of the CSF. This will in turn lead to increased respirations

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35
Q

Thiazide diuretics can lead to?

A

Increased blood calcium and cause kidney stones

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36
Q

GnRH is released in what type of fashion?

A

Pulsatile fashion to increased FSH/LH

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37
Q

Neuropeptide Y

A

PNS vasoconstrictor and role in appetite

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38
Q

Estrogen, tamoxifen and methadone effects on TBG?

A

Increase TBG leading to decreased free T

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39
Q

Sign of primary hyperaldosteronism

A

Increased urine aldosterone even in presence of high salt diet

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40
Q

Octreotide/somatostatin decrease

A

PORTAL and splanchnic blood flow

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41
Q

Sucralfate

A

Protects GI by binding to ulcerated tissue can lead to constipation, requires acid pH for activation

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42
Q

Toxicity: Ergot alk

A

Drowsiness and Hallucinations
PROLONGED VASOSPASM LEADING TO GANGRENE
Uterine contraction

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43
Q

Uses of Vitamin D

A

Nutritional rickets
Osteoporosis
Osteomalacia

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44
Q

Older individuals have what to clotting factors

A

Decreased levels of vitamin K dependent clotting factors

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45
Q

Cyprohepatidine

A

Used for treatment of serotonin syndrome

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46
Q

Toxicity - H1 antagonist

A

Sedation, urinary retention and blurred vision

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47
Q

lipophilic drugs are easier to travel?

A

Pass placental barrier and concentrate in milk

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48
Q

FDA pharmacogenetic tests

A

Warfarin, Isoniazid, mercaptopurine, Ironotecan, Codeine

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49
Q

Inducers of CYP450

A

ACIRS

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50
Q

Inhibitors of CYP450

A

VAIG

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51
Q

Lipophilic teritary amines are able to go where easier?

A

Cross blood brain barrier

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52
Q

Compare locations of acetylcholinesterase vs butyrylcholinesterases

A

AchE - found in neurons and RBCs

BchE - found in plasma, glia, and liver

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53
Q

Ipratropium

A

Antimuscarinic that inhibits vagal stimulation and decreases bronchoconstriction

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54
Q

Mepolizumab/Reslizumab

A

Anti-IL 5 inhibit IL-5 binding to mast cells and decrease action of eosinophils

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55
Q

Cromolym/Nedocromil

A

Reduce mast cell degranulation and release of histamine

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56
Q

Theophylline

A

Methylxanthine adenosine receptor antagonist

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57
Q

Diazoxide

A

Hyperpolarizing cell and activation of K+ channels

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58
Q

Indapamide

A

NaCl inhibitor at DCT

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59
Q

Metolazone

A

NaCl inhibitor at DCT

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60
Q

Bumetanide

A

Loop diuretic

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61
Q

Torsemide

A

Loop diuretic

62
Q

Acetazolamide can lead to what when taken in excess?

A

Metabolic acidosis (Type II RTA)
Hyponatremia
Hypokalemia
Decreased Bicarb

63
Q

Indication: Tamulosin

A

Used in the treatment of only BPH

64
Q

Indication: Terazosin

A

Used in the treatment of HTN and BPH

65
Q

Cholestyramine effects of digoxin

A

Due to effects on bile resins it would cause malabsorption

66
Q

Atenolol is a B1 selective blocker so it does not

A

so it does not tend to exacerbate asthma

67
Q

MUST KNOW: BEST COMBINATION FOR AFRICAN AMERICANS IN HF

A

Hydralazine and isosorbide dinitratie

68
Q

Mexiletine is also used in the treatment of?

A

Diabetic neuropathy

69
Q

Choice of drugs used for patients with wide complex tachycardia?

A

Procainamide and amiodarone

70
Q

Extremely short acting Beta blocker with half life of 9 minutes

A

esmolol

71
Q

Diuretic contraindicated in patients with severe hepatic cirrhosis

A

Acetazolamide

72
Q

Weight loss drug that can lead to progression of pulmonary HTN

A

Fenfluramine/phertermine

73
Q

Alpha acting drug that can be administered every 7 days

A

clonidine

74
Q

Ergot alkaloid with strongest stimulation on uterus

A

Ergonovine

75
Q

Prostaglandin to most likely cause bronchoconstriction in asthamtic

A

TXA2

76
Q

Endocrine drug that will enhance renal clearance of digoxin

A

Thyroxine

77
Q

Increased parasympathetic action and prolonged PR segment are most beneficial qualities of this drug

A

Digoxin

78
Q

Class 1 antiarrythmic that undergoes extensive 1st pass metabolism

A

Lidocaine

79
Q

African americans tend to have better responses to these drugs

A

Thiazide diuretics and Ca channel blockers

80
Q

BNP analog that leads to diuresis and arteriolar/venous vasodilation

A

Nesiritide

81
Q

What are the predominating signals through the body with a nicotinic agonist

A

Sympathetic - vasculature

Para - everywhere else

82
Q

Abnormal lab value with increased conductance to K+

A

Hyperkalemia

83
Q

Anti-arrhythmic that can precipitate digoxin toxicity

A

Quinidine

84
Q

Anti-arrhythmic that is contraindicated in prostatism

A

Disopyramide

85
Q

Anti-arrhythmic that is contraindicated in chronic arthritis

A

Procainamind

86
Q

Anti-arrhythmic that is contraindicated in lung disease

A

Amiodarone

87
Q

MOA: Omega 3

A

Activated PPAR alpha in hepatocytes and decrease plasma triglycerides

88
Q

Rapidly inhibits proteolysis and release of T3/T4 and is used against thyrotoxicosis - maximal effect in 2 weeks

A

Iodide salts

89
Q

Thyroid drugs that take 2-4 months to achieve euthyroid status

A

PTU/Methimazole

90
Q

Inhibits 5’ deiodinase leading to decreased T3

A

Iohexol and diatrizoate

91
Q

Drug given to determine the location of metastatic thyroid carcinomas

A

Thyrotropin

92
Q

ACTH produces a positive effect on ?

A

BOTH glucocorticoids and androgens

93
Q

ACTH has why type of pattern

A

Diurnal pattern - peaks and troughs are dependent on individual sleep wake cycle

94
Q

Muscle wasting syndrome due to increased SYNTHESIS OF METABOLIC enzymes relative to structural

A

Cushings syndrome

95
Q

Most potent time to dose ACTH

A

Evening dose of ACTH would prevent the morning surge of cortisol

96
Q

These levels are not altered by ACTH

A

Aldosterone

97
Q

This deficiency will progress to salt wasting syndrome and decreased BP

A

21 - hydroxylase deficiency

98
Q

Systemic steroids are not helpful in the treatment of

A

Skin diseases

99
Q

Increased non protein nitrogen is an early sign of danger in what

A

Adrenocortical insufficiency

100
Q

This diabetic drug is preferred in elderly due to relatively short half life a lower potency

A

Tolbutamide

101
Q

Diabetes drug that is most likely to cause a disulfuram like reaction following ingestion of ethanol

A

Chlorpropamide

102
Q

Drug class created to avoid problems like disulfuram rxns

A

Repaglinide

103
Q

Best treatment for patients in hypoglycemic states

A

Glucagon

104
Q

Blood lactate levels are often a good indicator of

A

volume replacement

105
Q

How to distinguish between anaphylactic and hypovolumic shock

A

Cardiac output

106
Q

Alteration of ECG by Beta 1 antagonist

A

Increased PR interval

107
Q

What happens to T waves during exercise

A

Shortened and spiked due to increased repolarization rate in ventricular myocytes

108
Q

High doses of AchE can form a

A

NM blockade

109
Q

Only used COX-2 inhibitor

A

Celecoxib

110
Q

Aspirin and Salicylic acid are

A

Salicylates

111
Q

These are critical inflammatory mediators in IBD

A

Leukotrienes

112
Q

Antihistamine that has greater incidience of HI disturb

A

Pyrlamine

113
Q

Antihistamine that is used for sedation

A

Promethazine

114
Q

This converts histidine to histamine

A

L-Histidine carboxylase

115
Q

Histamines effects on the heart are mediated through

A

Baroreceptors

116
Q

Bisacodyl is

A

Irritant cathartic given as a suppository

117
Q

Aluminum/Mg and MgOx/CaCarbonate are given because

A

These combinations of antacids avoid constipation and diarrhea

118
Q

This antacid interferes with absorption of phosphate and is beneficial in renal insufficiency

A

Aluminum hydroxide

119
Q

This drug should be used with caution in renal patients leading to solmnence

A

Magnesium containing

120
Q

Food aggrivates what type of ulcers

A

Gastric

121
Q

Excessive carcium carbonate antacids can lead to

A

Hypercalcemia
Hyperphosphatemia
Nephrolithiasis

122
Q

Use of sodium bicarbonate is limited in its use due to

A

Precipitation of renal stones and can cause metabolic alkalosis
Also cardiac failurem HTN and Renal Insufficiency

123
Q

Partial 5-HT4 agonist used for IBS treatmetn

A

Tegaserod

124
Q

Used for treatment of postpartum hemorrhage if oxytocin doesnt work

A

Ergonovine

125
Q

Direct histamine LIBERATORS

A

Morphine and Tubocurarine

126
Q

Hydrocortisone is more or less potent than dexamethasone

A

less

127
Q

Corticosteroids leads to (increased/decreased) lipocortin and (increased/decreased) AA metabolites

A

Increased lipocortin and decreased AA metabolites

128
Q

This is measured in urine to follow endogenous progesterone

A

Pregnanediol

129
Q

Oral contraceptives run the risk of

A

iron deficiency

130
Q

Used in the treatment of AIDS associated wasting syndrome

A

Oxandrolone

131
Q

This diruetic leads to increased prostaglandin levels leading to increased renal blood flow and increased cardiopulm fxn

A

furosemide

132
Q

1st choich of monotherapy of HTN in AA patients

A

Thiazide diuretics

133
Q

This drug is used in acute settings to reverse decrease CO, decrease BP and decrease urinary output

A

Dopamine

134
Q

Digoxin works to increase urinary output by acting on the

A

heart

135
Q

What changes will be noticed in HR when a patient is given tyramine following treatment with reserpine

A

NONE

136
Q

These layers of the adrenals respond to ACTH

A

Fasiculata and reticularis

137
Q

Minimal change disease is mediated by

A

T cells and cytokines

138
Q

Nephritic syndrome + Hemoptysis =

A

Goodpastures

139
Q

This stimulates the release of NE from neurons leading to systolic and diastolic increase

A

Epherdrine

140
Q

These are sex chord stromal tumors that secrete estrogens that can lead to unopposed endometrial hyperplasia

A

Fibromas and thecomas

141
Q

1st generation antihismamine used to treat motion sickness with decreased sedative effects

A

Cyclizine

142
Q

Medicare criteria

A

Over 65
disability for more than 24 months
dialysis
ALS diagnosis

143
Q

How will osteomalacia present differently from osteoporosis

A

Osteomalacia will have decreased vitamin D and osteoporosis will have normal levels

144
Q

PPIs lead to what

A

Increased H+ and Cl- in the body

145
Q

GnRH receptor agonist

A

Leuprolide

146
Q

Clomiphene is a

A

estrogen receptor agonist

147
Q

Characterized by hyponatremia and low serum osmo treated with demeclocycline

A

SIADH

148
Q

Tamoxifene

A

Breast cancers

149
Q

Raloxifene

A

Osteoporosis

150
Q

Clomiphene

A

Ovulation Induction

151
Q

Mefipristone

A

Postcoital abortifactant

152
Q

Danazol

A

Suppression of ovarian function

Integration and Consolidation (1 decks)

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