Term
|
Definition
| decarboxylation of AA L-histadine via pyridoxal phosphate dependent enzyme and L-histadine decarboxylase |
|
|
Term
| degradation of histamines |
|
Definition
rapidly converted to inactive metabolite
Periphery: oxidative deamination: catalized by diamine oxidase making imidazole acetic acid
CNS and periphery: methylation of tele-nitrogen in imidazole ring catalized by histamine-N-methyltransferase making t-N-methylhistamine |
|
|
Term
| 3 sites of histamine storage |
|
Definition
found in almost all tissies: low in plasma and body fluids
mast cells: major site of storage and release, activated by IgE
basophils: similar to mase cells, high IgE binding affinity, store and secrete histamine |
|
|
Term
| mast cells: locations 3, how is histamine stored |
|
Definition
high in skin, mucosa of bronchial tree and intestinal mucosa
histamine stored as granules with proteoglycan and chondroitin sulfate E |
|
|
Term
| basophils: location of high concentration, how does is histamine stored |
|
Definition
high in neurons of CNS
histamine stored in granules with proteogltcan chondroitin monosulfate |
|
|
Term
| 3 causes of histamine release |
|
Definition
| allergic disorders, drugs, endogenous peptides (bradykinin, substance P) |
|
|
Term
| explain the 2 processes of histamine release |
|
Definition
cytolytic: plasma membrane is damaged and contents leak out
non-cytolytic: ligand binds receptor on mast cell, ATP dependent change in Ca causes leaking of cytoplasm and exocytosis of granules |
|
|
Term
| what are the MOA of the 3 types of histamine receptors |
|
Definition
H1, H2, H3: G protein coupled receptors
H1: Gi receptor coupled to phospholipase C forms IP3 which releases Ca from ER and DAG which activates Ca via calmodulin dependent protein kinase and phospholipase A2 in target cell |
|
|
Term
| functions of the H1 and H2 receptors 3 |
|
Definition
1. histamine stimulates pain and hitch in nerve endings
2. histamine shock: large dose decreases BP and small vessels trap blood decreasing BV and CO
3. endothelium: increases Ca > phospholipase A2 > NO > diffusion to smooth muscle > guanylyl cyclase >>
> H1 receptor cGMP activates protein kinase and causes fast capillary dilation, increased permeability, lymph flow, and edema
> H2 receptor cAMP activates protein kinase and causes slow sustained capillary dilation |
|
|
Term
| functions of only the H1 receptr |
|
Definition
|
|
Term
| Tx of autocoid bronchoconstriction |
|
Definition
|
|
Term
| MOA and distribution of 1st gen antihistamine |
|
Definition
competitive reversible H1 inhibitor
crosses BBB
anticholinergic |
|
|
Term
| interactions of 1st gen antihistamine 3 |
|
Definition
| EtOH, CNS depressants, MAOI |
|
|
Term
| effects of only 1st gen antihistamine 8 |
|
Definition
CNS: restless, nervous, insomnia
OD: excitation, convulsion, coma, respiratory collapse
anticholinergic: increased SANS, inhibit M receptor / ACh, atropine like |
|
|
Term
| MOA and distribution of 2nd gen antihistamine |
|
Definition
competitive reversible H1 inhibitor
does not cross BBB
no anticholinergic effects |
|
|
Term
| effects of both 1st and 2nd gen antihistamine 7 |
|
Definition
| inhibit histamine on smooth muscle, vasoconstriction, permeability, edema, wheals, flare,itch |
|
|
Term
| what do antihistamines never effect 2 |
|
Definition
anaphylactic bronchoconstriction
H2 vasodilation |
|
|
Term
| what is the story for the 8 1st gen antihisamines |
|
Definition
| dying phrends and dying men hydrated cyclically like pros with purel with chlori and my bro's phrend ramine who used pro meth from a magazine |
|
|
Term
| what are the 8 1st gen antihistamines |
|
Definition
diphenhydramine
dimenhydrinate
hydroxyzine
cyproheptadine
purilamine
chlorpheniramine/brompheniramine
promethazine
meclizine |
|
|
Term
| diphrenhydramine: use 3, SE 2 |
|
Definition
allergies, OTC sleep med, extrapyrmidal SE
SE: sedation, lots of anti-M |
|
|
Term
| dimenhydrinate: use 1, SE 1 |
|
Definition
motion sickness
SE: anti-M |
|
|
Term
| hydroxyzine HCl: use 2, SE 1 |
|
Definition
long acting, skin allergies
SE: CNS depression, lots |
|
|
Term
| cyproheptadine: use 2, SE 3 |
|
Definition
drowsy, increased weight
mild anticholinergic |
|
|
Term
|
Definition
|
|
Term
| chlorpheniramine/brompheniramine: use 1, SE 1 |
|
Definition
allergy
SE: CNS stimulation (daytime med) |
|
|
Term
| promethazine: use 1, SE 2 |
|
Definition
nausea and vomiting
SE: anticholinergic, sleep |
|
|
Term
|
Definition
| motion sickness, less effective |
|
|
Term
| what is the story for 2nd gen antihistamines |
|
Definition
| des and lora dined on citrsy flex or grenadine |
|
|
Term
| what are the 4 2nd gen antihistamines |
|
Definition
desloratadine
loratadine
cetrizine
fexofenadine |
|
|
Term
| SE of the 2 2nd gen antihistamines (1 each) |
|
Definition
desloratadine: renal/hepatic damage (less)
loratadine: renal/hepatic damage
cetrizine: renal/hepatic damage
fexofenadine: renal damage (use 1/3 dose) |
|
|
Term
|
Definition
| hyperactivity of airway releases leukotrienes and histamine which cause smooth muscle proliferation, mucous gland hypertrophy, hypersecretion, inflammatory cells, edema, and loss of epithelium |
|
|
Term
| what are the 3 effector cells in asthma, at what point to they come into play |
|
Definition
mast cells - immediate response
eosinophils - late response
T cells - chronic response |
|
|
Term
| mast cell: location, 6 things they release |
|
Definition
3-5x more in respiratory tract of asthmatic
histamine, PGE, PAF, LTD, LTC, LTE |
|
|
Term
| eosinophils: effect, 1 thing they release |
|
Definition
primary airway effector
number in bronchial lavage fluid is related to bronchial hyperreactivity
major basic protein- damages airway epithelium |
|
|
Term
| T cells: effect, 2 thing they release |
|
Definition
number is proportional to bronchial hyperreactivity
releases interleukins |
|
|
Term
|
Definition
intrmittent
wheeze, cough, dyspnea, chest tightness |
|
|
Term
| 5 qualifications for intermittent asthma |
|
Definition
<2d/w
<2d/mo nocturnal symptoms
FEV >80%
FEV:FEC normal
SABA use <2d/wk |
|
|
Term
| 5 qualifications for persistant mild asthma |
|
Definition
>2d/wk
3-4d/mo nocturnal asthma
FEV >80%
FEV:FEC normal
SABA use >2d/wk |
|
|
Term
| 5 qualifications for persistant moderate asthma |
|
Definition
>2d/wk
>2d/mo nocturnal asthma
FEV >60% <80%
FEV:FEC <5% reduction
SABA use daily |
|
|
Term
| 5 qualifications of persistant severe asthma |
|
Definition
continous symptoms
frequent nocturnal symptoms
FEV <60%
FEV:FEC >5% reduction
hospitlized in last year for asthma |
|
|
Term
| 4 ways asthma is diagnosed |
|
Definition
reversible airway obstruction
history of symptoms
spirometric pulmonary function tests
methocholine challenge test |
|
|
Term
| 5 goals of asthma therapy |
|
Definition
normal activity and exercise levels
near normal pulmonary function tests
prevent chronic symptoms
prevent recurrent exacerbations
avoid medication SE |
|
|
Term
| 2 types of B2 agonists and their 8 drugs |
|
Definition
SABA: albuterol, levabuterol, terbutaline, pirbutrol, bitolerol, metaproterenol
LABA: salmeterol, formoterol |
|
|
Term
| SABA: onset, duration, usage |
|
Definition
rapid onset 5-15min inhaled
4-6h duration
DOC mild asthma, rescue inhaler (not anti-inflammatory |
|
|
Term
|
Definition
|
|
Term
|
Definition
relax bronchial smooth muscle (adenylyl cyclase > cAMP > PKA > MLCK > smooth muscle relaxation)
stabilizes mast cell membranes |
|
|
Term
|
Definition
more in oral/suryp (often used in kids)
tremor, tachyarrhythmia, muscle cramps |
|
|
Term
| 2 types of corticosteroids used in asthma and their 6 drugs |
|
Definition
inhaled: trimacinolone, flutocasone, budesonide
systemic- methylprednisone, prednisone, prednisolone |
|
|
Term
| how are steroids used in asthma, time of onset |
|
Definition
used in moderate to severe asthma with SABA PRN
continous prevention
onset in 4-12h |
|
|
Term
|
Definition
stimulate glucocorticoid receptors
inhibit inflammation
reduce mucous production
increase B2 receptors (increases SABA effectiveness) |
|
|
Term
|
Definition
only 10% of steroid reaches lung, 90% is metabolized by first pass if oral
increases deposition in lung by decreasing particle velocity and zise |
|
|
Term
| 3 techniques for inhaling and exhaling corticosteroids and their benifits |
|
Definition
open mouth: decreases particle size but also aim
closed mouth: increases aim but increases particle size
nose exhaling: helps with coating of mucosa in allergies |
|
|
Term
| what are 2 propellents used in inhalers |
|
Definition
chlorofluorocarbon (CFC)
hydrofluroalkaline (HFA) |
|
|
Term
| explain how to use an inhaler |
|
Definition
shake and remove cap
exhale slow with pursed lips
close/open mouth technique
press once
slowly inhale over 5 sec
hold breath 10 sec
exhale slowly
wait 1 min before next puff |
|
|
Term
| what is the story for the other drugs (non steroid or B2 agonist) used in asthma |
|
Definition
| the old man and liz needed chrome from chrome mountain, i prayed they throw the line to tio but monte leukast was za first leukast to salute on this |
|
|
Term
| what are the 9 other drugs used in asthma |
|
Definition
omalizumab
nedcromil
chromolyn
ipratropium
throphylline
tiotropium
monteleukast
zafirleukast
zileuton |
|
|
Term
|
Definition
| monoclonal anti-IgE antibody |
|
|
Term
| MOA nedcromil and chromolyn |
|
Definition
| inhibit mast degranulation and thus release of histamine and leukotrienes |
|
|
Term
|
Definition
| short acting muscarinic antagonist decreases PANS decreasing smooth muscle contraction |
|
|
Term
|
Definition
blocks adenosine (a bronchoconstrictor)
decreases PDE III in smooth muscle of bronchi
decreases PDE IV in inflammatory cells thus decreasing cytokines |
|
|
Term
|
Definition
| long acting muscarinic antagonist (with no M2 action) decreases PANS decreasing smooth muscle contraction |
|
|
Term
| MOA monteleukast and zafirleukast |
|
Definition
block leukotriene receptors (cys-LT)
anti-inflammatory
causes bronchodilation |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| SE nedcromil, chromolyn 4 |
|
Definition
anaphylaxis
laryngeal edema
headache
rash |
|
|
Term
|
Definition
| atropine like in high dose |
|
|
Term
|
Definition
| CNS, CV, increase HR, GI, diuretic like |
|
|
Term
|
Definition
| atropine like in high dose |
|
|
Term
| SE monteleukast, zafirleukast, zileuton |
|
Definition
|
|
Term
|
Definition
| severe allergen induced asthma |
|
|
Term
| use nedcromil, chromolyn 3 |
|
Definition
adjunct in mild-moderate asthma
exercise asthma
allergen asthma |
|
|
Term
| use ipratopium and tiotropium 2 |
|
Definition
in combination with B2 agonist (combivent, dunoeb) for COPD
pt with B2 intolerance
never acute use |
|
|
Term
| use monteleukast, zafirleukast, zileuton 2 |
|
Definition
alternate to steroid in mild asthma
adjunct to steroid in severe asthma |
|
|
Term
| age ok for use in monteleukast, zafirleukast, zileuton and administration |
|
Definition
monteleukast 1yo+ oral
zafirleukast 5yo+ oral
zileuton 10yo + oral |
|
|
Term
| ipratopium and tiotropium: onset, dosing timing, administration |
|
Definition
|
|
Term
| throphylline: administration 3, pharmacokinetic quality |
|
Definition
P450 inhibitor
oral, rectal, parentrail |
|
|
Term
| nedcromil, chromolyn: administration, age ok to use, benifits based on age |
|
Definition
inhaled
ok in kids - better than steroid but has not anti-inflammatory effect so steroid is still DOC |
|
|
Term
| omalizumab: age for ok use, administration, dosing timing |
|
Definition
|
|
Term
| explain the six stages of asthma treatment |
|
Definition
1. SABA PRN
2. LABA daily, SABA PRN
3. steroid daily, SABA PRN
4. LABA med dose daily, SABA PRN
5. LABA lg dose daily, SABA PRN
6. systemic steroid daily, steroid daily, SABA PRN
treat for 3mo, if stable step down a level |
|
|
Term
| what is the DOC for childhood asthma, what are 2 alternates |
|
Definition
steroid inhaled daily
monteleukast, cromolyn |
|
|
Term
| define and what is cause of exercise asthma |
|
Definition
pulmonary function decline (maybe only symptom or seen in 80% asthmatics)
caused by hyperventilation of cold air, respiratory heat, and water loss |
|
|
Term
| TX exercise induced asthma |
|
Definition
<3h exercise: albuterol or terbutaline, chromolyn alternate
>3h exercise mild asthma: LABA
>3h exercise mod asthma: corticosteroid |
|
|
Term
| define and hat is cause of nocturnal astham, 3 signs |
|
Definition
asthma in sleep or upon waking
worse 2-6am due to increased PANS, decreased epinepherine, increased inflammatory mediators, and GERD
morning cough, bronchospasm, esp in expiration (carcadian association) |
|
|
Term
|
Definition
LABA
corticosteroids if moderate to severe |
|
|
Term
| signs of aspirn induced asthma 3, when would you use aspirin anyways |
|
Definition
rhinorrhea, wheeze, SOB
desensitize for post MI arthritis |
|
|
Term
| what drug should you avoid in asthmatics |
|
Definition
non-specific BB (even timolol opthalamic)
be careful with B1 specific too |
|
|
Term
| causes or associations with COPD 8 |
|
Definition
asthma
cardiac disease
renal disease
smoking
grain
coal
asbestos
pollution |
|
|
Term
| pathological changes in chronic bronchitis |
|
Definition
| increased mucous and glands lead to obstruction, inflammation, edema, infection, bronchial hyperplasia of smooth muscle |
|
|
Term
| pathological changes in emphysema |
|
Definition
| increased proteases cause inflammation, fibrosis, destruction of alveolar wall and tissue which enlarge air space distal to terminal bronchioles, decrease elastic recoil and support leading to airway collapse without accessory muscle support to increase expiration |
|
|
Term
| 5 avenules of tx for COPD |
|
Definition
primary intervention - stop smoking
primary therapy - bronchodilators
corticosteroids
long term O2 treatment
immunizations - pneumococcus q6mo |
|
|
Term
| 2 drugs that help stop smoking, their MOA and SE |
|
Definition
buproprion: sustained release tablet antidepressant (SE suicide)
varenicline: nicotinic partial agonist decreases dopamine in mesolimbic tract and thus decreases reinforcement for smoking
SE: N/V, suicide |
|
|
Term
| what are the indications for long term O2 therapy, what is the timeframe |
|
Definition
15-20 h/d reduces mortality
PaO2 <55
right heart failure
polycythemia
impaired neuropsychological function with PaO2 <60 |
|
|
Term
| what is the drug combination used for bronchodilation in COPD |
|
Definition
ipratoripum or tiotropium + SABA PRN
add throphylline if unable to control |
|
|
Term
| explain how steroids are used in COPD |
|
Definition
really only benifit asthmatics
if not asthmatic, give 20-30mg prednisone for 2-3wks and if successful switch to inhaled steroid |
|
|
Term
| explain the physiology of a cough |
|
Definition
involves CNS, PNS, bronchial smooth muscle
physiological, normal response that helps clear debris |
|
|
Term
| what are the 4 antitussives |
|
Definition
codiene
hydrocodone
dextromethorphan
bensonate |
|
|
Term
| what is an expectorant and its MOA |
|
Definition
| guaifensin: increases respiratory fluid output by decreasing viscosity and surface tension |
|
|
Term
|
Definition
isomere of codine levorphanol (L isomere is addicting) acts on medulla to increase threshold
equal in effectiveness to codiene |
|
|
Term
|
Definition
GI
high dose causes CNS depression |
|
|
Term
| causes of acute rhinitis 6 |
|
Definition
virus
bacteria
foreign body
hypothyroid
pregnancy
drug induced - medicamentosa |
|
|
Term
| 9 causes of chronic rhinitis |
|
Definition
allergy - hay fever, perennial
vasomotor rhinitis
tumor
polyp nasal septal deviation
enlarged adenoids
sinusitis
CSF rinorrhea |
|
|
Term
| 5 modes of tx for rhinitis |
|
Definition
avoid allergen
reversible H1 antagonist
decongestant
corticosteroid - inhaled
cromolyn - inhaled |
|
|
Term
| when should you use reversible H1 antagonist in rhinitis 3 |
|
Definition
perennial
allergic rhinits or conjunctivitis |
|
|
Term
| what are 4 decongestants used in rhinitis |
|
Definition
pseudophredrine
phenhyleephrine
naphazoline
oxymetazoline |
|
|
Term
|
Definition
stimulate a1 (symphathomimetrics)
often in combo with H1 antagonist |
|
|
Term
|
Definition
| rebound congestion upon DC |
|
|
Term
|
Definition
| venodilator decreases preload which decreases work on heart |
|
|
Term
|
Definition
angina SL for acute attack
not great preventitive |
|
|
Term
| drugs good vo vasospasm angina |
|
Definition
never BB
CCB vascular specific - amlodipine |
|
|
Term
| drugs good for stable angina prevention |
|
Definition
#1 is BB
any CCB will work (amlodipine, ditilzaim, verapmil) |
|
|
Term
|
Definition
| work on ascending loop of henle targeting Na/K/2Cl diuretic |
|
|
Term
|
Definition
loops loose Ca
ototoxic
K loss and thus H loss so metabolic acidosis |
|
|
Term
|
Definition
| DOC acute pulmonary edema |
|
|
Term
|
Definition
| works on DCT NaCl channels |
|
|
Term
| hydrochlorothiazide: SE 4 |
|
Definition
K loss and thus H loss so metabolic acidosis
thiazides save Ca
hyperglycemia |
|
|
Term
| hydrochlorothiazide: use 2 |
|
Definition
DOC daily fluid balance duiretic (long half life)
DI NOT caused by lithium |
|
|
Term
| what is used to tx DI caused by lithium, why |
|
Definition
| amularide: becaue lithium and Na are similar in size and charge. comes into CD through Na channels |
|
|
Term
|
Definition
works in CD as direct Na channel blocker
K sparing |
|
|
Term
| eplerone and spironolactone: MOA |
|
Definition
works in CD as ALD receptor blocker decreasing number of Na chennals, thus indirect CD blocker
K sparing |
|
|
Term
|
Definition
| if you save K you save H causing metabolic acidosis |
|
|
Term
|
Definition
lowers VLDL, TG
raises HDL |
|
|
Term
|
Definition
|
|
Term
|
Definition
bile acid sequesterant (ie cholesterol)
complexes with bile so you cannot recycle them and you loose them from the body and liver needs to make more bile acids and thus need to pull cholesterol from the blood to do it |
|
|
Term
| cholestyramine: contrindications, why |
|
Definition
| hyperTG patients: further increases TG because when liver starts making more bile acids it starts making other lipids too |
|
|
Term
|
Definition
HMG CoA reductase (rate limiting step in cholesterol synthesis) inhibitor
benifit all aspects of lipid profile |
|
|
Term
| which statin is most likley to raise HDL, which is least |
|
Definition
| atrivostatin > simvastatin |
|
|
Term
|
Definition
| muscle toxicity (myalgia, myositis, rhabdomyalgia) |
|
|
Term
|
Definition
| take with P450 inhibitor increases statin levels and risk of muscle toxicity (never drink grapefruit juice!) |
|
|
Term
|
Definition
| increases gene expression of PPARy which increases lipoprotein lipase which lowers TG |
|
|
Term
| what two NT and change in parkinsons disease |
|
Definition
decreased dopamine
increased ACh (Relative) |
|
|
Term
|
Definition
taken into CNS and turned into dopamine
use carbadopa to avoid DOPA decarboxylase break down in periphery |
|
|
Term
|
Definition
| dopamine agonist directly stimulates D2 receptors |
|
|
Term
|
Definition
| stops metabolism of dopamine by MAOB blocking it |
|
|
Term
|
Definition
in periphery and CNS levodopa is converted to 3-o-methyodopa by COMT
drug blocks COMT to increases levadopa conversion to dopamine |
|
|
Term
|
Definition
targets ACh, muscarinic blocker
lowers effect of ACh in parkinsons |
|
|
Term
|
Definition
|
|
Term
| drugs used for parkinsons |
|
Definition
levodopa/carbadopa
ropinerole
selegiline
entacapone
benzotropine |
|
|
Term
| explain the break down process of ethanol and the SE 3 |
|
Definition
| ethanol > alcohol DH > acetaaldehyde > aldehyde DH > acid aldehyde > acidosis, N/V, headache |
|
|
Term
| explain break down process of methanol and the SE 2 |
|
Definition
| methanol > alcohol DH > formeldahyde > aldehyde DH > formic acid > acidosis, eye damage |
|
|
Term
| explain break down process of ethylene glycol and the SE 2 |
|
Definition
| ethylene glycol > alcohol DH > aldehyde > aldehyde DH > acid aldehyde > acidosis, kidney damage |
|
|
Term
|
Definition
| blocks aldehyde DH causing aldehyde buildup which causes toxic effects deturing from alcohol use |
|
|
Term
|
Definition
methylphenidate
dextroamphetamine |
|
|
Term
|
Definition
| promote release of NE and dopamine |
|
|
Term
|
Definition
|
|
Term
|
Definition
tachycardia
sweating
increased BP |
|
|
Term
|
Definition
uses antithombin III to cleave IIa, IXa, XIa, XIIa
works on activated factors so works rapidly |
|
|
Term
|
Definition
protamine: directly complexes with heparin stopping its action
rapid onset |
|
|
Term
|
Definition
| heparin induced thrombocytopenia (stop all drugs working through antithrombin III if induced, not just heparin) |
|
|
Term
| how can heparin be monitered |
|
Definition
|
|
Term
|
Definition
| low molecular weight heparin |
|
|
Term
|
Definition
| takes time, decreased synthesis of II, IV, IX, X by stopping vitamin K |
|
|
Term
| warfarin antidote and MOA |
|
Definition
Vit K: never going to be fast
fresh frozen plasma: fast, replenishes clotting factors |
|
|
Term
| how is warfarin monitered |
|
Definition
|
|
Term
| rivaroxban: MOA, how monitored |
|
Definition
blocks factor Xa
no need to monitor |
|
|
Term
| dabigatran: MOA, how monitored |
|
Definition
direct thrombin inhibitor
no need to monitor |
|
|
Term
|
Definition
ADP receptor blocker
cannot activate platelets
good back up to aspirin |
|
|
Term
|
Definition
| glycoprotein IIb/IIIa inhibitor blocks fibrinogen receptors prevents cross linking in platelet aggregation |
|
|
Term
|
Definition
angioplasty
acute coronary syndromes
unstable angina |
|
|
Term
|
Definition
tPA
fibrinolytic
breaks down clots |
|
|
Term
|
Definition
|
|
Term
| causes of nausea and vomiting in adults 10 |
|
Definition
metabolic
neuro
CV disorder
GI disorder
infection
pregnancy
operations
drugs
chemo
emotions |
|
|
Term
| causes of nausea and vomiting in kids 14 |
|
Definition
pyloric stenosis
duodenal ulcer
stress ulcer
adrenal insufficiency
septicemia
disease of pancreas, liver, biliary tree
GI obstruction
increased ICP
overfeeding
rapid feeding
inadequate burping
laying down too soon after feeding |
|
|
Term
|
Definition
| immediate need to vomit, gastric stasis |
|
|
Term
|
Definition
| rhythmic action of respiratory muscles (abdominal, inercostal, diaphragmatic) against closed glottis |
|
|
Term
|
Definition
| forceful expulsion of gastric contentents caused by GI retroperistalsis, salivation, shivering, vasomotor changes |
|
|
Term
| afferent sensory nerves send receptors for nausea and vomiting to 3 |
|
Definition
chemoreceptor trigger zone (CTZ)
cerebral cortex
visceral afferents from pharynx and GI |
|
|
Term
| afferent signals are intergrated by vomiting center in medulla and efferent impulses go to 5 |
|
Definition
salivation center
respiratory center
pharyngeal, GI, abdominal muscles |
|
|
Term
| NT involved in vomiting center, CTZ, GI tract 4 |
|
Definition
| ACH (M), histamine (H1), dopamine (D2), serotonin (5-HT3), opiate receptors |
|
|
Term
| categories of drugs that help with nausea and vomiting 5 |
|
Definition
5-HT3 antagonist
dopamine antagonist
antihistamine
anticholinergics
cannabis |
|
|
Term
| 2 5-HT3 antagonists used in nausea and vomitin |
|
Definition
|
|
Term
| 5 dopamine antagonist used in nausea and vomiting |
|
Definition
chlori was a pro, a pro at doing meth, a pro chlori was, she drop it like it hot on the metro, chlori pride
chelrpromazine
promethazine
prochlorperazine
deoperidol
metoclopramide |
|
|
Term
| 2 antihistamines used in nausea and vomiting and their administrations |
|
Definition
meclizine (oral)
diphenhydramine (oral, IM, IV) |
|
|
Term
| 1 anticholinergic used in nausea and vomiting |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| antagonist of central/peripheral 5-HT3 on vagal afferents, NTS, postremia |
|
|
Term
| what is the cause of post chemo nausea |
|
Definition
| serotonin released by enterochromaffin cells in SI in response to chemo may stimulate vagal afferents to vomiting reflex |
|
|
Term
| odansetron administration 4 |
|
Definition
|
|
Term
|
Definition
most effective for chemo and upper abdominal irridation nausea
effective against hyperemesis of pregnacy
somewhat effective for post-op nausea |
|
|
Term
| how is palonostron different than odansetron |
|
Definition
| has t1/2 40h, longest of serotonins |
|
|
Term
| prochlorperazine, chlorpromazine, promethazine: MOA 3 |
|
Definition
D2 antagonist at CTZ
antihistamine
anticholinergic |
|
|
Term
| prochlorperazine, chlorpromazine, promethazine: use 2 |
|
Definition
most common general antinausea and antiemetic
NOT effective for nausea associated with chemo |
|
|
Term
| prochlorperazine, chlorpromazine, promethazine: SE |
|
Definition
| most common drug to cause drowsiness |
|
|
Term
|
Definition
|
|
Term
| droperidol: administration 2 |
|
Definition
|
|
Term
|
Definition
surgical antiemetic
preop med when other tx not effective |
|
|
Term
|
Definition
alters cardiac conduction
sedation
acute dystonia |
|
|
Term
|
Definition
stimulate ACh release from enteric neurons increasing GI motility and LES pressure (prokinetic)
Blocks D3 receptors at CTZ
supresses inhibitor interneurons by antagonizing 5-HT3 receptor
stimulates 5-HT4 receptor
agonist of D2 receptors that inhibit cholinergic neurons |
|
|
Term
| metoclopramide: administration 3 |
|
Definition
|
|
Term
|
Definition
adjunct to PPI and H2 blocker for GERD
gastroparesis (increases gastric emptying)
antinausea
antiemetic |
|
|
Term
|
Definition
chronic use >12wk: tarditive dyskinesia
acute use: acute dystonia (reversible tarditive dyskinesia) or pseudoparkinsonism EPS symptoms |
|
|
Term
| MOA antihistamines for nausea and vomiting |
|
Definition
| H1 antagonist on vestibular afferents in brain stem |
|
|
Term
| use of antihistamines for nausea and vomiting |
|
Definition
|
|
Term
|
Definition
|
|
Term
| scopolamide: administration 2 |
|
Definition
injectable bromide
transdermal patch |
|
|
Term
|
Definition
prevent and tx motion sickness
NO role in chemo nausea |
|
|
Term
|
Definition
| stimulate CB1 cannaboid receptors on neurons in vomiting center |
|
|
Term
|
Definition
prophylactic for nausea in chrmo when other antiemetic uneffective
stimulate appetite in AIDS patients |
|
|
Term
|
Definition
central sympathomimetic activity
tachycardia
high |
|
|
Term
| antiemetics used in pregnancy 3 |
|
Definition
antihistamines
odanzatron
promethazine considered |
|
|
Term
| antiemetic used in severe nausea in chemo 3 |
|
Definition
metoclopramide
odanzetron
cannibis |
|
|
Term
| antiemetic used in moderate emesis in chemo 3 |
|
Definition
prochlorperazine
odanzetron
dronabinol |
|
|
Term
| antinausea and antiemetic used in severe chemo |
|
Definition
| combinations of ones for mild and moderate symptoms |
|
|
Term
|
Definition
visceral hypersensitvity from alterations to neuroreceptor in afferent spinal neuron function
CNS odulation of afferent input in way that results in long term sensitization of pathways involved in visceral sensation
no structural or biochemical factors |
|
|
Term
| IBS associated diseases 5 |
|
Definition
depression
anxiety
chronic fatigue syndrome
functional dyspepsia
fibromyalgia |
|
|
Term
|
Definition
lower abdominal pain
constipation
diarrhea
bloating |
|
|
Term
| tx of constipation predominate IBS 2 |
|
Definition
dietary fiber
psyllium if unable to tolerate dietary fiber |
|
|
Term
| DC tx of constipation predominate IBS and why, MOA, dosing |
|
Definition
tagsarod
heart attacks, severe diarrhea
12wk short term tx
5-HT4 agonist |
|
|
Term
| tx of diarrhea predominate IBS 3 |
|
Definition
psyllium
ipoeramide
avoid triggers |
|
|
Term
| triggers of diarrhea predominate IBS 7 |
|
Definition
caffiene
alcohol
sweeteners: sorbitol, fructose, mannitol
herbal medicines
tea (senna is laxative) |
|
|
Term
| tx of IBS with abdominal pain and bloating 2 and MOA |
|
Definition
antispasmotics:
dicylomide
atropine-hyoscyamide-phenobarbitol-scopolamide: anticholinergic DOC for IBS effectiveness not proven |
|
|
Term
| adjnct tx for IBS 2, 2 effects |
|
Definition
TCA, SSRI
help with analgesia with eating
relieve depression |
|
|
Term
| components of bile acids 3 |
|
Definition
cholic acid
chenodeoxycholic acid
deoxycholic acid |
|
|
Term
| functions of bile acids 4 |
|
Definition
induce flow of bile
feedback inhibition of cholesterol synthesis
eliminate cholesterol (promote excretion)
disperase and absorb lipids and fat soluble vitamins |
|
|
Term
|
Definition
|
|
Term
| ursodeoxycholic acid: MOA |
|
Definition
cytoprotective on hepaticytes
functional gallbladder needed: modified by bile
degrades cholesterol monohydrate crystals in 40% |
|
|
Term
| ursodeoxycholic acid: use 2 |
|
Definition
cannot be used for bile acid therapy alone due to unfavorable surface area to size ratio
gall bladder dissolution
cholestatic liver disease |
|
|
Term
|
Definition
| loss of gland function (Exocrine and endocrine), inflammation, and pain |
|
|
Term
| function of pancreatic enzymes |
|
Definition
| protein and fat digestion |
|
|
Term
| how are pancreatic enzymes released |
|
Definition
CCK releasing monitor peptide from duodenum triggers CCK then is degraded by trypsin
CCK stimulates release of pancreatic enzymes |
|
|
Term
| effects of chronic pancreatitis on physiology |
|
Definition
trypsin insufficiency increases CCK and causes pain due to continous stimulation of enzymes and increased intraductal pressure
decreased digestive enzymes cases protein maldigestion and seatorrhea when >90% pancreas lost leading to malabsorption and diarrhea |
|
|
Term
| goals of tx of chronic pancreatitis 2 |
|
Definition
prevention of malabsorption
pain relief |
|
|
Term
| 2 drugs used in chronic pancreatitis |
|
Definition
|
|
Term
|
Definition
| delivered to duodenum during 4h period with and after a meal |
|
|
Term
|
Definition
| decrease diarrhea and malabsorption due to pancreatitis |
|
|
Term
|
Definition
| delivered to duodenum and interrupts CCK mediated pain loop |
|
|
Term
| why would lipase and protease be coated or uncoated |
|
Definition
coated: treat malabsorption
uncoated: treat malabsorption and pain |
|
|
Term
| explain how the two main categories of prostaglandins are made |
|
Definition
phospholipid membrane (phosphitadil inositol) is broken by phospholipase A2 into arachidonic acid
arachidonic acid is converted to either 5-lipooxygenase, COX1, or COX2
to be converted to COX2 it needs to be induced by inflammation (unless in brain and kidney where it is constitutive) |
|
|
Term
| what type of receptors do prostaglandins use |
|
Definition
| G protein receptors that activate or inhibit adenylyl cyclase and phospholipase C |
|
|
Term
| explain the 5-lipooxygenase pathway and the 3 effects |
|
Definition
5, 12, 15 - HPETE > 5-HETES > leukotriene >>
phagocyte mobilization, change in vascular permeability, inflammation |
|
|
Term
| what are the 3 products of the COX pathway |
|
Definition
prostacyclin (PGI)
prostaglandin (PGE)
thromboxane A2 (TXA2) |
|
|
Term
| 3 effects of prostacyclin |
|
Definition
gastric acid secretion
decreased platelet aggregation
maintain renal flow despite vasoconstrictors |
|
|
Term
| 6 effects of prostaglandins |
|
Definition
maintain renal flow despite vasoconstrictors
sensitize nerve endings to bradykinin and histamine causing pain
increase thermoregulatory center in hypothalamus
stimulate stomach mucous
keep PDA open |
|
|
Term
| 1 effect of thromboxane A2 |
|
Definition
|
|
Term
| where do corticosteroids dysrupt the prostaglandin pathway |
|
Definition
| stop phospholipase A2 from breaking phosphitadil inositol from phospholipid membrane into arachidonic acid |
|
|
Term
| where do salycylates dysrupt the prostaglanding pathway |
|
Definition
| stop COX2 from inducing PGI, PGE, TXA2 |
|
|
Term
| what are the 4 salicylates |
|
Definition
acetylsalicylate (aspirin)
choline Mg trisalicylate
sulfasalazine
diflundail |
|
|
Term
|
Definition
acetylsalicylate - irreversible COX2 blocker
choline Mg trisalicylate - reversible COX2 blocker
sulfasalazine - reversible COX2 blocker
diflundail - reversible COX2 blocker |
|
|
Term
| which salicylate is differet, why |
|
Definition
| diflundail: does NOT cross BBB (NO antipyretic), does NOT affect uric acid secretion, 3-4x more potent |
|
|
Term
| 10 non-respiratory effects of salicylates |
|
Definition
anti-inflammation (PGE)
decrease pain (PGE)
anti-pyretic (no effect on normal body temp, PGE)
decrease gastric acid (PGI)
decrease stmach mucous (PGE) causes ulcers and hemorrhage
blood thinning (TXA2, PGI) (irreversible lasts life of platelet in aspirin)
closes PDA
vasoconstriction, Na/water retention, and kyperkalemia in renal vessels |
|
|
Term
| respiratory effects of normal, high, and toxic doses of salicylates |
|
Definition
normal: stimulates resporatory medulla, uncouples ETC increasing CO2 stimulating respiratory medilla too, leads to hyperventilation and respiratory alkalosis
toxic: supresses respiratory center causing respiratory acidosis and metabolic acidosis (drug is acid) |
|
|
Term
|
Definition
gout
RA
rheumatic fever
headache
arthralgia
myalgia
corns, callus, wart (topical)
blood thinner
angina
close PDA (dec PGE)
decrease colon cancer
ulcerative collitis
anti pyretic
analgesic
antiinflammatory |
|
|
Term
| how does the dose of salicylates effect the function |
|
Definition
low dose t1/2 3-5h: blood thinner
med dose t1/2 3-5h: anti inflamm
high dose t1/2 15h: zero order kinetics |
|
|
Term
| side effects of salicylates 7 |
|
Definition
epigastric distress
N/V
bleeding
metabolic depression
15% have intolerance/hypersensitivity
rye syndrome: aspirin in viral infection in kids causes hepatitis and cerebral edema |
|
|
Term
| interactions with salicylates 4 |
|
Definition
antacids: decrease absorption
heparin: hemorrhage
probenecid: decrease excretion (contraindicatedin grot)
prolonged t1/2, effects, toxicity of many drugs |
|
|
Term
| 5 signs of mild salicycate toxicity |
|
Definition
N/V
hyperventilation
headache
confusion
tinnitus |
|
|
Term
| 9 signs of severe salicylate toxicity |
|
Definition
restlessness
delirium
hallucinations
convulsions
dizziness
coma
death
respiratory acidosis
metabolic acidosis |
|
|
Term
| TX or salicylate toxicity 3 |
|
Definition
increase urine pH to help elimination
IV dialysis
fluids |
|
|
Term
| proprionic acid derivatives MOA |
|
Definition
|
|
Term
| story of proprionic acid derivatives |
|
Definition
| I bought a flurb producing napping oxen for ketoz profound ox fender |
|
|
Term
| 6 proprionic acid derivatives and their half lives |
|
Definition
ibprofen 2-4h (dose q4-6h)
flubiprofen 2-4h
naproxen 12-24h (dose q12h)
ketoprofen 2-4h
oxaprozin 58h (dose 1x/d)
fenoprofen 2-4h |
|
|
Term
|
Definition
GI irritation (bleed is rare)
renal failure
nephritis
nephrotic syndrome
less anti-coagulation effects means less interactions |
|
|
Term
|
Definition
| same as ibprofen plys CV effects |
|
|
Term
|
Definition
| some lipooxygenase inhibition (no greater antiinflammatory effect) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| val selectively rolfed on his cox |
|
|
Term
| 3 COX2 inhibitors and their SE |
|
Definition
celecoxib - sulfa hypersensitivity, don't anticoagulate (COX2 only), GI bleeds
rofecoxib - DC due to CV events
valdecoxib - DC due to SJS |
|
|
Term
|
Definition
RA
osteoarthritis
COX2 depressed in colon cancer and alzheimers disease |
|
|
Term
| story of COX1/2 inhibitors |
|
Definition
| so in the back the key tore Dic's fence so now theres a total lack in da mesh |
|
|
Term
|
Definition
sulindac
ketorolac
diclofenac
etodolac
indomethacin |
|
|
Term
|
Definition
related to indomethican
less SE
converted to sulfide |
|
|
Term
|
Definition
potent analgesic
moderate anti inflammatory
chronic/post-op pain, seasonal allergic conjunctivits |
|
|
Term
|
Definition
| formula with misoprostol (PGE-E1) to decrease GI SE, accumulates in synovium |
|
|
Term
|
Definition
| large difference between anti-inflamm dose and GI issue dose |
|
|
Term
| indomethacin MOA and uses 7 |
|
Definition
potent anti inflammatory used in gout, arthritis, anylosing spondylitis, acute shoulder
tocolytic: supresses contraction in preterm labor
closes PDA |
|
|
Term
|
Definition
GI upset
hepatic disease (increases amniotransferases) |
|
|
Term
|
Definition
|
|
Term
|
Definition
| GI upset, frontal headaches, neutropenia, thrombocytopenia, aplastic anemia |
|
|
Term
|
Definition
analgsic, antipyretic, NO anti inflammatory effect
inhibit PGE synthesis in CNS |
|
|
Term
| pharmacokinetics of acetaminophen: normal and OD |
|
Definition
significant first pass: conjugated via glucorindation/sulfination
hydroxylated to NAPQI which at normal dose reacts with glutathione but at toxic dose builds up and depletes glutathione and reacts to hepatic sulhydryl and causes necrosis |
|
|
Term
|
Definition
| n-acetyl cysteine sulfhydryl binds NAPQI as antidote |
|
|
Term
|
Definition
| well tolerated at normal doses, no effect on platelets or uric acid |
|
|
Term
|
Definition
analgesic
antipyretic
DOC reye syndrome prevention (fever in kids with viruses, VZV)
DOC gout pt (not reaction with probenicid) |
|
|
Term
|
Definition
lesion in gastric/duodenal mucosa at site where mucosal epithelium is exposed to acid and pepsin
normal mucosa is protected by mucous and can withstand acid and pepsin attack but excess acid, intrinsic defect of barrier allows ulcers to form |
|
|
Term
|
Definition
H. pylori
NSAID
stress related mucosa damage
zollinger ellison (inc gastric acid)
viral: CMV
cocaine: vascular insufficiency
radiation
chemo: hepatic artery insufficiency |
|
|
Term
| explain how acid is releaed in the stomach |
|
Definition
neuron releases ACh which stimulates gastrin release from duodenal G cells.
gastrin stimulates parietal cell in the fundus release of HCl and intrinsic factor
histamine is released from mucosa mast cells via paracrine pathway and stimulates acid release
H/K ATPase on Chief cells secrete pepsinogen against gradient. acid converts pepsinogen to pepsin which digests |
|
|
Term
| 3 things that protect us from acid |
|
Definition
mucous: secreted from epithelial and mucous cells in stomach, contains bicarbonate
continous cell removal
prostaglandin F2 inhibits acid secretion |
|
|
Term
| how does H. pylori cause damage |
|
Definition
colonizes acidic mucosa causing inflammatory gastritis, peptic ulcer, gastric lymphoma, adenocarcinoma
increases HCl secretion
decreases mucosa defenses |
|
|
Term
| clinical signs of gastric or duodenal ulcer |
|
Definition
| epigastric pain: burning, gnawing, aching |
|
|
Term
| what persent of population is infected and what percent develops ulcers from H. pylori |
|
Definition
50% infected
15% get ulcers |
|
|
Term
|
Definition
symptomatic clinical or histological alteration due to gastroesophageal refluc (retrograde acid into esophagus) due to decreased LES pressure
due to acid spending too much time in esophagus not too much acid
causes inflammation and erosive esophagitis |
|
|
Term
| food causes of decreased LES pressure 10 |
|
Definition
carminatives (mints)
chocolate
fat
coffee
cola
tea
citris
tomato
onion
garlic |
|
|
Term
| hormone causes of decreased LES pressure 8 |
|
Definition
CCK
estrogen
gastric acid
gucagon progesterone
PGE
secretin
VIP |
|
|
Term
| drug causes of decreased LES pressure 15 |
|
Definition
anticholinergic
barbituates
BDZ
caffiene
CCB
dopamine
estrogen
EtOH
narcotics
nicotine
progesterone
throphylline
phentolamine
nitrates
isoproterenol |
|
|
Term
| causes of increased LES pressure 10 |
|
Definition
protein meal
gastric alkalinization
gastrin
PGE F2
prokinetics
endorphonium
methacoline
NE
pentagastrin
phenylperine |
|
|
Term
| what are the anatomical changes caused by all the things that change LES pressure allowing GERD 3 |
|
Definition
lower GE sphincter pressure due to...
spontaneous LES relaxations
transient increases in intra-abdominal pressure
atonic LES |
|
|
Term
| what are the 4 aggregating factors causing inflammation and erosive esophagitis |
|
Definition
gastric acid
pepsin
bile
pancreatic enzymes |
|
|
Term
|
Definition
esophagitis
strictures
barretts esophagus
anemia |
|
|
Term
|
Definition
heartburn, may radiate to neck
hypersalivation
belching
regurgitation worse after fatty food, laying down, bending over |
|
|
Term
|
Definition
nonallergic asthma
chronic cough
horseness
pharyngitis
CP like angina |
|
|
Term
|
Definition
1. remove stress, smoking, NSAIDS
2. remove H. pylori
3. NSAID ulcer treatment
4. relief of symptoms |
|
|
Term
|
Definition
1 PPI + 2 of theses (clathriomycin, amoxicillin, metronidazole, tetracycline)
3 antibiotics may cause better compliance, effectiveness, less resistance |
|
|
Term
| how do we treat NSAID ulcers |
|
Definition
H2 antagonist, PPI, or sucralfate
NSAID discontinuation
PPI causes better ulcer healing |
|
|
Term
| what can be used for PUD symptom relief 3 |
|
Definition
OTC H2 antagonist and antacids
RX PPI |
|
|
Term
| 5 steps in GERD treatment |
|
Definition
1. elevate head when sleeping, protein rich meals, stop smoking and drinking
2. OTC meds
3. perscription H2 antagonist
4. perscription PPI or high dose H2 antagonist
5. surery |
|
|
Term
| what OTC meds can be used for GERD 3 |
|
Definition
antacids
alginic acid
H2 antagonists |
|
|
Term
| how can GERD be prevented 2 |
|
Definition
PPI
ranitidine (only H2 antagonist for erosive esophagitis) |
|
|
Term
| which categories of drugs can be used for both PUD and GERD 3 |
|
Definition
H2 antagonists
PPI
Antacids |
|
|
Term
| which categories of drugs can be used only for PUD 2 |
|
Definition
prostaglandins
antimuscarinic |
|
|
Term
| which categories of drugs can be used olny for GERD 2 |
|
Definition
mucosal protective agents
promotility (prokinetic agents) |
|
|
Term
| 3 H2 receptor antagonists |
|
Definition
it rained on the cement as they family dined
raitidine
cimetidine
famotidine |
|
|
Term
|
Definition
ome es just being ome; lancing raspberries in a pan
omeprazole
esomeprazole
lansoprazole
rabeprazole
pantoprazole |
|
|
Term
| which antipsychotic isnt a PPI |
|
Definition
|
|
Term
| what drug is a prostaglandin |
|
Definition
i missed the prostate and it released prostaglandins
misoprostol |
|
|
Term
| which drug is a antimuscarinic that can be used in PUD |
|
Definition
that dic collected my acid
dicyclomine |
|
|
Term
|
Definition
a glince of Al, Mg, Ca, Na, can fix the acid
aglinic acid
aluminum hydroxides
Magnesium hydroxides
calcium carbonates
sodium bicarbonates |
|
|
Term
| 2 mucosal protective agents |
|
Definition
collin bismith sure cared about the fate of his mucous
colloidal bismuth
sucralfate |
|
|
Term
| 1 promotility/prokinetic agent |
|
Definition
i got on the metro and the clomping made my GI turn
metoclopramine |
|
|
Term
| DOC for peptic ulcer and GERD |
|
Definition
|
|
Term
| which PUD/GERD drug promotes healing |
|
Definition
|
|
Term
| DOC for long term hypersecretion conditions (zollinger ellison) |
|
Definition
|
|
Term
| which PUD/GERD drug works on reflux esophagitis |
|
Definition
|
|
Term
| which PUD/GERD drug is also antimicrobial |
|
Definition
|
|
Term
| which PUD/GERD drug used for NSAID ulcer prevention |
|
Definition
|
|
Term
| which PUD/GERD drug used for NSAID ulcer treatment |
|
Definition
|
|
Term
| which PUD/GERD drug cannot be taken with antacids |
|
Definition
|
|
Term
| which PUD/GERD drug is also used in gastroparesis and as antiemetic |
|
Definition
|
|
Term
| MOA H2 receptor antagonist 4 |
|
Definition
blocking H2 in stomach inhibits acid, histamine (and thus HCl), and gastrin secretion
indirectly blocks M receptor and gastrin receptor due to role of histamine in their production |
|
|
Term
| H2 antagonist: administration and excretion |
|
Definition
oral
renal, excreted unchanged |
|
|
Term
|
Definition
| famotidine > ranitidine > cimetidine |
|
|
Term
|
Definition
DOC GERD and PUD
promote ulcer healing (need H. pylori tx or will reoccur) |
|
|
Term
|
Definition
limited H2 function in other tissues causes headache, dizziness, nausea
cimetidine is antiandrogenic (decreases production and blocks receptor) causing glyecomastia |
|
|
Term
| H2 antagonist: interactions 1 |
|
Definition
| cimetidine: P450 inhibitor which potentiates warfarin, diazepam, phenytoin, quinidine, carbamazepine, throphylline, imipramine |
|
|
Term
|
Definition
| H/K ATPase inhibitor inhibits gastri acid secretion by irreversibly inhibiting proton pump |
|
|
Term
| PPI: duration, administration |
|
Definition
oral delayed relase capsule: destoried by gastric acid without gelatin coated capsule which prevents release of drug until intestines which it is rapidly absorbed
actions are long lasting because their irreversible so once daily dosing |
|
|
Term
|
Definition
active ulcers
NSAID ulcers
reflux esophagatis
DOC zollinger ellison / hypersecretion |
|
|
Term
| PPI SE and interactions 5 |
|
Definition
omeprazole: P450 inhibitor increases warfarin, phenytoin, diazepam
3% get nausea, diarrhea, abdominal cholic
colpidogrel decreases drug effect |
|
|
Term
|
Definition
PGE E2 and I2 receptor agonist decreases cAMP and inhbits acid secretion
stimulates mucous and bicarb production |
|
|
Term
|
Definition
prevent NSAID (most selective, not most effective thats PPI)
peptic ulcer (less effective) |
|
|
Term
| misoprostol: pharmacokinetics |
|
Definition
| available in combo with diclofenac (NSAID) |
|
|
Term
|
Definition
diarrhea
abdominal cramps
abortion
premature birth
category X teratogenic birth defect |
|
|
Term
|
Definition
| adjunct to peptic ulcer treatment |
|
|
Term
|
Definition
| M blocker inhibits ACh stimulation of gastric acid secretion |
|
|
Term
|
Definition
| atropine like (Tachycardia, dry mouth, constipation, urine retention) |
|
|
Term
|
Definition
react with gastric acid to make water and salt
reduce pepsin activity by increasing pH
alginic acid: not as effective at neutralizing acid but protects esophageal mucosa |
|
|
Term
|
Definition
heal gastric ulcers
relieve GERD symptoms
AlOH slow relief
MgOH moderate relief
CaCO and NaHCO3 fast relief |
|
|
Term
|
Definition
| binds phosphate causing constipation |
|
|
Term
|
Definition
|
|
Term
|
Definition
systemic alkalosis - alkalinizes urine
liberate CO2 causing burps and farts |
|
|
Term
|
Definition
all have Na so important in HTN and CHF
affect absorption od drugs because they raise pH of stomach and bicarb alkalinizes urine
dont take other drugs +/-2h from antacid |
|
|
Term
|
Definition
requires acid for activation
complex of AlOH and sulfated sucrose binds positive charges in mucosa proteins
creates barrier impairing HCl diffusion and pepsin degradation
stimulates prostaglanding and bicarb release |
|
|
Term
|
Definition
| dont take with antacid, needs acid to activate |
|
|
Term
|
Definition
neutralize gastric acid
bind surface of stomach and create barrier
stimulate mucous and bicarb production
antibacterial on H. pylori |
|
|
Term
|
Definition
black tongue
black stool
increased bleeding time with bismuth subsalicylate (NSAID) |
|
|
Term
|
Definition
stimulate ACh release from enteric neurons increasing GI motility and LES pressure
blocks D2 receptors |
|
|
Term
|
Definition
adjunct to PPI and H2 block in GERD
gastroparesis
antiemetic |
|
|
Term
|
Definition
chronic use >12wk: tarditive dyskinesia
acute use: EPS/pseudo parkinsons |
|
|
Term
|
Definition
|
|
Term
|
Definition
HTN
CHF
in diabetic renal benifit |
|
|
Term
|
Definition
cough
angioedema: rapid sewlling of face after 1st dose |
|
|
Term
| contraindications of ACEI 1 |
|
Definition
|
|
Term
|
Definition
propranolol - no selective
desmolol, atenolol, metoprolol - B1 selective |
|
|
Term
| which BB are prefered in cardiac conditions |
|
Definition
|
|
Term
| contraindications to BB 3 |
|
Definition
asthma
diabetes
peripherial vascular disease: vasospastic angina |
|
|
Term
|
Definition
slows heart down
decreased CO
fatigue
never abruptly DC |
|
|
Term
|
Definition
HTN
CHF
anti-arrhythmic SVT class 2
angina |
|
|
Term
|
Definition
BB only used in arrhythmia
short t1/2 10 min |
|
|
Term
|
Definition
losartin
block ANG II receptor, benifits similar to ACEI |
|
|
Term
|
Definition
HTN
CHF
renal benifit in diabetes |
|
|
Term
|
Definition
|
|
Term
| contraindications of ARB 2 |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| vasodilates using NO with specificity for arterioles |
|
|
Term
|
Definition
| work through NO with sepcificity to VEINS |
|
|
Term
|
Definition
HTN
CHF - back up if unable to use ACEI/ARB |
|
|
Term
|
Definition
| drug most likley to cause drug induced lupus in slow acetylators |
|
|
Term
|
Definition
|
|
Term
|
Definition
main effect inside CNS
stimulates A2 inhibitory recetors decreasing sympathetic output |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| block PDE5 increasing cGMP and NO which causes vasodilation |
|
|
Term
|
Definition
pulmonary HTN
erectile dysfunction |
|
|
Term
| contraindications slidenafil |
|
Definition
| never use with nitrates, both work in same pathway too much dilation occurs |
|
|
Term
|
Definition
verapamil
diltaziam
amidopine |
|
|
Term
|
Definition
cardiodepressant
blocks L type Ca channels on heart |
|
|
Term
|
Definition
cardiodepressant
blocks L type Ca channels on heart mostly |
|
|
Term
|
Definition
vasodilates, drops BP
blocks L type Ca channels on vessels |
|
|
Term
|
Definition
HTN
angina
arrhythmia SVT class 4 |
|
|
Term
|
Definition
|
|
Term
|
Definition
HTN
angina
arrhythmia SVT class 4 |
|
|
Term
|
Definition
|
|
Term
|
Definition
reflex tachycardia
gingival hyperplasia |
|
|
Term
|
Definition
positive inotrope
inhibits Na/K ATPase on cardiac myosites
when Na goes up Ca does too and gets stored in sarcoplasmic reticulum so not it releases more causing positive inotropic effect |
|
|
Term
|
Definition
|
|
Term
|
Definition
low theraputic index
arrhythmia
blurry yellow vision |
|
|
Term
| contraindications of digoxin |
|
Definition
hypokalemia can enhance digoxin toxicity
digoxin and K bind same site on Na/K ATPase |
|
|
Term
| 4 drugs used for ventricular tachycardia |
|
Definition
procanamide
lodicaine
sotalol
amiodarone |
|
|
Term
| 4 types of drugs used for SVT |
|
Definition
|
|
Term
| 2 drugs used to ventricular tachycardia and SVT |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Procanamide: type, MOA, use |
|
Definition
1A
block Na and K
ventricular arrhythmia |
|
|
Term
| lidocainel type, moa, use |
|
Definition
1B
BB
ventricular arrhythmia |
|
|
Term
|
Definition
3
block K and BB
any arrhythmia |
|
|
Term
| amioderone: type, MOA, use |
|
Definition
3
block Na, K, Ca, BB
any arrhythmia |
|
|
Term
|
Definition
lupus in slow acetylators
torsades |
|
|
Term
|
Definition
|
|
Term
|
Definition
torsades - low risk
liver damage
pulmonary fibrosis
thyroid problems - due to iodine |
|
|
Term
|
Definition
stimulate adenosine receptors (Gi coupled so still inhibitory(
short half life 8s |
|
|
Term
| 2 Na channel blocker anti convulsants |
|
Definition
|
|
Term
|
Definition
Na channel blocker
glutamate inhibitor |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
teratogenic
gingival hyperplasia
p450 inducer
zero order kinetucs |
|
|
Term
|
Definition
|
|
Term
|
Definition
liver problems
hyperammonemia
teratogenic |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
| DC if any sign of rash could be SJS |
|
|
Term
|
Definition
morphine
meperidine
buprenorphine |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
meiosis
depressed respiratory - fatal
decreased GI/GU
gall bladder spasms |
|
|
Term
|
Definition
decreased respiration
serotonin syndrome |
|
|
Term
|
Definition
| when you put it with a full Mu agonist it causes withdrawl |
|
|
Term
|
Definition
mu antagonist
IV antidote to quickly reverse opioid action |
|
|
Term
|
Definition
5HT1D agonist
vasoconstriction |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| how many liters can the colon absorb max, how much on averate |
|
Definition
|
|
Term
| how many liters can the SI absorb |
|
Definition
|
|
Term
| what is the explain on why diarrhea and constipation occur |
|
Definition
when there is not enough fluid (<100mL) reabsorption takes it all up causing constipation
when there is too much fluid >50L then the colon can't take it up causing diarrhea |
|
|
Term
|
Definition
| excess fluid weight of stool >200g/d |
|
|
Term
|
Definition
retention of water in lumen
excessive secretion of electrolytes and water into lumen
exudation of protein and fluid from mucosa
altered intestinal motility
rapid transit |
|
|
Term
| sudden onset diarrhea complications 2 and prognosis |
|
Definition
dehydration
electrolyte imbalance esp in kids and elderly
benign and self limiting |
|
|
Term
| what is the general treatment for sudden onset diarrhea |
|
Definition
| solution with K, Na, Cl, glucose |
|
|
Term
| when should pharmacotherapy be used in diarrhea 5 |
|
Definition
when symptoms persistant
nonspecific antidiarrheal agents do not adress cause
symptomatic relief in mild diarrhea
need to decrease intestinal motility
avoided in acute diarrhea caused by invasive organisms (could delay clearance) |
|
|
Term
| what are the intraluminal antidiarrheals 5 |
|
Definition
Kal Lin does meth on cellulose paper in many cars. he chose to try, its his business
kaolin
methycellulose
polycarbophil
cholestyramine
bismuth subsalicylate |
|
|
Term
| what are the opioid antidiarrheals |
|
Definition
he lopped a dop of pares then gourged
loperamide
dophenoxylate
paregoric |
|
|
Term
| what is the somatostatin analalog antidiarrhea |
|
Definition
it too 8 tides for his diarrhea to stop
octreotide |
|
|
Term
|
Definition
| clay that binds water and some enterotxins |
|
|
Term
|
Definition
| symptomatic relief of mild diarrhea |
|
|
Term
| MOA methylcellulose/polycarbophil |
|
Definition
absorb water and increase stool bulk, poorly fermented
effect takes 1-3d |
|
|
Term
| USE and contrindications of methylcellulose/polycarbophil 2 |
|
Definition
constipation, chronic diarrhea IBS
contraindicated in patients with obstructive symptoms |
|
|
Term
|
Definition
| anion exchange resin that binds bile acids and some bacterial toxins |
|
|
Term
|
Definition
resection of distal ileum <100cm salt induced diarrhea
diarrhea caused by clindamycin
clostridium difficile colitis |
|
|
Term
| why cant cholestyramine be used for ieal resection salt induced diarrhea >100cm |
|
Definition
| drug aggrevates diarrhea because of evuntal bile salt deplation causing setaorrhea |
|
|
Term
| how does cholestyramine help with resection of distal ileum <100cm salt induced diarrhea |
|
Definition
| interrupts enterohepatic circulation of bile salts increasing concentrations and stimulating water and eletrolyte secretion |
|
|
Term
| bismuth subsalicylate composition 3 |
|
Definition
trivalent bismuth
salicylate
MgAl salicate clay |
|
|
Term
| bismuth subsalicylate MOA |
|
Definition
reacts with HCl in stomach to make bismuth oxychloride and salicylic acid (which is absorbed in stomach)
bismuth oxychloride passes unaltered into feces and stops inflammation, microbes, secretion, nausea, cramps |
|
|
Term
| bismuth subsalicylate use 4 |
|
Definition
non syndromic episodic diarrhea
TX and prevention of travelers diarrhea
H. pylori infection |
|
|
Term
|
Definition
| dark black stool and tongue due to reaction of drug and sulfides made by bacteria in mouth |
|
|
Term
| how do opioids affect diarrhea |
|
Definition
Mu receptor induces intestinal motility
delta receptor induces intestinal secretion
Mu and delta receptors both induce absorption
diarrhea is most affected by Mu receptors |
|
|
Term
| loperamide potency and distribution |
|
Definition
antidiarrheal 50x more potent that morphine
does not penetrate CNS (some does in kids) preventing abuse |
|
|
Term
|
Definition
chronic diarrhea diseases
travelers diarrhea
occasional bout of diarrhea |
|
|
Term
| dophenoxylate potency and related drug |
|
Definition
slightly more potent antidiarrheal than morphine
drug and metabolite structurly related to meperidine |
|
|
Term
|
Definition
CNS effects potential for abuse and addiction
atropine added to discourage abuse and deliberate OD |
|
|
Term
| paregoric: composition and use |
|
Definition
camphorated tincture of opium
rarley used due to addiction potential |
|
|
Term
|
Definition
| inhibit secretory diarrhea caused by hormone secreting tumors (usually VIP in carcinoid syndrome) of pancreas and GI |
|
|
Term
|
Definition
solidify, store, and evacuate stool
absorb water |
|
|
Term
| what determines the eficiency of the colon 4 |
|
Definition
luminal contents
integrity of colon
absorption
neuromuscular action |
|
|
Term
|
Definition
| stool <3x/wk, difficulty initiating poo, small poo, incomplete pooing |
|
|
Term
| define chronic constipation |
|
Definition
| defect in common motility (NMJ at rectoanal region) |
|
|
Term
| 5 reversible or secondary causes of constipation |
|
Definition
| lack of dietary fiber, drugs, hormone disturbances, neurogenic disorders, systemic illness |
|
|
Term
| what are the two sources of fiber and their effects |
|
Definition
wheat and branL high lignin, most effective at increasing stool weight
fruits/veggies: pectins/hemicellyloses, more fermentable, adds less weight |
|
|
Term
|
Definition
affects bulk, softness, and hydration of feces
resistant to enzyme digestion (fermentation)
enters colon unchanged
attracts water and increases stool bulk |
|
|
Term
|
Definition
psh your silly doing meth on cellulose paper in many cars
psyllium
methylcellulose |
|
|
Term
|
Definition
| hydrophillic mucilloid that is fermented in colon increasing colonic bacterial mass |
|
|
Term
| 3 stool wetting agents and emollients |
|
Definition
the document stated, the document stated use mineral oil, Na, Ca
docusate sodium
docusate calcium
mineral oil |
|
|
Term
| MOA docusate Na and docusate Ca |
|
Definition
stool softener
anionic surfactant that lowers surface tension of stool allowing mixing of aquous and fat softening stool |
|
|
Term
| use docusate Na and docusate Ca |
|
Definition
| marginal effects on constipation |
|
|
Term
| mineral oil MOA and administration |
|
Definition
| penetrates and softens stool, take for 2-3d |
|
|
Term
|
Definition
may interfere with absorption of water and fat soluble substances
foreign body reaction in mucosa
leakage of oil |
|
|
Term
| what are the osmotically active laxatives 3 |
|
Definition
| saline laxatives: Mg sulfate, Mg citrate, Na phosphate |
|
|
Term
| MOA saline laxatives, administration |
|
Definition
cathartic action due to osmotically mediated water retention which stimulates peristalsis
effective in 1-3h |
|
|
Term
|
Definition
evacuation of bowel
before exams
eliminate parasites |
|
|
Term
| saline laxatives 5 contraindications |
|
Definition
| avoid in renal damage, CV disease, electrolute imbalance, with diuretics |
|
|
Term
| what are the nondigestable sugar alcohols 2 |
|
Definition
|
|
Term
|
Definition
trihydeoxy alcohol absorbed orally and acts as hygroscopic agent and libricant when given rectally
water retention stimulates peristalsis and cause bowel movement in <1h |
|
|
Term
| define inflammatory bowel disease |
|
Definition
diseases affecting SI and LI caused by chronic inflammation without a cause
thought to be caused by putative antigen in genetically susceptible patient
inflammatory response mediated by cytokines, ROS, leukotrienes |
|
|
Term
| ulcerative colitis: location, depth |
|
Definition
continous, in colon
superificial |
|
|
Term
| chrons disease: location, depth, complications 2 |
|
Definition
small and large bowel, segmental
all wayers
abscess, fistulae |
|
|
Term
| signs of inflammatory bowel disease 6 |
|
Definition
diarrhea
ulceration
exudate
protein loss enteropathy
bleeding
malabsorption |
|
|
Term
| treatment of complex inflammatory bowel disease |
|
Definition
unknown inciting agent
chronic variable nature of inflammation
needs to incorporate variations in pharmacokinetics of drugs related to patient (genetic composition, age, severity of disease) |
|
|
Term
|
Definition
relieve symptoms
induce remission of active disease
prevent relapse with maintenance therapy
heal fistulae
avoid emergency surgery |
|
|
Term
| categories of drugs that treat IBD 4 |
|
Definition
5-aminosalicylates
glucacorticoids
immune supression
biological response modifers |
|
|
Term
|
Definition
(jamie) was messy and lame and took sulfa
mesalamine
sulfasalazine |
|
|
Term
|
Definition
(pH)
prednisone
hydrocortisone |
|
|
Term
|
Definition
i was doing meth while trecking on my cycle at the prince (concert)
methotrexate
cyclosporine
asathioprine |
|
|
Term
| 1 biological response modifier |
|
Definition
in the flick i got mad b/c my BF wouldnt stop binding me
infliximab |
|
|
Term
|
Definition
|
|
Term
|
Definition
mild to moderate UC
chronic UC prophylaxis |
|
|
Term
|
Definition
minor: headache, GI, rash
serious: nephrotoxicity (rare) |
|
|
Term
|
Definition
conjugate of mesalamine diazo bonded to sulfapyridine
bacterial azoreductases in colon split into components
MOA is of masalamine, sulfapryridine has minor role
AZO bond prevents early absorption of aminosalicylate in SI |
|
|
Term
|
Definition
acute to moderate UC
UC prophlyaxis |
|
|
Term
|
Definition
sulfapyridine causes fever, malaise, GI, megaloblastic anemia (give folate) agranulocytosis, SLE, SJS
additional SE of mesalamine |
|
|
Term
| use of prednisone in IBD 2 |
|
Definition
UC remission 90%
chrons remission 60-90% |
|
|
Term
| hydrocortizone use and administration in IBD |
|
Definition
severe IBD
enema or rectal |
|
|
Term
|
Definition
inhibit calcineurin
supress proinflammatory TF |
|
|
Term
|
Definition
| when glucacortioids dont work for remission of UC or chrons episode (80% effective, no prophylaxis) |
|
|
Term
|
Definition
| converted to 6-mercaptopurine, supresses lymphocytes |
|
|
Term
|
Definition
|
|
Term
|
Definition
reduce need for steroids
maintain serious UC and chrons |
|
|
Term
|
Definition
| Ig binds TNF and neutralizes it |
|
|
Term
|
Definition
severe chrons tx
heal fistula in chrons |
|
|
Term
| where are H1 and H2 receptors located |
|
Definition
H1 everywhere
H2 on parietal cells |
|
|
Term
| what kind of receptor are H1 receptors on endothelium |
|
Definition
| Gq pathway with cGMP and NO |
|
|
Term
| how come the histamine causes vasodilation and vasoconstriction |
|
Definition
on endothelium histamine releases NO which vasodilates. histamine has a higher affinity for endothelium
on vessel smooth muscle histamine causes constriction but because there is a high affinity for the endothelial cells this does not play a part |
|
|
Term
| what is the difference between the first and second generation histamine antagonists |
|
Definition
1. crosses BBB, anticholinergic, more useful in nausea and motion sickness, atropine like SE
2. does not cross BBB, no anticholinergic activity, expensive |
|
|
Term
| what are the 4 2nd gen histamine antagonists |
|
Definition
loratadine
desloratadine
cetirizine
fexofenadine |
|
|
Term
| what are the steps for asthma treatment |
|
Definition
1. SABA PRN
2. ICS + SABA PRN
3. LABA + ICS + SABA PRN
4. increase LABA dose
5. systemic steroid + SABA PRN |
|
|
Term
|
Definition
inhibits PGE III in lung smooth muscle to relax bronchi
inhibits PDEIV in inflammatory cells preventing cytokine release
blocks adenosine (bronchoconstrictor) |
|
|
Term
|
Definition
PGE III stops break down of cAMP. inhibition increases cAMP in heart causing arrhythmia
increase with P450 inhibitors
low theraputic index |
|
|
Term
| TX exercise induced asthma |
|
Definition
|
|
Term
|
Definition
1. SABA + long acting M blocker (tiotropium)
2. other bronchodilator (theophylline)
3. ICS (not main strategy) |
|
|
Term
| 2 drugs used for smoking cessation and their MOA |
|
Definition
buproprion
verenicilne: N partial agonist prevents binding and blocks release of dopamine in mesolimbic tract stopping reinforcement of dopamine (SE: nausea, suicide) |
|
|
Term
| 4 things only aspirin does (or is more likley to do) |
|
Definition
more likley to cause hyperuricemia or gout than other NSAID
decreased platelet aggregation
cause 1st OD signs of tinnutis and hearting loss
respiratory and metabolic acidosis more likley |
|
|
Term
| how does aspirin cause antiplatelet activity |
|
Definition
TXA2 is on platelet and increases aggregation. PGI2 is on endothelium and decreases aggregation. Both are released by COX
aspirin stops COX which decreases both but PGI2 just regenerates because endothelium has nuclei, plateles dont |
|
|
Term
| what are 2 things that all NSAIDS cause that people mistake fore being only aspirin |
|
Definition
increase gastric acid and decrease mucous causing ulcers and hemorrhage
hypersensitivity and asthma |
|
|
Term
|
Definition
antiinflammatory: gout, arthritis, ankylosing spondylitis, osteoarthritis, acute shoulder
tocolytic agent to supress uterine contraction
CLOSE PDA
OK WITH GERD!! |
|
|
Term
|
Definition
GI complaints
severe frontal headaches
SERIOUS MARROW SUPRESSION: NEUTROPENIA, THROMBOCYTOPENIA, APLASTIC ANEMIA |
|
|
Term
| what drug is a COX2 inhibitor, how is it different than the COX1 |
|
Definition
celecoxib
specific to anti inflammatory
less GI issues
do not inhibitor platelet aggregation |
|
|
Term
|
Definition
analgesic and antipyretic (NOT ANTIINFLAMMATORY SO NOT NSAID)
inhibits COX in CNS ONLY NO PERIPHERAL SO NO AFFECT ON PLATELETS, BLEEDING TIME, ASTHMA, EXCRETION OF URIC ACID |
|
|
Term
|
Definition
| INCREASED NAPQI DEPLETES HEPATIC GLUTATHIONE AND IT IS NOT DEGRATED BY SULFHYDRYL GROUP OF GLUTATHIONE LEADING TO HEPATIC NECROSIS |
|
|
Term
| acetaminophen OD antidote MOA |
|
Definition
N-acetylcystine
HAS SULFHYDRYL LIKE GLUTATHIONE AND BINDS NAPQI AND DEGRADES IT (give within 10h) |
|
|
Term
| what receptors do we want to block 4 and stimulate 1 to help with nausea and vomiting |
|
Definition
block: 5HT3, D2, M1/H1 (because the antihistamine gen 1 do both)
stimulate: CB1 |
|
|
Term
|
Definition
| does not penetrate CNS (some does in kids) so it is OTC and has no abuse potential |
|
|
Term
| dophenoxylate distribution |
|
Definition
CNS effects, potential for abuse and addiction
atropine is added to discourage abuse and deliberate OD |
|
|
Term
| what drugs are used to tx complex or severe IBD |
|
Definition
immune supressors
cyclosporine
azothoromine
methotrexate
infliximab |
|
|
Term
| mesalamine: MOA, where does it effect |
|
Definition
inhibits COX, stops ROS
effects ENTIRE GI |
|
|
Term
| sulfalazine: MOA, where does it effect |
|
Definition
conjugate of mesalamine diazo bonded to sulfapyridine
bacterial azoreductases in colon split it into components
then mazalamine does it normal thing
ONLY WORKS IN THE COLON |
|
|
Term
| 3 immune supressing agents and thier MOA |
|
Definition
cyclosporine: inhibit calcineurin, supress inflammatory TF
azathioprine: converted to 6-mercaptopurine, supresses lymphocytes
methotrexate: cytotoxic, immune supression, antiinflammatory |
|
|
Term
|
Definition
| Ig binds TnF and neutralizes it |
|
|
Term
|
Definition
P450 inhibitor: potentiates effects of wararin, diazepam, phenytoin, quinidine, carbamazepine, throphylline, imipramine
antiandeogenic: decreases production and blocks receptor causing glyecomaztia |
|
|
Term
| antibiotics that tx H. pylori |
|
Definition
metronixazole
clathromycin
amoxicillin
tetracycline |
|
|
Term
| why cant you take meds within 2h of antacids |
|
Definition
| affect absorption of other drugs because they raise pH of stomach, bicarb alkalinizes urine |
|
|
Term
| what does general anesthesia supres |
|
Definition
| reversible loss of sensation and consciousness: analgesia, amnesia, LOS, relax skeletal muscle, somatic, autonomic, endocrine reflexes, hemodynamic stability |
|
|
Term
| what are three things that affect transfer of drug from machine to alveoli |
|
Definition
inspired PP
alveolar ventilation
characteristics of the breathing system |
|
|
Term
| what are three things that effect the transfer of drug from alveoli to arteriole |
|
Definition
blood bas partition coefficient
cardiac output
alveolar to venous PP difference |
|
|
Term
| what are three things that affect transfer of drug from arterial blood to brain |
|
Definition
brain blood partition coefficient
cerebral blood flow
arterial to venous PP difference |
|
|
Term
| how does the PP of a anesthetic change its effect in a person |
|
Definition
it is proportional to fractional concentration of the mixture
increased amount dissolved (solibility) decreases partial pressure in solution
driving force that moves gas from machine to lung, lung to blood, blood to brain
at equlribium PP are equal in all body tissues, alveoli, inspired mixture |
|
|
Term
| how does solubility of a anesthetic change its effect in a person |
|
Definition
blood gas partition coefficient: relationship between arterial PP and solubility
higher solubility means more dissolved and less PP of gas
more dissolved (water soluble) means faster distribution but slower induction
lipid soluble means slow distribution but fast induction into tissue |
|
|
Term
| how is alveolar ventilation of anesthetic calculated |
|
Definition
| = RR x (TV - dead space) x rate of drug induction |
|
|
Term
| why do we care about alveolar ventilation of anesthetic |
|
Definition
more dead space means that same drug gets to lung less in some people
it is adjusted in respiratory depressants (opioids, barbs), pulmonary disease, emphysema, COPD |
|
|
Term
| what is the law of mass action |
|
Definition
| initially at alveoli PP of anesthetic is higher than alveolar blood so gas move sinto PP and PP in blood increases and as gradient lessens it slows |
|
|
Term
| how does changes in cardiac output effect inhaled anesthetics |
|
Definition
CO determines pulmonary flow, increased pulmonary flow decreases induction of anesthetic
same volume of gas from alveoli diffuse into larger volume of blood per time
initially reduced concentration in blood and PP is proportional to its concentration
any increase in CO means more perfusion to tissues other than the brain |
|
|
Term
| what does increase in anesthetic concentration, alveolar ventilation, solubility of anesthetic, and CO do to rate of induction |
|
Definition
concentration: increases
ventilation: increases
solubility: decreases
CO: decreases |
|
|
Term
| what actions of the drug in the body determine potency of general anesthetic |
|
Definition
concentration in the brain
correlates with lipid solubility |
|
|
Term
| what is the minimum alveolar concentration |
|
Definition
expression of potency of inhaled anesthetic
concentration that prevents 50% from responding to painful stimuli like incision
range for surgery 1-2
MAC 1.3 gives ED99 |
|
|
Term
| what is the volume of expansion theory |
|
Definition
molecules of drug dissolve in lipid bilayer causing neuronal membrane to expand stopping ion channels and propagation of AP
specific receptor binding on GABAa
NO effect on Cl channel like BDZ and barbs |
|
|
Term
| 6 inhaled general anesthetics |
|
Definition
no one deserves seven isolated halos en florance
nitrOUS oxide
desflurane
sevoflurane
isoflurane
halothane
enflurane |
|
|
Term
| inhaled general anesthetic most commonly used |
|
Definition
|
|
Term
| inhaled general anesthetic not able to be used alone in surgery |
|
Definition
|
|
Term
| inhaled general anesthetic often delivered with opioids or volitale anesthetics |
|
Definition
|
|
Term
| nitrous oxide: potency and why |
|
Definition
low lotency, poor blood solubility
allows rapid achievement of alveolar to brain PP of lung |
|
|
Term
|
Definition
not flamable but can support combustion
minimal skeletal muscle relaxation
inhaled anesthetics are addictive
considered safest |
|
|
Term
|
Definition
low incidence of toxic effects, not flammable
rapid awakening
low margin of safety: circulatory depression, decreased CO, hypotension, bradycardua
halothane hepatitis: hepatic failure and death due to metabolism of immunologic biproducts
releases bromide
malignant hypothermia with succinylcholine (TX dantrolene) |
|
|
Term
|
Definition
decreased BP due to decreased vascular tone
no renal of hepatic metabolism
irritating to airway |
|
|
Term
|
Definition
significant release of fluoride with prolonged use and high doses
seizure with high doses
less proability of arrhythmia |
|
|
Term
|
Definition
less irritating to airway
no tachycardia (preferred in pt prone to MI)
potential nephrotoxicity due to compound A: degradation made by sevofluraine, CO2, and sodalime |
|
|
Term
|
Definition
laryngeal spasm: not indicated for inhalation induction
special delivery system to make liquid at room temp |
|
|
Term
| why use IV anesthetic over inhaled |
|
Definition
| add flexability and permit administration of lower concentrations of inhaled agents |
|
|
Term
| drugs used as IV anesthetics 7 |
|
Definition
barbituates
benzos
kit, amy, e tom dated droned pairs of dolls on fentanyl and propfol
ketamine
etomidate
doperidol
fetanyl
propfol |
|
|
Term
| barbs used in IV anesthetics 2 |
|
Definition
thios penpal sent him meth in a hexagon envelope
thiopental
methohexital |
|
|
Term
| benzos used for IV anesthetics 1 |
|
Definition
mydalzing lamb had no pain
midazoloam |
|
|
Term
| barb as IV anesthetic: 1 good 1 bad |
|
Definition
sedation
poor analgesia, may increase response to pain |
|
|
Term
| benzos as IV anesthetic: use, effects |
|
Definition
midazoloam is only one used in anesthesia
other benzos provide anesthesia without analgesia and can only be used in procedures with little pain or adjunct to inhaled anesthetic |
|
|
Term
| doperidol and fentanul: use, SE |
|
Definition
neuroleptic anesthesia
slow induction
may need ventilation |
|
|
Term
|
Definition
opioid sigma agonist
NMSA antagonist |
|
|
Term
|
Definition
dissociative amnesia: dissociation from enivornment (eyes open, unresponsive to pain)
analgesia
amnesia
hallucinations
bad dreams
delirium: days to weeks later
increased ICP: do not use in cerebral ischemia risk pt
potent bronchodilator: good for patients with bronchospasm risk |
|
|
Term
|
Definition
interacts with GABAa receptors
rapid redistribution and elimination for short procedures and out patient surgery
low nausea and vomiting
pain on ijection |
|
|
Term
|
Definition
interacts with GABAa receptors
high incidence of myclonus
pain on injection |
|
|
Term
| what does general anesthesia supres |
|
Definition
| reversible loss of sensation and consciousness: analgesia, amnesia, LOS, relax skeletal muscle, somatic, autonomic, endocrine reflexes, hemodynamic stability |
|
|
Term
| what are three things that affect transfer of drug from machine to alveoli |
|
Definition
inspired PP
alveolar ventilation
characteristics of the breathing system |
|
|
Term
| what are three things that effect the transfer of drug from alveoli to arteriole |
|
Definition
blood bas partition coefficient
cardiac output
alveolar to venous PP difference |
|
|
Term
| what are three things that affect transfer of drug from arterial blood to brain |
|
Definition
brain blood partition coefficient
cerebral blood flow
arterial to venous PP difference |
|
|
Term
| how does the PP of a anesthetic change its effect in a person |
|
Definition
it is proportional to fractional concentration of the mixture
increased amount dissolved (solibility) decreases partial pressure in solution
driving force that moves gas from machine to lung, lung to blood, blood to brain
at equlribium PP are equal in all body tissues, alveoli, inspired mixture |
|
|
Term
| how does solubility of a anesthetic change its effect in a person |
|
Definition
blood gas partition coefficient: relationship between arterial PP and solubility
higher solubility means more dissolved and less PP of gas
more dissolved (water soluble) means faster distribution but slower induction
lipid soluble means slow distribution but fast induction into tissue |
|
|
Term
| how is alveolar ventilation of anesthetic calculated |
|
Definition
| = RR x (TV - dead space) x rate of drug induction |
|
|
Term
| why do we care about alveolar ventilation of anesthetic |
|
Definition
more dead space means that same drug gets to lung less in some people
it is adjusted in respiratory depressants (opioids, barbs), pulmonary disease, emphysema, COPD |
|
|
Term
| what is the law of mass action |
|
Definition
| initially at alveoli PP of anesthetic is higher than alveolar blood so gas move sinto PP and PP in blood increases and as gradient lessens it slows |
|
|
Term
| how does changes in cardiac output effect inhaled anesthetics |
|
Definition
CO determines pulmonary flow, increased pulmonary flow decreases induction of anesthetic
same volume of gas from alveoli diffuse into larger volume of blood per time
initially reduced concentration in blood and PP is proportional to its concentration
any increase in CO means more perfusion to tissues other than the brain |
|
|
Term
| what does increase in anesthetic concentration, alveolar ventilation, solubility of anesthetic, and CO do to rate of induction |
|
Definition
concentration: increases
ventilation: increases
solubility: decreases
CO: decreases |
|
|
Term
| what actions of the drug in the body determine potency of general anesthetic |
|
Definition
concentration in the brain
correlates with lipid solubility |
|
|
Term
| what is the minimum alveolar concentration |
|
Definition
expression of potency of inhaled anesthetic
concentration that prevents 50% from responding to painful stimuli like incision
range for surgery 1-2
MAC 1.3 gives ED99 |
|
|
Term
| what is the volume of expansion theory |
|
Definition
molecules of drug dissolve in lipid bilayer causing neuronal membrane to expand stopping ion channels and propagation of AP
specific receptor binding on GABAa
NO effect on Cl channel like BDZ and barbs |
|
|
Term
| 6 inhaled general anesthetics |
|
Definition
no one deserves seven isolated halos en florance
nitrOUS oxide
desflurane
sevoflurane
isoflurane
halothane
enflurane |
|
|
Term
| inhaled general anesthetic most commonly used |
|
Definition
|
|
Term
| inhaled general anesthetic not able to be used alone in surgery |
|
Definition
|
|
Term
| inhaled general anesthetic often delivered with opioids or volitale anesthetics |
|
Definition
|
|
Term
| nitrous oxide: potency and why |
|
Definition
low lotency, poor blood solubility
allows rapid achievement of alveolar to brain PP of lung |
|
|
Term
|
Definition
not flamable but can support combustion
minimal skeletal muscle relaxation
inhaled anesthetics are addictive
considered safest |
|
|
Term
|
Definition
low incidence of toxic effects, not flammable
rapid awakening
low margin of safety: circulatory depression, decreased CO, hypotension, bradycardua
halothane hepatitis: hepatic failure and death due to metabolism of immunologic biproducts
releases bromide
malignant hypothermia with succinylcholine (TX dantrolene) |
|
|
Term
|
Definition
decreased BP due to decreased vascular tone
no renal of hepatic metabolism
irritating to airway |
|
|
Term
|
Definition
significant release of fluoride with prolonged use and high doses
seizure with high doses
less proability of arrhythmia |
|
|
Term
|
Definition
less irritating to airway
no tachycardia (preferred in pt prone to MI)
potential nephrotoxicity due to compound A: degradation made by sevofluraine, CO2, and sodalime |
|
|
Term
|
Definition
laryngeal spasm: not indicated for inhalation induction
special delivery system to make liquid at room temp |
|
|
Term
| why use IV anesthetic over inhaled |
|
Definition
| add flexability and permit administration of lower concentrations of inhaled agents |
|
|
Term
| drugs used as IV anesthetics 7 |
|
Definition
barbituates
benzos
kit, amy, e tom dated droned pairs of dolls on fentanyl and propfol
ketamine
etomidate
doperidol
fetanyl
propfol |
|
|
Term
| barbs used in IV anesthetics 2 |
|
Definition
thios penpal sent him meth in a hexagon envelope
thiopental
methohexital |
|
|
Term
| benzos used for IV anesthetics 1 |
|
Definition
mydalzing lamb had no pain
midazoloam |
|
|
Term
| barb as IV anesthetic: 1 good 1 bad |
|
Definition
sedation
poor analgesia, may increase response to pain |
|
|
Term
| benzos as IV anesthetic: use, effects |
|
Definition
midazoloam is only one used in anesthesia
other benzos provide anesthesia without analgesia and can only be used in procedures with little pain or adjunct to inhaled anesthetic |
|
|
Term
| doperidol and fentanul: use, SE |
|
Definition
neuroleptic anesthesia
slow induction
may need ventilation |
|
|
Term
|
Definition
opioid sigma agonist
NMSA antagonist |
|
|
Term
|
Definition
dissociative amnesia: dissociation from enivornment (eyes open, unresponsive to pain)
analgesia
amnesia
hallucinations
bad dreams
delirium: days to weeks later
increased ICP: do not use in cerebral ischemia risk pt
potent bronchodilator: good for patients with bronchospasm risk |
|
|
Term
|
Definition
interacts with GABAa receptors
rapid redistribution and elimination for short procedures and out patient surgery
low nausea and vomiting
pain on ijection |
|
|
Term
|
Definition
interacts with GABAa receptors
high incidence of myclonus
pain on injection |
|
|
