Pain Management: Nsaids And Narcotics And Plumonary Agents

Front 1

Therapy for pain and ___ effects often go hand in hand.

Back 1

anti-inflammatory

Front 2

Nonsteroidal Anti-inflammatory drugs (NSAIDS) work by inhabitation of ___ synthesis

Back 2

prostanoid

Front 3

Prostanoids , such as prostaglandins, prostacyclins, and thromboxanes, are products of the metabolism of a fatty acid found in cell membranes, called ___ acid.

Back 3

arachidonic

Front 4

NSAIDS inhibit the first step in this metabolism, by inhibiting an enzyme called ___(COX).

Back 4

cyclooxygenase

Front 5

Thromboxanes (thromboxane A_2 or TXA_2) are found in the platelet and facilitate ___, which eventually leads to clot formation. Thromboxanes also cause vessels to ___.

Back 5

platelet aggregation
constrict

Front 6

Prostacyclins are found in the cells lining blood vessels (vascular endothelial cells) and ___ platelet aggregation. They also cause vasodilation.

Back 6

inhibit

Front 7

Prostanoids in the bronchioles of the lung have a protective function, and keep the airways open. They are ___.

Back 7

bronchodilatory

Front 8

Prostanoids in the cells liking the stomach are ___ – they protect the stomach lining from gastric acid.

Back 8

cytoprotective

Front 9

There are two isoenzymes of cyclooxygenase, Cox-1 and Cox2. Although both are anti-imflammatory, only ___ is responsible for platelet aggregation and the cytoprotective effect in the stomach.

Back 9

COX-1

Front 10

Different drugs have different selectivies for the two isoenzymes. Those that affect COX-1 will promote ulcers and have an antithrombotic (inhibitory action toward ___) action, and will prolong bleeding time.

Back 10

platelets

Front 11

___ – inhibitory action toward platelets

Back 11

Antithrombotic

Front 12

Narcotic analgesics act at the level of the ___ to relieve pain. These agents also act at sites in the central nervous system to reduce the perception of pain

Back 12

spinal cord

Front 13

Drugs that affect the cardiovascular system are the most frequently prescribed group of drugs. These drugs modify heart rate, blood pressure, and cardiac conduction, as well as work to increase perfusion to organs by increasing ___ flow

Back 13

blood

Front 14

Drugs that affect the autonomic nervous sytem (ANS) – these drugs are useful in the therapy of hypertension, hypotension, angina, and arrhythmias. Most of the drugs prescribed are inhibitors of the ___ portion of the ANS, either directly or indirectly.

Back 14

sympathetic

Front 15

Calcium channel blockers – these drugs have a variety of actions and are useful in the therapy of hypertension, angina, arrhythmias, and congestive heart failure. Depending on the class of calcium channel blocker, these drugs may increase cardiac ___ and or decrease the work of the heart.

Back 15

output

Front 16

___ inhibitors and angiotensin II receptor blockers – decrease levels or activity of the potent vasoconstrictor angiotensin II, and are useful in congestive heart failure and hypertension.

Back 16

ACE

Front 17

___ – dilate arteries and are useful in the therapy of hypertension, congestive heart failure (CHF), and angina.

Back 17

Vasodialators

Front 18

___ – dialate veins and increase nyocardial perfusion. They are useful in the therapy of angina.

Back 18

Venodilators

Front 19

___ agents – increase the strength of contraction of the heart muscle and are used in congestive heart failure (CHF)

Back 19

Inotropic

Front 20

___ – are agents that act at the level of the kidney to lower plasma (fluid) volume. They are useful in the therapy of hypertension, CHF, and angina.

Back 20

Diuretics

Front 21

___ – targeted to block the B_1 receptor, which functions to increase heart rate and force contraction of the heart muscle.

Back 21

Beta receptor Antagonists (Beta Blockers)

Front 22

By blocking the Beta receptor, heart rate and cardiac output are ___. This results in decreased blood pressure and increased tissue perfusion
Cardiac conduction rate is slowed, decreasing the possibility of arrhythmias.
The production of rennin is decreased, resulting in reduced production of the ___ angiotension II.

Back 22

decreased
vasoconstrictor

Front 23

___ - regulates one's (mean arterial) blood pressure

Back 23

renin

Front 24

Adverse effects of beta Blockers – the blockade of B_1 and B_2 receptors may interfere with the regulation of blood sugar (this is a ___ contraindication)

Back 24

diabetic

Front 25

The blockade of B_2 receptors may cause bronchoconstriction (___ contraindication)

Back 25

asthmatic

Front 26

Many adverse effects are caused by the blockade of ___ receptors so most drugs on the market are selective for the B_1 receptor. Unfortunately, none are completely without B_2 blockade. (i.e. very small amounts of B_2 blockade are present, which are considered negligible)

Back 26

B_2

Front 27

Beta Receptor Agonists – these drugs are useful in increasing the force of ___ of the heart, which raises blood pressure and cardiac output. These may be useful in cases of hypovolemia, severe hypotension, etc. These agents can also increase blood sugar.

Back 27

contraction

Front 28

Selective ___ receptor agonists are useful in the therapy of asthma.

Back 28

B_2

Front 29

___ – mechanism of action – blockade of Alpha_1 receptors results in a decrease in peripheral vasoconstriction, and lowering of blood pressure and cardiac afterload.

Back 29

Alpha Receptor Antagonists

Front 30

___ – a drop in blood pressure due to a change in body position when a person moves to a more vertical position.

Back 30

Postural hypotension

Front 31

___ – in emergency situations, these drugs are used intravenously in the therapy of shock. They are also used intravenously as decongestants.

Back 31

Alpha receptor agonist

Front 32

Adverse effects of Alpha_1 agonists are related to ___ in blood pressure.

Back 32

increases

Front 33

___ – these agents decrease the release of norepinephrine by binding to the regulatory Alpha_2 receptor on the sympathetic neuronal ending and nucleus tractus solitaries (NTS). Useful in the therapy of ___

Back 33

Alpha_2 receptor agonists
hypertension

Front 34

___ – these drugs act at the level of the muscarinic receptor to block parasympathetic effects

Back 34

Muscarinic Antagonists

Front 35

___ system – control smooth muscle contraction, regulate cardiac muscle, or stimulate or inhibit glandular secretion.

Back 35

Parasympathetic

Front 36

Calcium channel blockers block type “L” membrane channels for calcium, resulting in decreased calcium entry into the ___, in a dose-dependent manner.

Back 36

cells

Front 37

Vascular smooth muscle – calcium channel blockers can relax the smooth muscle of arteries and cause ___. They are therefore useful as antihypertensive and antianginal drugs.

Back 37

vasodilation

Front 38

Cardiac muscle – certain calcium channel blockers decrease conduction rate in cardiac tissue, resulting in a decrease in ___ and cardiac excitability. These drugs are thus useful as antiarrhythmics and antihypertensives, as well as the therapy of angina.

Back 38

heart rate

Front 39

Calcium channel blockers can also affect neuronal tissue in high therapeutic doses. Calcium is required for the release of ___, and calcium channel blockers can actually have sympatholytic effects.

Back 39

neurotransmitter

Front 40

PHYSIOLOGY REVIEW
Skeletal muscle obtains the calcium needed for contraction from intercellular stores, whereas cardiac muscle and smooth muscle obtain calcium from ___ the cell. Thus skeletal muscle is not effected by calcium channel blockers, while vascular and cardiac muscles are.

Back 40

outside

Front 41

The adverse effects of calcium channel blockers include flushing, ___, constipation, and nausea.

Back 41

dizziness

Front 42

___ - Inhibitors of Angiotension-Converting Enzyme

Back 42

(ACE inhibitors)

Front 43

___ is a potent vasoconstrictor that is produced through a cascade of events in the plasma.

Back 43

Angiotensin II

Front 44

___ – released from the kidney, acts on a blood protein, angiotensionogen, to form angiotension I, which is then acted upon by ACE to form angiotensin II. Ace also breaks down bradykinin, a potent vasodilatior. The net result is vasoconstriction and an ___ in blood pressure.

Back 44

Renlin
increase

Front 45

ACE inhibitors are competitive antagonists of ACE – they bind to angiotension I and complete with ACE for ___.

Back 45

binding sites

Front 46

ACE Inhibitors are useful in the therapy of hypertension, particularly in persons who are ___ and those with existing cardiac problems.

Back 46

obese

Front 47

___ have been shown to be less effective in populations of African descent, due to certain genetic differences.

Back 47

ACE inhibitors

Front 48

The inhibition of angiotension II formation results not only in less ___, but less release of aldosterone, as well. This results in less fluid and sodium retention.

Back 48

vasoconstriction

Front 49

ACE inhibitors may increase renal blood flow, so they are ___ in renal patients.

Back 49

constraindicated

Front 50

ACE inhibitors are constraindicated in pregnancy: when used in pregnancy during the second and third trimesters, ACE inhibitors can cause injury and even death to the developing ___.

Back 50

fetus

Front 51

ACE inhibitors generic names usually end in “___” or “___” so you can recognize them easily.

Back 51

pril
prat

Front 52

Angiotension II receptor Blockers - These agents are simply competitive antagonists of angiotension II at its ___.

Back 52

receptor

Front 53

Less adverse effects are seen with angiotension II receptor blockers than with ___, due to less bradykinin available, but the total blood-pressure-lowering effect is also less.

Back 53

ACE inhibitors

Front 54

Angiotension II receptor blockers reduce the ___(not levels) of angiotension II (e.g. vasoconstriction and increased secretion of aldosterone, a hormone that retains sodium and water from the renal tubules).

Back 54

effects

Front 55

___ – act at the level of arteriolar smooth muscle to relax it, resulting in dilation of the arteriole. Useful in the therapy of congestive heart failure, hypertension, and angina

Back 55

Direct vasodilators

Front 56

Venodilators (___) – act a the level of the vein to relax the venous smooth muscles and increase capacitance.

Back 56

Nitrates

Front 57

___ are not useful in the therapy of hypertension, as they do not significantly effect anteriolar smooth muscle.

Back 57

Venodilators

Front 58

Cardiac muscle is composed of contractile filaments made of actin and myosin, which overlap. The end (head) of the myosin molecule is an enzyme, which cleaves a phosphate group off the body’s energy source: ATP. This results in the release of energy and ___(cAMP), which regulates the contractile process.

Back 58

cyclic AMP

Front 59

In cardiac muscle, the contractile process starts with the binding of ___ to proteins surrounding the actin and ends with the degradation of cAMP by phosphodiesterase. By increasing the amount of calcium present or inhibiting phosphodiesterase (which allows the cAMP to stay around longer), we increase the number of active contractile filaments and increase the force of contraction.

Back 59

calcium

Front 60

___ agents increase the strength of contraction of cardiac muscle.

Back 60

Inotropic

Front 61

There are three classes of drugs presently used to increase contractile force.
The ___, which increase the amount of calcium available and thus increase the force of contraction.
The ___, which decrease the activity of phosphodiesterase and therefore increase levels of cAMP
The ___, which inhibit phosphodiesterase and increase levels of cAMP.

Back 61

cardiac glycosides
bipyridines
methylxanthines

Front 62

___ inhibit the actions of the cellular pump that pumps sodium out of the cell and potassium back in, after the action potential has occurred. This result is a bildup of sodium in the cell that can then exchange for calcium.

Back 62

Cardiac glycosides

Front 63

heart cells depend on calcium from the outside, the trapping of calcium in the cell and the additional pumping of calcium in from outside causes a large amount of calcium to be available for ___ and increases the number of contracting muscle fibers.

Back 63

contraction

Front 64

At the same time that sodium levels are building up within the cell and activating the sodium/calcium exchange, the potassium is building up outside of the cell. This can cause ___ in heart conduction.

Back 64

abnormalities

Front 65

___ levels are thus critical in a patient on cardiac glycosides and must be monitored closely.

Back 65

Potassium

Front 66

Phosphodiesterase inhibitors presently consist of two classes of drugs: the methylxanthines and bipyridines. These drugs increase levels of ___, resulting in longer and stronger contraction of cardiac muscle.

Back 66

cAMP

Front 67

___ – used as local anesthetics. They decrease excitation of conductive tissue. As agents used to block pain, they decrease the firing of pain neurons.

Back 67

Sodium channel blockers

Front 68

___ - Drugs used to decrease fluid volume

Back 68

(Diuretics)

Front 69

___ act on the nephron to increase retention of sodium in the urine, decrease the concentrating ability of the renal medulla, or increase the excretion of water and salt.

Back 69

Diuretics

Front 70

___ – act by disrupting the concentration mechanism in the kidney. As a result the urine is very dilute, which means that more water is iliminated. As water is eliminated, the plasma becomes more concentrated, drawing water out of tissues and decreasing edema.

Back 70

Loop Diuretics

Front 71

___ – act at the distal end of the nephron and impair the ability of the kidney to reabsorb chloride (and thus sodium) into the body.

Back 71

Thiazide diuretics

Front 72

___ – inhibit the conversion of carbon dioxide to carbonic acid, a process that utilizes water and brings it back into the body. The result is a slight loss of water and large loss of bicarbonate

Back 72

Carbonic Anhydrase inhibitors

Front 73

___ – these are very poor diuretics, They are used in combination with a potassium-wasting diuretic (e.g. thiazides)

Back 73

Potassium-Sparing Diuretics

Front 74

___– used intravenously, under supervised conditions. They are sugar polymers that bind to water and are filtered into the urine. As a result, they prevent the reabsorption of water and cause dieresis.

Back 74

Osmotic Diuretics

Front 75

___ – bind bile salts in the intestine. This prevents them from being absorbed and reused. Since bile salts are necessary for the digestion of fats, the body must then use cholesterol stores to make new bile salts. This lowers cholesterol stores (particularly LDL)

Back 75

Bile Binding resins

Front 76

___ - Drugs that interfere with triglyceride synthesis

Back 76

(Fibrates)

Front 77

The enzyme lipoprotein lipase breaks down VLDL. ___ increase the synthesis of this enzyme, resulting in decreased levels of VLDL.

Back 77

Fibrates

Front 78

Inhibitors of ___ – these drugs inhibit the first step in cholesterol biosynthesis

Back 78

HMG CoA Reductase

Front 79

___ – interfere with the clotting cascade

Back 79

Anticoagulants

Front 80

___ agents – interfere with platelet aggregation

Back 80

Antithrombolytic

Front 81

___ agents – break down an existing clot

Back 81

Throbolytic

Front 82

Anticoagulants interfere with various stages of the clotting cascade in blood plasma. They do not have a major effect on platelets. There are two main anticoagulant drugs, ___(which is used intravenously) and ___, which is taken orally.

Back 82

heparin
warfarin

Front 83

Heparin is a carbohydrate polymer that potentiates a natural anticoagulant called antithrombin III. This substance interferes with the formation of ___, which is required for clot formation.

Back 83

thrombin

Front 84

Because ___ is essentially a sugar, it would be digested if given orally.

Back 84

heparin

Front 85

Warfarin is an oral anticoagulant, that inhibits the recycling of ___

Back 85

vitamin K

Front 86

Since vitamin K is required for the action of several clotting factors that are necessary for the clotting cascade , and ___ effectively decreases liver stores of vitamin K, these clotting factors no longer function and clotting decreases in a dose-dependent manner.

Back 86

warfarin

Front 87

___ – these drugs interfere with the actions of the platelet plug and decrease platelet aggregation. This may result in a decrease in the number of small clots (thrombi) that routinely form in the course of normal blood flow, due to random platelet activation.

Back 87

Antithrombotic agents

Front 88

___ – break up formed clots. They act from within the clot to lyse (break up) the clot. The dangers of thrombolytic drugs lie in the formation of smaller clot pieces that can block small vessels and cause myocardial infarction or stroke. These are administered intravenously.

Back 88

Thrombolytic drugs

Front 89

The most common lung disorder treated pharmacologically is ___.

Back 89

asthma

Front 90

The objective in the treatment of asthma is to increase ___ diameter.

Back 90

bronchiolar

Front 91

___ – drugs that stimulate the Beta_2 receptor will cause bronchodilation, due to an increase in cyclic AMP. Those that block the receptor will inhibit this bronchodilation, and may cause ___.

Back 91

Sympathetic agonists
bronchoconstriction

Front 92

___ – since acetylcholine can cause bronchoconstriction, blocking receptors for acetycholine may cause bronchodilation.

Back 92

Muscarinie antagonists

Front 93

Methylxanthines – these are ___ inhibitors and raise the level of cAMP, resulting in dilation of bronchioles

Back 93

phosphodiesterase

Front 94

___ – these drugs will decrease the inflammatory response in the lung, which may be initiated by airborne pollutants, stress responses, or similar factors. These drugs decrease the inflammatory response by stabilizing mast cells, which secrete histamine, as well as stabilizing intracellular lysosomes, which release toxic substances.

Back 94

Steroids and other anti-inflammatory drugs

Front 95

___ – thise is the newest class of therapy for asthma. Leukotrienes are prostanoid derivatives that may be released in response to irritation, and which cause constriction of smooth muscle – in this case bronchiolar smooth muscle. By antagonizing these inflammatory agents, bronchioles remain dilated.

Back 95

Leukotriene antagonists

Front 96

Drugs that are useful in asthma are selective agonists at the ___ adrenergic receptor.

Back 96

Beta_2

Front 97

___ - These drugs are glucocorticoids. They decrease inflammation, resulting in decreased swelling of bronchiolar tissue and increased airway space.

Back 97

Corticosteroids

Front 98

Taken systematically, steroids cause inhibitory effects on the ___ gland and require gradual withdrawal in order to allow the ___ gland to resume normal functioning

Back 98

adrenal
adrenal

Front 99

Corticosteroids also inhibit the ___ system and may decrease production of certain hormones. These are metabolized in the liver and may affect liver function.

Back 99

immune