NEET MDS Lessons
Pharmacology
Gastric acid secretion inhibitors (antisecretory drugs):
HCl is secreted by parietal cells of the gastric mucosa which contain receptors for acetylcholine (muscarinic receptors: MR), histamine (H2R), prostaglandins (PGR) and gastrin (GR) that stimulate the production, except PGs which inhibit gastric acid production.
Therefore, antagonists of acetylcholine, histamine and gastrin inhibit gastric acid secretion (antisecretory). On the other hand, inhibitors of PGs biosynthesis such as NSAIDs with reduce cytoprotective mechanisms and thus promote gastric mucosal erosion. Also, the last step in gastric acid secretion from parietal cells involve a pump called H+ -K+-ATPase (proton pump). Drugs that block this pump will inhibit gastric acid secretion. Antisecretory drugs include:
1. Anticholinergic agents such as pirenzepine, dicyclomine, atropine.
2. H2-receptors blocking agents such as Cimetidine, Ranitidine, Famotidine, Nizatidine (the pharmacology of these agents has been discussed previously).
3. Gastrin-receptor blockers such as proglumide.
4. Proton pump inhibitors such as omeprazole, lansoprazole.
Major clinical indications of antisecretory drugs:
• Prevention & treatment of peptic ulcer disease.
• Zollinger Ellison syndrome.
• Reflux esophagitis.
Lamotrigine (Lamictal): newer; broad spectrum (for most seizure types)
Mechanism: ↓ reactivation of Na channels (↑ refractory period, blocks high frequency cell firing)
Side effects: dizziness, ataxia, fatigue, nausea, no significant drug interactions
Stages of anesthesia
Stage I
Analgesia
Still conscious but drowsy
Stage II
Excitement stage
Loss of consciousness, however, irregular ventilation may be present which affects absorption of inhalation agents.
Reflexes may be exaggerated.
This is a very dangerous stage
Stage III
Surgical anesthesia
Loss of spontaneous movement
Regular, shallow respiration
Relaxation of muscles
Stage IV
Medullary paralysis
Death
Antiarrhythmic Drugs
Cardiac Arrhythmias
Can originate in any part of the conduction system or from atrial or ventricular muscle.
Result from
– Disturbances in electrical impulse formation (automaticity)
– Conduction (conductivity)
– Both
MECHANISMS OF ARRHYTHMIA
ARRHYTHMIA – absence of rhythm
DYSRRHYTHMIA – abnormal rhythm
ARRHYTHMIAS result from:
1. Disturbance in Impulse Formation
2. Disturbance in Impulse Conduction
- Block results from severely depressed conduction
- Re-entry or circus movement / daughter impulse
Types of Arrhythmias
• Sinus arrhythmias
– Usually significant only
– if they are severe or prolonged
• Atrial arrhythmias
– Most significant in the presence of underlying heart disease
– Serious: atrial fibrillation can lead to the formation of clots in the heart
• Nodal arrhythmias
– May involve tachycardia and increased workload of the heart or bradycardia from heart block
• Ventricular arrhythmias
– Include premature ventricular contractions (PVCs), ventricular tachycardia, and ventricular fibrillation
|
Class |
Action |
Drugs |
|
I |
Sodium Channel Blockade |
|
|
IA |
Prolong repolarization |
Quinidine, procainamide, disopyramide |
|
IB |
Shorten repolarization |
Lidocaine, mexiletine, tocainide, phenytoin |
|
IC |
Little effect on repolarization |
Encainide, flecainide, propafenone |
|
II |
Beta-Adrenergic Blockade |
Propanolol, esmolol, acebutolol, l-sotalol |
|
III |
Prolong Repolarization (Potassium Channel Blockade; Other) |
Ibutilide, dofetilide, sotalol (d,l), amiodarone, bretylium |
|
IV |
Calcium Channel Blockade |
Verapamil, diltiazem, bepridil |
|
Miscellaneous |
Miscellaneous Actions |
Adenosine, digitalis, magnesium |
Indications
• To convert atrial fibrillation (AF) or flutter to normal sinus rhythm (NSR)
• To maintain NSR after conversion from AF or flutter
• When the ventricular rate is so fast or irregular that cardiac output is impaired
– Decreased cardiac output leads to symptoms of decreased systemic, cerebral, and coronary circulation
• When dangerous arrhythmias occur and may be fatal if not quickly terminated
– For example: ventricular tachycardia may cause cardiac arrest
Mechanism of Action
• Reduce automaticity (spontaneous depolarization of myocardial cells, including ectopic pacemakers)
• Slow conduction of electrical impulses through the heart
• Prolong the refractory period of myocardial cells (so they are less likely to be prematurely activated by adjacent cells
Isoflurane (Forane) MAC 1.3%, Blood/gas solubility ratio 1.4
- Better muscle relaxation than with the other halogenated anesthetic agents.
- Isoflurane markedly potentiates the action of the neuromuscular blocking agents.
- Produces rapid onset and recovery of anesthesia.
- Does not sensitize the heart to catecholamines.
- Produces respiratory depression, but produces less cardiovascular depression
- than does halothane.
- It has an extremely low degree of metabolism and is apparently relatively
- nontoxic.
NATURAL ANTICOAGULANTS:
1. PGI-2.
2. Antithrombin.
3. Protein-C.
4. TFPI.
5. Heparin.
6. Fibrinolytic system.
Oxytetracycline
Treats Oxytetracycline is a medicine used for treating a wide range of infections including infections of the lungs, urinary system, skin and eyes. It may also be used to treat sexually transmitted infections, infections caused by lice, rickettsial infections, cholera and plague. It is very occasionally used to treat leptospirosis, gas gangrene, and tetanus.