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NN Pharmcology and pathophysiology > Year2 Sem PPP2 > Flashcards

Year2 Sem PPP2 Flashcards

1
Q

Sleep disorder drug

A

(sedating antihistamines? indication: allergic symptoms/ rhinitis, eczema, pruitis Adverse effect:drowsiness, dizziness)

Zopiclone/ Zolpidem (半Benzo),
Benzodiazepines
Melatonin

Other agents:
TCA brings antimuscarinic side effects (not good for insomnia only)
Antipsychotics ( indicated for insomnia due to dementia)
Chloral hydrate (used in procedures e.g. children)
Phenobarbitone (unacceptable safety profile-suicide)

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2
Q

Zopiclone/ Zolpidem (半Benzo)

indication:

mode of action:

adverse effects:

precautions:

A

indication: hypnotic

mode of action: increase the inhibitory effect of GABA on neuronal membrane permeability to chloride ion

adverse effects: oversedation, drowsiness, memory loss, light-headedness, ataxia
(less common: headache, disorientation, cognitive impairment, decreased libido, anterograde amnesia, respiratory depression)

black box warning: complex sleep disorders including sleep-walking

precautions: short term use only (7-10days), rapid onset, caution in pt with depression(suicidal ideation), extreme caution in pt with risk of falls

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3
Q

Benzodiazepines

indication:

mode of action:

adverse effects:

precautions:

A

indication: anxiolytic, sedative, hypnotic, muscle relaxant

similar with Zopiclone/ Zolpidem

(not a good option to sleep disorders due to side effect, but good for anxiety+insomnia)

precautions: short-term use only (2-4weeks), long-term use may cause tolerance and dependence

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4
Q

Acetylcholinesterase inhibitors

Mode of action:

Indication:

Adverse effect:

Contraindication:

Practice points:

A

Donepezil, Galantamine (tablet)
Rivastigmine (capsule)(stonger side effect: GI upset)

Mode of action:
decrease breakdown of acetylcholine
reduce the apparent deficiency of cholinergic neurotransmitter activity in Alzheimer’s disease

Indication: Alzheimer’s disease (mild to moderate)

Adverse effect: diarrhea, vomiting, nausea, anorexia, abdominal pain, dyspepsia, headache, insomnia, vivid dreams, depression, fatigue, drowsiness

Contraindication: previous GI obstruction, active peptic ulcer

Practice points: assess response after 3 months at full dose/highest well-tolerated dose

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5
Q

What are the primary risk factors associated with Osteoarthritis?

A

Increasing age, obesity, genetic factors, inactivity, and repetitive joint use.

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6
Q

Describe the pathophysiology of Osteoarthritis.

A

It involves the degradation of articular cartilage, leading to loss of cartilage, exposure of underlying bone, and formation of osteophytes.

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7
Q

What are the common clinical manifestations of Osteoarthritis in the knee?

A

Pain on motion, limitation of motion, crepitus, and joint instability.

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8
Q

How is Osteoarthritis diagnosed?

A

Through medical history, physical examination, X-rays showing joint space narrowing, and possibly ESR.

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9
Q

What treatment options are available for managing Osteoarthritis symptoms?

A

Physical therapy, NSAIDs, analgesics, corticosteroids, and possibly joint replacement surgery.

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10
Q

What is the physiological mechanism leading to Gouty Arthritis?

A

It is caused by elevated serum uric acid levels, leading to the formation of monosodium urate crystals in joints.

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11
Q

List common risk factors for Gouty Arthritis.

A

Male gender, aging, obesity, hypertension, and consumption of a purine-rich diet.

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12
Q

What are the clinical manifestations of acute Gouty Arthritis?

A

Severe pain in one or more joints, often starting at night, with redness, swelling, and tenderness, usually affects the first metatarsophalangeal joints.

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13
Q

How is Gouty Arthritis diagnosed?

A

Through serum uric acid levels, 24-hour urine tests for uric acid, and synovial fluid analysis for monosodium urate crystals, x-ray of affected area, blood for CBP

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14
Q

What pharmacological treatments are commonly used to manage Gouty Arthritis?

A

NSAIDs, colchicine, corticosteroids (e.g. prednisolone), and xanthine oxidase inhibitors like allopurinol.

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15
Q

What is the pathophysiology of Rheumatoid Arthritis?

A

It involves an autoimmune response leading to synovial membrane inflammation, pannus formation, and joint destruction.

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16
Q

What systemic symptoms are commonly associated with Rheumatoid Arthritis?

A

Fatigue, weight loss, low-grade fever, and generalized stiffness.

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17
Q

Describe the diagnostic criteria for Rheumatoid Arthritis.

A

Diagnosis requires at least 5 out of 10 criteria, including joint involvement, serology, acute phase reactants, and symptom duration.

Joint involvement (swelling/tenderness in multiple joints, reduced motion, soft&spongy feeling)
Cloudy synovial fluid

Serology (positive rheumatoid factor or anti-CCP antibodies, , **HLA-DRB1antigen+ve)

Acute phase reactants (elevated ESR or CRP)

Duration of symptoms (lasting more than 6 weeks)
Physical examination findings (morning stiffness lasting more than 30 minutes)

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18
Q

What are the key treatment goals for managing Rheumatoid Arthritis?

A

To reduce pain, decrease inflammation, maintain joint function, and prevent joint destruction.

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19
Q

How do the clinical manifestations of Rheumatoid Arthritis differ from Gouty Arthritis?

A

RA typically presents with symmetric joint involvement and systemic symptoms, while Gouty Arthritis often affects a single joint acutely.

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20
Q

CPR in lab results means?

A

C-reative protein

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21
Q

What is a Simple (Closed) fracture?

A

A fracture where the bone is broken, but the skin remains intact.

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22
Q

What is a Compound (Open) fracture?

A

A fracture where the bone breaks through the skin.

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23
Q

What is a Complete fracture?

A

A fracture that goes all the way through the bone.

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24
Q

What is an Incomplete fracture?

A

A fracture that does not completely traverse the bone (e.g., greenstick fracture).

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25
Q

What is a Comminuted fracture?

A

A fracture where the bone is shattered into multiple pieces.

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26
Q

What is a Stress fracture?

A

A small, hairline crack in the bone due to repetitive force or overuse.

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27
Q

What T-score indicates normal bone density in a DEXA scan?

A

T-score ≥ -1.0

28
Q

What T-score range indicates osteopenia in a DEXA scan?

A

T-score between -1.0 and -2.5

29
Q

What T-score indicates osteoporosis in a DEXA scan?

A

T-score ≤ -2.5

30
Q

What is classified as severe osteoporosis in relation to T-scores?

A

T-score ≤ -2.5 with a history of fractures.

31
Q

What equipmetn for screening purpose, not suitable for diagnosis in osteoporosis?

A

Quantitative ultrasound

32
Q

5 stages of the fracture healing process

A

Hematoma formation stage,
Cellular proliferation stage/granulation
Callus formation stage
Ossification stage
Consolidation and remodeling

33
Q

What is the pathophysiology of ischemic stroke?

A

Ischemic stroke involves occlusion of an artery by an atheroma, leading to reduced blood flow and potential infarction. Cerebral edema and increased area of infarction occur within the first 48 to 72 hours, resulting in neurologic deficits.

34
Q

What causes hemorrhagic stroke?

A

Hemorrhagic stroke is caused by the rupture of a cerebral artery, often due to severe hypertension or aneurysms. This leads to increased intracranial pressure (ICP) and disrupted blood supply, causing significant brain damage.

35
Q

What are the key features of Parkinson’s disease pathophysiology?

A

Parkinson’s disease involves the degeneration of neurons in the substantia nigra, leading to decreased dopamine production. This results in impaired muscle movement coordination and motor function, causing tremors, rigidity, and bradykinesia.

36
Q

How does dopamine loss affect movement in Parkinson’s disease?

A

The loss of dopamine impairs the basal ganglia’s ability to smooth out muscle movements, leading to difficulties in initiating movement, tremors at rest, and issues with posture and gait.

37
Q

What are the key pathological features of Alzheimer’s Disease?

A

Alzheimer’s disease is characterized by the accumulation of amyloid-beta plaques and tau tangles in the brain. These abnormalities disrupt neuronal communication and lead to neurodegeneration, resulting in cognitive decline and memory loss.

38
Q

What are generalized seizures?

A

Generalized seizures involve both hemispheres of the brain from the onset and typically affect consciousness. They can manifest in various forms, including tonic-clonic, absence, myoclonic, and atonic seizures.

39
Q

What are tonic-clonic seizures?

A

Consist of two phases:

Tonic Phase: Muscles stiffen, and the person may fall.
Clonic Phase: Rhythmic jerking of the limbs occurs.
Consciousness is lost during the seizure.

40
Q

What are absence seizures?

A

Involve brief episodes of staring or unresponsiveness, typically lasting a few seconds. Consciousness is impaired, but there is no significant motor activity.

41
Q

What are myoclonic seizures?

A

Myoclonic seizures are characterized by sudden, brief jerks or twitches of muscles. They may occur as a single event or in clusters and usually do not cause a loss of consciousness.

42
Q

What are atonic seizures?

A

Atonic seizures involve a sudden loss of muscle tone, leading to collapse or falls. These seizures are sometimes referred to as “drop attacks” and typically result in a brief loss of consciousness.

43
Q

What is status epilepticus?

A

Status epilepticus is a medical emergency characterized by a prolonged seizure lasting more than 5 minutes or by recurrent seizures without full recovery of consciousness between episodes.

44
Q

How are seizures diagnosed?

A

History and physical examination
* Birth and developmental history
* Significant illnesses and injuries
* Family history
* Febrile seizures
* Comprehensive neurologic assessment

Seizure history
* Precipitating factors
* Antecedent events
* Seizure description: onset,
duration, frequency, postictal state:
altered state of consciousness after
an epileptic seizure)

Diagnostic studies:
❑ CBC
❑ Urinalysis
❑ Electrolytes, creatinine, fasting
blood
❑ glucose
❑ Lumber puncture for CSF analysis
❑ CT, MRI, PET scan
❑ Electroencephalography (EEG)

45
Q

What are the treatments options of seizures other than drugs?

A

Surgery
Resection of epileptogenic tissue
Common site: anterior temporal lob resection

Vagal Nerve Stimulation Therapy
(Used as adjunct to medications when
surgery is not feasible)
* Surgically implanted electrode in the neck is programmed to deliver the electrical impulse to the vagus nerve

46
Q

Drugs for seizures

A

Carbamazepine, Valproate Sodium

47
Q

Practice points of Carbamazepine:

A

Testing of HLA-B*1502 gene prior to initiation (increased risk of Stevens-Johnson syndrome)

Strong enzyme inducer
Induces hepatic enzymes; may decrease the effectiveness of other medications (e.g., oral contraceptives, warfarin).
Use caution with other CNS depressants (e.g., alcohol, benzodiazepines).

48
Q

Practice points of Valproate Sodium

A

Subject to multiple drug interactions
Pregnancy category X

49
Q

Drug that required testing of HLA-B*1502 gene

A

Carbamazepine

50
Q

Drug that optional testing of HLA-B*1502 gene

A

Phenytoin

51
Q

Levodopa

Indication:

Mechanism of Action:

Formulations:

Common Side Effects:

Practice point:

A

Indication: Primary treatment for Parkinson’s disease.

Mechanism of Action: Converts to dopamine in the brain, replenishing depleted dopamine levels.

Formulations: Often combined with Carbidopa to enhance effectiveness and reduce peripheral side effects.

Common Side Effects: Nausea, dizziness, orthostatic hypotension, dyskinesias (involuntary movements).

Practice point: take before food always (at the same time)

52
Q

Indication: Used as an adjunct to Levodopa/Carbidopa therapy for patients with fluctuating symptoms.
Mechanism of Action: COMT (catechol-O-methyltransferase) inhibitor; prevents the breakdown of Levodopa, increasing its availability in the brain

A

Entacapone

53
Q

Dopamine Agonists

A

Mode of actions: Stimulate dopamine receptors

less intensive effects, absent of on-off effect

54
Q

Cushing’s Reflex

A

A response to increased ICP characterized by:
-Hypertension
-Bradycardia (decreased heart rate)
-Bradypnea (decreased respiratory rate)

Emergency Situation: Requires immediate intervention.

55
Q

Mild Traumatic Brain Injury (mTBI)

A

Head injury causing alteration in brain function, typically defined by a Glasgow Coma Scale (GCS) score of 13 to 15.

Common Symptoms:
Confusion and amnesia
Loss of consciousness
Headache, dizziness, nausea, vomiting
Mood disturbances and sensitivity to light/noise

56
Q

Monitoring mTBI
Observation Criteria:

A

GCS < 15
Abnormalities on CT (e.g., hemorrhage)
Seizures or recurrent vomiting
Other neurological deficits

57
Q

Intracranial Pressure (ICP)

A

Normal ICP: 0-15 mmHg; increased ICP ≥ 20 mmHg is life-threatening.

Early signs of Increased ICP:
Decreased level of consciousness
Severe headache
Projectile vomiting
Papilledema (swelling of optic disc)
Pupil, fixed and dilated

Later stages:
Cushing’s reflex/ Cushing triad

58
Q

Practice points of bisphosphonates (Alendronate)

A
  1. Oral: take drug first thing in the morning
  2. with a glass of water (if not, may stick to esophagus)
  3. on an empty stomach
  4. sit-up straight for 30 mins (if not, causing GERD)
59
Q

Drugs for maintain cartilage health and may aid in joint lubrication.

A

Glucosamine

caution in people with shell fish allergy

60
Q

Nasal decongestant

A

Xylometazoline, phenylephrine
(otrivin)

practice points:
not use more than 7 days, need to stop for 3 days

contraindication: Hypertension

61
Q

Drugs for Acne

A

Vitamin A derivative (e.g. isotretinoin)

Cat X pregnancy

patient should be instructed not to donate blood during the treatment and for 1 month after treatment discontinuation

Double forms of contraception 1 month prior to start of treatment, and for 1 month after treatment discontinuation

Avoid skin resurfacing procedures, e.g. laser, dermabrasion, wax epilation, during treatment and for at least 6 months after discontinuing treatment

62
Q

Adverse effects of corticosteroid (oral: prednisolone)

Practice point:

A

Dyspepsia, peptic ulcer, insomnia, palpitaion, fat-redistrubution, darkening of skin pigment, impaired glucose tolerance, osteoporosis, fluid retention, acne vulgaris, hirsutism (多毛症), risk of infection

Practice point: taken once in the morning after food

63
Q

RA drug

concomitant drug

A

Methotrexate

concomitant drug: folic acid

64
Q

ABCDE of Skin Cancer

A

A - Asymmetry
One half of the mole does not match the other.
B - Border
Edges are irregular, ragged, or blurred.
C - Color
Color is not uniform; color variegation (may include shades of brown, black, tan, red, white, or blue)
D - Diameter
Larger than 6 mm
E - Evolving/ elevated/enlarging

65
Q

Rule of Nines

A

assessing percentage TBSA total percentage of body surface area in adult

66
Q

Methods for measure extent of burns

A

Rule of Nines
For infants and children: Lund-Browder chart
Rule of Palm: palm = ~0.5% of body surface area
(good for TBSA<15%, irregular burn/patchy)

67
Q

Burn wound can be divided into three zones:

A

Zone of coagulation (most damage, central portion)
Zone of stasis/ischemia
Zone of hyperaemia (outermost region, increased inflammatory vasodilation)

NN Pharmcology and pathophysiology (8 decks)

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