Micro and Neuro part 2 Flashcards Preview

FirstAID > Micro and Neuro part 2 > Flashcards

Flashcards in Micro and Neuro part 2 Deck (83):
1

Inhaled anesthetic that may cause nephrotoxicity?

-->Methoxyflurane

2

inhaled anesthetic that may cause seizures?

Enflurane

3

Most common drug used for anesthesia during endoscopy?

Midazolam (benzo, given by IV)
-->may cause amnesia; so, in case pt wakes up during procedure, won't remember!

4

Which opiates may be used for general anesthesia?

-->Morphine and Fentanyl

5

Ketamines: (Arylcyclohexylamines)

-->PCP analogs; can be used for anesthesia
-blocks NMDA (glutamate) receptors
-can cause bad dreams and hallucinations; generally only given to pre-pubertal kids

6

Drug used for rapid anesthesia induction and short procedures (drug that killed Michael Jackson)?

-->Propofol
-aka "milk of anesthesia", b/c high TG-content, so looks milky
-Potentiates GABA

7

2 classes of local anesthetic drugs:
-Mechanism of local anesthetics?

-->Block Na+ channels
*Esters: procain, cocaine, tetracaine
*Amides: lidocaine, mepivacaine, bupivacaine

8

Why are local anesthetics sometimes given with epinephrine?

b/c epinephrine = vasoconstrictor --> will make sure drug stays local, doesn't flow elsewhere!

9

In local anesthesia: which type of fibers get nerve blockade the fastest/first? Small vs Large, Myelinated vs Unmyelinated fibers:

-Small fibers > Large fibers
-Myelinated > Non-myelinated fibers

***Size matters more - So:

Small Myelinated > Small Unmyelinated > Large Myelinated > Large Unmyelinated

10

In local anesthesia, which senses are lost first/fastest?

Pain (lost first) > Temp > Touch > Pressure (lost last)

11

Dantrolene:
-mechansim?
-uses?

-->blocks Ca release from sarcoplasmic reticulum of skeletal muscle

*uses:
-Malignant hyperthermia (a rare side effect of inhaled anesthetics and Succinylcholine, a NM-blocking drug)
-Neuroleptic Malignant Syndrome (side effect of antipsychotic drugs)

12

Succinylcholine:
-class of drug?
-uses?
-mechanism?
-onset time and how long it lasts?
-toxicities?
-antidote?

*Neuromuscular-blocking drug
*Induces muscle relaxation --> used for muscle paralysis or mechanical ventilation (ie to do a tracheal intubation)

-->it's a depolarizing neuro-muscular blocking drug; acts on nicotinic receptors to have prolonged depolarization

*Mechanism: 2 phases:
Phase 1 = Depolarizing Phase:
-->may get muscular fasciculations while fibers are getting depolarized
Phase 2 = Desensitizing phase:
-->after enough depolarization of fibers, muscle is no longer responsive to acetylcholine released by motor neurones; At this point, full neuromuscular block has been achieved

*Rapid onset (about 30 seconds); short duration (about 5-10 minutes)

*Reversal of blockade:
-Phase 1: cannot be reversed; no antidote (if give anti-cholinesterase drugs, can prolong depolarization!)
-Phase 2: can be reversed with cholinesterase inhibitors (like Neostigmine, which stimulates release of endogenous ACh)

*Toxicities:
-Hyperkalemia
-Hypercalcemia
-Malignant hyperthermia (can be treated with Dantrolene)

13

Depolarizing Neuromuscular-blocking drug?

-->Succinylcholine

14

Nondepolarizing Neuromuscular-blocking drugs:
-->common suffix?
-->uses?
-->mechanism?
-->reversal of blockade?

*all end in "-curarine, -crurium, -curonium"
(Tubocurarine, Atracurium, Mivacurium, Pancuronium, Vecuronium, Rocuronium) --> think CURRY!

*Uses: muscle relaxation--> muscle paralysis during surgery, mechanical ventilation (intubations)

*Mechanism: Competitively compete with ACh receptors (so, block ACh at NMJ)

*Reversal of blockade: Cholinesterase inhibitors (increase amount of ACh in junction to overcome competitive inhibition)--> ie Neostigmine, Endrophonium, or others.

15

Bromocriptine
-use?
-mechanism?

Dopamine-agonist (agonist for dopamine receptors)
-->used to treat Parkinson's

16

Pramipexole
-use?
-mechanism?

Dopamine agonist; used to treat Parkinson's

17

Ropinirole
-use?
-mechanism?

Dopamine agonist, used to treat Parkinson's

18

Amantadine
-use?
-mechanism?

antiviral drug; can be used in Parkinson's to increased dopamine release

19

L-Dopa/Carbidopa: mechanism?

Parkinson's drugs
-->converted to dopamine in CNS (L-Dopa can cross BBB, unlike dopamine; Carbidoma prevents peripheral conversaion of L-dopa to dopamine)

20

Selegiline:
-use?
-mechanism?

-treatment of Parkinson's
*mechanism:
-selective MAO type B inhibitor; prevents dopamine breakdown

21

Entacapone, Tolcapone:
-use?
-mechanism?

-used in treatment of Parkinson's
-COMT inhibitors--> prevent degradation of L-Dopa, so increase dopamine availability

22

Benztropine
-use?
-mechanism?

-used to treat parkinsons'
-is an anti-muscarinic (anti-cholinergic) --> helps with the excess ACh in Parkinson's; improves tremor and rigidity; but not effect on bradykinesia

23

Dopamine drugs: mnemonic?

"BALSA"
-Bromocriptine (agonizes dopamine receptors)
-Amantadine (increases dopamine release)
-L-Dopa (increases dopamine)
-Selegiline (prevents dopamine breakdown)
-Antimuscarinics (like Benztropine)

24

Memantine:
-uses?
-mechanism?

-Alzheimer drug
-NMDA (glutamate) receptor antagonist

25

Donepezil
-use?
-mechanism?

treatment of Alzheimers
-anti-cholinesterase

26

Galantamine:
-use?
-mechanism?

-Alzheimer's
-anti-cholinesterase

27

Rivastigmine:

-->can be used to treat Alzheimers
-->anti-cholinesterase

28

Toxicity of Triptans?

-->Vasospasm

29

Galantamine:
-use?
-mechanism?

-Alzheimer's
-anti-cholinesterase

30

Rivastigmine:

-->can be used to treat Alzheimers
-->anti-cholinesterase

31

Rivastigmine:

-->can be used to treat Alzheimers
-->anti-cholinesterase

32

Toxicity of Triptans?

-->Vasospasm

33

Toxicity of Triptans?

-->Vasospasm

34

Aminoglycosides: (use mnemonic)

"Mean GNATS canNOT kill anaerobes"
-Gentamicin
-Neomycin
-Amikacin
-Tobramycin
-Streptomycin

*Toxicities:
-Nephrotoxicity (esp when used with cephalosporins)
-Ototoxicity (esp when used with loop diuretics)
-Teratogenic

*Require O2 for uptake; so can't be used to treat anaerobes

-->main clinical use is gram (-) rod infections

*Aminoglycosides are 30S ribosome/protein synthesis inhibitors

35

Neomycin:

-->Aminoglycoside; used for bowel surgery

36

Demeclocycline:

-Tetracycline
-->ADH-blocker; can be used to treat SIADH (acts as a diuretic)

37

Doxycycline:

-->Tetracycline
-fecally-eliminated, so can be used in pts with renal failure

38

Clinical uses of Tetracyclines:

"VACUUM THe BedRoom"
-Vibrio cholera
-Acne
-Chlamydia
-Ureaplasma Urealyticum
-Mycoplasma pneumonia
-Tularemia
-H. pylori
-Borrelia burgdorferi
-Rickettsia

39

Contraindication with tetracyclines?

-->Don't take with milk, antacids, or iron-containing preparations! b/c divalent cations inhibit absorption of tetracyclines in gut

*Also, teratogenic --> don't take during pregnancy

40

Treatment for atypical pneumonias (chlamydia, legionella, mycoplasma)?

-->Macrolides (Erythromycin, Azithromycin, Clarithromycin)

41

Toxicity of Erythromycin?

-->prolonged QT interval

42

Toxicity/main cause of noncompliance of Tetracyclines?

--> GI discomfort

43

Treatment of meningitis (H. influenza, N. meningitidis, Strep pneumonia)?

-->Chloramphenicol

44

Toxicities associated with Chloramphenicol:

-Aplastic anemia
-Gray baby syndrome (in preemies, b/c they lack UDP-glucuronyl transferase, so can't get rid of bilirubin)

45

Treatment for anaerobic infections (Bacteroides, Clostridium perfringens) in aspiration pneumonia or lung abscesses?

-->Clindamycin
(for anaerobic infections above the diaphragm)

***toxicity = pseudomembranous colitis!

(note: use Metronidazole for anaerobic infections below the diaphragm)

46

TMP-SMX

cause sequential block of folate synthesis (so, block nucleotide synthesis)
*Sulfas --> block Dihyropteroate synthase
*Trimethoprim --> blocks Dihydrofolate reductase (like methotrexate!)

*TMP = "Treats Marrow Poorly" --> side effects of Trimethorpim: megaloblastic anemia, leukopenia, granulocytopenia

47

Fluoroquinolones mechanism:

--> inhibit DNA gyrase = Topoisomerase II

48

One case in which use fluoroquinolones in kids?

-->CF

49

Metronidazole mechanism:

--> Damages DNA
-forms free radical toxic metabolites in the bacterial cell that damage DNA

50

Metronidazole uses:

"GET GAP"
-Giardia
-Entamoeba
-Trichomonas
-Gardnerella
-Anaerobes (Bacteroides, C. diff)
-H. Pylori (used with bismuth and amoxicillin (or tetracycline) for "triple therapy" against H. pylori)

51

Side effects of Metronidazole?

--> Disulfiram-like rxn with alcohol (also get a disulfirum rxn when take cephalosporins with alcohol!)
-metallic taste

52

4 drugs used to treat Myco. TB:

-Rifampin
-Isoniazid (+ Pyridoxine/B6)
-Pyrazinamide
-Ethambutol

53

Dapsone:

--> treats Mycobacterium leprae

54

Isoniazid mechanism:

Decreases synthesis of Mycolic acids (so, specific to mycobacteria)
--> used as solo prophylaxis against TB (but not used alone in treatment of TB)

55

Isoniazid toxicities:

-drug-induced lupus
-P-450 inhibitor
-Hepatotoxicity
-Neurotoxicity

***Give Pyrodixine (Vitamin B6) with Isoniazid to prevent neurotoxicity and lupus side effects...

56

Rifampin mechanism:

--> Blocks mRNA synthesis by inhibiting DNA-dependent RNA polymerase (RNA-Polymerase inhibitor)

***Used to treat M Tb (RIPE) and for meningococcal prophylaxis (ciprofloxacin is also used for prophylaxis...)

57

Rifampin side effects:

-->Orange body fluids! (not toxic, just happens)
-->P-450 inducer

58

Pyrazinamide:
-use?
-mechanism?

-->Treatment for M Tb (RIPE)
-->inhibits mycolic acid production; effective in acidic environemnts --> acidic pH of phagolysosomes: best drug for reaching Tb organisms within macrophages!

59

Ethambutol:
-use?
-mechanism?
-Toxicity?

-->treats M Tb (RIPE)
-->decreases carbohydrate polymerization of mycobacterium (blocks enzyme)


***Toxicity: Red/Green color blindness = Optic neuropathy (Reversible!)

60

Prophylaxis against meningococcal infection?

--> Ciprofloxacin (1st choice)
--> Rifampin

61

prophylaxis against gonorrhea?

ceftriaxone

62

prophylaxis against syphilis?

penicillin G

63

prophylaxis in pts with recurrent UTIs?

-->TMP-SMX

64

prophylaxis for pts with endocarditis undergoing dental procedures?

Penicillins

65

Prophylaxis for HIV pt with CD4 <200? why?

--> TMP-SMX
--> prophylaxisx against PCP

66

Prophylaxis for HIV pt with CD4 < 100? why?

--> TMP-SMX
--> prophylaxis against PCP and Toxoplasmosis

67

Prophylaxis for HIV pt with CD4 < 50? why?

--> Azithromycin
--> prophylaxis against MAC

68

Amphotericin mechanism?

--> Disrupts membrane function
-Binds ergosterol; forms pores in membrane allowing leakage of elecrolytes

69

Nystatin: mechanism? use?

--> like Amphotericin; binds ergosterol, forms membrane pores and causes leakage of electrolytes

*Very toxic, so only used topically
*Uses: Candidiasis
-swish-and-swallow for oral thrush
-topical for diaper rash or vaginal candidiasis

70

-azoles (Fluconazole, Ketoconazole, etc):
-->Mechansim?

Inhibits egrosterol synthesis (by binding P-450 enzyme that converts lanosterol --> ergosterol)

71

Caspofungin:
-mechanism?
-use?

-->inhibits fungal cell wall synthesis by inhibiting synthesis of Beta-glucan

*Used to treat Invasive Aspergillosis

72

Terbinafine:
-mechanism?
-uses?

Inhibits fungal enzyme Squalene Epoxidase
-->indirectly blocking ergosterol synthesis

*Uses:
-toe nail fungus; other skin fungal infections

73

Griseofulvin:
-mecanism
-uses

--> Interferes with fungal microtubule function; disrupts metosis; deposits in keratin-containing tissues (like nails)
-->Treatment of Dermatophytes (like tinea, ringworm; also can be used for toe nail fungal infections)

74

Amantadine:
-mechanism?
-uses?

-Blocks viral penetration/uncoating (M2 protein)
-Causes release of dopamine from intact nerve terminals

*Uses:
-Influenza A (though most strains are resistant)
-Parkinson's

75

Oseltamivir:
-mechanism?
-use?

-Inhibits influenza NA (Neuraminidase), decreasing release of progeny virus
-Treats influenza A and B

76

Zanamivir

-Inhibits influenza NA (Neuraminidase), decreasing release of progeny virus
-Treats influenza A and B

***like oseltamivir

77

Ribavirin:
-mechanism?
-uses?
-toxicities?

-Inhibits synthesis of guanine nucleotides by inhibiting IMP dehydrogenase

*Uses:
-RSV
-chronic hepatitis C

*Toxicity:
-hemolytic anemia
-Teratogenic
***Only use in adults; except if severe case of RSV, can give to kids/infants... but, normally contraindicated

78

Acyclovir:
-mechanism?
-main uses?

Guanosine analog, so incorporates into newly replicated viral DNA, and inhibits viral DNA polymerase by chain termination
--> it's monophosphorylated by HSV/VZV thymidine kinase

*Uses:
-HSV, VZV, EBV

79

Valacylcovir:

similar to Acyclovir, but better oral availability

80

Famciclovir:

similar to Acyclovir; but, drug of choice for herpes zoster (shingles)

81

Gangciclovir:
-mechanism?
-uses?

Guanosine analog; inhibits viral DNA polymerase

*Uses:
-CMV, especially in imm-compromised pts
***#1 choice for CMV retinitis (if fails, then use foscarnet)

82

Foscarnet:
-mechanism?
-use?

Viral DNA polymerase inhibitor (does not require activation by a viral kinase, unlike acyclovir and gangciclovir)

*Use:
-CMV retinitis in immunocompromised pts when Gangciclovir fails

83

Cidofovir:

Inhibits viral DNA polymerase
-->treats CMV retinitis in imm-compromised pts

***does not require phosphorylation by viral kinase (like foscarnet; unlike acyclovir and ganciclovir)