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Pharmacy 2024 > Exam 4 > Flashcards

Exam 4 Flashcards

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1
Q

What is hemostasis ?

A

the body’s ability to clot blood

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2
Q

What does hemostasis comprise ?

A

Injury -. Exposed collagen -> vWF
Interacts with glycoproteins in the surface - activates clotting cascade

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3
Q

What are red thrombi

A
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4
Q

What are the four phases of Platelets ?

A
  1. Adhesion
  2. Aggregation
  3. Secretion
  4. Cross-linking of adjacent platelets
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5
Q

What are the bricks o f thrombogenisis ?

A

formation of platelet plugs - thrombocytes

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6
Q

What is coagulation ?

A

formation of a clot

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7
Q

What is fibroinolysis ?

A

break down of a clot

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8
Q

thrombogenesis pathway

A

endothelial cells that produce PGI2 (prostacyclin) ->Damage expose vWF & collagen - Collagen binds to 1A , vWF binds to 1B (Adhesion)
Signals other platelets to come Aggregate
Secretion of 5-HT , TXA2, and ADP
Creates Cross- linked platelets

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9
Q

What does aspirin target ?

A

The clot itself
irreversible due to acetyl group

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10
Q

What are the pathways of blood coagulation ?

A

Extrinsic pathway - tissue damage exposes tissue factor
Intrinsic pathway - platelets interact with damaged endothelium

BOTH lead to common pathway
Thrombin activation - formation of fibrin clot

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11
Q

Factor 10 does what to fibrin?

A

Activates it

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12
Q

What helps platelets aggregate ?

A

Fibrin and fibrinogen

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13
Q

Tissue factor activates what ?

A

Extrinsic pathway

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14
Q

Extrinsic Pathway

A

trauma tissue factors - activates factor7
7 activates 10 directly
10 is in the common pathway - creates thrombin then fibrinogen to fibrin

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15
Q

Thrombin’s main effect

A

To convert fibrinogen to fibrin

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16
Q

Intrinsic pathway

A

surface damage effects internal factors -
activates Factor 12
then factor 11
then factor 9
then facto 10 common pathway
Prothrombin (2) is converted to thrombin
fibrinogen is then converted to fibrin
cross linked through additional actions of factor 13
thrombin activates 13
which then activates 5 - will assit to activate more thrombin
Factor 11 is activated and then activates protein C and protein S aids it in inhibiting factor 5 and 8 ( negative feedback to control clotting.)

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17
Q

PTT is which pathway ?

A

Intrinsic pathway

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18
Q

PT is what pathway ?

A

Extrinsic

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19
Q

Activators of coagulation pathway ?

A

thrombin - 5,8,11, 3, and protein C

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20
Q

Inhibitors of coagulation pathway ?

A

Protein c - 8 & 5
Antithrombin - 10

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21
Q

Virchow’s Triad

A

Stasis - decreased blood flow
Hypercoagulability - blood clots
Endothelial injury - damage to the inside of the blood vessels

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22
Q

Where do DVT’s occur?

A

large veins of lower limbs
But can break off and travel - potentially fatal
Starts form virchow’s triad

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23
Q

What are white thrombi ?

A

platelets and

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24
Q

Where are red thrombi ?

A

low pressure veins
A lot of fibrin and a long tail

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25
DVT Risk factors ( genetically.)
Antithrombin 2 deficiency Sickle Cell Protein C & S deficiency Activated protein C resistance
26
Acquired DVT risk factors
bedridden Surgery / trauma Obesity Estrogen use Malignancies Chronic venous insufficiency
27
why do we need Regulation of Coagulation
must be confined to avoid over coagulation DIC
28
Treatment of DIC
plasma transfusion Underlying cause 10-15% mortality
29
Regulation of Coagulation
fibrin inhibition Fibrinolysis Protease inhibitors Fibrinolyitc system - after clot is formed Broken down with plasmin
30
What does t-PA do ?
activates plasminogen to plasmin
31
What protects clots ?
Aminocaproic acid TXA
32
Coagulation Modifiers
Anticoagulant Antiplatelets Thrombolytic drugs (FIbrinolytic) Hemostatic or Antifibrinolytic drugs
33
Drugs to treat Thromboembolism
Anticoagulant- heparin - inactivate clotting via factor 10 Warfarin- decreases synthesis Aspirin - decreases platelet aggregation Streptokinase - fibrinolysis
34
Indirect thrombin Inhibitors act how ?
inactivation of factor Xa
35
Heparin MOA
Antithrombin 3 Binds and activates AT Enhances activity 1000X Catalyzes reaction without being consumed
36
Which heparin is more specific for factor Xa?
LMW heparin
37
Where does heparin come from ?
pig or cow intestine
38
LMW heparin examples ?
Enoxaparin Dalteparin Tinzaparin
39
what lab is monitored with Heparin ?
aPTT (Activated partial thromboplastin)
40
When does HIT happen and what is it ?
Heparin induced thrombocytopenia 7-10 days after administrations body builds up antibodies to it
41
PT time looks at what ?
extrinsic pathway The time to clot
42
What is INR ?
time to clot compared to control Normal 1 Warfarin target 2-3
43
aPTT assess what ?
intrinsic system Normal is 35-45
44
Heparin reversal ?
Protamine sulfate
45
Protamine sulfate has no effect on which drug ?
Fondaparinux
46
Fondaparinux (Arixtra) is good for what ?
HIT - less bleeding risk Activates Antithrombin molecules Synthetic Not as effective - dont need a reversal
47
Heparin contraindications all deal with what concern?
will this patient bleed out
48
Active sites for Direct thrombin inhibitors ?
directly to thrombin Active and substrates
49
Direct Thrombin Inhibitors
Lepirudin Angiomax Argatroban Melagatran Dabigatran (Pradaxa
50
What kind of organ is the pancreas?
Endocrine and Exocrine
51
Whats the smallest portion of the pancreas?
the endocrine
52
What are the cell types of Pancreas ?
Alpha - release glucagon Beta - release insulin two more we dont need to know right now.
53
Alpha cells release what in the pancreas? ?
GlugAgon
54
Beta cells release what in the pancreas? ?
Insulin
55
Delta (D) cells produce what in the pancreas?
Somatostatin jk know this one
56
G cells produce what in the pancreas?
Gastrin
57
F (PP) cells produce what in the pancreas?
Pancreatic Polypeptide
58
What are the control centers for blood glucose?
insulin from beta cells and glucagon from alpha cells
59
normal blood glucose level?
90 70-110 normal range
60
What the renal threshold for glucose ?
160 and above
61
Difference between DM and DI ?
DI will not have high glucose
62
what does mellitus mean ?
Sugar
63
Earlier test for diabetes mellitus ?
drink urine - sweet= positive
64
Types of DM
Four types 1 = insulin dependent 2 = non - insulin dependent 3 = other causes ( pancreatitis or drugs) 4 = Gestational
65
Name for Type 1 DM ?
IDDM Idiopathic diabetes Melitus
66
Whats lost in Type 1 DM?
80-90% of function of the insulin-secreting beta cells in the islet of Langerhans is lost. PPP, weight LOSS and fatigue DKA big problem
67
Type 1 DM manifestations
PPP, weight LOSS and fatigue DKA big problem
68
Type 2 DM name ?
NIDDM
69
When does type 2 DM occur ?
Adult onset causes metabolic syndrome
70
Most common medication for type 2 DM ?
Metformin "GLucophage"
71
Other name for Metformin ?
Glucophage
72
Type 2 DM manifestations?
Nonketotic hyperosmolar coma
73
What are hyperosmolar comas caused from ?
Dehydration
74
Hyperglycemia and the polyol pathway ?
Sorbitol from high glucose --> increases intraocular pressure water rushes in and cells burst mostly located around eyes - causes vision distubances
75
Protein Kinase C can be inappropriately activated by what ?
hyperglycemia
76
How does Gestational Diabetes develop?
77
Whos at an increased risk for life long DM with gestational diabetes ?
mom and baby
78
How is DM diagnosed ?
Fasting glucose or Glucose tolerance test
79
How is DM monitored? ( 3 test)
self - GLucose POC Hemaglobin A1C Insulin
80
How many Glucose transporters are there?
5
81
what are the glucose transporters ?
GLUT 1,2,3,4,5
82
GLUT 1 tissues and function ?
ALL tissue , red cells and brain basal uptake of glucose , trsnport across blood brain barrier
83
GLUT 2 Tissues and function ?
Beta Cells of pancreas; liver , kidny gut Regulation of insulin release
84
GLUT 3 tissues and function ?
Brain, kidney , PLACENTA uptake into neurons
85
GLUT 4 tissues and function ?
Muscle, adipose insulin mediated uptake of glucose
86
GLUT 5 tissues and function ?
Gut, Kidney Absorption of fructose
87
Insulin secretion pathway
Elevated Glucose levels in blood.- transported into cell vis GLUT 2 ( Low affinity)----> metabolised to ATP through glycolysis ATP bind to potassium channels and closes it --- depolarizes membrane ( more positive) -- Calcium rushes in to fix positive - binds to insulin and causes vesicle fusion and exocytosis of insulin.
88
What are the Insulin secretagogues ?
Glucose Amino Acids Hormones Fatty Acids Incretins Drugs ( sulfonylureas , isoproteronol )
89
How long does insulin last in the blood stream ?
6 mins
90
What are the insulin Receptors ?
Tyrosine Kinase
91
What are IRS?
Insulin response substrate
92
What are the low affinity glucose transporters ?
GLUT 2 and GLUT 4
93
What are the main endocrine effects of insulin ?
Inhibits glycogenolysis inhibits conversion of fatty acids and amino acids to keto acids promotes glucose storage as glycogen
94
What are leptin ?
Adipose cells
95
What inhibits insulin secretion?
Insulin Leptin SNS (alpha adrenergic ) Chronically high glucose Drugs ( Diazoxide, phenytoin, vinblastine, colchicine)
96
Short acting Insulins ( regular)
Novolin, humulin
97
What insulin is given with meals and how?
Insulin lispro Aspart Glulisine given as injection
98
What insulin is not tight contoroll?
70/30 Pre-mixed
99
Ways to inject insulin ?
SQ injection - hypodermic needle portable pen injectors CSIID (continuous SQ insulin infusion devices )
100
Whats good for "Tight control "?
CSIID must be changed every few days
101
Different types of insulin calculations
BASAL - 1 - long acting BOLUS - carbohydrate covering CORRECTION - high glucose
102
Carbohydrate Coverage calculations for INsulin dosing ?
Bolus 1 unit of RA - disposes 12-15g of carbs 60g carbs = 4 units of RA (60/15)
103
High glucose calculation for insulin injections ?
Corrections 1 unit of RA needed to drop 50mg/dl 200 mg /dL (50mg/dL x 2= 100 mg/dL drop)
104
Do our insulin levels ever reach 0 ?
no - called constitutive insulin
105
What is a endogenous Ligand ?
Naturally bind and activate a response
106
3 Types of Endogenous Ligands ?
Endorphins Enkephalins Dynorphins
107
What does continuous exercise stimulate the release of ?
endorphins
108
2 CNS Neuron types?
Relay neurons Circuit Neurons
109
What do relay neurons do ?
relay signal to other parts of CNS EPSP - Glutamate
110
What do circuit neurons do ?
Local control IPSP - GABA, glycine negative feed-forward or feedback
111
Which Neurontransmiters act as diffuse systems in pain ?
Monoamine - NE , Dopamine, 5-HT, - non-hierarchial ACh- choline ester
112
Are diffuse systems heavily myelinated or lightly myelinated ?
unmyelinated - slower conduction
113
What is Alzheimers disease linked to ?
deterioration of Ach diffuse system
114
Two components of pain
Sensory and emotional
115
Pain Stimuli types
Noxious chemical Thermal Mechanical
116
How can the emotional component of pain be initiated ?
by the anticipation of pain - before it happens , can make it worse
117
How is pain measured ?
as a symptom with a pain scale
118
What are nociceptors?
pain receptors all free nerve endings
119
What are at the tips of nociceptors?
PG's leukotryines
120
LTMR sense what ?
Low-threshold mechanoreceptors - touch, feel , movement or sensation
121
Where is pain processed ?
somatosensory cortex
122
How is pain blocked with opiods?
we use opioids to block the pathway that sends pain signals.
123
A-Beta fibers send what kind of pain ?
Non -noxious mechanical stimuli
124
A-Delta fibers send what kind of pain ?
Noxious , heat, mechanical stimuli , sharp pain , initial reflex response
125
C fibers send what kind of pain ?
noxious - slow - burning
126
Which fibers or unmyelinated ?
C-fibers
127
Gate Control Theory implies what ?
implies that pain can be suppresed with some other pain fibers ... gates in spinal cord can be adjusted to increase or decrease pain usually large A fibers can suppress C fibers.
128
Noxious Chemical continues to send pain how?
damaged tissue activates WBC - release of PG's - bind to receptor and activate PKc and PKa inflammatory cytokines are released too Bradykinin 1 & 2 Others : VG- CA, Na channels all elicit a action potential to signal pain
129
What is affective sensation ?
reception of pain signal and desire to do something about it
130
Spinothalamic pain pathway -
primary pain pathway 0 thalamus to postcentral gyrus ends in somatic sensory cortex
131
Spinoreticular pathway
more emotional passes through reticular formation of pons ends in somatic sensory cortex
132
Spinomesencephalic pain pathway
Periaqueductal grey - terminates in PGA can be suppressed by other pain pathways
133
Type of Opioid classifications
Agonist Partial agonist Antagonist
134
Most Opioids target what receptor?
mu
135
Partial agonist opioids?
Codeine oxycodone
136
Full agonist opioids ?
morphine , fentanyl
137
Antagonist Opioids ?
Narcan
138
Other opioid receptor targets ?
Delta and Kappa
139
Kappa has what effects ?
Pyschotomometic effects
140
Which opioid has low first pass effect ?
Codeine - primarily given orally
141
What is heroine processed by ?
tissue esterases to morphine
142
MOA of opioids
bind to receptors in brain and spinal cord and shut down pain pathway and reduce ESPS can also hypo-polarize postsynaptic neurons
143
Mu Receptor effects
Analgesia , euphoria, respiratory depression , dependence
144
Over all Organ effects from opioids ?
analgesia - emotional and sensory euphoria (dysphoria) sedation Respiratory depression Miosis BradyCardia (tachy from demerol) and constipation
145
side effects of loperamide with opioids ?
given to relieve constipation - but can increase respiratory depression significantly and get patient high
146
What all should be involved with pain assessments ?
pathology patient history and duration
147
Immediate treatment of Acute coronary Syndrome ?
Morphine - pain & anxiety Oxygen Nitroglycerin Aspirin
148
How does tolerance build up with opioids ?
develops fairly rapidly theories - receptor phyosphorylation , increased cAMP , internalization of receptor , uncoupling with g-proteins
149
When will a patient definietly have withdrawal symptoms ?
150
Pathways to addiction ?
tolerence and dependence = mesolimbic system
151
What is opioid Induced Hyperalgesia (OIH)
increased pain sensation , distinct form original pain not related to tolerance/ withdrawal
152
How does OIH happen ?
sensitization of muOP -- MOR- 1K -- splice varient of MuOP - increases cAMP in cell
153
Drug overdose ?
Narcan
154
Alcohol withdrawal drug
naltrexone
155
Three different classes of opioid structures
Phenanthrenes Phenylheptylamines Phenylpiperidines
156
Strong agonist of Phenanthrenes
Morphine , dilaudid, heroin
157
Strong agonist of Phenylheptylamines
Methadone
158
Strong agonist of Phenylpiperdine
fentanyl , demerol
159
What was carfentanil made for ?
sedation of large animals
160
Demerol concerns
serotonin syndrome , - inotrope , seizures
161
How do we treat post- op shivering ?
Merperdine , ondansetron biggest concern is the amount of oxygen consumed with shivering
162
Moderate agonist of Phenanthrenes
Codeine, oxycodone more effective as combination Oxy + acetaminophen = percocet oxy + aspirin = percodon
163
Moderate agonist of Phenylheptylamines
Propoxyphene ( Darvon)
164
Moderate agonist of phenylpiperdines
tramadol also has SNRI activity racemic mixture safer alternative
165
How quickly does narcan reverse overdose ?
1-3 minutes.
166
Gram positive bacteria is targeted how ? example abx?
Inhibition of cell wall synthesis PCN cephalosporin
167
Which abx has a five ring structure ? and what type of bacteria does it treat?
PCN - Gram +
168
Which abx has a six head ring structure and what type of bacteria does it treat?
Cephalosporin - Gram +
169
MOA of PCN and cephalosporin ?
B-Lactam ring attaches to the enzymes that cross-link peptidoglycans , and prevent cell wall synthesis
170
What is resistant to PCN ?
Beta-lactamase
171
What drug can be given if a patient is PCN resistant ?
Carbapenems - very expensive or vanc - can be vanc resistant
172
Vancomyocin is useful for what kind of infection ?
Gram +
173
What kind of drug is Vancomycin ?
Glycopeptide
174
What is red neck syndrome ?
caused from Vancomycin toxicity
175
MOA of polypeptide abx?
act as detergents - bind to phospholipids best in gram -
176
Disruption of cell membrane abx ?
Polymyxin triple abx - OTC polymycin - gram - neomycin - bacterial protein synthesis bacitracin - cell wall synthesis - gram +
177
Tetracyclines MOA -
Bacteriostatic slow down growth but do not kill bacteria
178
Tetracyclines side effect pneumonic ?
DEVIL'S CAP Dentition - teeth Epigastric Pain , nausea Vestibular toxicity Insipidus diabetes Liver Damage Superinfections Kidney damage Anti-Anabolic effect phototoxicity
179
5 MOA's of Abx's ?
Inhibition of Cell wall Synthesis Disruption of Cell Membrane Inhibition of Protein Synthesis Inhibition of Nucleic Acid Synthesis Inhibition of Folic Acid Synthesis
180
Two ways folic acid abx's function ?
competitive inhibition incorporated into important molecules
181
Antifungal agents
Dermatophytes Polyenes Imidazoles
182
Antiprotozoan agents and what can it treat ?
Quinine - malaria Metronidazole - Flagyl
183
Flagyl can cause what ?
black hairy tongue cancer and birth defects
184
Treatment of Parasitic worms ?
Niclosamide -- Tapeworms Mebendazole - Round worms Ivermectin - river blindness roundworm permethrin - lice
185
How do we acquire resistance ?
natural selection chromosomal mutation extrachromosomal Resistance
186
What induces abx resistance ?
premature termination of abx treatment
187
Cell wall targeting abx's ?
PCN /Ampicilin/ amoxicilin Cephalosporin Carbapenems Vancomyocin
188
Cell membrane targeting abx's?
Polymyxin Daptomycin
189
Protein Synthesis targeting abx's
Tertacycline Erythromycin Azithromycin Chloramphenicol Linezolid
190
DNA/RNA targeting abx's
Rifamycin Floroquinolones/Cipro/Levaquin/floxin
191
Folic Acid targeting abx's
192
Lysogenic means what ?
slow release - prolonged
193
Lytic means what ?
burst of host cell cleared quickly - acute
194
DNA viruses | DD
D.S S.S Parvo - can be super harmful to dogs
195
do viruses resemble cells ?
no they lack protein synthesis
196
Classes of Viruses
DNA Viruses RNA Viruses Retrovirus - part of RNA
197
What is reverse transcriptase ?
the enzyme we can target in antiviral therapy
198
All viruses have a minimum of what ?
Nucleic acid and Capsid
199
What part of the virus targets cell proteins ?
the spike
200
What is an envelope virus ?
a virus with an outer shell membrane come from the part of the cell membrane it came from
201
What the difference between a naked virus and a envelope virus ?
the outer shell membrane the envelope virus will take with it
202
what is a nucleocapsid ?
capsid and nucleic acid together
203
Steps of Viral Replication
Adsorption Penetration Synthesis Maturation Release
204
What happens in Adsorption
attachment of virus to host cell - target viral spike
205
What happens in Penetration
how the virus gets into the cell un-coat or shed its outer membrane can just inject nucelic acid into host
206
What happens during Synthesis
new nucleil acids , capsid proteins, and viral compnents
207
What happens during Maturation
assembly of newly synthesized viral components into complete virions
208
What happens during Release
departure of new virions from host cells two main forms - Lytic Lysogenic
209
Why are viruses hard to treat ?
mutate very quickly
210
How long have antivirals been available ?
only since late 1970
211
What enzymes cause DNA replication ?
DNA polymerases
212
What is Acyclovir referred to ?
DNA chain Terminator missing the chain to allow DNA polymerases to attach to
213
What does HIV target ?
CD4 ( T-Cells)
214
What do HIV drug target?
inhibitor of reverse transcriptase
215
Most common signs of Parkinson's
Tremors rigidity bradykinesia postural instability cognitive decline
216
What is Choreathetosis ?
overlapping of Chorea, athetosis , and Dystonia usually associated with trauma
217
How does the substantia Nigra control the thalamus ?
release of dopamine
218
What do all parkinsons patients have in common?
slow decrease in dopamine levels from substantia nigra
219
What are occupational risk factors for Parkinson's ?
Teaching , healthcare , and Farming
220
Most severe and most common muscle disease ?
Duchennes MD
221
How long is Duchenne's ?
over 1 million long
222
How is Duchenne's developed and who contract it?
X-Linked inheritance from mothers mostly effects males
223

Pharmacy 2024 (3 decks)

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