NEET MDS Lessons
Pharmacology
Agonist, Antagonist, and Partial Agonists
Agonists: molecules that activate receptors. A drug that mimics the body's own regulatory processes.
Antagonists: produce their effects by preventing receptors activation by endogenous regulatory molecules and drugs. Block activation of receptors by agonists.
Noncompetive Antagonist: Bind irreversibly to receptors, and reduce the maximal response that an agonist can elicit.
Competitive Antagonist: Bind reversibly to receptors, competing with agonists for binding sites.
Partial Agonists: Have moderate intrinsic activity, the maximal effect that a partial agonist can produce is lower than that of a full agonist. Act as antagonists as well as agonists.
PSEUDOEPHEDRINE
Pseudoephedrine appears to have less pressor activity and weaker central nervous system effects than ephedrine. It has agonist activity at both β1 and β2 adrenoceptors, leading to increased cardiac output and relaxation of bronchial smooth muscle.
Pseudoephedrine is rapidly absorbed throughout the body. It is eliminated largely unchanged in urine by N-demethylation.
It is indicated in symptomatic relief from stuffed nose, respiratory tract congestion, bronchospasm associated with asthma, bronchitis and other similar disorders.
Class IV Calcium Channel Blockers
• Block the movement of calcium into conductile and contractile myocardial cells
• Treatment: treatment of supraventricular tachycardia
– Diltiazem
– Verapamil
Adverse Effects
• Adverse effects associated with vasodilation of blood vessels throughout the body.
• CNS – dizziness, weakness, fatigue, depression and headache,
• GI upset, nausea, and vomiting.
• Hypotension CHF, shock arrhythmias, and edema
Ketoconazole
synthetic antifungal drug
used for infections such as athlete's foot, ringworm, candidiasis (yeast infection or thrush), jock itch.
Ketoconazole is used to treat eumycetoma, the fungal form of mycetoma.
MOA: Ketoconazole is imidazole structured, and interferes with the fungal synthesis of ergosterol, the main constituent of cell membranes, as well as certain enzymes. It is specific for fungi, as mammalian cell membranes contain no ergosterol.
Sensitive fungi Ketoconazole inhibits growth of dermatophytes and yeast species (such as Candida albicans).
Ketorolac
Mechanism of action
primary action responsible for its anti-inflammatory/antipyretic/analgesic effects is inhibition of prostaglandin synthesis through inhibition of the enzyme cyclooxygenase (COX). Ketorolac is not a selective inhibitor of COX enzymes
Indications: short-term management of pain
Contraindications
hypersensitivity to ketorolac, and against patients with the complete or partial syndrome of nasal polyps, angioedema, bronchospastic reactivity or other allergic manifestations to aspirin or other non-steroidal anti-inflammatory drugs (due to possibility of severe anaphylaxis).
Insulin
Insulin is only given parenterally (subcutaneous or IV) Various preparations have different durations of action
|
Preparation |
Onset (hrs) |
Peak (hrs) |
Duration (hrs) |
| Lispro (rapid-acting) | 15 min | 0.5-1.5 | 3-4 |
| Regular (short-acting) | 0.5-1 | 2-4 | 5-7 |
| NPH (intermediate) | 1-2 | 6-12 | 18-24 |
| Glargine (long-acting) | 1 | None | >24 |
Mechanism
bind transmembrane insulin receptor
activate tyrosine kinase
phosphorylate specific substrates in each tissue type
liver
↑ glycogenesis
store glucose as glycogen
muscle
↑ glycogen and protein synthesis
↑ K+ uptake
fat
increase triglyceride storage
Clinical use
type I DM
type II DM
life-threatening hyperkalemia
increases intracellular K+
stress-induced hyperglycemia
Toxicity
hypoglycemia
hypersensitivity reaction (very rare)
Insulin Synthesis
first generated as preproinsulin with an A chain and B chain connected by a C peptide.
c-peptide is cleaved from proinsulin after packaging into vesicles leaving behind the A and B chains
Examples of calculations of doses of vasoconstrictors
Ratio concentrations represent grams per millilitre
1:100,000 = 0.01 mg/mL or 10 µg/mL
1:200,000 = 0.005 mg/mL or 5 µg/mL
1:50,000 = 0.02 mg/mL or 20 µg/mL
1 cartridge of epinephrine 1:200,000 = 9 µg
1 cartridge of epinephrine 1:100,000 = 18 µg
1 cartridge of epinephrine 1:50,000 = 36 µg
1 cartridge of levonordefrin 1:20,000 = 90 µg