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Pharm Test 2 > 9/18 > Flashcards

9/18 Flashcards

1
Q

Pralidoxime is what is going to be beneficial to someone who has

A

organophosphate overdose

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2
Q

If you have nicotine toxicity it is probably due to what type of ingestion?

A

eating them

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3
Q

if you have a muscarinic overdose, give

A

atropine

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4
Q

Why is there not much use for ganglion blockers?

A

It affects both the SNS and PNS because ACh is released in all ganglion

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5
Q

What is atropine derived from?

A

Belladona

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6
Q

ACh has what effect on the pupil?

A

constricts it

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7
Q

Atropine has what effect on the pupil?

A

dilates it

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8
Q

Atropine has L and D isomer but it is given as a

A

racemic mixture because the D isomer will switch to the L isomer which is 100X more potetent than d isomer

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9
Q

atropine is a

A

competitive inhibitor of muscarinic receptors for ACh

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10
Q

scopolamine is similar to

A

atropine

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11
Q

scopolamine is used to treat

A

nausea

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12
Q

What are examples of when we have an overproduction of parasympathetic response?

A

bradycardia
increased respiratory secretions
Increase in GI activity
constriction of airways
excessive eye watering
excessive urination (micturation)

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13
Q

What is cycloplegia?

A

the paralysis of ciliary muscle

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14
Q

scopolamine drops in the eye induce what? and reduces what?

A

cycloplegia
accommodation (flattening of the lens to adjust for near and far vision)
and eye watering

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15
Q

what is the difference between atropine, scopolamine, and tropicamide?

A

the duration
atropine: 7-10 days
scopolamine: 3-7 days
Tropicamide: 0.25 days

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16
Q

What is tropicamide used for?

A

short acting dilation of the pupil during a routine eye exam.

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17
Q

In low doses of atropine, pharmacologists assume that the dip in heart rate is due to

A

atropine effects the presynaptic muscarinic cell which releases ACh more than it’s effecting the effector cell.

Atropine comes in and increases the amount of ACh, slowing down the heart rate.
With larger doses we see the effect of atropine blocking the effector cell receptors and not allowing ACh to reach it, therefore speeding up heart rate

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18
Q

contraindications to atropine

A

glaucoma patients= blindness
elderly men (BPH)=Urinary retention

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19
Q

anticholinergic toxidrome

A

hot as a hare
blind as a bat
dry as a bone
red as a beet
mad as a hatter (confusion and hallucinations)

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20
Q

What is another name for antinicotinic drugs? if they target both Nm and Nn

A

ganglion blocking drugs

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21
Q

What is a ganglion?

A

a cluster of cell bodies in the PNS

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22
Q

Where do muscle relaxants work?

A

The nicotinic muscular receptors in the neuromuscular end plate of skeletal muscles

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23
Q

muscular relaxants work in 2 different ways

A
  1. depolarizing muscle relaxant
    -depolarizes the neuromuscular endplate and does not allow it to repolarize

2.nondepolarizing muscle relaxant
-block ACh receptors
- can have short, intermediate, or long effects
curare derivatives

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24
Q

Succinylcholine

A

acts as a really strong ACh receptor agonist
BECAUSE it doesn’t get broken down at the NMJ. This causes it to stay longer in the synapse and then push a phase 1block into a phase 2 block

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25
Q

How is succs broken down?

A

by cholinesterase in the plasma within 5-15 minutes

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26
Q

What is phase 1 block?

A

depolarization and lack of repolarization

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27
Q

what is phase 2 block?

A

depolarization happens but the NMJ adapts and finally repolarizes

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28
Q

non-depolarizing muscle relaxants work by

A

blocking the effects of ACh

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29
Q

non-depolarizing muscle relaxants originated from

A

poisonous dart frogs in south America

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30
Q

non-depolarizing muscle relaxants are

A

competitive antagonists

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31
Q

What are the 2 non-depolarizing muscular blockage reversal agents?

A

Neostigmine
Sugammadex - for roc and vec

32
Q

How does sugammadex work to reverse vec and roc?

A

it is a cyclic molecule that wraps itself around the vec and/or roc and keeps it from interacting with the ACh receptor

33
Q

How does neostigmine work?

A

It blocks AChE so that ACh is not broken down and therefore we have more ACh in the system

34
Q

Where does epinephrine come from

A

adrenal medulla

35
Q

what are the catacolamines?

A

epi
norepi
dopamine
dobutamine
isoproterenol

36
Q

what is a catacol group?

A

a benzine ring with 2 OH groups

37
Q

catecholamines have maximal activity at

A

adrenergic receptors (receptors that bind to epi, norepi, dopamine, isoproterenol)

38
Q

substitution greatly reduces

A

potency

39
Q

Why can’t you take epi or norepi orally?

A

because catecholamines are inactivated by COMT (Catechol-O-methyltransferase) found in the stomach

40
Q

What is COMT

A

Catechol-O-methyltransferase

41
Q

How is phenylephrine different from epinephrine?

A

It is missing an OH group, making it NOT a catecholamine meaning it does NOT get broken down by Catechol-O-methyltransferase and can therefore be taken orally

42
Q

What does a substitution at the alpha carbon do?

A

It changes the drug and give it a prolonged action by blocking oxidation by Monoamine oxidase (how NE is broken down)

43
Q

what is the order of chatacholamine drugs that bind to alpha receptors strongest to weakest?

A

Epi>=norepi>isoproterenol

44
Q

what is the order of chatacholamine drugs that bind to beta receptors strongest to weakest?

A

isoproterenol>epi>= norepi

45
Q

when you see B2 think

A

lungs

46
Q

beta 1 has equal affinity for

A

epi and norepi

47
Q

beta 2 has greater affinity for ___ than ____

A

epi than norepi

48
Q

Dopamine Gs

A

increases cAMP

49
Q

Dopamine Gi

A

decreases cAMP

50
Q

Overall effect of alpha 1

A

vasculature smooth muscle contraction = higher bp

51
Q

Overall effect of alpha 2

A

adrenergic and cholinergic nerve terminal inhibition of transmitter release= relaxed

52
Q

Overall effect of beta 1

A

heart, juxtaglomerular cells= increased force and rate of heart and increase renin

53
Q

Overall effect of beta 2

A

respiratory, uterine, vascular smooth muscle= smooth muscle relaxation

54
Q

Overall effect of dopamine

A

smooth muscle dilates renal blood vessels

55
Q

with beta 3 think

A

fat

56
Q

What is Cardiac output?

A

CO5L/min

57
Q

What is the sterling law?

A

the more stretch that is applies, the more forceful the contraction will be

58
Q

alpha agonist effects on vascular resistance, cardiac, and blood pressure?

A

Increased
mixed
increased

59
Q

beta agonist effects on vascular resistance, cardiac, and blood pressure?

A

decreased
increased
decreased

60
Q

mixed beta and alpha agonist effects on vascular resistance, cardiac, and blood pressure?

A

mixed
increased
increased

61
Q

Blood vessel tone in most blood vessels vs. skeletal blood vessels

A

most blood vessels a primarily alpha 1-contract
most skeletal vessels are primarily beta 2-relax

62
Q

Blood vessel tone in most blood vessels vs. skeletal blood vessels during Sympathetic response

A

most blood vessels a primarily alpha 1- contract
most skeletal vessels are primarily beta 2-relax

63
Q

Blood vessel tone in most blood vessels vs. skeletal blood vessels during Parasympathetic response

A

most blood vessels a primarily alpha 1- relax
most skeletal vessels are primarily beta 2-relax

64
Q

the dilator muscle in the eye has what receptors?

A

alpha

65
Q

what drug class decreases aqueous humor?

A

beta blocker eye drops

66
Q

what receptors are in the bronchial smooth muscle?

A

beta2

67
Q

what do beta 2 agonists do?

A

bronchodilation

68
Q

both alpha and beta stimulation ____ the GI tract

A

relax

69
Q

Epi works on both

A

beta1 and beta 2. mixed agonist

70
Q

norepinephrine has less effects on________ than epi and therefore has little respiratory effects

A

beta 2

71
Q

isoproterenol mainly effects

A

beta as a vasodilator
very little alpha

good if you want to increase cardiac output but not effect the bp this is a better option

72
Q

Dopamine is a mixed agonist based on

A

dose.
low dose= decrease peripheral resistance
high dose= mimics action of epinephrine

73
Q

Dobutamine is selective for which receptor?

A

Beta 1

74
Q

Phenylephrine is selective for

A

alpa

75
Q

what drug can be used for tetralogy of fallot?

A

phenylephrine raises BP

-holes in the heart that allows oxygenated and deoxygenated blood to mix in the heart

76
Q

What receptor does midodrine focus on?

A

alpha 1

77
Q

examples of sympathomimetics?

A

Direct:
Epinephrine
Norepinephrine
Isoproterenol
Dopamine
Dobutamine
Phenylephrine
Midodrine
Clonidine
Dexmedetomidine
Ephedrine

Indirect:
Amphetamine
Cocaine

Pharm Test 2 (9 decks)

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