Pharm Revision Flashcards
(151 cards)
1
Q
How does the SS and PS regulate HR
A
SS increase cAMP which increases opening of iF and iCa to inc depolarisation
PS dec cAMP which inc opening of iK to prolong repolarisation
2
Q
How do beta 1 receptors regulate contractility
A
inc cAMP which inc pKA to promote contraction by decreased calcium going into the SR so more is available for contraction
3
Q
What is the class of drug that verapamil comes under
A
Phenylalkylamines
4
Q
What is the other class of rate slowing calcium antagonists (not verapamil)
A
Benzothiazepines such as Diltiazem
5
Q
What is the problem with dihydropyridines for dec contractility
A
No effect on the heard but profound vasodilation can cause reflex tachycardia
6
Q
How does vasodilation and venodilation affect preload and afterload
A
vasodilation dec afterload
venodilation dec preload
7
Q
5 key beta blocker side effects
A
Bronchoconstriction
Cold extremities + worsening of peripheral artery disease
Dec heaptic gluconeogenesis and glycogenolysis DIABETICS
Bradycardia (heart block)
Worsening of cardiac failure (reduction in CO)
8
Q
Side effects of both type of calcium blockers
A
Verapamil = bradycardia and AV block. Constipation Dihydro = ankle oedema, headache flushing, palpitations due to reflex tachy
9
Q
Adenosine MOA and USE
A
stimulates alpha 1 in SAN and AVN to reduce cAMP and dec chronotropy and dromotopy
stimulates alpha 2 in vasc smooth muscle to inc cAMPt to relax
SVT’s short lived
10
Q
Verapamil MOA and USE for anti arrhythmic
A
Depress SA atuoomaticity and AV
reduce ventricular responsivess to atrial arrhythmias
SVT and AF
11
Q
Amiodarone moa use adverse
A
SVT and VT
multiple ion block
accumulates and can cause skin rash, hypo/hyper thyroidism, pulmonary fibrosis
12
Q
effect of digoxin bc of blocking the pump
USE
Adverse effects
A
inc intracellular ca
positive ionotropic effect
vagal stimulation causes inc refractory period and reduced rate of conduction through AV node
AF and Flutter
Dysrhythmias and hypokalaemia can lower toxicity
13
Q
M1 Receptors
A
neural tissue
14
Q
M3 receptors
A
exocrine and smooth muscle
15
Q
ACh enzyme to make
A
choline acetyl transferase
16
Q
Dopamine to noradrenaline
A
Dopamine beta hydroxylase
17
Q
COMT stands for
A
catechol-O-methyl trasnferase
18
Q
SS vs PS response key words
A
coordinated and divergent
discrete and localised
19
Q
why do effects of cannabis last so long
A
storage in adipocytes
20
Q
Dronabinol
A
delta 9 thc = chemo NV
21
Q
nabilone
A
delta 9 thc = chemo NV
22
Q
sativex
A
delta 9 thc and cannabidiol = symptom improved for spasticity due to MS
23
Q
rimonabant
A
CB1 antagonists = anti-obesity but depression and suicide
24
Q
effect of enterohepatic recycling on measuring intoxication
A
11 OH THC is more potent and recycles so delta 9 thc is a bad indicator
25
what is anterior cingulate cortex function
performance monitoring and behavioural adjustment
26
part of brain for munchies
lateral hypothalamus
27
endogenous cannibinoid
anandamide
28
appetite neurones for pharm
Melanin concentrating hormone neurones
| orexin
29
cannabis and hunger neurones
inhibits GABA on MCH so inc in MCH and orexin production so inc hunger
30
cannabis and psychomotor performance
depresses cerebral cortex
31
cannabis and CV system
TRPV1 receptor to cause calcium influx-> tachycardia
32
cannabis vasodilation
conjunctivae
33
cannabis memory loss
inhibits production of brain derived neurotrophic factor in hippocampus
34
cannabis levels in the brain
rise v quickly but fall v quickly bc brain is highly perfused
35
how much smoked cannabis reaches bloodstream
30%
36
define alkaloid
any class of nitrogenous compound of plant origin that has profound physiological actions on humans
37
THC =
tetrahydrocannabinol
38
what type of receptors is CB
g protein i = negative with AC
39
four types of cocaine
crack = precipitated with alkaline solution
cocain paste = plant mushed up
freebase= dissolve crack in a non-polar solvent
cocaine hcl = therapeutic
40
what is the cocaine plant name
erythroxylum coca
41
cocaine CVS risks (3 actions)
vasoconstriction
platelets
atherosclerosis
42
cocaine and seizures
vasoconstriction in brain arteries leading to inc in temp
43
why is nicotine in a cigarette so effective
melts the tar to make droplets
alkaloids dissolve in droplets
easily absorbed
44
why is nicotine not absorbed in the mouth
cigarette smoke is acidic and pKa of mouth is alkaline so ioniside
45
nicotine euphoria
nachr causes sodium influx so inc firing rate
46
nicotine and CVS
inc SS
vasoconstriction coronary arterioles
atherosclerosis
inc thromboxane A2
47
nicotine and parkinson's and alzheimers
inc cyp450 which remove neurotoxins which contribute to onset of parkinson's
diminishes some of the proteins
48
caffeine and euphoria
adenosine antagonist so removed inhib effect on dopamine and D1 receptor function
49
nicotine metabolism
CYP2A6 in liver
produces cotinine
excreted in urine
50
cocaine pKA
weak base so less absorbed in stomach
51
cocaine half life
20-90 mins
52
cocaine metabolism
```
liver = inactive ecgonine methyl ester and benzoylecgonine
plasma = plasma cholinesterases
```
53
how to work out how much alcohol in g/100ml
ABV% x 0.78
54
how much alcohol is metabolises
90%
55
acetaldehyde metabolism
aldehyde dehydrogenase -> acetic acid
56
chronic alcohol and ataxia
cerebellar cortex degeneration
57
Alcohol receptor targets in CNS
Allopregnelone -> enhances GABA
dec NMDA
reduces Ca2+ influx so less exocytosis
58
why alcohol and cutaneous vasodilation
less calcium influx and more prostaglandins
| acetaldehyde
59
alcohol and reward pathways
less dopamine bc inc gaba and reduces nmda
60
brain targets of alcohol
```
hypothaalmus
RAS
hippocampus
cerebellum
basal ganglia= time
```
61
alcohol and HR
dec sensitivity of baroreceptors so less baroreceptor firing so inc HR
62
benefits of alcohol
```
dec mortality from coronary artery disease
inc HDL
inc tPA
dec platelet aggregation
POLYPHENOLS
```
63
alcohol hepatitis
cytochrom p450 -> oxygen freeradicals inflammation
64
alcohol cirrhosis
fibroblasts recruited
| connective tissue laid down
65
alcohol endocrine (3)
inc cortisol
dec DDAVP
dec testosterone
66
why do u get nausea
gastric irritation
vagus
vomiting centre
67
wernicke korsakoff
thiamine B1 deficiency
oxidative stress
wernicke encephalopathy = mitochondrial injury
K psychosis = apoptosis in the brain
68
alcohol and liver
```
uses up NAD+
no beta oxidation of lipids
pyruvate -> lactate
acetyl coA -> ketones
lipids build up
```
69
BAC limit
80mg/100ml
70
heart contractility
calcium enters thru dihydropyridine receptors
| ryanodine receptors on SR causing more calcium release
71
SERCA2a
removal of calcium
| rate of relaxation and contractility of next beat
72
how is calcium removed from the cell
plasma membrane calcium ATPase
sodium calcium exchanger
SERCA2a
73
why is hypokalaemia dangerous with digoxin
digoxin competes with potassium so if less potassium then more effect
74
organic nitrates MOA
NO -> GC vasodilaiton
75
verapamil target
l type calcium channel so less depolarisation
76
gastric vs duodenal ulcer symptoms
gastric while eating, duodenal after eating 3 hours
77
molecule that is protective in the stomach
prostaglandins
78
PS and gastric acid
inc histamine which inc acid
79
what type of transporter in parietal cells
H/K ATPase
80
PPI's in stomach active why
weak base accumulates in canaliculi
81
histamine receptor antagonist side effects
dizziness headache
82
H pylori antibiotics
tetracycline/quinolone
amoxicilin
clarithromycin/metronidazole
83
why is ondasteron used for chemo NV
chemo is toxic to enterochromaffin cells
cause excessive serotonin release
antagonises receptors on NTS, VC, CTZ
84
what is ondasteron given with
glucocorticoids to reduce free radical production
| aprepitant = neurokinin 1 receptor antagonists NTS = VC
85
motion sickness MOA
neural mismatch
vestibular sustem Machr receptors
hypothalamic histamine release into ctz
muscarinic to VC
86
anti-emetic side effects
```
histamine = drowsy
serotonin = headaches
muscarininc = dry mouth constipation
dopamine = EPS
```
87
aldosterone sodium channel antagonist
amiloride
88
when is mannitol used
major oedema
89
which diueretics lead to loss of potassium recyclcing so inc loss of calcium and magnesisum
acetazolimide
frusemide
thiazide
90
side effects of loop diuretics and thiazides
hypovolemia
metabolic alkalosis bc inc cl-loss
hyperuricaemia
hypokalaemia
91
side effect of carbonix anhydrase inhib
metabolic acidosis due to inc bicarb loss
92
side effect of potassium sparing
hyperkalaemia
93
why are thiazides used in htn
chronic thiazides vasodilate leading to reduced tpr
94
PGE2 unwanted actions
acute inflam
immune
tumorigenesis
inhibition of apoptosis
95
what are the receptors thought to lower pain threshold with prostanoids
ep1 ep4
96
pge2 derisable actions
bronchodilation
renal salt and water homeostasis
gastroprotection
vasoregulation
97
how do NSAIDs cause renal toxicity
constriction of afferent renal arteriole
reduction in renal artery flow
reduced glomerular filtration rate
98
aspirin side effects
gastric
bronchospasm
bleeding times
nephrotoxicity
99
why is paracetamol overdose
NAPQI has to metabolised by glutathione-S-trasnferase
| if glutathione is depleted then NAPQI oxidises thiol group of hepatic enzymes causing cell death
100
antidote for paracetamol poisioning
add compound with SH
IV Acetylcysteine
Oral Methionine
101
paracetamol laws
16 x 500mg
2 packs in transaction
illegal to sell more than 100
102
aminosalicylates MOA
inhibit IL1 - TNF alpha and PAF
dec antibody secretion
reduced cell migration
localised inhibition of immune responses
103
problem with anti-tnf alpha
anti-drug antibodies and inc drug clearance
TB
septicaemia
heart failure
104
3 immunosuppressives for IBD
azothioprine
methotrexate
cyclosporin
105
2 x aminosalicylates
olsalazine
| mesalazine
106
azothioprine side effects
pancreatitis
bone marrow suppression
hepatotoxicity
lymphoma and skin cancer
107
Manipulation of microbiome for IBD
Nutrition based for UC
Faecal microbiota replacement therapies
Rifaximin - binds to RNA polymerase sustains remission in CD
108
anti tnf alpha eg
infliximab
109
new targets IBD
integrins
interleukins
interleukin rececptors
janus kinase cell signalling
110
Type a not atenolol
anticholinergics and dry mouth
| nsaids and peptic ulcers
111
tybe c not methotrexate
aantimalrials and ocular toxicity
112
type d
immunosuppressants and thalidomide
113
type 2 pharm
methyldopa and haemolytic anaemia
114
type 3 pharm
procainamide induced lupus
115
overlapping toxicities
ethanola nd BDZ
116
antagonistic effects
amitriptyline and acetylcholinesterase inhibitors
117
cyp450 inducers
- grapefruit
- fluoxetine
- cimetidine
- erthryomycin
ketoconazole
ciprofloxacin
ritonavir
118
inhibitions vs induction of cyp450
induction days
| inhibition quick
119
drug elimination reactions
probenecid and pencillin
| lithium and thiazides
120
asthma deliberate interaction
salbutamol and ipratropium
121
nAChR in skeletal muscle structurs
5 subunits alpha x 2 beta gamma delta
| ach opens both alpha to allow sodium influx to generate end plate potential
122
example of a spasmolytic that stops propagation of AP
dantrolene
| dec release of calcium from DR to dec force of contraction and dec spasticity
123
administration of suxamethonium and metabolism
IV bc highly charged
| pseudo-cholinesterases
124
unwanted effects of suxamethonium
post op muscle pains
bradycardia bc stimulates M2
hyperkalaemia so avoid in soft tissue injury
inc intra-ocular pressure
125
how to reverse tubocurarine
anticholinesterases to inc endogenous acetylcholine
126
tubocurarine side effects
hypotension due to ganglion blockade and histamine release
reflex tachy due to blockade of vagal ganglia
bronchospasm
excessive secretions
apnoea
127
side effects of ACEi ARBs
```
Cough
hypotension
urticaria/angioedema
hyperkalaemia
fetal injury
renal failure if renal artery stenosis
```
128
describe smooth muscle contractision
membrane depolarisation opens VGCC
Ca binds to calmodulin
complex binds to and activated myosin light chain kinase
phosphorylation leads to SMC
129
what is in red thrombi and white thrombi
```
red = high fibrin
white = high platelet
```
130
three stages of cell based theory
initiation
amplification
propagation
131
dabigatran vs rivaroxaban
2a vs 10a
132
example of low molecular weight heparin
Dalteparin
133
heparin route of administration
IV/SC
134
anticoag indications
AF stroke
135
ADP receptor name
P2Y12
136
abciximab route
IV/SC
137
antiplatelets indication
acute coronary syndormes MI
| AF stroke
138
thrombolytics indication
stroke
| STEMI
139
other antiplatelet that i forget
aspirin cox 1 thromboxane
140
nucleic acid synthesis
paraaminobenzoate
dihydropteroate
dihydrofolate
tetrahydrofolate
141
what inhibits bactoprenol
bacitracin
142
methods of antibiotic resistance
```
Destruction enzymes
additional target
alteration in target enzyme
inc levels of target
reduction in aquaporins and inc efflux
```
143
polyene example
amphotericin
144
azole moa
cyp450 sterol synthesis
145
ribavirin moa
nucleoside analogue prevents viral rna synthesis
146
boceprivir moa
protease inhibitor
147
enfuvirtide target
HIV GP41
148
zidovudine
nucleoSide RT inhibitor
149
what encodes all viral proteins
Gag precursor
150
HSV sturcutre
dsDNA with tegument and lipid bilayer
151
influenza structure
multipartite ssRNA
