week 6 Flashcards

1
Q

define ion channels

A

hole in membrane - have a pore that once opens allows ions to flow in and out of the cell based on electrochemical & osmotic gradients

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2
Q

selectivity of ion channels

A

each channel is selective to the specific ion e.g., sodium, potassium, calcium

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3
Q

what five drivers move ions through channels

A

ions move toward electrochemical equilibrium through:

  1. electricity
  2. diffusion
  3. v-gated ion channels
  4. transporters
  5. passive
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4
Q

how to ions move through channels via electricity

A

= ions will move across a membrane if you introduce an electrical field. ions carry charge & pos NA will move towards negative terminal (inside cell) & likewise, neg CI will move towards pos terminal (outside cell)

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5
Q

ions moving through membrane via facilitated diffusion

A

= ions will move across the membrane passively provided channels are present & there is a concentration gradient i.e. more salt outside than in or vice versa

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6
Q

examples of channels that aren’t as selective/structured

A
  1. n-AChR conducts K, Na, Ca = 5-fold symmetry

2. chloride channel = 2 fold symmetry = ion pathway less obvious

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7
Q

three activations of ion channels

A
  1. voltage-gated
  2. ligand-gated ion channel
  3. G-protein coupled receptor
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8
Q

the steps of the movement of ions in a voltage gated sodium, potassium channel

A
  1. cell membrane depolarises
  2. sodium channels open = sodium rushes into the cell
    • massive inward flow of charged sodium = changes
      membrane to positive potential
  3. causes potassium channels to open or activate = potassium starts flowing out of the cell carrying its positive charge with it = repolarising the membrane
    • causes membrane to move back closer to resting
      neg membrane potential
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9
Q

what does the rapid movement of ions across the cell membrane cause

A

causes “action potentials” to propagate from one cell body, down axons to the synapse where they initiate release neurotransmitters

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10
Q

steps in APs & V-gated channels & transporters working together

A

step 1: membrane “resting” = sodium, potassium pump is closed, sodium & potassium channel closed (but still some passive movement)

step 2: rapid membrane depolarisation = sodium & potassium pump closed, sodium channel opens & sodium flows in

step 3: membrane repolarises = potassium channel opens, sodium channel starts closing (potassium flows out, sodium stops flowing)

step 4: membrane returns to rest = sodium & potassium pump open, sodium & potassium channel closed (sodium & potassium flows to equilibrium)

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11
Q

examples of functions of calcium channels

A

memory, neurotransmitter release, pace making action potentials, adrenaline/insulin secretion, contraction muscle tone

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12
Q

example of ion channel diseases

A
  • cycstic fibrosis, epilepsy, cancer, heart disease
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13
Q

define channelopathies & 2 causes

A

= defects in ion channels

  1. genetic factors = mutations that lead to malfunction of ion channels can cause multiple diseases such as epilepsy
  2. environmental factors = continuous exposure to pain or certain drugs may cause channels to malfunction leading to chronic pain for example
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14
Q

How do calcium T-type regulate sodium, potassium driven action potentials

A
  1. injury occurs
  2. chemicals called cytokines are released
  3. this activates G-protein coupled receptors
  4. this activates protein kinases
  5. this hyperpolarises & activates T-type protein calcium channels
  6. the influx of highly positive calcium into the cell creates a deploarising event, triggering the sodium channel threshold causing the action potential to commence
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15
Q

how is ionic movement effected

A

by changes in the open/closed state as well as speed of open/closed state of channel (activation & inactivation kinetics)

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16
Q

channels activate & inactivate in response to

A

changes in membrane voltage

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17
Q

how can ionic movement be controlled

A

ion channel conformation can be controlled through drugs i.e. keep open/closed, active/inactive = bind to channel & restrict/reduce flow or opposite increase affinity

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18
Q

example of drugs that control ionic movement

A
  1. sodium channels e.g. AEPs, anaesthetics

2. calcium channel blockers e.g. DHPs, VDs

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19
Q

what does the movement of ions generate

A

electrical signals called action potentials that are tiny electrical units of information that connect neural circuits & instigate release of neurotransmitters

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20
Q

how much of hospital admission are estimated to be medicine -related causing significant morbidity & mortality

A

2-3%

1.4% likely to be due to adverse drug reaction

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21
Q

define therapeutic index

A

used to compare the therapeutic does to the toxic does of a pharmaceutical agent

= dose vs response in the population

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22
Q

define ED50

A

the drug dose that produces a therapeutic response in 50% of the population

23
Q

define TD50

A

drug does that produces a toxic response in 50% of the population

24
Q

equation for therapeutic index

A

TD50 divided by ED50

25
the lower the TI the ...
the less safe the drug = the difference between the effects of the two concentrations is small
26
define therapeutic window
mostly determined by plasma concentration of the drug verse the response in the pop = range of steady-state concentrations of drug that provide therapeutic efficacy with minimal toxicity
27
does therapeutic window guarantee safety & efficacy
no
28
what does therapeutic window indicate
indicates at which doses the probability of efficacy is high & adverse effects is low
29
drugs with low therapeutic index are especially likely to be involves in ...
adverse drug reactions
30
2 types of adverse effects and their subheadings
1. predictable = overdose, side effect or withdrawal | 2. unpredictable = allergy/hypersensitivity
31
what characteristic of drugs can you predict the adverse reaction
drugs with low TI
32
examples of drugs with low TI
anticoagulants (warfin), lithium & hyperglycemia drugs (drugs for diabetes)
33
3x characteristic of predictable adverse reactions from drugs
mostly preventable & reversible & dose related
34
4x characteristics of unpredictable adverse drug reactions
less common & most serious (requires drug withdrawal) & not dose related (may occur at low doses) & idiosyncratic
35
define predictable adverse drug reactions
consequence of main pharmacological effect (pk)
36
define unpredictable adverse drug reactions
unrelated to the known pharmacological action of the drug (off target)
37
define idiosyncratic
- unique to individual, if it is known it becomes predictable
38
6 classifications of ADRs (adverse drug reactions)
1. Dose-related (augmented) 2. non-dose related (Bizarre) 3. dose-related & time related 4. time related 5. withdrawal 6. unexpected failure of therapy
39
examples of dose-related ADRs
toxic effects = digoxin & SSRIs side effects = anticholinergic effects of TCA
40
examples of non-dose related ADRs
immunological reactions: penicillin hypersensitivity idiosyncratic reactions: malignant hyperthermia (reaction to general anaesthetic
41
examples of dose related & time related ADRs
hypothalamic - pituitary - adrenal axis suppression by glucocorticoids
42
examples of time related ADRs
teratogenesis (thalidomide, valproate) --> affects foetal | carcinogenesis --> causes cancer
43
examples of withdrawal ADRs
- opiate withdrawal syndrome | - myocardial ischemia (beta-blocker)
44
examples of unexpected failure of therapy ADRs
- inadequate dosage of oral contraceptive, particular when used with enzyme inducers
45
meaning of predisposition to ADRs
patient related factors
46
examples of factors that increase predisposition to developing ADRs - patient related factors
- age (very young, or very old) - gender - underlying disease - hepatic & renal function - body weight & fat distribution - genetic factors
47
examples of factors that increase predisposition to developing ADRs - other drug related factors
- other drugs taken (smoking, alchohol, polypharmacy) - route of administration - dose of the drug and frequency
48
define drug to drug interactions
the modification of the action of one drug by another
49
type of drug-drug interactions
1. behavioural (altered compliance) 2. pharmaceutic (outside the body) 3. pharmacokinetic (altered concentration) 4. pharmacodynamic (altered effect)
50
2 types of pharmacodynamic interactions
= most common 1. additive effect = drugs have similar actions e..g, alcohol & bezodiazepine (both CNS depressants) 2. opposite effects = drugs cancel each others effects e. g., beta-blockers (heart condition) with beta-agonists (asthma)
51
meaning of pharmacokinetic interactions
change in concentration leading to clinical consequences
52
3 types of pharmacokinetic interactions
1. altered bioavailability = oral contraception & antibiotics 2. altered distribution = displacement of drug bound to plasma albumin 3. altered clearance = metabolism, prodrugs, excretion (penicillin & probenecid)
53
how to manage poisoning
1. assessment & examination 2. prevent further absorption 3. specific antidotes 4. increase elimination
54
what is the three state model of voltage-gated ion channels
1. closed = at the resting potential, the channel is closed 2. open = in response to a nerve impulse, the gate opens and sodium enters the cell 3. inactivated = for a brief period following activation, the channel does not open in response to a new signal