Term
what are 2 different ways to say coronary artery disease |
|
Definition
ischemic heart disease athlerosclerosis of epicardial vessels |
|
|
Term
when does coronary artery disease begin |
|
Definition
begins early in life, manifests middle aged and beyond |
|
|
Term
what are 5 manigestations of coronary artery disease |
|
Definition
heart failure arrhythmia stroke peripherial vascular disease acute coronary artery disease |
|
|
Term
what are the 4 types of coronary artery disease |
|
Definition
angina syndrome stable (exercise induced) angina prinzmetal (vasospastic) angina unstable angina |
|
|
Term
|
Definition
describes variation in manigestation of agonia and its symptoms |
|
|
Term
what are the symptoms of angina due to |
|
Definition
ischemic pain (angina equlivaents) and accumulation of metabolites in striated muscle |
|
|
Term
where is the pain in angina from most to least common 4 |
|
Definition
anterior chest left upper arm left lower arm neck pain |
|
|
Term
what causes vasospasm in CAD |
|
Definition
imbalance of oxygen use and delivery |
|
|
Term
|
Definition
when myocardial requirement increases (like exercise0 coronary flow does not increase proportionally causing ischemia and pain |
|
|
Term
what is prinzmetal angina |
|
Definition
oxygen delivery decreased due to reversible coronary vasospasm not brought on by exertion or emotional stress not relieved by rest |
|
|
Term
EKG signs of prinzmetal angina |
|
Definition
ST elevation (injury marker) |
|
|
Term
cause of prinzmetal angina |
|
Definition
altered vasodilators (NO, prostacyclin) or vasoconstrictors (entothelial, ANG II) |
|
|
Term
|
Definition
change in stable angina or angina at rest |
|
|
Term
|
Definition
increased coronary tone or platelet clots on athlerosclerosis |
|
|
Term
what is the general approach to angina treatment |
|
Definition
tissue ischemia is thwarted using vasodilator or anti-vasoconstrictor drugs |
|
|
Term
what is the order of treatment and theory behind each in treatment/prevention of stable angina |
|
Definition
1. BB: decrease myocardial O2 demand 2. CCB: vasodilation decreases coronary/peripherial resistance and heart O2 demand 3. nitrates: venodilation decreases proload and myocardial O2 demand |
|
|
Term
what are the tx of variant angina |
|
Definition
nitrates: relax coronary vessels, reduces spasm CCB: relax coronary vessels, reducing spasm |
|
|
Term
|
Definition
aspirin, heparin DOC: nitroglycerin BB CCB |
|
|
Term
what is the tx of angina post MI |
|
Definition
|
|
Term
what is the tx of angina with DM |
|
Definition
|
|
Term
what is the tx of angina with LV dysfunction |
|
Definition
|
|
Term
what is the tx of angina with CAD or LDL>130 |
|
Definition
|
|
Term
what is the tx of angina with increased platelets |
|
Definition
aspirin clopidogerl pasugrel |
|
|
Term
|
Definition
converte nitrate ions to NO activates guanylyl cyclase increases cAMP increases protein kinase G activates phosphatases dephosphyorlyate myosin light chain vasodilation |
|
|
Term
how is notroglycerin different at different doses |
|
Definition
moderate: dilates large veins > pooling of blood > decreases proload
all doses: dilate coronary vessels > increased blood to heart muscle |
|
|
Term
administration and time of onset of nitroglycerin |
|
Definition
sublingual 2 min transdermal 12h on 12h off prophylaxis |
|
|
Term
|
Definition
headache: migraine caused by vasodilation orthostatic hypotension reflex tachycardia rolerance/tachyphylaxis (avoid with 6-8h nitrate free interval) |
|
|
Term
how is isorbide mononitrate and isorbide dinitrate different from nitroglycerin |
|
Definition
oral administration longer onset and duration |
|
|
Term
interactions with nitro drugs |
|
Definition
NEVER COMBINE WITH PHOSPHODIESTERASE INHIBITORS (slidenafil, vardenafil, tadalafil) causes extreme hypotension and death
erectile dysfunction is common in people with CAD |
|
|
Term
what 3 BB are used for angina |
|
Definition
propranolol metoprolol atenolol |
|
|
Term
what BB are not good for angina, why |
|
Definition
partial agonists (sympathomimetric) are less efective (pindolol, acebutolol) |
|
|
Term
|
Definition
decrease sympathetic tone, HR, contractability block B1 receptors reduce frequency and severity of angina |
|
|
Term
what are the CCB that work on angina and how |
|
Definition
dihydropyridines: work on vessels, causes reflex tachycardia verapmil and diltiazem: work on heart (preferred) |
|
|
Term
|
Definition
stop influx of Ca via L-Ca channels which stops calmodulin from turning Ca into Ca-calmoulin so it cannot activate myosin LC kinase and thus cannot cause contraction vasodilation reduces coronary vasospasm and myocardial O2 demand also used in raynaud's (vasospasm in cold) |
|
|
Term
|
Definition
who knows, dosent reduce HR and BP |
|
|
Term
|
Definition
adjunct therapy to BB, CCB, nitrates |
|
|
Term
|
Definition
prolonged QT syndrome (causes torsades) |
|
|
Term
|
Definition
|
|
Term
|
Definition
increase in renal Na excretion and thus water excretion (diuretic) |
|
|
Term
define diuretic and function |
|
Definition
inhibits ion transport and decreases Na transport in nephron
manage fluid retention (edema), tx HTN |
|
|
Term
|
Definition
filtered in glomerulus and not reabsorbed causes osmotic attraction of water (not Na) to tubular lumen |
|
|
Term
mannitol location of action 3 |
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
maintain urine flow during toxic ingestion of substances causing renal failure
reduce increased ICP
lower pressure in acute glaucome
rhabdomyolysis: severe muscle injury to eliminate myoglobin |
|
|
Term
what are the 6 types of K supplements and their adlministration |
|
Definition
K-DUR: KCl tablets K-LOR: KCl powder K-LYTE/CL: KCl tablets K-TAB: KCl tablets KLOTRIX: KCl tablets KAO lectrolyte: fluid and electrolyte replacement |
|
|
Term
what is KAO lectrolyte made of 6, when is it used |
|
Definition
dextrose, Na, K, citrate, calories, phenylalanine
mild/moderate diarrhea/vomiting |
|
|
Term
|
Definition
hepatic ascites: accumulation of fluid in abdomen
hyperALD: primary, secondary, decreased ability of liver to inactivate
nephrotic syndrome: glomerular membrane damaged and allows protein through decreasing colloid osmotic pressure
premenstural edema: increased estrogen causes loss of fluid into ECF |
|
|
Term
causes of hepatic ascites |
|
Definition
cirrhosis causes portal system obstruction and decreased colloid osmotic pressure |
|
|
Term
what are the drugs that work on the PCT 4 |
|
Definition
acetazolamide brinzelamide dorzolamide methazelamide |
|
|
Term
what are the drugs that work on the loop of henle |
|
Definition
loop diruetics- bumetanide furosemide torsemide etharcynic acid |
|
|
Term
thiazide diuretics and analogs 4 |
|
Definition
hydrochlorathiazide chlorthalidone metazone indapamide |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
describe the cells of the PCT |
|
Definition
tall microvili basla invaginations interdigitated borders |
|
|
Term
explain how the PCT regulates acid/base |
|
Definition
CA changes bicarbonate+H from urine into CO2+H2O which can diffuse into the cell CA turns it back into bicarbonate+H H is sent back to urine with Na/H antiporter bicarbonate uses facillitated transport to enter the blood |
|
|
Term
other than the pumps for acid base regulation, what other transport is happening in the urine |
|
Definition
Na/glucose, AA, lactate, HPO4 symporter from lumen to blood
Na/K ATPase on blood side
60% of H2O diffuses into blood
organic anions and cations diffuse into urine |
|
|
Term
what organic anions 3 and cations 3 diffuse into urine in PCT |
|
Definition
diuretics antibiotics uric acid
creatinine procanamide choline |
|
|
Term
|
Definition
carbonic anhydrase inhibitior makes it so bicarbonate cannot form CO2+H2O and diffuse into the cell causing metabolic acidosis
there isnt enough H to run the Na/H pump so Na also stays in the urine and draws water (Weak diuretic)
Cl is retained in the blood causing hyperchloremia |
|
|
Term
|
Definition
DOC chronic glaucoma
acute mountain sickness prophylaxis
seizure adjunct medicing |
|
|
Term
how is acute mountain sickness treated, what are the symptoms |
|
Definition
5d prior to ascent
prevents weakness, SOB, dizziness, nausea, cerebral and pulmonary edema |
|
|
Term
|
Definition
hyperchloremic metabolic acidosis renal stones (basic urine favors CaP) sulfonamide allergies hypokalemia |
|
|
Term
what exchange happens in the thin limbs of the loop of henle |
|
Definition
thin limbs do not participate in reabsorption of Na they are permeable to water which is impaired by mannitol and glucose |
|
|
Term
what drugs interact with loop diuretics |
|
Definition
aminoglycocides digoxin (decreases) |
|
|
Term
what are the channels of the thick loops |
|
Definition
K/Na/2Cl symporter from urine to cell K leak channel from cell to urine Na/K antitiporter from cell to blood K/Cl symporter from cell to blood
Mg+Ca charge driven transport paracellular from urine to blood |
|
|
Term
|
Definition
stop Na/L/Cl channel causing ion and water retention in ascending loop
increase Ca in urine because when Na/K/Cl transport is stopped there is no K build up and no leak which stops positive charge and Mg/Ca dont diffuse into blood |
|
|
Term
|
Definition
acute pulmonary edema (IV rapid onset, powerful) CHF HTN nephrotic system edema kidney failure edema |
|
|
Term
|
Definition
ototoxicity: tinnutis, vertigo, deafness, fullness (worse with amnioglucocides and etharynic acid)
hyperuricemial: WA competes for transport in PCT to stay in urine
acute hypovolemia: severe, rapid, shock, arrhythmia
orthostatic hypotension
hypokalemic acidosis
sulfonamide allergy |
|
|
Term
what is the most powerful diuuretic |
|
Definition
|
|
Term
how much Na is reabsorbed in each portion of nephron |
|
Definition
PCT 50% loop 40% DCT 10% CD 5% |
|
|
Term
what carbonic anhydrase inhibitors are specific to IOP and used in OPEN angle glaucoma |
|
Definition
brinselamide derzelamide methazolamide |
|
|
Term
why use a thiazide analog |
|
Definition
thizade diuretics dont work GFR <40 |
|
|
Term
|
Definition
simple cuboidal impermeable to water |
|
|
Term
|
Definition
inhibits Na/Cl co-transporter and has some action on Ca in PCT
increased Na/Cl in urine pulls water
causes K loss because they increase delivery of Na to CD and Na/K channel causes K excretion
this alters balance of Na/Ca exchanger and increases Ca in the blood
decreases TPR and BP which can decrease CP and causes hypotension |
|
|
Term
|
Definition
HTN: decreases TPR wo major diuretic effect CHF: decreases extracellular edema edema: CHF, cirrhosis, kidney edema hypercalcuria: good for CaOxylate stones nephrogenic DI: cause hyperosmloar urine (act like ADH) |
|
|
Term
|
Definition
hypokalemic acidosis
hypercalcemia
orthostatic HTN
hyperlipidemia
sexual dysfunction
sulfonamide allergy
hyperuricemia: WA competes with uric A in PCT
hypoglycemia |
|
|
Term
why do thiazides cause hypoglucemia |
|
Definition
B cells K channels are normally open diuretic causes loss of K so they stay open longer and dont make much insulin |
|
|
Term
what are the 4 transporters in the DCT |
|
Definition
Na/Cl synporter from urine to cell Ca channel from cell to urine Na/K ATPase on blood side Na/Ca antiporter with Na going from blood to cell |
|
|
Term
how is transport in the DCT regulated |
|
Definition
PTH regulates luminal Ca channels and apical Na/Ca antiporter |
|
|
Term
why do drugs cause K sparing |
|
Definition
they increase Na before the CD/CT and the concerntration sucks the K into the CD/CT when Na tries to get out in the exchanger |
|
|
Term
what are the channels on the luminal side of the principal cell 3 |
|
Definition
Na into cell N into lumen water into cell |
|
|
Term
what are the channels/pumps on the apical side of the principal cell 2 |
|
Definition
Na/K ATPase H2O ALD controlled channels |
|
|
Term
what pericellular transport is there in the CD |
|
Definition
|
|
Term
what are the transporters on the intercalated cells |
|
Definition
ATP pump H into urine Cl/bicarb antiporter putting bicarb into blood |
|
|
Term
what is the primary site of H secretion |
|
Definition
intercalated cells of the CD |
|
|
Term
how does ADH regulate the CD |
|
Definition
opens aquporin channels on apical side of cells |
|
|
Term
how does ALD regulate the CD |
|
Definition
increases activity in luminal Na and K channels buy increasing activity of Na/K ATPase putting K into urine and Na into blood |
|
|
Term
|
Definition
ALD receptor antagonists stimulate Na reabsorption into urine without K loss
spironolactone also blocks androgen receptors |
|
|
Term
uses of K sparing diuretics 4 |
|
Definition
duiretic: low efficacy in Na mobalization
secondary hyperaldosteronism: cardiac failure decreases remodeling, cirrhosis, nephrosis
primary hyperaldosteronism: adrenal adenoma
female histurism: spironolactone only due to androgen blocking |
|
|
Term
|
Definition
spironolactone: P450 inducer and prodrug
spironolactone: gynacomastia in males, irregular menses (never give high dose chronically)
hyperkalemia
nausea, letharty, mental confusion |
|
|
Term
MOA triametrene and amiloride and use |
|
Definition
block Na channels decreasing Na/K ATPase activity and thus retention of K (does not depend on ALD like spironolactone)
not as effective as diuretic so often combine with other diuretic to save K |
|
|
Term
SE Na channel blocking diuretics 2 |
|
Definition
hyperkalemia leg cramps (triameterene |
|
|
Term
|
Definition
lipoproteins (plasma lipid complexes) are elevated increasing overall TG in the blood |
|
|
Term
complications of hyperlipidemia |
|
Definition
acute pancreatitis athlerosclerosis |
|
|
Term
types of lipids, their optimal amounts |
|
Definition
APO B-100 LDL <100mg/dl IDL VLDL TG/LP (lipoproteins) <150mg/dl HDL >60mg/dl lipoprotein liase |
|
|
Term
|
Definition
convey lipids to the artery wall |
|
|
Term
|
Definition
retreive cholesterol from artery wall and inhibit oxidation of lipoporteins |
|
|
Term
lipoprotein lipase: location, function, regulation |
|
Definition
on endothelial and adipose cells hydrolysis of TG on chylomicrons/VLDL controlled by insulin |
|
|
Term
what fat regulating enzyme is altered in diabetics? what is the result? |
|
Definition
lipoprotein lipase decreased insulin causes hypertriglyceridiemia |
|
|
Term
3 ways lipid levels are altered |
|
Definition
diet and exercise inherited genetic deficits pharmacologic intervention |
|
|
Term
|
Definition
foam cells: transformed macrophages that endocytose lipoproteins and ROS
smooth muscle cells filled with cholesterol esters
atheroma: growth of collagen, fibrin, Ca |
|
|
Term
treatment of athlerosclerosis outcomes |
|
Definition
can slow regression but can allow migration of inflammatory activity of macrophages |
|
|
Term
8 risk factors for coronary artery disease |
|
Definition
increased age family history smoking hypertension obesity sedentary DM high LDL low HDL |
|
|
Term
|
Definition
inhibits lipolysis in IN ADIPOSE decreasing circulating free Fa providing liver with less raw materials to make TG and thus VLDL |
|
|
Term
overall what fats does niacin raise and lower |
|
Definition
lower: VLDL, LDL, cholesterol, TG raises: HDL (great extent) |
|
|
Term
|
Definition
tupe IIB, III, IV hyperlipoproteinemia (elevation of VLDL and LDL) |
|
|
Term
niasin: administration, excretion |
|
Definition
|
|
Term
|
Definition
cutaneous flushing and warmpth (reduce with aspirin)
puritis (limits use)
gout/hyperuricemia: inhibits tubular secretion of uric acid |
|
|
Term
what are the 3 fibrate drugs |
|
Definition
gemfibrozil fenofibrate fenofibric |
|
|
Term
|
Definition
ligands for nuclear transcription receptor peroxisome proliferation activated receptor alpha (PPAR-a)
upregulate lipoprotein lupase and down regulate APO CIII (lipolysis inhibitor) |
|
|
Term
overall what fats do fibrates raise and lower |
|
Definition
|
|
Term
|
Definition
hypertriglyceridemia (decreases TG) |
|
|
Term
administration of fibrates |
|
Definition
completely absorbed orally |
|
|
Term
|
Definition
N/V (lessens over time) lithiasis/malignancy (gelfibrozil): gall stones and hepatobilliary neoplasms
muscle: myositis (inflammation of skeletal muscle) |
|
|
Term
interactions with fibrates |
|
Definition
warfarin (compete for binding on plasma proteins increasing warfarin effects) |
|
|
Term
3 bile acid binding resins |
|
Definition
cholestryamine, colespipol, colesevelam |
|
|
Term
MOA bile acid binding resins |
|
Definition
cationic resin binds negative bile salts and interrupts enterohepatic cycle
bile salts excreted in feves and more cholesterol must be used to replace them so the cells upregulate LDL receptors to pull more cholesterol in |
|
|
Term
use bile acid binding resins 3 |
|
Definition
type IIa and IIb hyperlipidemias often in combination with diets and statins |
|
|
Term
bile acid binding resins: administration, distribution |
|
Definition
|
|
Term
SE bile acid binding resins |
|
Definition
GI: constipation, nausea, flatulence (lessens over time)
absorption: decreased in absorption of fat soluble vitamins, ascorbate, folate |
|
|
Term
interactions with bile acid binding resins |
|
Definition
tetracycline, phenobarbitol, digoxin, warfarin, aspirin, statins, thiazides
interacts with most drugs absorption so takes 1-2h before 4h after this drug
chloride salts: hyper chloremic metabolic acidosis |
|
|
Term
6 HMG-CoA Reductase inhibitors |
|
Definition
paravastatin sinvastatin atorvastatin fluvastatin lovastatin rosuvastatin |
|
|
Term
MOA HMG-CoA reductase inhibitor |
|
Definition
HMG-CoA is first enzyme and rate limiting step in sterol synthesis converting 3-hydroxy-3-methylglutarate into cholesterol
inhibition of HMG-CoA reductase: depletes intracellular supply of cholesterol
decrease in LDL and increase in LDL receptors: depletion of intracellular cholesterol causes increase in hepatocyte LDL receptors which picks up more LDL from plasma
increased plasma HDL: decrease risk of coronary artery disease (esp atrovastatin) |
|
|
Term
pharmacokinetics of HMG-CoA reductase inhibitors |
|
Definition
atorvastatin/sinvastatin: first pass removes 50% excretion in bile and feces |
|
|
Term
SE HMG-CoA reductase inhibitors |
|
Definition
liver and muscle: evaluate function every 6mo (minor effects in 5y trial)
teratogenic, contraindicated in teens and kids
diminish visual activity (lens is 50% cholesterol)
less inclined to form osteoperosis |
|
|
Term
interactions with HMG-CoA reductase |
|
Definition
increase warfarin levels (evaluate prothrombin time frequently) |
|
|
Term
|
Definition
superstatin HMG-CoA reductase inhibitor (same MOA/SE) lowers LDL 50% more effective raises HDL 14% more effective |
|
|
Term
|
Definition
sometimes in combo with simvastatin blocks absorption of cholesterol in SE decreases cholesterol by 15% (50% in combination with statins) |
|
|
Term
|
Definition
|
|
Term
what are the 3 categories of psychomotor stimulants |
|
Definition
methylaxanthines nicotine amphetamines |
|
|
Term
what 2 drugs are methylaxanthines |
|
Definition
|
|
Term
what 8 drugs are amphetamines |
|
Definition
sodium oxybate modafinil cocaine ephedrine methamphetamine phentermine deotroamphetamin |
|
|
Term
what 3 drugs are used for the same purposes as amphetamines but are not amphetamines |
|
Definition
sibtramine amoextine quanfacine |
|
|
Term
what 2 drugs are methylaxathines |
|
Definition
|
|
Term
|
Definition
stimulates nicotinic receptors in CNS causing depolarization |
|
|
Term
|
Definition
euphoria arousal improves attention learning problem solving reaction time |
|
|
Term
where is nicotine absorbed 5 |
|
Definition
oral mucosa lungs GI mucosa skin |
|
|
Term
where is nicotine distributed |
|
Definition
lipid soluble so everywhere |
|
|
Term
where is noctine metabolized 2 |
|
Definition
|
|
Term
how is nicotine used in medicine |
|
Definition
|
|
Term
|
Definition
release of biogenic amines (NE, D, SE) from storage sites in nerve terminals
may interfere with re-uptake of NT into neurons |
|
|
Term
|
Definition
|
|
Term
amphetamines metabolization |
|
Definition
catabolic pathway excreted in urine possible Fe trap of weak base |
|
|
Term
dopamine SE of amphetamines 4 |
|
Definition
increased alertness decreased fatigue decreased appetite insomnia |
|
|
Term
CNS SE of amphetamine OD 8 |
|
Definition
restlessness tenseness irritability weaness insomnia confusion delirium paranoid hallucinations suicdal/homicidal |
|
|
Term
|
Definition
headahce palpitation arrhythmia HTN circulatory collapse sweating |
|
|
Term
what organ systems are affected in amphetamine OD 3 |
|
Definition
CV Cns autonomic - sweating |
|
|
Term
why are amphetamines abused 2 |
|
Definition
tolerance develops to anorexia and wuphoria psychological dependence with chronic use |
|
|
Term
why are amphetamines used in medicine 2 |
|
Definition
nacrolepsy: uncontrollable desire for sleep ADHD: hyperactivity in children |
|
|
Term
|
Definition
less central effects more peripherial effects |
|
|
Term
|
Definition
more central effects less peripherial effects less euphoria and CNS effect |
|
|
Term
|
Definition
piperdine amphetamine derivative |
|
|
Term
|
Definition
|
|
Term
|
Definition
acts on adrenergic and dopamine pathways (similar to aphetamine) |
|
|
Term
|
Definition
short term behavorial modification, with diet and exercise in obese (3wk) |
|
|
Term
SE/interactions with phentermine 2 |
|
Definition
contraindicated with CV issues HTN crisis with MAOI |
|
|
Term
|
Definition
a and b adrenergic antagonist, enhances NE release |
|
|
Term
|
Definition
|
|
Term
|
Definition
block reuptake of dopamine by inhibiting NT in pre-synaptic neuron |
|
|
Term
|
Definition
similar properities to amphetamine wea dopamine reuptake inhibitor |
|
|
Term
|
Definition
narcolepsy high dose for ADHD |
|
|
Term
|
Definition
|
|
Term
|
Definition
unspecific CNS depressant |
|
|
Term
|
Definition
narcolepsy cataplexy: muscle weakness reduces attacks (take at bed time 2.5-4h after falling asleep) |
|
|
Term
|
Definition
depression bedwetting sleep walking abuse potential |
|
|
Term
|
Definition
inhibits re-uptake of NE and SE and interacts with receptors causing hunger |
|
|
Term
|
Definition
|
|
Term
contraindications and interactions with sibutramine 7 |
|
Definition
HTN CV disease stroke glaycoma renal/hepatic disease cardiac valve disorders interaction - MAOI |
|
|
Term
|
Definition
re-uptake inhibitor of NE and SE |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
agonist at post synaptic a-2A adrenergic receptors |
|
|
Term
contraindications quanfacine |
|
Definition
caution with cardiac problems |
|
|
Term
what are the two main sources of caffiene |
|
Definition
coffee- coffea arbica cola - cola acuminate |
|
|
Term
how much caffiene is the effective oral dose, what 3 symptoms |
|
Definition
85-150mg increased alertness loss of fatigue better attention |
|
|
Term
how much caffiene is OD, what are 3 signs |
|
Definition
>200mg nervousness restlessness tremors |
|
|
Term
|
Definition
|
|
Term
|
Definition
phosphodiesterase inhibitor increases cAMP adenosine A1/2 receptor antagonist increases neurotransmission amplifying cyclic nucleotide second messengers |
|
|
Term
where is throphylline absorbed 3 |
|
Definition
|
|
Term
where is throphylline metabolized and how 2 |
|
Definition
liver demythlation oxidation |
|
|
Term
wht is throphylline used for, how is it dosed |
|
Definition
high dose: seizure refractory to anti-convulsants any dose: stimulates resporation, N/B, increase CP and HR (lessens with repeated use) |
|
|
Term
what is the initial effet of low dose alcohol |
|
Definition
stimulant due to supression of inhibitor systems |
|
|
Term
what is the effect of high dose alcohol (non chronic) 3 |
|
Definition
sedation impairs recent memory causes black outs |
|
|
Term
what is the effect of heavy alcohol consumption on the body 9 |
|
Definition
toxic to liver, CV disease, endocrine, GT, malnutrition, CNS dysfunction
tolerance, physical dependence, withdrawl |
|
|
Term
how much alcohol does it take to be dangerous in the presence with another CNS depressant |
|
Definition
respiratory depression occurs at 200-300mg/dl so at this time |
|
|
Term
how much alcohol does it take to be dangerous even without another CNS depressant |
|
Definition
>300mg/dl unconcious severe respiratory and CV depression black outs |
|
|
Term
what is the highest amt of alcohol recorded consumed without death |
|
Definition
|
|
Term
what what amount of alcohol is driving impaired and when is the person unable to drive |
|
Definition
impaired from 0-100mg inability from 100mg+ |
|
|
Term
what amount of alcohol will someone stagger |
|
Definition
|
|
Term
where does alcohol distribute to in the body |
|
Definition
everywhere even CNS (fetal alcohol syndrome) |
|
|
Term
explain the metabolism of ethanol |
|
Definition
liver > alcohol DH turns it into acetaldehyde acetaldehyde DH turns it into acetate acetate goes to tissues and is odidized into CO2 and water |
|
|
Term
explain excretion of ethanol |
|
Definition
varies with genetic mix of isoenzymes and blood concentration
leads to limited zero order kinetics metabolism |
|
|
Term
what do asians ahve a defficiency in |
|
Definition
|
|
Term
what 3 drugs are used to treat chronic alcoholism |
|
Definition
disulfram anltrexone acamprostate Ca |
|
|
Term
|
Definition
inhibits ADH and ALDH so acetyaledhyde accumulates |
|
|
Term
|
Definition
vasodilation throbbing headache hypotension thirst sweating CP vomiting |
|
|
Term
|
Definition
|
|
Term
|
Definition
in vitro affinity for GABA a and b receptors but dosent share their effects suggesting other MOA
decreases effect of naturally occuring excitatory NT glutamate in the body |
|
|
Term
|
Definition
decreases plesant high associated with alcohol comsumption |
|
|
Term
why is ethanol used in medicine, in conjunction with what other procedure |
|
Definition
ethanol competes for ADH and prevents conversion of toxic substances
usually the toxic substance isnt broke down into a toxin and must be removed by hemodialysis |
|
|
Term
how is methanol broken down in the body |
|
Definition
ADH metablizes it to formaldehyde and formic acid |
|
|
Term
|
Definition
|
|
Term
how is ethylene glycol broken down in the body |
|
Definition
ADH metabolizes to glucolic and oxalic acids causes renal toxicity and severe acidosis |
|
|
Term
|
Definition
50-70yo 15% have family history bradykinesia: slowness of movement muscle rigidity: tremor, posture instability shiffling gait frequent falls cognitive impairment death due to immobility (pulmonary embolism, aspiration pneumonia) |
|
|
Term
|
Definition
ROS or diminished antioxidants or both damage nigrostrital dopaminergic area
dopamine can undergo auto-odidative reactions forming H2O2
Fe and H2O2 cause hydroxyl radicals and cellular damage through proteins, lipids, and DNA
MPTP is metabolized to MPP radical which is a neurotoxin causing the disease |
|
|
Term
how is dopamine nroken down |
|
Definition
AMO degrades into DOPAC and HDO@
H2O2 is broken into OH by Fe or into water by glutathione |
|
|
Term
chages in the CNS in parkinsons disease |
|
Definition
loss of pigmented dopamine neuronsin substantia nigra (midbrain)
lewy bodies: abnormal cytoplasmic inclusions
loss of nitrostriatal dopamine neurons (no stimulation to D1/2 increases GABA input to cerebral cortex)
increased ACh: dopamine can no longer inhibit release, increased GABA transmission occurs as result |
|
|
Term
what are the two dopamine receptors and their function |
|
Definition
D1 stimulates direct pathway D2 inhibits indirect pathway
dopamine acting on either receptor causes excitatory input for the cerebral cortex |
|
|
Term
what are the 6 categories of parkinsons therapy |
|
Definition
increased dopamine direct dopamine receptor agonist dopamine storage uptake/reelease inhibit MAO-B anti-cholinergics inhibit COMT |
|
|
Term
what drugs increase dopamine 1 |
|
Definition
|
|
Term
what drugs are dopamine receptor agonists 4 |
|
Definition
bromoctyptine perfolide pramipexole ropinirole |
|
|
Term
what drugs are dopaine release/uptake drugs |
|
Definition
|
|
Term
what drug is a MOA-B inhibitor |
|
Definition
|
|
Term
what drugs are anti-muscarinic agents 2 |
|
Definition
truhexylphenidyl benzotropine |
|
|
Term
what drugs are COMT inhibitors 2 |
|
Definition
|
|
Term
|
Definition
meabolic precursor of dopamine |
|
|
Term
|
Definition
crosses BBB on active carrier (aromatic AA) so can reach brain but little does |
|
|
Term
where is levodopa metabolized 3, how |
|
Definition
liver, kidney, GI
formulated with peripheral L-aromatic AA decarboxylase inhibitor (carbidopa) |
|
|
Term
what are the SE of levodopa no matter how long youve been taking it 3 |
|
Definition
decarboxylation to dopamine in dopaminergic neurons in striatum causes SE
nausea and vomiting (less when combined with carbidopa)
on-off phenomenon |
|
|
Term
what are the early SE of levodopa 5 |
|
Definition
N/V orthostatic hypotension tachycardia arrhythmia dark urine |
|
|
Term
what are the late SE of levodopa 5 |
|
Definition
dyskinesias: choreiform movements hypersentive receptors mental disturbance: hallucinations, wild dreams, delusions |
|
|
Term
what is the on-off phenomenon |
|
Definition
when blood levels of levodopa drop there is an immediate reversal of symptoms (esp in sustained release formula) deelops 2y into therapy B6 increases peripherial breakdown and levodopa makes this worse |
|
|
Term
|
Definition
DOC and most effective for parkinsons disease |
|
|
Term
|
Definition
D2 agonist D1 partial antagonise may save other dopaminergic neurons from oxidative stress |
|
|
Term
|
Definition
often used as adjunct to levodopa to lessen on-off phenomenon |
|
|
Term
|
Definition
dyslinesias orthostatic hypotension mental disturbance: hallucinations, wild, dreams, delusions pleuropulmonary and retroperitoneal fibrosis (ergot like) |
|
|
Term
|
Definition
no longer on market causes heart valve fibrosis due to activation of 5HT 2B receptors agonist of D1 and D2 receptors more potent than bromocryptine |
|
|
Term
MOA pramipexole and ropinirole |
|
Definition
non-ergot dopamine agonist at D2/3 receptors |
|
|
Term
USE pramipexole and ropinirole 3 |
|
Definition
first line or adjunct for parkinsons in pt who have not had levodopa may delay need for levodopa
restless leg syndrome fibromyalgia |
|
|
Term
SE pramipexole and ropinirole |
|
Definition
less hallucinations and orthostatic hypotension (like ergot agonists)
reward seeking behavior: drinking, smoking, gambling |
|
|
Term
how is pramipexole elimiated by |
|
Definition
|
|
Term
contraindications to primipexole |
|
Definition
cimetidine increases t1/2 by 40% |
|
|
Term
|
Definition
anti-viral drug alters dopamine release of uptake (uless mass effect) anticholinergic effects litte effect on tremor good gainst rigidity and bradkyinesia |
|
|
Term
|
Definition
|
|
Term
|
Definition
orthostatic hypotension dry mouth hallucinations |
|
|
Term
|
Definition
MOA-B is prodominate form in striatum and causes most oxidative metabolism of dopamine that causes harm in parkinsons
low doses do not affect MOA-A bu high doeses will causing severe HTN |
|
|
Term
|
Definition
severe HTN in high dose due to MOA-A mass effect |
|
|
Term
|
Definition
|
|
Term
MOA trihexylphenidyl and benstropine |
|
Definition
blocks cholinergic transmission to augment dopamine modest anti-parkinson action |
|
|
Term
use of trihexylphenidyl and benstropine |
|
Definition
|
|
Term
SE trihexylphenidyl and benstropine |
|
Definition
same as high dose atropine |
|
|
Term
|
Definition
selective inhibitor of COMT (minor enzyme in pathway of levodopa metabolism)
often combined with carbidopa which blocks peripherial decarboxylase and 3-O-methyldopa is formed that competes with levodopa for active transport in the CnS
inhibition of COMT decreases 3-O-methyldopa increasing central levodopa uptake
helps with on-off phenomenon |
|
|
Term
|
Definition
hepatotoxic: measure heptatic enzymes blood dyscarcies |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
not hepatotoxic no blood dyscrasias |
|
|
Term
|
Definition
short acting (administer with ea dose of levodopa/carbidopa) |
|
|
Term
cause of alzheimers disease |
|
Definition
loss of cortical and subcortical neurons causes dementia
due to b-amyloid causing ROS attack and loss of cholinergic transmission |
|
|
Term
3 acetylcholinesterase inhibitors, 1 SE |
|
Definition
tacrin: hepatotoxic donepezil rivastigmine |
|
|
Term
what 2 categories of drugs tx alzheimers disease |
|
Definition
acetylcholinesterase inhibitors n-methyl-d-aspartate receptor antagonist |
|
|
Term
what drug is a n-methyl-d-aspartate receptor antagonist |
|
Definition
|
|
Term
|
Definition
overstimulation of NMDA receptors by glytamate lets Ca flow freely into the cell
sustained over exposure of the cells causes cellular degeneration |
|
|
Term
what symptomatic tx can be used in alzheimers disease |
|
Definition
depression - SSRI (citalopram, paroxetine, sertaline, fluoxetine, edcitalopran)
psychosis/agitation: atypical anti-psychotics (risperidone, olanzapine, queitapine) |
|
|
Term
5 drugs that treat bleeding |
|
Definition
aminocarpoic acid factor VIII factor IX protamine sulfate vitamine K |
|
|
Term
|
Definition
inhibit plasminogen activation and stops bleeding |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
protamine sulfate: origin, composition |
|
Definition
derived from fish sperm testes high arginine (basic) |
|
|
Term
|
Definition
positive protein interacts with negative heparin antagonizing effects interacts with platelts and fibrinogen stopping bleeding |
|
|
Term
|
Definition
interferes with anticoagulant activity of warfarin (response takes 24h) causing bleeding |
|
|
Term
|
Definition
iron folic acid cyanocobalamin B12 erythropoietin |
|
|
Term
|
Definition
stops growth mensturation pregnancy |
|
|
Term
tx Fe deficiency 2, what the difference |
|
Definition
ferrous sulfate - oral ferrous gluconate - oral, less GI upset |
|
|
Term
6 causes of folic acid deficency |
|
Definition
increased demand: pregnancy, lactation SI pathology alcoholism dihydrofolate reductase inhibitors: methotrexate, trimethoprim |
|
|
Term
cause of B12 deficiency 4 |
|
Definition
diet, poor absorption no intrinsic factor (pernicious anemia), loss of reuptake inhibitos |
|
|
Term
|
Definition
oral or SQ life long if has pernicious anemia |
|
|
Term
|
Definition
treat anemia due to end stage renal disease, HIV, cancer |
|
|
Term
5 categories of blood thinners |
|
Definition
direct thrombin inhibitors indirect thrombin inhibitors platelet aggregation inhibitors GP IIb/IIIa receptor blockers thrombolytic drugs - not technically anticoagulants |
|
|
Term
4 indirect thrombin inhibitors |
|
Definition
heparin enoxaprin warfarin rivaroxban |
|
|
Term
2 direct thrombin inhibitors |
|
Definition
|
|
Term
6 platelet aggregation inhibitors |
|
Definition
aspirin copidogrel parsugrel ticagrelor cilostazol dipyridamole |
|
|
Term
3 GP IIb/IIIa receptor blockers |
|
Definition
triofiban efitfibatide aciximab |
|
|
Term
|
Definition
streptokinase urokinase antistreplase altelpase (t-PA) |
|
|
Term
where does heparin come from |
|
Definition
hg intestinal mucosa or beef tongue |
|
|
Term
|
Definition
glycoasmine and hucoronic / iduronic acid acetylated/sulfated lucosamine unsulfated hydroxyl groups |
|
|
Term
|
Definition
arginine binds lysing on serine protease anti-thrombin III (a clotting inhibitor) |
|
|
Term
what does high dose heparin inhibit 4 |
|
Definition
|
|
Term
what does low dose heparin inhibit |
|
Definition
|
|
Term
what does chronic or intermittent dose heparin inhibit |
|
Definition
reduces AT-III activity increasing thrombosis |
|
|
Term
|
Definition
IV administration: binds proteins causing hematoma
increased half life in kidney or liver failure
hemorrhage: monitor bleeding time
thrombocytopenia: after 8d therapy can develop anti-platelet antibodies |
|
|
Term
signs of heparin hypersensitivity 4 |
|
Definition
chills fever prophylaxis uticaria anaphylaxis |
|
|
Term
contrindications of heparin 5 |
|
Definition
bleeding disorders alcoholids hypersensitivity surgery to brin, eye, spinal cord
does not cross placenta but shows 13-20% still birth in last trimester |
|
|
Term
|
Definition
deep SC or IV short term use (days)
acute anticoagulation: IV volus then continous influsion |
|
|
Term
where is heparin metabolized |
|
Definition
reticuloendothelial system (liver cirrhosis and kidney failure increase t1/2) |
|
|
Term
|
Definition
DVT pulmonary embolism acut eMI aurgical prophylaxis dialysis prophylaxis
DOC: pregnancy women with prosthetic valve or venothromboembolism |
|
|
Term
|
Definition
low molecular weight heparin longer anticoagulation |
|
|
Term
explain the reactions and clotting factors used in clotting with vitamin K |
|
Definition
(factors II, VII, IX, X: glutamic acid) + (VitK) + (vitamin L epoxide reductase) + (CO2 carboxylation) -->
(factors II, ViI, ix, I: glytamic-COOH/carbodyglutamicA) + (epoxide) -->
binds Ca and causes cell membranes to stick for clotting |
|
|
Term
|
Definition
blocks vit K epoxide reductase and cofactors for clotting are not activated |
|
|
Term
|
Definition
hemorrhage: monitor clotting time |
|
|
Term
what substances increase activity of warfarin 5 |
|
Definition
chronic alcohol barbituates gluthemide grisofulvin rifampin |
|
|
Term
what substances decrease activity of warfarin 8 |
|
Definition
acute alcohol cimetidine chloramphenicol cortimoxazole disulfiram metronidazole phenylbutazone aspirin - not directly |
|
|
Term
what 2 health conditions are contraindicated with warfarin |
|
Definition
hepatic disease vitamin K dericiency augment response |
|
|
Term
administration o warfarin 2 |
|
Definition
|
|
Term
how is warfarin distributed |
|
Definition
99% bound to albumin prevents spread to CSF, placenta, milk |
|
|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
|
Definition
anticoagulation perdictable and does not require clotting monitoring |
|
|
Term
administration rivaroxban |
|
Definition
|
|
Term
|
Definition
recombinate from leech saliva made in yeast |
|
|
Term
|
Definition
irreversible thrombin antagonist 1 lepirudin: 1 thrombin |
|
|
Term
|
Definition
|
|
Term
|
Definition
reversible thrombin antagonist |
|
|
Term
|
Definition
|
|
Term
|
Definition
venous thrombosis artial fibrillation |
|
|
Term
|
Definition
irreversibly block thromboxane A2 synthesis from arachadonic acid in platelets |
|
|
Term
|
Definition
prolonged bleeding hemorrhagic stroke GI bleeds |
|
|
Term
metabolism of aspiring timing |
|
Definition
effects life span of plate ets 7-10d |
|
|
Term
|
Definition
prophylaxis of stroke, MI, infarcts |
|
|
Term
|
Definition
selective inhibitor of ADP binding to platelet receptor (synergistic to aspirin |
|
|
Term
|
Definition
prophylaxis: stroke, MI, post-MI infarcts |
|
|
Term
|
Definition
inhibit ADP pathway involved in fibrinogen and platelet binding (prodrug) |
|
|
Term
|
Definition
platelet inhibition of ADP induced platelet aggregation |
|
|
Term
|
Definition
fastest onset of platelet aggregation inhibitors |
|
|
Term
|
Definition
inhibit ADP pathway in fibrinogen and platelet aggregation and vasodilation |
|
|
Term
|
Definition
increased HR ventricular tachycardia |
|
|
Term
administration cilostazol |
|
Definition
co-administration with aspirin 23-33% inhibition of AD{ |
|
|
Term
|
Definition
intermittent claduication |
|
|
Term
|
Definition
increased cAMP inhibiting cyclic neculotide phosphodiesterase in platelets |
|
|
Term
administration of dipyridamole 2 |
|
Definition
within warfarin: inhibits embolism from prosthetic valves
with aspirin: mild increase in aspirin effects |
|
|
Term
|
Definition
increase effects of aspirin
prophylaxis: embolization from prosthetic valves (with warfarin) |
|
|
Term
|
Definition
mimic arginine-glycine-aspartic acid on fibrinogen |
|
|
Term
|
Definition
IV adjunct to percutaneous coronary intervention |
|
|
Term
|
Definition
prophylaxis: cardiac ischemia complications |
|
|
Term
|
Definition
|
|
Term
administration efitfibatide 2 |
|
Definition
usually with aspirin and heparin
IV adjunct to percutaneous coronary intervention |
|
|
Term
how long does efitfibatide last |
|
Definition
platelet function returns in 6-12h |
|
|
Term
|
Definition
prophylaxis: cardiac ischemia complication |
|
|
Term
|
Definition
monoclonal Ab aginst receptor blocks fibrinogen binding |
|
|
Term
|
Definition
IV adjunct to percutaneous intrvention |
|
|
Term
|
Definition
platelet function returns in 24-48h |
|
|
Term
|
Definition
prophylaxis: cardiac ischemia complications |
|
|
Term
|
Definition
activates plasmin which breaks down fibrin degrades fibrinogen factors V and VII |
|
|
Term
|
Definition
increased plasmin may cause bleeding by dissolving platelet plugs
hypersensitivity to BCS |
|
|
Term
signs of streptokinase hypersensitivity 3 |
|
Definition
|
|
Term
streptokinase administration |
|
Definition
must give enough to overwhelm antibodies to avoid hypersensitivity
give within 4h of MI then infuse for 1h |
|
|
Term
|
Definition
|
|
Term
|
Definition
DVT pulmonary embolism MI peripherial arterial thrombosis/emboli unclotting cathetcs and shunts |
|
|
Term
|
Definition
human cultures of fetal renal cells |
|
|
Term
|
Definition
enzyme degrades fibrinenzyme degrades fibrin |
|
|
Term
|
Definition
|
|
Term
|
Definition
only use when pr is sensitive to streptokinase |
|
|
Term
|
Definition
streptokinase and noncovalent 1:21 complex plasminogen
acetylates catalytic site of plasminogen so its inactive until fibrin binds |
|
|
Term
|
Definition
|
|
Term
metabolism of antistreplase |
|
Definition
de-acetylation lengths thrombolytic effect after IV injection
t1/2 90min |
|
|
Term
|
Definition
DVT pulmonary embolism MI peripherial arterial thrombosis/emboli unclotting cathetcs and shunts |
|
|
Term
|
Definition
low affinity for plasminogen but rapidly binds plasminogen bound to fibrin in thrombus (fibrin selective at low dose) |
|
|
Term
|
Definition
|
|
Term
|
Definition
DVT pulmonary embolism MI peripherial arterial thrombosis/emboli unclotting cathetcs and shunts DOC for older clots |
|
|
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
before you treat metabolic acidosis what do you need to consider |
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Definition
if they have ketoacidosis or lactic acidosis they may restore bicarbonate on their own in hours and may not need to be treated
hyperchloremic (diarrhea) will be unable to regenerate bicarbonate and kidney will take days to compensate so need alkali therapy |
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Term
how do you treat metabolic acidosis 2 |
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Definition
sodium bicarbonae tromethamine |
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Term
what are the benifits of using sodium bicarbonate to treat metabolic acidosis |
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Definition
fluid, electrolute and pH replacement increase cardiac funtion, perfusion, oxygenation, and lactate metabolism |
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Term
what are SE of sodium bicarbonate treatment 5 |
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Definition
IV: CO2 generated diffuses better across cell membranes into myocardial and CSF cells which can DECREASE pH more there
shift of Hb saturation curve LEFT impairs oxygen release
sodium and water overload
decreased ionized Ca and thus myocardial contractability
bicarbonate overshoot causes alkalosis if administered too fast |
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Term
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Definition
alkaline Na free organic amine proton acceptor combines with ions to form carbonic acid to form bicarbonate
osmotic diuretic ability increases urine flow, pH, and excretion of acids, CO2, and electrolytes |
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Term
what do you need to think about before you treat metabolic alkalosis |
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Definition
begin with focus on treating cause, if that dosent work then correct the values
increase tubular bicarbonate threshold: decrease ECF, hypochloremia, hypokalemia, duiretics, Ng suction |
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Term
how do you treat NaCl responsive metabolic alkalosis 4 |
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Definition
expand intravascular volume and replenish NaCl stores...... NaCl and K solutions acetazolamide hydochloric acid ammonium chloride |
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Term
how do you treat NaCl resistant metabolic alkalosis 3 |
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Definition
spironolactone amiloride triametrine |
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Term
when to use acetazolamide, why |
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Definition
volume expanded or intolerant to Na pt only because it its less effective as bicarbonate levels fall |
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Term
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Definition
converted by liver to urea and free hydrochloric acid |
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Term
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Definition
limits DCT H inhibition of ALD stimulated Na reabsorption blocks ALD effect on H ion secretory pump |
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Term
MOA amiloride and trimetrene |
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Definition
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Term
if the pt has decreased pH, increased CO2 what do they have |
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Definition
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Term
if the pt has decreased pH and normal (or slight decrease) CO2 what do they have |
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Definition
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Term
if the pt has increased pH and normal (or slight increase) CO2 what do they have |
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Definition
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Term
if the pt has increased pH and decreased CO2 what do they have |
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Definition
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Term
if the pH and CO2 move in opposite directions and they acidic what do they have |
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Definition
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Term
if the pH and CO2 move in same direction and their acidic what do they have |
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Definition
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Term
if the pH and CO2 move in the opposite direction and their basic what do they have |
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Definition
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Term
if the pH and CO2 move in the same direction and their basic what do they have |
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Definition
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Term
how do you treat respiratory acidosis 2 |
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Definition
establish airway give oxygen or ventilation |
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Term
how do you treat respiratory aklalosis 5 |
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Definition
if pH <7.5 no tx
if pH >7.5 paper bag, control hyperventilation, oxygen therapy for hypothermia, mechanical ventilation if severe |
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