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 |
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Term
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Definition
pulmonary HTN erectile dysfunction |
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Term
contraindications slidenafil |
|
Definition
never use with nitrates, both work in same pathway too much dilation occurs |
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Term
|
Definition
verapamil diltaziam amidopine |
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Term
|
Definition
cardiodepressant blocks L type Ca channels on heart |
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Term
|
Definition
cardiodepressant blocks L type Ca channels on heart mostly |
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Term
|
Definition
vasodilates, drops BP blocks L type Ca channels on vessels |
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Term
|
Definition
HTN angina arrhythmia SVT class 4 |
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Term
|
Definition
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Term
|
Definition
HTN angina arrhythmia SVT class 4 |
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Term
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Definition
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Term
|
Definition
reflex tachycardia gingival hyperplasia |
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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 |
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Term
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Definition
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Term
|
Definition
low theraputic index arrhythmia blurry yellow vision |
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|
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 |
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|
Term
4 types of drugs used for SVT |
|
Definition
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|
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 |
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|
Term
lidocainel type, moa, use |
|
Definition
1B BB ventricular arrhythmia |
|
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Term
|
Definition
3 block K and BB any arrhythmia |
|
|
Term
amioderone: type, MOA, use |
|
Definition
3 block Na, K, Ca, BB any arrhythmia |
|
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Term
|
Definition
lupus in slow acetylators torsades |
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Term
|
Definition
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|
Term
|
Definition
torsades - low risk liver damage pulmonary fibrosis thyroid problems - due to iodine |
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Term
|
Definition
stimulate adenosine receptors (Gi coupled so still inhibitory( short half life 8s |
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Term
2 Na channel blocker anti convulsants |
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Definition
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Term
|
Definition
Na channel blocker glutamate inhibitor |
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Term
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Definition
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Term
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Definition
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Term
|
Definition
teratogenic gingival hyperplasia p450 inducer zero order kinetucs |
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Term
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Definition
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Term
|
Definition
liver problems hyperammonemia teratogenic |
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Term
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Definition
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
DC if any sign of rash could be SJS |
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Term
|
Definition
morphine meperidine buprenorphine |
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Term
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Definition
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Term
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Definition
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Term
|
Definition
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Term
|
Definition
meiosis depressed respiratory - fatal decreased GI/GU gall bladder spasms |
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Term
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Definition
decreased respiration serotonin syndrome |
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Term
|
Definition
when you put it with a full Mu agonist it causes withdrawl |
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Term
|
Definition
mu antagonist IV antidote to quickly reverse opioid action |
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Term
|
Definition
5HT1D agonist vasoconstriction |
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Term
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Definition
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Term
|
Definition
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|
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 |
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Term
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Definition
interacts with GABAa receptors
rapid redistribution and elimination for short procedures and out patient surgery
low nausea and vomiting pain on ijection |
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Term
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Definition
interacts with GABAa receptors high incidence of myclonus pain on injection |
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Term
what does general anesthesia supres |
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Definition
reversible loss of sensation and consciousness: analgesia, amnesia, LOS, relax skeletal muscle, somatic, autonomic, endocrine reflexes, hemodynamic stability |
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Term
what are three things that affect transfer of drug from machine to alveoli |
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Definition
inspired PP alveolar ventilation characteristics of the breathing system |
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Term
what are three things that effect the transfer of drug from alveoli to arteriole |
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Definition
blood bas partition coefficient cardiac output alveolar to venous PP difference |
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Term
what are three things that affect transfer of drug from arterial blood to brain |
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Definition
brain blood partition coefficient cerebral blood flow arterial to venous PP difference |
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Term
how does the PP of a anesthetic change its effect in a person |
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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 |
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Term
how does solubility of a anesthetic change its effect in a person |
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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 |
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Term
how is alveolar ventilation of anesthetic calculated |
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Definition
= RR x (TV - dead space) x rate of drug induction |
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Term
why do we care about alveolar ventilation of anesthetic |
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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 |
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Term
what is the law of mass action |
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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 |
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Term
how does changes in cardiac output effect inhaled anesthetics |
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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 |
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Term
what does increase in anesthetic concentration, alveolar ventilation, solubility of anesthetic, and CO do to rate of induction |
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Definition
concentration: increases ventilation: increases solubility: decreases CO: decreases |
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Term
what actions of the drug in the body determine potency of general anesthetic |
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Definition
concentration in the brain correlates with lipid solubility |
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Term
what is the minimum alveolar concentration |
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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 |
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Term
what is the volume of expansion theory |
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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 |
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Term
6 inhaled general anesthetics |
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Definition
no one deserves seven isolated halos en florance nitrOUS oxide desflurane sevoflurane isoflurane halothane enflurane |
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Term
inhaled general anesthetic most commonly used |
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Definition
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Term
inhaled general anesthetic not able to be used alone in surgery |
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Definition
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Term
inhaled general anesthetic often delivered with opioids or volitale anesthetics |
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Definition
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Term
nitrous oxide: potency and why |
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Definition
low lotency, poor blood solubility allows rapid achievement of alveolar to brain PP of lung |
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Term
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Definition
not flamable but can support combustion minimal skeletal muscle relaxation inhaled anesthetics are addictive considered safest |
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Term
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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) |
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Term
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Definition
decreased BP due to decreased vascular tone
no renal of hepatic metabolism
irritating to airway |
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Term
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Definition
significant release of fluoride with prolonged use and high doses
seizure with high doses
less proability of arrhythmia |
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Term
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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 |
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Term
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Definition
laryngeal spasm: not indicated for inhalation induction
special delivery system to make liquid at room temp |
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Term
why use IV anesthetic over inhaled |
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Definition
add flexability and permit administration of lower concentrations of inhaled agents |
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Term
drugs used as IV anesthetics 7 |
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Definition
barbituates benzos
kit, amy, e tom dated droned pairs of dolls on fentanyl and propfol ketamine etomidate doperidol fetanyl propfol |
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Term
barbs used in IV anesthetics 2 |
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Definition
thios penpal sent him meth in a hexagon envelope thiopental methohexital |
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Term
benzos used for IV anesthetics 1 |
|
Definition
mydalzing lamb had no pain midazoloam |
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Term
barb as IV anesthetic: 1 good 1 bad |
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Definition
sedation poor analgesia, may increase response to pain |
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Term
benzos as IV anesthetic: use, effects |
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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 |
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Term
doperidol and fentanul: use, SE |
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Definition
neuroleptic anesthesia slow induction may need ventilation |
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Term
|
Definition
opioid sigma agonist NMSA antagonist |
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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 |
|
|