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FirstAID > Micro and Neuro part 2 > Flashcards

Micro and Neuro part 2 Flashcards

1
Q

Inhaled anesthetic that may cause nephrotoxicity?

A

–>Methoxyflurane

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2
Q

inhaled anesthetic that may cause seizures?

A

Enflurane

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3
Q

Most common drug used for anesthesia during endoscopy?

A

Midazolam (benzo, given by IV)

–>may cause amnesia; so, in case pt wakes up during procedure, won’t remember!

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4
Q

Which opiates may be used for general anesthesia?

A

–>Morphine and Fentanyl

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5
Q

Ketamines: (Arylcyclohexylamines)

A
  • ->PCP analogs; can be used for anesthesia
  • blocks NMDA (glutamate) receptors
  • can cause bad dreams and hallucinations; generally only given to pre-pubertal kids
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6
Q

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

A
  • ->Propofol
  • aka “milk of anesthesia”, b/c high TG-content, so looks milky
  • Potentiates GABA
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7
Q

2 classes of local anesthetic drugs:

-Mechanism of local anesthetics?

A
  • ->Block Na+ channels
  • Esters: procain, cocaine, tetracaine
  • Amides: lidocaine, mepivacaine, bupivacaine
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8
Q

Why are local anesthetics sometimes given with epinephrine?

A

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

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9
Q

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

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

***Size matters more - So:

Small Myelinated > Small Unmyelinated > Large Myelinated > Large Unmyelinated

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10
Q

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

A

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

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11
Q

Dantrolene:

  • mechansim?
  • uses?
A

–>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)
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12
Q

Succinylcholine:

  • class of drug?
  • uses?
  • mechanism?
  • onset time and how long it lasts?
  • toxicities?
  • antidote?
A
  • 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)
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13
Q

Depolarizing Neuromuscular-blocking drug?

A

–>Succinylcholine

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14
Q

Nondepolarizing Neuromuscular-blocking drugs:

  • ->common suffix?
  • ->uses?
  • ->mechanism?
  • ->reversal of blockade?
A

*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.
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15
Q

Bromocriptine

  • use?
  • mechanism?
A

Dopamine-agonist (agonist for dopamine receptors)

–>used to treat Parkinson’s

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16
Q

Pramipexole

  • use?
  • mechanism?
A

Dopamine agonist; used to treat Parkinson’s

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17
Q

Ropinirole

  • use?
  • mechanism?
A

Dopamine agonist, used to treat Parkinson’s

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18
Q

Amantadine

  • use?
  • mechanism?
A

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

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19
Q

L-Dopa/Carbidopa: mechanism?

A

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

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20
Q

Selegiline:

  • use?
  • mechanism?
A
  • treatment of Parkinson’s
  • mechanism:
  • selective MAO type B inhibitor; prevents dopamine breakdown
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21
Q

Entacapone, Tolcapone:

  • use?
  • mechanism?
A
  • used in treatment of Parkinson’s

- COMT inhibitors–> prevent degradation of L-Dopa, so increase dopamine availability

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22
Q

Benztropine

  • use?
  • mechanism?
A
  • 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
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23
Q

Dopamine drugs: mnemonic?

A

“BALSA”

  • Bromocriptine (agonizes dopamine receptors)
  • Amantadine (increases dopamine release)
  • L-Dopa (increases dopamine)
  • Selegiline (prevents dopamine breakdown)
  • Antimuscarinics (like Benztropine)
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24
Q

Memantine:

  • uses?
  • mechanism?
A
  • Alzheimer drug

- NMDA (glutamate) receptor antagonist

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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)

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