ANS Flashcards by Bashar Qasem

MAO-B present in …….. And more active on ………

Brain…. Dopamine

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Parkinsonism is treated by inhibition of MAO-B (e.g. ………) and COMT (e.g. ……..) enzymes.

Selegiline..and.. Tolcapone

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Botulinum toxins lead to blocks ACh release and causes skeletal muscle paralysis…. True or False

True

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Which of the following cases we can administrated by Adrenaline :
Anaphylactic shock
Acute bronchospasm
Cardiac arrest
With local anesthetics
Cardiogenic shock

First four cases

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Contraindications of Adrenaline are :
Presence of Hypotension
Ischemic heart disease
Cardiac arrhythmia
Uses of digitalis
Acute pulmonary edema
Cardiac outflow obstruction
Thyrotoxicosis

1- true d.t cause cerebral hemorrhage
2-true
3-true ( cause ventricular fibrillation)
4- true ( cause vent. fibrillation)
5- false (it’s a side effect of Adrenaline)
6- true
7- true

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Norepinephrine act mainly on…and….
In Acute hypotensive states give NE by…………..to cause VC

a1 and B1
by slow i.v infusion

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Dopamine given by continuous i.v infusion… True or False

True

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Example of selective B1 agonist which use in ttt of cardiogenic shock..?

Dobutamine

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Selective B2 agonists which are non catecholamines..?

Salbutamol, terbutaline, salbutrol, formoterol and ritodrine.

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Salbutamol used in ttt of………..
Ritodrine used in……..

Bronchial asthma
Utrine relaxation and delay preterm labor

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Non-selective B agonist that is rarely used..?

Isoproterenol = isoprnaline

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Selective a1 agonists which have long duration of action (2h), increase SBP & DiaBP, use in correcting Hypotension, and can be used locally as eye or nasal drops ( VC and nasal decongestant)…?

Phenylephrine, methoxamine and medodrine.

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Non-selective a agonist which used locally as eye or nasal drops (slight selectivity to a1 rec)…?

They also have three adverse effect, count them?

Xylometazoline and oxymetazoline

1-Absorbed systemically and produce severe hypertension (so should be avoided in hypertensive patients)
2-Atrophy in prolonged use (>3 weeks)
3-Rebound may occur

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Selective a2 agonists such as…..

Clonidine and tizanidine

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Clonidine are not associated with change in RBF or GFR. It used in two cases…………….and………………
And it has three side effects

Management of hypertension complicated by renal disease
Reduce anxiety accompanying opiate withdrawal

S.E
Sedation, rebound hypertension and salt & water retention.

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Tizanidine found onla in a2 rec. of spinal cord and used as sk.m relaxant in spastic conditions such as………..

Multiple sclerosis, back pain and spine injuries.

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Dopamine receptor agonist act on D1 receptor l.t VD, so that it used to treat emergency hypertension..?

Fenoldopam
Its only side effect is increasing IOP, so that it is danger for glaucoma patient.

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Amphetamine and it’s derivative act indirectly by……
Derivative examples are……… and…….. Mention their therapeutic uses?

Increase outflow of NE, DOPAMINE AND SEROTONIN. And block their neuronal uptake.

Methylphenidate used in ttt of ADHD and MODAFENIL used in ttt of narcolepsy

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Manifestations of cocaine toxicity is managed by

Benodiazepine
It’s only used as eye drops for producing local anesthetics

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Chronic orthostatic hypotension caused by :
1-……..
2-……..
3-……..
4-……..

And treated by :
1-……..
2-……..

Caused by :
Tricyclic antidepressant drugs
a blockers
Diabetes
Autonomic neuropathy

Treated by:
a1 agonist (e.g. Medodrine and phenylephrine)
Ephedrine

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Non-selective a-blockers (e.g. ……..&……)
Its therapeutic uses is………..
Its adverse effects are………..

Phenoxybenzamine and phentolamine

Management of pheochromocytoma

Orthostatic hypotension & reflex tachycardia
Impairment of ejaculation
Miosis

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Pheochromocytoma diagnosed by…….. . And why it treated by a and B blockers such as…………used with………

Drug may act as a and B blocker is called…….

CT scan and VMA

Phenoxybenzamine used with propranolol to prevent excess catecholamines fron acting on a and B receptors.

Labetalol

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Selective a1-blockers (e.g. ………) decrease BP by two ways……….and…….
They cause marked changes in COP, RBF & GFR. (true or false)

Prazosin(prototype), terazosin, doxazosin(longest duration 22h) and tamsulosin(specific to a1A & a1D in sphincters of GIT and UB, and also have a little effect on BP)

Decrease BP by a1-receptor blockade and direct VD of a. & v. of sm.m

False (minimum)

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Therapeutic uses of a1-blockers :
-………
-………
-………

Its side effects are:
- ……
- ……
- ……
- ……

moderate hypertension especially in patient with renal failure
congestive heart failure d.t. decrease afterload and preload
benign prostatic hyperplasia by tamsulosin d.t. its properties.

S.E
- first dose hypotension or syncope
- fluid retention (ttt by giving diuretic with a1-blockers drugs)
- False positive test for rheumatoid arthritis
- worsen incontinence in females

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Selective a2-blockers (e.g. .........) sometimes used as............

Yohimbine As aphrodisiac

Natural and semi-synthetic ergot alkaloids : - - - - - - - Absorption of ergotamine increases by caffeine (T Or F)

Ergotamine Ergometrine Ergotoxine Dihydroergotamine Methylergometrine Dihydroergotoxine Bromocryptine T

Mention receptors of the following drugs: ergotamine, Methylergometrine, Dihydroergotoxine Bromocryptine.

Partial agonist on a- and 5-HT receptors Agonist on a-receptors Antagonist on a-receptors Agonist on dopamine receptor

Acute migraine treated by............which should be given at the start of....... , and combined with caffeine to......... If given as prophylaxis, it will lead to................. Its effects are long lasting and cumulative (T or F)

Ergotamine Aura Increase Absorption Induce VC of cerebral Bl.vs leading to migraine (T)

Methylergometrine used in postpartum hemorrhage definitely in the..........stage of labor.

Third

Therapeutic uses of Bromocryptine?

Suppress normal lactation and in parkinson's disease as dopamine alternative

Therapeutic uses of Dihydroergotoxine?

Cerebral VD in senile cerebral insufficiency.

S.E of ergot alkaloids : - - - -

Nausea and vomiting (by stim. of CTZ) High doses l.t. VC of small aa. Of fingers causing gangrene. VC of coronary artery causing angina pain Abortion if given during pregnancy

Drugs used in acute attack of migraine :

Ergotamine, Dihydroergotamine and triptans (e.g. Sumatriptan, zolmitriptan)

Effect of stimulation of 5HT1D and 5HT1B by triptans? What occurs if given to Ischemic heart disease patient?

5HT1D inhibit inf. of meningies, pain transmission, and inh. releasing of VD substances 5HT1B cause VC of dilated cerebral vessels. Recover during 2h. Causing coronary spasm (contraindicated).

Drugs used for prophylaxis of migraine? - - - -

Propranolol most commonly Calcium channels blocker Clonidine Tricyclic antidepressant drugs

Non-selective B-blockers : Popranolol Atenolol Timolol Pindolol Nebivolol Nadolol Sotalol

All true except 2 & 5 Popranolol is prototype and lipophilic Atenolol is hydrophylic(long half life)

Cardio-selective B1-blockers: Popranolol Sotalol Atenolol Metoprolol Carvedilol Nebivolol Bisprolol

All true except 1,2&5

B-blockers with additional VD action : Popranolol Carvedilol Metoprolol Dilevalol

2&3 are true VD occur due to block a1 receptor, increase synthesis of PGE2 and PGI2, and increase release of NO

B-blockers decrease BP due to: - - - - - -

-⬇️ COP (B1) -⬇️ Renin release(B1) -⬇️ norepinephrine (B2) - they cause resetting of barroceptors at lower level -⬆️ synthesis of PGI1 &PGE2 - they also block a1 receptors

B-blockers drug that have excellent effect in ttt glaucoma (⬇️IOP)?

Timolol or betaxolol

Give specific properties for the following drugs: -propranolol -Pindolol -esmolol -labetolol -carvedilol -nebivolol

- has local anesthetics (membrane stabilization) action i.e. inhibit excitability of Cardiac muscle. - is partial agonist (not cause excessive bradycardia) -act for only 10 minutes then hydrolysis by plasma esterases. Used to control arrhythmia during emergency -blocks a- and B- receptors -additional antioxidant action -most selective B1 blocker and ⬆️NO causing VD.

How B-blockers can treat classic angina and acute MI?

-⬇️ contractility, HR, systolic BP, Cardiac work and oxygen demands -⬆️ diastolic (coronary) filling time - redistribution of blood in Ischemic region - improve cardiac metabolism by metabolic switching

Therapeutic uses of B-blockers? - ttt of hypertension - Ischemic heart disease such as classic angina or acute MI - cardiac arrhythmias such as supraventricular and thyrotoxic arrhythmia - hypertrophic outflow cardiomyopathy - hyperthyroidism - Esophageal varies due to liver cirrhosis - open angel glaucoma

All are correct, can you mention their mechanism of treating

S.E. of B-blockers?

Fatigue Bradycardia Peripheral Ischemic and cold extremities Hypoglycemic effect(mask tachycardia and tremors)

Absolute Contraindications of B-blockers : Acute chronic heart failure Bronchial asthma Diabetes mellitus Prinzmetal's angina Peripheral vascular diseases Any degree of heart block Atheletes involved in strenuous sports

1,4,5&7 are false ( considered as relative contraindications) Others are true

Therapeutic uses of a-methyldopa and why?

Hypertension in pregnancy, because of its long and reliable track record.

Drug that blocks vesicular uptake of NE, DOPAMINE & SEROTONIN?

Reserpine If we give MAO inhibitors with it, Acute hypertensive crisis will occur.

Mention the muscarinic and nicotinc receptors, their sites and mechanism of action..?

See teble page 45

Muscarinic agonist : Lobeline Carbachol Physostigmine Bethanecol Pilocarpine Donepezil Cevimeline

1,3 & 6 are false

Nicotine agonist : Nicotine Lobeline Pyridostigmine Donepezil Varenicline

3 and 4 are false

Reversible ChE inhibitors : Popranolol Physostigmine Neostigmine Lobeline Donepezil Pyridostigmine

1&4 false

Irreversible ChE inhibitors are organophosphate compounds (T or F)

(T)

Carbachol acts only on muscarinic receptors(T or F) Mention uses of it..?

False, also nicotinc receptors Eye drops to ⬇️ IOP in glaucoma

Bethanecol acts on............receptors. And it's used in......

M only (mainly M3 of GIT and UB). Post operative urinary retention and paralytic ileus (in absence of organic obstruction). N.B. Bethanecol administrated orally or s.c., but not i.v. or i.m. (it will l.t. Cardiac arrest M2 receptors)

Cevimeline and Pilocarpine : Acts only as muscarinic agonist (.....) Their therapeutic uses are.......

True (mainly M3 of all secretory glands) Use to ⬆️ salivation and ⬇️ dry mouth (xerostomia) associated with Sjogren syndrome. Also Pilocarpine used as eye drops for ⬇️ IOP

Adverse effects of muscarinic agonists: - D..... - U..... - M.... - B..... - E...... - L...... - S......

Diarrhea Urination Miosis Bradycardia and bronchospasm Emesis or vomiting Lacrimation Salivation and sweating

Contraindications of muscarinic agonists : - - -

Peptic ulcer Bronchial asthma Utrinary retention by organic obstruction

Small doses of Nicotine will STIMULATE Autonomic ganglia leading to : - hypotension - tachycardia - ⬆️ GIT peristalsis and HCl secretion - CNS stimulation Toxic amount of Nicotine will lead to hypotension and CNS blockade (...)

All are true except hypotension is false (hypertension) (true)

How smoking ⬆️ BP..?

Nicotine stim. symp. ganglia and suprerenal medulla to sec. catecholamines Nicotine also stim. ADH release from pit. gland Tobacco smoke accelerates atherogenesis in vascular endothelial

Varenicline is partial agonist used for............. It's contraindicated in............

Smoking cessation Pregnancy and breast feeding

Physostigmine is : Tertiary amine (...) Has muscarinic, nicotinc and central effects (...) Its therapeutic uses are....

True True 1-As local eye drops in glaucoma to produce miosis (⬇️ IOP) 2-Reverse central and peripheral manifestations of ATROPINE POISONING.

Neostigmine is: Quaternary amine (...) Not have central effects (...) Its therapeutic uses......

True True 1-Use to reverse post operative urinary retention and paralytic ileus 2-Reverse post operative muscle paralysis resulting from using non-depolarizing neuromuscular blockers 3-Treatment of Myasthenia Gravis (use it with atropine to prevent unwanted muscarinic effects)

Why Pyridostigmine is preferred than Neostigmine?

1-More selective action on NMJ (fewer unwanted muscarinic effects) 2-Longer duration of action

Duration of action of Edrophonium is........ And its therapeutic uses are.......

Short (5-15 min) Diagnosis of Myasthenia Gravis (Tensilon test)

Donepezil and rivastigmine are more selectively on..............enzyme, and used in...........

Central AChE Alzheimer's disease

Organophosphate compounds include: - drugs (e.g. ..........) - insecticides (e.g. ........) - nerve gases (e.g. ........)

- echophiophate ( the only non-absorpable organophosphate) and used as eye drops for glaucoma - parathion and malathion - sarin and soman

Manifestations of organophosphate toxicity? How to manage them?

D U M B E L S 1-Artificial respiration 2-Gastric lavage and skin wash 3-⬆️ BP by i.v normal saline 4-The triad : atropine - pralidoxime - diazepam