DRUGS

misc

100

What chemical substances/neurotransmitters
signal that a noxious stimulus has occurred
and should be perceived as pain? Where are
they located?

Substance P

>At receptor (sensitizer), inflammation,

vasodilation

>Dorsal horn (neurotransmitter)

Glutamate

>Dorsal horn (neurotransmitter)

200

What chemical substances or
neurotransmitters can INHIBIT the
perception of noxious stimuli?(3)

 Endogenous opioids
(Enkephalins/Endorphins)
 Serotonin
 Norepinephrine

300

The four stages of anesthesia

analgesia, excitement, surgical anesthesia
and medullary depression

400

•There is a _____
correlation between MAC
and potency

inverse

MAC: the alveolar partial
pressure that abolishes a
movement response to surgical
incision in 50% of patients

500

There is a _____ correlation between speed of induction and solubility

example of high v low?

inverse

NO = low solubility

halothane = high solubility

Speed of induction is dependent on :
•Solubility=B-G partition coefficient
(more soluble=slower),
•Alveolar Ventilation
•Concentration (%) of inhaled
anesthetic
•The more rapidly a drug equilibrates
with the blood, the more quickly the
drug passes into the brain to produce
anesthetic effects

relationships to drugs

100

A physiological state in which abrupt drug
cessation or the administration of an
antagonist will precipitate a withdrawal
(abstinence) syndrome.

What is Physical Dependence?

200

A physiological phenomenon in which a
higher dose of a drug is required to produce
an effect, as a result of prior administration.
Shortening on efficacy interval.

What is Tolerance?

300

Psychological dependence and substance
abuse. A medical and psychosocial
phenomenon characterized by loss of
control over intake, preoccupation with
supply, continued use despite medical harm.

What is SUD?

400

Diazepam can be used to treat what two types of withdrawal?

BDZ and ETOH

500

All the inhaled and IV induction agents
(except _____ and _______) act at the _____ receptor

ketamine, opioids, GABAa

townies

100

Esters in general are metabolized by

Plasma pseudocholinesterases

200

Amides metabolized by?

Microsomal P-450

300

Local Anesthetic Mechanism of action

Block voltage-dependent  sodium channels thus preventing depolarization Work best when the axon is firing.

Non-ionized form crosses the lipid membrane. But the ionized form in the cytoplasm is the more effective blocking entity.

400

Local Anesthetic system Toxicity timeline of events

PLASMA CONCENTRATION (µg/mL) | EFFECT

-----------------------------|------------------------------------

1–5                          | Analgesia

5–10                         | Lightheadedness, Tinnitus, Numbness of tongue

10–15                        | Seizures, Unconsciousness

15–25                        | Coma, Respiratory arrest

>25                          | Cardiovascular depression

500

this fiber type is most susceptible to blockade

small myelinated fibers

today

100

the difference in MOA between methylphenidate and amphetamine

• Methylphenidate: Primarily blocks the reuptake of dopamine and norepinephrine at the presynaptic neuron, increasing their availability in the synaptic cleft.

• Amphetamines (dextroamphetamine, mixed amphetamine salts): Increase the release of dopamine and norepinephrine from presynaptic storage vesicles and block their reuptake, leading to higher concentrations of these neurotransmitters in the synaptic cleft.

200

The difference in MoA between Atomoxetine and 

Clonidine and Guanfacine

• Atomoxetine

  • Selective norepinephrine reuptake inhibitor (NRI): Increases extracellular levels of norepinephrine (and to a lesser extent dopamine) in the prefrontal cortex by preventing its reabsorption into presynaptic neurons.

• Clonidine and Guanfacine

  • Alpha-2 adrenergic agonists: Specifically, they act on alpha-2A receptors in the prefrontal cortex. This action helps regulate attention and impulsivity by modulating noradrenergic signaling in brain regions associated with executive function.

300

Stimulant SEs (5)

• Decreased appetite and weight loss (due to appetite suppression)
• Increased heart rate and/or elevated blood pressure
• Insomnia or difficulty sleeping
• Headache
• Irritability, mood swings
• Gastrointestinal discomfort (e.g., nausea, abdominal pain)
• Tics (rare but can be exacerbated in susceptible individuals)
• Potential for misuse or abuse (especially in those with a history of substance use disorder)

400

Clonidine and Guanfacine SEs (2)

Sedation, drowsiness

Hypotension, dizziness

Bradycardia 

Dry mouth

Headache

Irritability or mood changes

500

Sympathomimetic toxicity sx and tx

Stimulant toxicity presents with restlessness, tachycardia, paranoia, psychosis
delusions, hyperthermia, hyperreflexia, seizures, necrotizing
arteritis, cerebral hemorrhage
Susceptibility to temperature extremes:
• Sympathomimetics like cocaine and amphetamines increase
endogenous heat production which increases risk of hyperthermia
during heat waves

Management is supportive, including benzodiazepines for agitation/seizures, IV fluids, cooling measures, and cardiac monitoring.

MCN

100

CNs 2, 3, 4, 6, and V1 branch of CN 5

orbital apex

200

cavernous sinus

CNs 3, 4, 6, and V1 and V2 branches of CN 5

300

cerebellopontine angle

CNs 5, 7, 8 (+/− CN 9 and CN 10)

400

CN 9, CN 10, and CN 11 (+/- 12, horner's)

jugular foramen

500

internal auditory canal

CN 7 and CN 8