Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Themed Learning Weeks > Week 1 09/11-13/11 > Flashcards

Week 1 09/11-13/11 Flashcards

(91 cards)

Start Studying
1
Q

What are the 4 main symptoms that are often presented in skin disease?

A

Itch
Pain
Dysfunction
Cosmesis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

How would you examine different skin disease?

2 main things to looks at

A

Lesion - type, colour, shape, associated signs

Distribution - body sites, extent, pattern

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What are the different types of lesions in skin disease?

6

A 
Macule, patch
Plaque, weal
Papule, nodule
Vesicle, bulla
Pustule, abscess
Erosion, ulcer
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What are the ways skin disease can be distributed?

A 
Generalised
Localised
Palmo-plantar 
Flexor/extensor
Dermatomal
Scalp, nails
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What are some examples of drugs with analgesic activity?

A 
Opiods (morphine-like)
NSAIDs (aspirin-like)
Paracetamol
Local anaesthetics
Gabapentinoids
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What receptors depolarise sensory nerve endings in response to:

a) Damaging heat?
b) ATP released from damaged cells?
c) Acid?

A

a) TRPV1 receptors
b) P2X receptors
c) Acid Sensing Ion Channels (ASICs)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What food product can activate TRPV1 receptors?

A

Capsaicin in chili peppers

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What inflammatory mediators can sensitise sensory nerve endings in nocioception?

A

Bradykinin

Prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

How do local anaesthetics work to reduce pain?

Why are they inherently toxic?

A

Block voltage dependant Na channels (Nav)
Not selective for Nav in sensory nerve endings (affect any nerve type) so local administration produces localised effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What subtype of Nav are found in sensory nerves for nocioception?

A

Nav 1.7

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What NTs are released in dorsal horn of spinal cord during synaptic transmission? (nocioception)

A

Glutamate
neuropeptide substance P
calcitonin gene related peptide (CGRP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What happens in ‘central sensitisation’?

What does it cause?

A

Enhanced transmission at synapse for nociception, strengthens synaptic connection
Leads to hyperalgesia and allodynia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are gabapentanoids?

A

Gabapentin and pregabalin

Analogues of GABA (inhib NT, gamma aminobutyric acid)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

How do gabapentinoids work to reduce pain?

A

Decrease expression of functional voltage-dependent Ca channels on sensory nerve endings in dorsal horn
Decrease NT release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How does the marine cone snail toxin conotoxin help reduce pain?

A 
Synthetic analogue (ziconotide) blocks voltage-dependant Ca channels
Administer intrathecally (into spinal canal/subarachnoid space)  to treat intractable pain
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What happens to ascending axons in nociceptive pathway? (After synapse on dorsal horn?)

A

Travel in contralateral spinothalamic tract
Synapse in medial thalamus
Further projections travel to somatosensory cortex.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

How do antidepressant drugs enhance descending inhibition to decrease pain?
Examples?

A

Inhibit Noradren uptake - so increase Norad conc in CNS
Enhances descending inhibition produced by noradrenergic neurons in dorsal horn
Noradren hangs around longer so synapse keeps uptaking it
Amitriptyline, duloxetine, venlafaxine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Do SSRIs have the same analgesic effect as antidepressant drugs?

A

No

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Where is arachidonic acid stored and released?

A

Phospholipids in most cell membranes

Released by phospholipase a2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What can arachidonic acid be metabolised into?

Via what enzymes?

A

Cyclooxygenase ==> prostaglandins, thromboxanes

Lipoxygenase ==> leukotrienes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What molecule production increases during acute and chronic inflammation?

A

Prostaglandins

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Where are PGE2 and PGI2 released from?

What do they do?

A

Endothelial cells + WBC

Mediate increased blood flow + hyperalgesia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Where is PGD2 released from?

What are it’s functions?

A

Mast cells
Mast cell maturation
Vasodilation
Eosinophil recruitment + allergic reactions

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is function of LTC4 and LTD4?

A

Increase microvascular permeability

Broncho-constrictors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
What is function of LTB4?
Chemotaxin | Recruits neutrophils to inflammatory sites
26
What are functions of PGE2?
``` Vasodilation + vascular leakage Pyrogenic (fever) Hyperalgesia Decrease gastric acid production Increase gastric acid mucus secretion Increase uterine contraction ```
27
What are functions of PGFalpah2?
Vasoconstriction Uterine contraction Bronchoconstriction
28
What is role of prostaglandins at inflammatory sites?
Vasodilation Potentiate oedema formation Sensitise nerves (hyperalgesic)
29
How do NSAIDs affect arachidonic acid?
Inhibit its metabolism via COX
30
What are some non-specific NSAIDs? | Side effects?
Aspirin Ibuprofen Indomethacin Gut and kidney
31
What are some COX-2 selective inhibitors? | Side effects?
Celecoxib Rofecoxib (Vioxx) Meloxicam Fewer gut side effects but adverse cardiac effects
32
What are functions of thromboxane?
Enhance platelet aggregation | Vasoconstriction
33
What are functions of prostacyclin? (PGI2)
Vasodilation | Decrease platelet aggregation
34
What enzyme does glucocorticoids inhibit in inflammatory pathway?
Phospholipase A2
35
What enzyme do NSAIDs inhibit in inflammatory pathway?
Non-selective, COX 1 and 2
36
What enzyme does the drug zileuton inhibit in inflammatory pathway?
5-lipoxygenase
37
How do the drugs zafirlukast and montelukast inhibit in inflammatory pathway?
Competitive inhibitors for receptors of LTC4, D4, E4
38
How do leukotrienes aggravate bronchial asthma?
Induce bronchoconstriction, mucous secretion + accumulation
39
What is difference between NSAIDs and paracetemol?
NSAIDs - analgesic, antipyretic, anti-inflammatory | Paracetamol - analgesic, antipyretic
40
What are side effects of NSAIDs and why?
Stomach upset/ulcers - PG increase blood flow, increase mucous secretion to protect gut Kidney problems - PG increase blood flow so lack of this affects kidney Bleeding risk - from ulcers Hypertension/stroke
41
Where is COX-1 found and what is it's functions?
Found most cells Constitutive (always there) Involved normal physiology to maintain homeostasis e.g. in GI tract, PGs wichtig maintaining good blood flow e.g. in vasculature TxA2 stimulates platelets to aggregate (thrombus), PGI2 inhibits this
42
Where is COX-2 found and what is it's functions?
Induced in inflammatory cells by inflammatory stimuli | Releases high levels of PGs at inflammatory sites
43
What is another name for paracetamol?
Acetaminophen (APAP)
44
What systems is the mechanism of paracetamol mediated by?
Serotonergic system Eicosanoid system Cannabinoid system Opioid system
45
How does the serotonergic pathway work aid in the descending pain system? How does paracetamol affect this?
Activation of pathways results in suppression of pain transmission in CNS, esp spinal cord Enhances inhibitory effects
46
How does paracetamol affect the eicosanoid pathway?
Non-selectively inhibits COX-1 and 2
47
Why does paracetamol not reduce inflammation?
Found to mostly inhibit peroxidase enzyme which is normally low conc in CNS so paracet can effectively inhibit During inflammation in peripheral tissues, destroyed cells produce large amounts peroxidase that paracet x inhibit
48
How does paracetamol affect the cannabinoid pathway?
Helps produce metabolite AM404 which: Activates cannabinoid receptors Mediates release of endogenous cannabinoids Mediates anti-pyretics though inhibition of central PG production
49
How does paracetamol partially affect opioid pathway?
Activation of mu + kappa (greek letters) opioid receptors Synergism of opioid and serotonergic pathway AM404 (paracet metabolite) activates both opioid and cannabinoid receptors
50
What is the efficacy of paracetamol?
Same as: equivalent dose of NSAID/ 10mg iv morphine
51
What are the clinical uses of paracetamol?
``` Acute + chronic mild-moderate pain Musculoskeletal pain Headaches - tension + migraine Various surgical procedure Pyrexia ```
52
What can paracetamol be combined with?
NSAIDs, Codeine, Caffeine, Tramadol
53
What is the benefit of combining paracetamol with other analgesics?
Increases analgesic efficacy Decreases dose of analgesics Decreases side effects
54
What is the main side effect of paracetamol?q
Hepatotoxicity
55
Why can paracetamol induce hepatotoxicity even at therapeutic doses in v small % of pop? (CYP450)
Many CYP450 isozymes involved in oxidation of paracet + production of NAPQI CYP-2D6 isozyme has genetic polymorphism Few peeps have ultra-rapid + extensive CYP-2D6 activity
56
Why can paracetamol induce hepatotoxicity even at therapeutic doses in v small % of pop? (Glutathione)
Glutathione storage may be low in: Infants, malnourished, alcoholic, malabsorption, elderly Low NAPQI detoxification ability, accumulates in liver
57
What medicine is used in paracetamol overdose? | How does it work?
N-acetylcysteine Precursor to glutathione so can conjugate NAPQI Enhances sulphate conjugation so more paracet is conjugated
58
How can paracetamol be administered?
Orally, rectally, IV
59
What is the oral dose of paracetamol of adults >50kg?
0.5-1.0g every 4-6 hours | Max dose is 4g
60
How are opioids pharmacologically defined?
Any substance whose actions are reversed by naloxone
61
What opiates are derived from the opium ?- dried sap from seed capsule of Papaver Somniferum plant
Morphine, codeine, diamorphine (heroine)
62
What are the 3 subtypes of opioid receptors? | What is the close relative receptor?
mu - MOP delta - DOP kappa - KOP Nociceptin opioid receptor - NOP, distinct pharmacology (x blocked by naloxone), activated by nociceptin peptide
63
How many endogenous opioid peptides have been found? What families are they in? What do they have in common?
13 Beta endorphins - from proopiomelanocortin Enkephalins - from pro-enkephalin Dynorphins - from pro-dynorphin Same N-terminal sequence Tyr-Gly-Gly-Phe-Met/Leu
64
What is structure and origin of nocioceptin?
From pro-nociceptin pro hormone 17 AA long, diff N-terminal sequence - Phe-Gly-Gly-Phe-Thr
65
What type of receptors are all 4 opioid receptors?
G protein coupled - Gi/Go
66
What cellular responses arise from activation of opioid receptors?
Inhibition of adenylyl cyclase Activation of MAP kinase Inhibition of Ca entry into nerve terminals through voltage gated Ca channels Activation of K channels, so hyperpolarization of neurons
67
What NT do opioids inhibit the release of?
Substance P/glutamate from dorsal horn | AcH release from nerves in GI tract - constipation
68
How do opioids affect the cortex to help reduce pain?
Euphoric effects of opioids acting in cortex contribute to analgesia, make pain less troublesome
69
How do opioids affect PAG to help reduce pain?
Produce disinhibition Inhibit inhibitory GABAergic neurones within PAG Overall increase in excitatory output to RVM Enhanced descending inhibition
70
How do opioids affect the synapse in the dorsal horn to help reduce pain?
Pre + post synaptic opioid receptors present Pre - inhibit Ca entry by voltage gated Ca channels, less NT released Post - open K channels to hyperpolarize, decrease excitability of projection neurone in spinothalamic tract
71
How are opioid receptors in synapse of dorsal horn activated?
Enkephalins, produced by enkephalinergic interneurons
72
What is neuropathic pain?
Pain to sensory nerves themselves
73
What are clinically important actions of morphine?
Analgesia - moderate-severe pain, x neuropathic pain Euphoria Respiratory depression - resp centre in medulla less sensitive to pCO2 Nausea + vomiting Inhibit GI motility - constipation Contraction of gall bladder + biliary sphincter Inhibit cough reflex Centrally mediated pupil constriction Tolerance + dependance
74
What can prolonged use of morphine cause? | How can this be reduced?
Hyperalgesia | Change to another opioid
75
What effect of morphine causes death in overdose?
Respiratory depression
76
What is administered alongside morphine to reduce nausea and vomiting?
Anti-emetic e.g. prochlorperazine
77
What substance is used in cough remedies to reduce cough reflex?
Pholcodeine
78
What medicine is used in lung cancer to reduce cough reflex?
Diamorphine linctus
79
What is a important diagnostic sign in opioid overdose?
Pin-point pupil
80
Definition of tolerance in drugs?
Reduced effect upon repeated administration of a drug at a constant dose
81
Definition of dependance in drugs?
Repeated, compulsive use of a drug to receive chemical rewarding effect/ avoid punishing effects of drug withdrawal
82
What are the 2 types of dependance?
Psychological - user takes drug to experience pleasurable, rewarding effects, oft characterized by powerful “craving” for drug Physical - user takes drug to avoid unpleasant withdrawal symptoms; abstinence syndrome
83
What is the relationship between tolerance and physical dependance?
Adaptive changes occur to counteract effects of prolonged exposure to opioids E.g. desensitisation of receptors, changes in intracellular signalling pathways On removal of opioid, adaptive changes now lead to excessive activity - withdrawal symptoms
84
How can withdrawal symptoms and addicts be helped?
Severe withdrawal precipitated in addicts by administration of naloxone - only severe cases as withdrawal symptoms bad af Methadone wean addicts off heroin as withdrawal response less severe - leaves body slowly
85
How can morphine be administered?
Orally or injection
86
How is morphine processed in liver?
1st pass metabolism - conc of drug greatly reduced b4 reaches systemic circulation Glucuronidation occurs at 3- + 6-OH positions Morphine-6-glucuronide is potent analgesic Glucuronides excreted in urine
87
What is the plasma half-life of morphine in adults? | Neonates?
3-6 hrs Longer in neonates cos low conjugating capacity of liver - risk of neonatal resp depression if morphine given during childbirth
88
What is codeine and diamorphine metabolised into?
Morphine
89
How is buprenorphine administered?
Sublingually
90
How is fentanyl and sufentanil administered?
Intrathecally during surgery
91
What opioid is used in obstetrics? | Why?
Pethidine - shorter half life than morphine May still need to reduce effects of neonate resp syndrome using naloxone N-demethylation of pethidine by liver produces norpethidine, hallucogenic + convulsant effects

Themed Learning Weeks (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions