Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

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

Week 1 09/11-13/11 Flashcards

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
Q

What is function of LTB4?

A

Chemotaxin

Recruits neutrophils to inflammatory sites

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

What are functions of PGE2?

A 
Vasodilation + vascular leakage
Pyrogenic (fever)
Hyperalgesia
Decrease gastric acid production
Increase gastric acid mucus secretion
Increase uterine contraction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

What are functions of PGFalpah2?

A

Vasoconstriction
Uterine contraction
Bronchoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is role of prostaglandins at inflammatory sites?

A

Vasodilation
Potentiate oedema formation
Sensitise nerves (hyperalgesic)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

How do NSAIDs affect arachidonic acid?

A

Inhibit its metabolism via COX

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

What are some non-specific NSAIDs?

Side effects?

A

Aspirin
Ibuprofen
Indomethacin
Gut and kidney

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

What are some COX-2 selective inhibitors?

Side effects?

A

Celecoxib
Rofecoxib (Vioxx)
Meloxicam
Fewer gut side effects but adverse cardiac effects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

What are functions of thromboxane?

A

Enhance platelet aggregation

Vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What are functions of prostacyclin? (PGI2)

A

Vasodilation

Decrease platelet aggregation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
34
Q

What enzyme does glucocorticoids inhibit in inflammatory pathway?

A

Phospholipase A2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
35
Q

What enzyme do NSAIDs inhibit in inflammatory pathway?

A

Non-selective, COX 1 and 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
36
Q

What enzyme does the drug zileuton inhibit in inflammatory pathway?

A

5-lipoxygenase

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
37
Q

How do the drugs zafirlukast and montelukast inhibit in inflammatory pathway?

A

Competitive inhibitors for receptors of LTC4, D4, E4

38
Q

How do leukotrienes aggravate bronchial asthma?

A

Induce bronchoconstriction, mucous secretion + accumulation

39
Q

What is difference between NSAIDs and paracetemol?

A

NSAIDs - analgesic, antipyretic, anti-inflammatory

Paracetamol - analgesic, antipyretic

40
Q

What are side effects of NSAIDs and why?

A

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
Q

Where is COX-1 found and what is it’s functions?

A

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
Q

Where is COX-2 found and what is it’s functions?

A

Induced in inflammatory cells by inflammatory stimuli

Releases high levels of PGs at inflammatory sites

43
Q

What is another name for paracetamol?

A

Acetaminophen (APAP)

44
Q

What systems is the mechanism of paracetamol mediated by?

A

Serotonergic system
Eicosanoid system
Cannabinoid system
Opioid system

45
Q

How does the serotonergic pathway work aid in the descending pain system?
How does paracetamol affect this?

A

Activation of pathways results in suppression of pain transmission in CNS, esp spinal cord
Enhances inhibitory effects

46
Q

How does paracetamol affect the eicosanoid pathway?

A

Non-selectively inhibits COX-1 and 2

47
Q

Why does paracetamol not reduce inflammation?

A

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
Q

How does paracetamol affect the cannabinoid pathway?

A

Helps produce metabolite AM404 which:
Activates cannabinoid receptors
Mediates release of endogenous cannabinoids
Mediates anti-pyretics though inhibition of central PG production

49
Q

How does paracetamol partially affect opioid pathway?

A

Activation of mu + kappa (greek letters) opioid receptors
Synergism of opioid and serotonergic pathway
AM404 (paracet metabolite) activates both opioid and cannabinoid receptors

50
Q

What is the efficacy of paracetamol?

A

Same as: equivalent dose of NSAID/ 10mg iv morphine

51
Q

What are the clinical uses of paracetamol?

A 
Acute + chronic mild-moderate pain
Musculoskeletal pain
Headaches - tension + migraine
Various surgical procedure
Pyrexia
52
Q

What can paracetamol be combined with?

A

NSAIDs, Codeine, Caffeine, Tramadol

53
Q

What is the benefit of combining paracetamol with other analgesics?

A

Increases analgesic efficacy
Decreases dose of analgesics
Decreases side effects

54
Q

What is the main side effect of paracetamol?q

A

Hepatotoxicity

55
Q

Why can paracetamol induce hepatotoxicity even at therapeutic doses in v small % of pop?
(CYP450)

A

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
Q

Why can paracetamol induce hepatotoxicity even at therapeutic doses in v small % of pop?
(Glutathione)

A

Glutathione storage may be low in:
Infants, malnourished, alcoholic, malabsorption, elderly
Low NAPQI detoxification ability, accumulates in liver

57
Q

What medicine is used in paracetamol overdose?

How does it work?

A

N-acetylcysteine
Precursor to glutathione so can conjugate NAPQI
Enhances sulphate conjugation so more paracet is conjugated

58
Q

How can paracetamol be administered?

A

Orally, rectally, IV

59
Q

What is the oral dose of paracetamol of adults >50kg?

A

0.5-1.0g every 4-6 hours

Max dose is 4g

60
Q

How are opioids pharmacologically defined?

A

Any substance whose actions are reversed by naloxone

61
Q

What opiates are derived from the opium ?- dried sap from seed capsule of Papaver Somniferum plant

A

Morphine, codeine, diamorphine (heroine)

62
Q

What are the 3 subtypes of opioid receptors?

What is the close relative receptor?

A

mu - MOP
delta - DOP
kappa - KOP
Nociceptin opioid receptor - NOP, distinct pharmacology (x blocked by naloxone), activated by nociceptin peptide

63
Q

How many endogenous opioid peptides have been found?
What families are they in?
What do they have in common?

A

13
Beta endorphins - from proopiomelanocortin
Enkephalins - from pro-enkephalin
Dynorphins - from pro-dynorphin
Same N-terminal sequence Tyr-Gly-Gly-Phe-Met/Leu

64
Q

What is structure and origin of nocioceptin?

A

From pro-nociceptin pro hormone
17 AA long, diff N-terminal sequence
- Phe-Gly-Gly-Phe-Thr

65
Q

What type of receptors are all 4 opioid receptors?

A

G protein coupled - Gi/Go

66
Q

What cellular responses arise from activation of opioid receptors?

A

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
Q

What NT do opioids inhibit the release of?

A

Substance P/glutamate from dorsal horn

AcH release from nerves in GI tract - constipation

68
Q

How do opioids affect the cortex to help reduce pain?

A

Euphoric effects of opioids acting in cortex contribute to analgesia, make pain less troublesome

69
Q

How do opioids affect PAG to help reduce pain?

A

Produce disinhibition
Inhibit inhibitory GABAergic neurones within PAG
Overall increase in excitatory output to RVM
Enhanced descending inhibition

70
Q

How do opioids affect the synapse in the dorsal horn to help reduce pain?

A

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
Q

How are opioid receptors in synapse of dorsal horn activated?

A

Enkephalins, produced by enkephalinergic interneurons

72
Q

What is neuropathic pain?

A

Pain to sensory nerves themselves

73
Q

What are clinically important actions of morphine?

A

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
Q

What can prolonged use of morphine cause?

How can this be reduced?

A

Hyperalgesia

Change to another opioid

75
Q

What effect of morphine causes death in overdose?

A

Respiratory depression

76
Q

What is administered alongside morphine to reduce nausea and vomiting?

A

Anti-emetic e.g. prochlorperazine

77
Q

What substance is used in cough remedies to reduce cough reflex?

A

Pholcodeine

78
Q

What medicine is used in lung cancer to reduce cough reflex?

A

Diamorphine linctus

79
Q

What is a important diagnostic sign in opioid overdose?

A

Pin-point pupil

80
Q

Definition of tolerance in drugs?

A

Reduced effect upon repeated administration of a drug at a constant dose

81
Q

Definition of dependance in drugs?

A

Repeated, compulsive use of a drug to receive chemical rewarding effect/ avoid punishing effects of drug withdrawal

82
Q

What are the 2 types of dependance?

A

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
Q

What is the relationship between tolerance and physical dependance?

A

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
Q

How can withdrawal symptoms and addicts be helped?

A

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
Q

How can morphine be administered?

A

Orally or injection

86
Q

How is morphine processed in liver?

A

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
Q

What is the plasma half-life of morphine in adults?

Neonates?

A

3-6 hrs
Longer in neonates cos low conjugating capacity of liver - risk of neonatal resp depression if morphine given during childbirth

88
Q

What is codeine and diamorphine metabolised into?

A

Morphine

89
Q

How is buprenorphine administered?

A

Sublingually

90
Q

How is fentanyl and sufentanil administered?

A

Intrathecally during surgery

91
Q

What opioid is used in obstetrics?

Why?

A

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.
© 2024 Bold Learning Solutions. Terms and Conditions