CVS 7 Flashcards by Hassan Khokhar

zero order kinetics drugs

WATTP
Warfarin 
Aspirin
Theophyline
Tolbutamide ( first gen sulfonylurea)
Phenytoin

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failure of therapy caused by enzyme inducer or inhibitors

INDUCER

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list of enzyme inducers

My New GPRS Cell Phone
Modanifil —- increase DA (narcolepsy ADHD)
Nevirapine —– NNRTI
Griseofulvin —– microtubules
Phenytoin —– Na in heart and brain
Rifampin —— Rna polym II
Smoking/ St john wart ——— increase 5HT
Carbamezapine (na-) and CHRONIC alcohol
Phenobarbital —— GABA duration cl- channels

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what is the eukaryotic RNA polymerase inhibitor

Amantina phelloides death cap mushroom

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most common types of RNA

R rna—— I
M rna—— II
T rna —— III

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CYP 450 inhibitors 3A4 most common type

Sodium valproate  Na - / gaba transaminase -/ t  typ ca
Isoniazid
Cimetidine
Ketoconazole
Fluconazole
Acute alcohol / avirs / amiodarone ( 5' deiodinase)
Chloramphenicol / cipro/ clarythro
Erythromycin
Sulfa --------- dehypteroate synthase
C
Omeprazole
Metronidazole
Grapefruit juice

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tiagabine MOA

blocks reabsp of GABA

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Gabapentin

acts on GABA receptors +ve

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vigabatrin

gaba transaminase inhibitor
GABA doesnt break down —– increase levels of GABA

for infantile spasms

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sodium valproate

gaba transaminase inhibitor
Na channels inhib
t type calcium channels

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pregabalin

increases releae of GABA

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Chemical mediators are divided into CELLULAR AND PLASMA

what are the plasma ones?

made in liver
complement
kinin
clotting

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Cellular chemical mediators

PREFORMED
hsitamine
serotonin
lysosomal enzymes

FRESHLY FORMED
prostaglandins
leukotreines
cytokines
nitric oxide PAF

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TLR CD 14

Gram negative endotoxin

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cytokines and mast cells degenerate to make

hsitamines

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how do steroids function

induce lipocortin —– breaks PLP to AA

innactivating NF-κB
NF-κB is the transcription factor that induces the production of TNF-α and other inflammatory agents

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antibodies against PLP A2

the enzyme that breaks PLP to AA

membranous nephropathy

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lipoxigenase inhibiotor drug

zileuton

highly hepatotoxic

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blocks leukotreine receptors

zafirleukast moteleukast

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Prostacyclin PGI2 function and drug name

inhibits platelet agg
EPOPROSTENOL
ILOPROST

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Prostaglandins PGE1

decrease vascular tone

ALPROSTADIL

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PGE2

increase uterine tone
pain
pyrexia
DINOPROSTONE

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PGF2 alpha

increase uterine tone

CARBOPROST

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Thromboxane 2

increase platelet agg
increase vascular tone
ASPIRIN ihibits this

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LOX pathway makes LTB4 and LTC D E 4

LTB4 ----- neutrophil chemotaxis LTC D E 4 ------ vasodialation and increase bronchial tone

chemotactic agents include

``` LTB4 IL 8 C5a Kallikrenin formyl methionine ```

what are the physiological functions of COX 1

gastric mucose protection increase renal perfusion platelett aggregation

COX 2 has physiological and pathological functions

PHYSIOLOGICAL increase renal perf vasodialation tissue repair PATHOLOGICAL increase pain sensitivity inflammation

asprin induced asthma mechanism

blocks COX 1 2 .... shifts towards LOX ------ LTC D E 4 increase and case bronchospams

drugs that inhibit mast cell degranulation

cromolyn nedocromil ketotifen

igE INDEPENDENT mast cell degranulation

morphine opiods Vancomycin Radiocontrast histamine bradykinin released ---- localised swelling and urticaria

what activates teh classical pathway

IgG and IgM

C3 derivatives

C3a ------ anaphylotoxin | C3b ----- opsonin IgG

what are the three pathways of complement cascade

classical ---- IgM IgG lecithin------- mannose binding lecithin C4 alternate----- spontaneous C3

c1 c2 c4 c3 -------

c5b6-9-- MAC mac is cytotoxic

mac can also bind to self cells like RBC and WBC but normally what blocks this?

PIGA gene is responsible for formation of GPI ( glycosyl phosphatidyl inositol ) this makes DAF ( CD55) and MIRL ( CD59) these prvent complent mediated desctruction

paroxysmal nocturnal hemoglobinemia

normocytic anemia | at night because of shallow breathing---- retntion of CO2 --- acidic ph activates ALTERNATIVE pathway

PNH what can be seen in this condition

dark urine hemoglobinuria decrease haptoglobin levels hemosiderinuria PLT microthrombi ---- hepatic vein thrombosis--- budd chiari

hemosiderin laden macrophages can be seen in

heart failure

what is the most common cause of budd chiari

polycythemia vera

c1 esterase def

hereditary angioedema

treatment for hereditary angioedema

DANAZOL | ECALLANTIDE

which drugs to avoid in pts with HAE

ACEi | sacubitril

If funny channels

IVABRIDINE increases BP visual brightness bradycardia

what is the function of neprilysin

breaks down ANP BNP and ang II

what is the function of Ag II

increases aldosterone which increases Na and dec K+ constricts efferent arteriole ADH secretion

sacubitril must be given with ? and why

ARBS because AgII levels also increase ANP and AgII will work against each other

what are teh side effects of sacubitril

decrease BP hypokalemia angioedema

Captopril side effects

``` Cough Angioedema Pregnancy CI ----- renal failure/ potter seq Taste disturbance Orthostatic hypoT Prodrugs (activate in liver) RAS Increase K contraindication ( ACE i increases K) Lowers ag II formation ```

deficiency in C2 C4

risk of pyogenic infections and increase risk of AUTOIMMUNE disease

def in C5-C9

increase risk of infection due to nisseria and txoplasma

neprilysin breaks down

substance p and bradykinin so when neprilysin is blocked by sacubitril these increase substance p ---- pain bradykinin ---- angioedema

steps of leukocyte extravasation

``` Margination Rolling Adhesion Transmigration (DIAPEDESIS) Chemotaxis Opsonization Phagocytosis O2 dep killing ```

Margination cell adhesion molecules include | vasculature and leukocyte

VASCULATURE P selectin E selectin L selectin LEUKOCYTE sialyl lewis

E L selectin

IL 1 TNF alpha

P selectin

released from weibel palade bodies

what else is secreted from weibel palade bodies

VWF | can be induced by desmopressin

Adhesion molecules | vasculature and leukocytes

VASCULATURE ICAM 1 CD54 VCAM 1 CD 106 LEUKOCYTES CD 11/18 integrin

what induces integrin

C5a | LTB4

Transmigration diapedesis | vasculature and leukocytes

VASCULATURE PECAM 1 CD31 LEUKOCYTES PECAM 1

Migration

``` LTB4 C5a IL8 kallikrein platelet activating factor ```

CGD and the tests

``` def in NADPH oxidase XLR nitrobluetetrazolium test ---- blue test positive means no deficiency ``` DHR test ---- O2 ---> O2- requires NADPH oxidase O2- is needed to convert DHR ---> rhodamine so in NADPH oxidase def no O2- is made hence no rhodamine made so INCREASE IN DHR

organisms that can cause infection in CGD

``` catalse +ve Cats Need PLACESS to Belch their Hairballs Candida Nocardia Pseudomonas Listeria Aspergillus Candida E coli Staph Serratia Burkolderia cepaciae H.pylori ```

O2 independent mechanism of killing

major basic protein lactoferrin lysozyme (tears /saliva)