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86 Cards in this Set
- Front
- Back
- 3rd side (hint)
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Rheumatoid factor attacks the ___ portion of the circulating ___ antibody
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Fc
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IgG
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Which 3 autoantibodies can be used as the Rheumatoid factor?
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IgM, IgA, or IgG
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Citrullination (or deimination) involves what amino acid?
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arginine
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IL-1Ra, sTNFR, IL-10, IL-13, and IL-4 are all what?
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endogenous anti-inflammatory substances
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Are lipoxins involved/around in RA patients?
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NO - why hard to get resolution
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What receptor is sTNF have greater affinity for?
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TNFR1
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What cytokine is very similar in activity as TNF?
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IL-17
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T/F. IL-6 does not play a big in RA.
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False; it does very much so
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In RA the Type III rxn is in the ____ ____.
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synovial fluid
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In RA the Type IV rxn is in the ____ _____.
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Synovial membrane
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Biological agents have obivous benefits during the ___ stage of RA.
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late
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How does MTX help when given with Biologic agents?
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by decreasing AB formation (due to mouse parts); as well as increasing efficacy
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On average how long do DMARDs take to act? Why?
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4-6 months
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Bc suppressing the immune system takes this long on average
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What is the one possible affect NSAIDs have on RA? (where does in work in RA pts)
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stopping the upregulation of Cox-2
(maybe TNF, IL-1 and Neutrophils too) |
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Main thing steroids stops in RA pts that leads to a halt of many different areas of immune system?
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antigen processing
(thus no T-cell activation --> no IL-2 released; lessened B-cell activation --> so less RF and ACPA --> no neutrophil regurgitation (inflammation) |
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Main thing steroids stop in RA pts that leads to a halt of many different areas of the inflammatory system?
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stopping the synthesis of cytokines
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What DMARD concentrates on lysosmes, decreases chemotaxis and antigen processing?
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Plaquenil
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How does Plaquenil help with SLE?
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by blocking antigen processing (rmbr: SLE is a Type III rxn)
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What does DMARD Sulfasalazine consist of? (2)
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sulfapyridine + 5-Amino salicylic acid
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Which DMARD's MOA maybe Adenosine like MTX?
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Sulfasalazine
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Which DMARD decreases IgG production and decreases neutrophil function?
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Azulfidine
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Do Gold Salts have acute AI activity?
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No!
Only immune by dec T-cell activation/ RF titers |
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How does MTX AI? Immuno-suppress
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by releasing Adenosine
(but maybe more of an AI drug) |
blocking folate's route (DHFR)
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At high doses MTX blocks both ____ and ____ synthase
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DHFR
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thymidine
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At low (AI) doses, MTX blocks only ____.
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DHFR
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What causes Adenosine to build up with MTX?
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bc by blocking DHFR, AICAR goes up and that blocks Adenosine Deaminase
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Does MTX affect neutrophils? What does it increase directly?
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NO! Not directly
(Adenosine does that, along with many other AI affects) |
Endogenous AI substances
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Which DMARD inhibits MMP, decreases adhesion molecules, and inhibits dihydroorotate dehydrogenase?
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Arava
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Is Arava teratogenic?
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yes
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Which DMARD causes inflammed bladder, is teratogenic and alopecia?
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Cytoxan
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What 4 DMARDs act by being an immunosuppressant?
(ICCC) |
Imuran, Cytoxan, Cellcept and cyclosporin
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What's AZA's MOA?
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6-thio-IMP replaces IMP
so no GMP or AMP --> replaces them with 6-thip-AMP or 6-thio-GMP this still increases the feedback mechanism and so less purine made (less T&B cell form.) |
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T/F. You can get hyperuracemia while on AZA.
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true bc the urate will come out of cells due a decrease in uric acid formation
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What's Cellcept's MOA?
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it's a selective inhibitor of IMP dehydrogenase --> inhibits purine synthesis & thus dec T&B cell formation
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How does NFAT become activated?
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by the Calcineurin-Ca-Calmodulin complex cutting off the Phosphate group on NFAT --> ACTIVE
(IL-2 then gets released) |
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Can Cyclophilin go and inhibit Calcineruine directly?
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yes!!
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Which drug inhibits IL-2 release, causes hirsutism, and gingival hyperplasia?
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cyclosporine
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What DMARD is Prograf similar to? What's its MOA in RA?
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Cyclosporin
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activates FKBP (via the drug FK506) --> this inhibits the C-Ca-C complex like cyclosporin does
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Can one take Cyclosporin + NSAID? Why or why not?
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No
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bc of Cyclosporin's major toxicity against the kidneys
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Enkephalins and Beta-endorphins are two endogenous ligands mainly for for what receptors?
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mu and delta
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Dynorphins are endogenous ligands mainly for what receptor?
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kappa
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Opioids decrease __ thus decreasing c___.
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Adenyl Cyclase
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cAMP
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Activation of endogenous pathway occurs when the stimulus reaches what specific area of the Brain Stem?
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PAG
(periaqueductal gray) |
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In the Gate Control Theory of pain, the Type C (Type A delta) Fiber can inhibit this neuron..
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Enkephalin (inhibitory) neuron --> thus allowing SP to be transmitted and pain to be perceived
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In the Gate Control Theory of pain, the Type A beta Fiber can excite this neuron..
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Enkephalin neuron --> thus inhibiting pain SP transmission
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T/F. Kappa (pain) receptors are only involved in analgesia and psychomimetic.
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True; mu receptors are the ones with multiple actions (minus being psychomimetic)
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Which opioid receptor cause analgesia, sedation, and euphoria?
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mu receptor
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What causes the euphoria effect from stimulating the opioid receptors (all 3 can cause)?
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the inhibiting of the inhibitor neuron (GABA neuron) --> this allows DA to be released, is no longer blocked by GABA
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Which two ways does cough suppression occur?
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by blocking the cough centers in the medulla
or by opioids interfering with transmission of impulses to the CNS via vagus nerve |
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T/F. Respiratory depression and cough suppression is as a result of the mu receptor only.
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False.
Yes for resp. depression, but cough suppression is not the same |
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T/F. Pain increases respiration
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true - why opioid help bc cause resp depression (they cancel each other out to equal normal)
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T/F. Codeine has a low ceiling compared to other opioids and cannot be antagonized by naloxone
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True
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Stimulating which opioid receptors causes miosis & accommodation?
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mu and kappa
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Reason for pinpoint pupils?
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opioids inhibit an inhibitory nerve --> this activates the Edinger-Westphal nucleus of CN 3
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What do opioids do to the CV system? Which receptor(s) is responsible for this?
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decreases BP thru dilation of BV's - why can be used in pulmonary edema
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mu
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Why does constipation occur while on opioids? Which receptor(s) is responsible for this?
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bc inhibits release of ACh in GI tract
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mu & other opioid receptors
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Opioids cause contraction of the Sphincter if Oddi.What happens as a result?
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get a build up of secretions in liver, gallbladder and pancreas --> inflammation and pain!
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What happens to histamine's release while on opioids?
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get a non-immunologic release of it from mast cells --> nasal stiffness, BP drops, and itching
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Which is the only opioid receptor responsible for anti-diuretic effect? Why does this occur?
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mu
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bc relaxes the detrusor muscle and contracts the sphincter muscle
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Tolerance of opioids is based on which main mechanism?
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NMDA receptor activation --> this inc glutamate binding to NMDA --> inc excitatrory resp to pain
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Which opioid can be used for addicts and for neuropathic pain?
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Methadone
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Which mu-receptor opioid has NMDA repector antagonist activity, plus ability to block SERT and NET?
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methadone
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Tolerance of opioids is based on which main mechanism?
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NMDA receptor activation --> this inc glutamate binding to NMDA --> inc excitatory resp to pain
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Which opioid can be used for addicts and for neuropathic pain?
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Methadone
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Which opioid has NMDA repector antagonist activity, plus ability to block SERT and NET?
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Methadone
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Can Lomotil and Imodium produce opioid-like effects?
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only Lomotil at sufficient doses; Imodium does not get into CNS so OTC for constipation
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What are the 3 important factors of Ultram?
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1. binds to mu receptors
2. inhibits uptake of SE and NE 3. stimulates alpha 2 receptors |
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T/F. Tessalon Perles anti-tussive effect comes from it's opioid like activity.
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False; its unrelated to opioid activity
maybe by exerting anesthetic like effect |
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Does Buprenex have kappa receptor antagonism?
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yes; so no psychomimetic activity; plus very powerful partial agonist of mu receptor
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Nalbuphine is a mu receptor antagonist plus a strong kappa receptor ___?
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agonist
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Where does Prialt work?
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the N-type Ca2+ channel on primary afferent nociceptive neurons
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Pentazocine gets its analgesic activity from which receptor?
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kappa
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Which opioid is used to treat alcohol dependence?
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Revia
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Which opioid drug is used to treat respiratory depression, sedation and hypotension?
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Narcan
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Does Narcan work on kappa receptors? If so how?
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reverses the kappa receptor effects
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Relistor is a selective _____ for the ____ receptor.
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antagonist
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mu
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What is the main function of Relistor, since too big to get into the CNS?
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restore bowel function
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What 5 drug types can be used for neuropathic pain?
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TCA's, anticonvulsants, local anesthetics, neuropeptide antagonist, and NMDA receptor antagonist
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How can TCA's help with neuropathic pain?
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by blocking SERT and NET; thus inc NE and SE (which can be inhibit the pain impulse in dorsal horn or brain)
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How can anticonvulsants help with neuropathic pain?
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by blocking Na+ and Ca2+ channels --> leading to a dec in release of NT's
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This drug inhibits Na+ influx, L-type Ca2+ channels, NMDA receptors; potentiates GABA and enhances K+ efflux...
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Topamax
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How do local anesthetics help with neuropathic pain?
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by binding (reversibly) to a specific site on the Na+ channel - blocking depolarization
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NMDA stimulation leads to the influx of which ion?
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Ca2+
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This opioid drug is an anti-viral that can be used for Parkinson's disease.
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Symmetrel
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Can Ketalar cause psychomimetic rxns? What kind of drug is this?
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yes
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NMDA receptor antagonist
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Nucynta combines which 2 analgesic mechanisms?
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mu receptor agonist and NE reuptake inhibitor
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