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132 Cards in this Set
- Front
- Back
how do LA work?
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AROMTIC END (LIPOphilic and hydrophobic) gets it into the nerve
amino (hydrophilic end does the work) it gets ionized and blocks sodium uptake |
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More _______ nerves are affected first.
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myeline\ated are more susceptible.
pain>cold>warm>pressure> motorneurons |
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esters have______duration compared to amino
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shorter bc of plasma cholinestarase inplasma breaks it down instead oh liver
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infected tissues have a _______pH so
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lower,
so LA is less effective in infected tissue |
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_________ is the only vasoconstricting LA
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cocaine
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___________ ar emore likely to cause allerigic rxns
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esters
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cocaine is used for
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opthalmic, nasal surgery
it causes epithelial cell toxixity |
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benzocaine is used
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topically, has lowsolubilty and absorbed slowly--->long duration
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benoxinate is used in combination with ...
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fluroescein--(shows damaged areas and check intraocular pressure)
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proparacaine
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nothing special and ester
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tetracaine is
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very potent used for spinal anesthesia
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procaine
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short half life never used topically, doesn't penetrate mucus membrane
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what are the esters
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the BBC's PPT
(british broadcasting comp precipitates) B B C P P T |
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amino amides have
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two i's in their name
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Amino amide LA include
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Procainamide
Lidocaine Articaine Mepivacaine Bupivacaine Prilocaine Ropivacaine |
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most widely used LA
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Lidocaine
IV for arrythmias |
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Articaine can
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get into bones and cause paraestesias
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mepivacaine causes
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less vasodilation used w/o epi
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bupivacaine takes
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longer to get in neuron but works longer
and is inhibitor of ionotropes- decreases heart contractibilty |
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prilocaine
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used w/o epi and can cause methemoglobemenia, decreases ox carrying capacity
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ropivacaine is the
(What doesn't belong in this list : Meat, Eggs, Wife, Blowjob?) |
s enantiomer of bupivacaine
(Blowjob: You can beat your meat, eggs or wife, but you can't beat a blowjob.) |
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SE of amino amides
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If CNS-disorientation
slurred speech nystagmusallergic rxns at inf site |
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tetrodotoxin
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TTX-potent marine toxin
blocks na+ channels |
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Thyroid gland produces
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Thyroxine (t4) and calcitonin( inh osteoclasts-we have enough ca++)
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Thyroid peroxidase is responsible for
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coupling rxn and organificaton
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T3 gets into the the target cell (lipid sol) and binds
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intracellular receptors migrates to spec spot on DNA
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Myxedema
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most common cause of I- def (90%)
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Hashimoto Thyroiditis
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second most common I- def
AI disease Abs tp TSh receptors or affects Thyroid peroxidase |
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tyroid def
think Dr. Sharples |
dec BMR
dec body temp dec heart rate weight gain dec mental capacity |
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levothyroxine
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DOC- lasts longer
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Liothyronine
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T3
T4- T1/2= 6-7 dyas T3- T1/2= 1 day |
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liotrix
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(T3 +T4)
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anything that inc p450 decreases ________
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T3/T4
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Thyrotoxicosis
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most common is graves disease
SE- inc SNS irratibility tremor tachycardia ansomnia wt. loss inc BMR inc Body temp exothalmos-bulging eyes(not cock jonas!) Ca++ -osteoporosis |
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Tx of Thyrotoxicosis
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Inh of Thyroid syn- -thionamides(prop and meth)
-perchlorate -thiocyanate Iodide- lugols- KI Radioactive I131 Amiodarone Dopamine Beta blockers Ca++ supplements |
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thyroid peroxidase inh-
(25% who take get cured) |
Propylthiouracil- used if prego
Methimazole-DOC but teratogen, fewer SE |
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SE of Thyroid Peroxidase inhibitors
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agranulocytosis
hepatitis rash- S- ion present |
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Perchlorate
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aplastic anemia
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Thiocyanate
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in cabbage or ciggerette smoke
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Iodide can cause
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hyperthyroid in pts wit I- def or inhibit in pts with normal I-
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I 131 eneters thyroid gland and emits
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beta particle, destroys local tissue
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amiodarone
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anti arrythmic drug
inhibits deiodonase (t4-->t3) |
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dopamine
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dec TSH
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beta blockers-
Ca++ supplements- |
-relieves symptoms fo too much thyroid aaction
ca++ counteracts Ca++ loss |
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If low Ca++
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PTH is inc
causes Inc ca++ abs, inc ca++ retention in kidney, and inc release of ca++ from bones |
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tissue with most medulla activity
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spinal vertebrae
radius bone femoral neck |
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disorders of Ca++ met
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senile ostoporosis
post menopausal osteo secondarily from diet, drugs (heparin and glucocorts), RENAL DISEASE, AND DEC VIT d Paget disease--Inc in osteoclast act |
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Agents to tx Osteoporosis
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Bisphosphonates
PTH analog Estrogen Analog Vit D analogs Others-Fluoride, Calcitonin, and glucocorticoids |
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Bisphosphonates-
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"dronates"
only TILUdronate and ETIdronate are bisphosphonates-cause dec in ATP prod and osteoclasts die all the others are amino bisphosphonates- they inh an enzyme->osteoclast apoptosis |
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Bisphosphonates- Se
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ONJ
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teriparitide
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pth analog
only ont that stimulates osteoblasts but long term exposure inc osteoclasts ??? |
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cinecalcet is a
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ca++ mimetic- dec pth secretion
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raloxifene is an
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estrogen analog- inh osteoclast activty an assoc with pulmonary emboli
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Vit D is made active by the
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UV light
liver kidney---->makes calcitriolwhich leads to inc Ca++ abs fro kidney and liver and inc in pth |
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relative efficacy of Ostoporosis agents...
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Pth analog(teripari)>
Bis(alendronate)> Estrogen ana(relox)> Calcitonin |
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cornerstone of Diabetes tx
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diet
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short acting insulins
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crystalline insulin
lispro aspart glulisine |
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intermediate acting insulins
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isophane (NPH)
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long acting insulins
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detemir
glargine |
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First gen sulphonylureas
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(amide)
tolbutamide-6-12 hrs acetohexamide tolazamide chlorpropamide-60 hrs |
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2nd gen sulphonylureas
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"gli or Gly"
glipizide glyburide glimepiride |
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Sulphonylurea like cmpnds
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glinides
repaglinide natglinide -used right before meals\ |
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hypoglycemia is mor common with
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longer duration drugs
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The Incretin Enhancers include
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EX SIT LIRA
exenatide-analog of GLP-1, not met by DPP4,2x a day sitagliptan- inhibits DPP4, Liraglutide- analog 1X a day |
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Insulin enhancers
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Metformin-inc gluc receptors, muscles use more
se-lactic acidosis Thizolidinones-- Rosi and Pio glitazone bind PPAR, inc insulin rec |
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metformin
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inc gluclose rec, dec gluclose prod by liver
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rosi and pio glitazone
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inc insulin recptors and binding PPAR
SE- wt gain, macular edema, CHF |
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Gluclose Abs delayers include
(Fat bastards, almost as bad as that fat blocking anal leakage shit) |
Acarbose and
Migitol--alpha-glucosidase inhibitors prAMLINtide0 Amylin analog-- decrease appetite by slowing down gastric emptying se-severe hypoglycemia |
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How do u treat GERD?
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antacids
H2 blockers Proton pump inh |
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What contributes to Peptic Ulcers?
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Gentic factors Inc susceptibilty
H. pylori glucocorticoids NSAIDS Smoking Strress |
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h2 blockers
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idines
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Atropine and Prpantheline are
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cholinergic blockers to dec acid production
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H+ inhibtors
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"Prazoles"
all are weak bases to stay in parietal cells prodrugs that inhibit enzyme H+/K+ pump atpase |
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prazoles se
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hypochlorhydria- too little H+
leads to dec ca++ abs and dec bone density |
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Antacids=
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NaHCO3- systemic alkinzation w Na+ compounds
CaCO3- constipation Al(OH)3 constipation Mg(OH)3- laxative |
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mylanta=
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Al(oh)3 (const) and Mg(OH)3 (lax
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Sulcralfate
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becomes viscous in acid, , should not be given w/ acid depleters
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Bismuth Subsalicylate se
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darkening of feces, tongue and teeth
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Ab for H. pylori
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mtronidazole, amoxicillin, and tetra cyclin
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PGE2 analog=
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misoprostole, Pgs essential for mucous production, bicarbonate
used in NSAID induced ulceration but is an aborticant |
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Agents that cure Gastroparesis-delayed gastric emptying
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Metoclopromide- DA and 5HT blocker
se-parkinsons like symptoms Erythromycin- acts on motilin receptors in intestines se- ototoxicity |
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Erythromycin
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acts on motilin receptors in intestines se- ototoxicity
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Metoclopromide-
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DA and 5HT blocker
se-parkinsons like symptoms |
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never give laxatives to someone with
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undiagnosed belly pain
laxs are often abused (gretchen) |
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Classes of laxatives (cathartics)
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stool softeners(DSS,mineral oil,
Bulk addind agents (bran,methyl celluylose,pyllium, and polycarophil) Gastric Irritants(anthraquinones, castor oil, bisacodyl osmotic agents-MgSO4, polyethylene glycol, lubiprostone |
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Dont use mineral oil
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it causes impairment of fat sol vitamins and causes aspirationpneumonia in elderly
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bulk adding agent include...
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bran,
methylcellulose, peyllium, polycarbophil |
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anthrquinones are natural products
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gastric irritants and include: aloe, senna , cascara
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bisacodyl acts by
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activating the gut nervous system (enteric system)
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lubiprostone is a
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PGE analog
se- nausea and ab distention |
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Adverse effects of cathartics include...
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fluid imbalance
colitis(mucosal injury)malabsorbtion if u stop them might get constipation |
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Anti Diarrhea agents are
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narcotics(opiods- morphine or codiene,diphenoxylate,loperamide)
absorbing agents(bismuth subsalicylate) Anticholinergics(atropine and scopolamine) Misc(simethicone) |
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opiods cause
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non rhythmic gut contractions
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diphenoxylate
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does not enter cns, but high doses it does tkae with atropine
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loperamide
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no cns, fewer opiate like effects
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what absorbs bacterial endotoxin
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bismuth subsalicylate
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simethicone is a
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somatostatin analog, dec in int hormones, slowing of gut
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IBS
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some take lax and some take anti diarreal to tx
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How to cure Inflammatory bowel disease?(crohns and ulcerative colitis)
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salicylates (sala)- inh COX
glucocorticoids(predisnone) infliximab others-methotrexsate, 6Mp (azathioprine), cyclosporine |
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Ipecac
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makes u puke, abused by pt w eating disorder
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Anti Emetics include
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Anti histamines(didphehydromine,dimenhydramine, meclizine)
Anticholinergics(scopolamine patch, blocks musc receptor) THC D1 blockers(procloperazine se-extrpyramidal effects)******* 5HT receptor blockers(ondansetron se constipation) Inh of Neuroknin receptors (aprepitant) |
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Anti histamines(
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didphehydromine,dimenhydronate, meclizine)
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5HT receptor blockers
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ondanSETRON se constipation
SelectivE TeRmination Of Nausea |
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Inh of Neuroknin receptors (
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aprepitant)
antiemesis |
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thiamine (B1) def
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beri-beri; Wernicke's encephalopathy- nystagnus
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riboflavin (B2) def
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dermatitis; angular stomatitis
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niacin (B3) def
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pellegra- dermatitis, diarrhea, dementia
toxicity-flushing and itching |
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pantothenic acid (B6) def
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"burning feet" syndrome
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folic acid
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megaloblastic anemia; neural tube defects- spinal bifida
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cyanocobalamine (B12)
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pernicious anemia; neuronal damage
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ascorbic acid (vit C)
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scurvy
too much- kidney stones |
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vitamin A
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blindness; damgae to rods in eye
tto much-inc in intracranial pressure, inc in Ca++ dep, cirrhosis, teratogen |
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vitamin D
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rickets
too much-↑↑ Ca2+ mobilization → hypercalcemia |
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vitamin E
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hemolytic anemia of newborns
too much- dec clotting |
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Flax seed/ oil is good for
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regularity
it may dec in Hba1c dec in cholesterol dec symptoms of menopause |
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ginko is used for
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cerebral insuffiency, dementia
*it can interact w coumadin(warfarin) |
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ginseng
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inc in energy, no clear effect
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garlic
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could dec blood lipids,
comtains allicin *may induse p450 |
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echinecea is good for
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upper resp infection
can have allergic rxns! |
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St John's wart
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moderate depression or anxiety
(Hyperfaracin- inh reuptake of 5HT DA NE) *Activate p450, may interact w other cns drugs |
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Saw palmetto
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BPH
inh testosterone reductase |
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Soy txs
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Hyperlipidemia, hot flashes, it is met. to an estrogen like compound
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ephedrine
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nasal decongestant
alpha and beta agonist, inc NE |
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valerian
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sedative, may inh gaba transminase (inc GABA)
se-drowsy, withdrawal effects |
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Kava Kava
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antianxiolytic
se-liver damage ( diazepam) |
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why haven't they sent a woman to the moon yet?
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it doesnt need to be cleaned
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How does a guy know if he has a high sperm count?
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If the girl has to chew, before she swallows.
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What does an airport and an abortion have in common?
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the hanger
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What do you call it when someone farts in a gay bar?
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A love call.
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What do tight pants and a cheap motel have in common?
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No ball room
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What is the difference between a Harley and a Hoover?
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The position of the dirt bag.
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What's the difference between a Trisket and a lesbian?
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A Trisket is a snack cracker and a lesbian is a crack snacker
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