EMT205 Flashcards
1
Q
Tetrahydrocannabinols are what class drug?
A
Schedule I
2
Q
Morphine is what class drug?
A
Schedule II
3
Q
Agency that regulates biological products?
A
Public Health Service
4
Q
Agency that suppresses false or misleading advertising?
A
FTC
5
Q
Science of dispensing drugs called…?
A
Pharmaceutics
6
Q
Study of how a body handles a drug over a period of time?
A
Pharmacokinetics
7
Q
NAVEL stands for…?
A
Naloxone, Atropine, Vasopressin, Epinephrine, Lidocaine
8
Q
What compounds absorbed through skin?
A
Lipid-soluble compounds
9
Q
Drugs distributed first where…?
A
Organs that have rich blood supply (e.g. heart, liver, kidneys, brain)
10
Q
2 processes that create drug reservoirs are called what?
A
Plasma protein binding and Tissue binding
11
Q
Albumin does what to drugs?
A
Traps it in the bloodstream (albumin molecule attaches to drugs, but is too large to pass through cell membrane)
12
Q
“Free drug” is what?
A
The portion of the drug not bound to albumin, and that is thus biologically active
13
Q
What happens as free drugs are eliminated?
A
Drug-protein complex dissociates, and releases more drug into the bloodstream to replace free drug
14
Q
Type of drug with affinity for adipose tissue?
A
Lipid-soluble
15
Q
Blood-brain barrier allows only what type of drug through cell membrane?
A
Lipid-soluble
16
Q
Placental barrier allows what type of drug to pass?
A
Certain non-lipid-soluble drugs
17
Q
Process by which drugs are chemically converted to metabolites is called what?
A
Biotransformation (metabolism)
18
Q
First-pass metabolism is what?
A
Occurs when orally administered drugs travel to the liver and are partially metabolized before entering circulation—reduces amount of drug that enters circulation
19
Q
Drugs excreted by which organ systems? (5)
A
- Kidneys
- Intestines
- Lungs
- Sweat/salivary glands
- Mammary glands
20
Q
Study of how a drug acts on a living organism is called what?
A
Pharmacodynamics
21
Q
Reactive cellular sites known as…?
A
Receptors
22
Q
Therapeutic range for most drugs is what?
A
The concentration that 1. provides for the highest probability of response with 2. the least risk of toxicity
23
Q
Biological half-life is what?
A
The time it takes to metabolize or eliminate 50% of a drug in the body
24
Q
A drug is considered the be eliminated from the body after ___?
A
After 5 half-lives have passed (~3% of the drug will be left in the body—test question will ask “under 5%”)
25
Therapeutic index is what?
A measure of the relative safety of a drug
26
Wide TI indicates what? Narrow TI?
Wide TI = drug is fairly safe
| Narrow TI = drug is fairly dangerous
27
Two drugs that will crystallize when mixed together?
1. Calcium chloride
| 2. Sodium bicarbonate
28
Category ratings for pregnancy patients?
Category A (safest), B, C, D, and X (significant fetal risk)
29
Important difference in infants vs. adults concerning drug distribution?
Infants have more total body water (70-75% compared to 50-60% in adults); means that higher dosages (weight-proportionate) of water soluble drugs may be needed to have effective blood levels in an infant
30
Protein binding - increased or decreased in infants?
Reduced -> greater chance of toxicity in an infant
31
What unit of measurement is used to measure body organs or blood pressure?
Centimeters and millimeters
32
1 gram = ?
= the weight of 1 mL of distilled water at 4 degrees C
33
Primary unit of the apothecary system?
Grain
34
What medications are available in units of the apothecary system? (2)
Aspirin and nitroglycerin
35
Household system: average coffee cup and average teaspoon?
Coffee cup = 5-9 oz
| Teaspoon = 4-6 mL
36
Normal body temperature in degrees C and F?
```
Celsius = 37
Farenheit = 98.6
```
37
Conversion formula: temp C to F?
Multiply by 9/5 and add 32
38
Conversion formula: temp F to C?
Subtract 32 and multiply by 5/9
39
Five patient rights?
1. Right patient
2. Right dose
3. Right drug
4. Right route
5. Right time
40
Ok to give a med from unlabeled container or one on which label is not legible?
Never
41
Ok to give a med that was prepared by someone else?
Never
42
How long should you monitor a patient for any adverse effects after giving a medication?
At least 5 minutes
43
What is the removal or destruction of disease-causing organisms or infected material called?
Medical asepsis
44
Chemical used only on nonliving objects that are toxic to living tissue?
Disinfectants
45
Chemical used on living tissue that are more dilute and prevent cell damage?
Antiseptic
46
What is the most frequent method of drug administration?
Oral
47
How to check that gastric tube has been inserted correctly?
Inject 30-50 mL of air into the tube and auscultate the epigastric region for sounds of air movement
48
After giving drug via gastric tube, what should you do?
Flush the drug with about 30 mL of water
49
Tuberculin syringes marked in what increments?
0.01 mL increments
50
Insulin syringes marked how?
1 unit increments
51
SubQ injections usually given with what size needle?
23- or 25-gauge needle
52
IM injections usually given with what size needle?
19- or 21-gauge needle
53
What did the year 2000 signify in needle-stick prevention?
Congress passed the Healthcare Worker Needlestick Prevention Act, OSHA in 2001 followed up to recommend needleless or "needle safe" devices
54
Single-dose glass containers that hold one dose of medication for injection are called what?
Ampules
55
Why is filter needle used with ampules?
To prevent shards of glass from entering syringe
56
Glass containers with rubber stoppers are called what?
Multidose vials
57
Why do we inject a volume of air into vial equivalent to amount of solution to be withdrawn?
Prevents a vacuum in the vial
58
Procedure to protect fingers when withdrawing solution from an ampule?
Wrap neck of glass ampule with alcohol swab or gauze dressing
59
Procedure for cleansing an injection site with alcohol swab?
Work outward in concentric circles from the site to prevent recontamination
60
Amount usually injected for intradermal injection?
Less than 0.5 mL
61
Common sites for intradermal injection? (2)
Forearm
| Back
62
What to do with skin for intradermal injection? What angle do you go in? Bevel up or down?
Hold skin taut
10-15 degree angle
Bevel up
63
Amount usually injected for subQ injection?
Less than 0.5 mL
64
How to prepare skin for subQ injection?
Elevate slightly by gently pinching site
65
What angle for subQ injection? Bevel up or down?
45-degrees
| Bevel up
66
Why do we aspirate after needle placement on subQ injections?
To ensure we are not in a blood vessel
67
After subQ injection, what can we do to help distribute medication?
Massage site with alcohol swab
68
Maximum volume for IM injection?
5 mL
69
Common muscles used for IM injections? (5)
1. Deltoid (shoulder)
2. Dorsogluteal site (butt)
3and4. Vastus lateralis and rectus femoris (thigh)
5. Ventrogluteal (side of hip)
70
Where in deltoid for IM injection? Avoid what?
Inverted triangle with acromion process as base
| Radial nerve
71
Where in dorsogluteal for IM injections? Do not give here for what age range? Avoid what?
Divide buttock into quadrants, site is upper outer quadrant in center
Do not give for under 3 years
Want to avoid sciatic nerve
72
Where for vastus lateralis and rectus femoris for IM injections?
One hand on upper thigh, one just above knee, thumbs in---site is between thumbs
Rectus femoris is on anterior thigh, vastus lateralis is on lateral aspect of thigh
73
IV---which extremities first?
Upper, then if unavailable, go to lower
74
Which type of needle not advised for prehospital care because stabilizing the needle is difficult?
Hollow (butterfly)
75
What type of needle preferred for prehospital care?
Over-the-needle catheter
76
Incidences of embolism higher at which two IV sites?
Jugular veins in neck
| Long saphenous veins in the leg
77
If second puncture necessary after first IV, place where?
Proximal to first puncture
78
How to place patient for external jugular IV placement?
Supine, head-down, turn pt's head to opposite side
79
What angle for IV needle penetration?
15-20 degrees
80
How to know needle placement correct for IV?
Penetrate until flash (blood return in hub encountered), continue to advance approx. 2mm further before placing catheter
81
Local complications for IV include? (5)
1. Hematoma
2. Thrombosis
3. Cellulitis
4. Phlebitis
5. Sloughing/necrosis
82
Collection of blood at site of injection is what?
Hematoma
83
Blood clot formed inside a blood vessel is what?
Thrombosis
84
A potentially serious bacterial infection of connective tissue is called what?
Cellulitis
85
Inflammation of a vein is called what?
Phlebitis
86
What causes phlebitis? (2)
Catheter too large for vein, or
| Catheter has been left in place longer than 48 hours
87
Why does sloughing or necrosis occur?
Infiltration of some IV medicines (d50, sodium bicarb, promethazine)
88
Separation of tissue called what?
Sloughing
89
Tissue death called what?
Necrosis
90
What are some systemic complications of IV therapy? (3)
1. Sepsis
2. Pulmonary embolism
3. Catheter fragment embolism
91
A bacterial infection in the bloodstream is called what?
Sepsis
92
The sudden blocking of an artery in the lung is called what?
Pulmonary embolism
93
Sudden onset of chest pain, shortness of breath, tachycardia and hypotension can indicate what?
PE
94
How does catheter fragment embolism occur?
Reinsertion of a needle through catheter during IV insertion
95
What to do if you suspect catheter shear?
IV stopped, vein should be palpated for catheter tip, venous tourniquet should be placed above tip to prevent further movement
96
Part of the catheter shears off, allowing embolus to travel in bloodstream--called what?
Catheter fragment embolism
97
How to know you've punctured an artery during IV placement?
Bright red, pulsating blood in catheter hub
98
Coolness around the skin, swelling at puncture site, and sluggish or absent flow rate can indicate what?
Infiltration of an IV site
99
How to check for infiltration?
Fluid reservoir lowered to dependent position, look for blood in tubing (absence of backflow = infiltration)
100
How much air is needed for air embolism? For a critically injured pt?
100 mL
| 10 mL can be fatal for critically injured pt
101
When pushing medications through IV port, how long do you push?
1 to 3 minutes, slowly
102
Drugs administered IO should be followed by what?
Saline flush of at least 5 mL
103
Site of choice for IO is where?
Tibia, just below tubercle on anteromedial surface
104
Alternate site for IO for children? Adults?
```
Children = femur, above lateral condyles in midline
Adults = sternum, just below sternal notch
```
105
Contraindications for IO?
```
Fx at site or proximal to site
Traumatized extremity
Cellulitis
Burns
Congenital bone disease
```
106
When using MDI, how long should pt inhale during administration? How long to hold in lungs? Repeat after how long?
Inhales over 5 sec
Hold breath for 5-10 sec
Repeat in 5-10 min
107
Devices that use the Bernoulli principle to create aerosol mist are called what?
Handheld nebulizers
108
When giving drugs via ET route, how much medication?
2 to 2.5 times the IV dose
109
For ET route, dilute to what?
Dilute to 10 mL with normal saline
110
When giving eye drops, administer where?
Conjunctival sac of lower lid
111
Ear medications: remain in ear up position for how long?
10 minutes to allow medication to disperse
112
Blood samples---ideal time to obtain?
Once IV line established
| Prior to infusing fluids or drugs
113
Face shields are indicated when administering what type of medication?
Endotracheal (ET)
114
Port a Cath is an example of what kind of device?
Implantable access
115
Asthma medications are usually administered via what kind of device?
Metered dose inhaler (MDI)
116
Positioning a child for rectal administration how?
Lateral recumbent, legs flexed
117
Pneumothorax is common complication of cannulating which vein?
Subclavian
118
Proper position of tourniquet should allow what?
Allow arterial flow while occluding venous flow
119
Liquid or solid particles of a substance dispersed in a gas or solution and given as medications are called what?
Aerosol medications
120
Antiseptics and disinfectants kill what?
Specific groups of microorganisms
121
Microdrip set delivers what?
60 drops/mL
122
Emergency medication that can be given via gastric tube?
Activated charcoal
123
Sterilization is recommended for what?
Instruments or devices that penetrate the skin
124
Most common infection resulting from needlestick injury?
Hep C
125
What is the process of aspiration?
Pulling back on plunger to ensure that needle has not been placed in a blood vessel
126
Purpose of using cleaning techniques in the field?
Focus on destroying pathogens
127
Technique for giving medications in less than 1-3 minutes through IV line is called what?
Bolus
128
The use of equipment and fields that are free from all forms and types of life is called what?
Sterile technique
129
Sixth patient right of medication administration is what?
Right documentation
130
Position that promotes gluteal muscle relaxation?
Prone, toes pointing inward
131
IM injection, how to hold skin for injection?
Hold taut
132
Parenteral medication = document medication, dosage, time, route and what?
Site of injection
133
When reconstituting dry powders for injection, what action should you take?
Mix dilutent and powder in the closed vial
134
Buccal medications are administered where?
Between cheek and gum
135
Site used for central venous cannulation?
Subclavian vein
136
Proper way to address infiltration?
Discontinue IV and restart in a different location
137
Source of digoxin?
Plant source
138
Atropine comes from what plant?
Belladonna plant
139
NAVEL drugs?
```
Naloxone
Atropine
Vasopressin
Epinephrine
Lidocaine
```
140
ET drug concentration?
2 to 2.5 times IV dose
141
SubQ intended for what administration?
Slow and sustained effect
142
Which route of administration is subject to first pass metabolism?
Oral
143
A liquid medication that is combined with an alcohol is called what?
Elixir
144
Give an example of a hypotonic solution.
D5W
145
Which cells are responsible for activation of the inflammatory response?
Mast cells
146
Define chronotropic
Drugs that affect heart rate
147
Define dromotropic
Drugs that affect conduction velocity through the conducting tissues of the heart
148
Define inotropic
Drugs that affect the force of cardiac contraction
149
Type of drug that reduces blood pressure by inhibiting the conversion of angiotensin I to angiotensin II
ACE inhibitor
150
Name the different classes of antidysrhythmic drugs (class I-IV)
Class I: Sodium channel blockers
Class II: Beta blockers
Class III: Potassium channel blockers
Class IV: Calcium channel blockers
151
What effect do sodium channel blockers have on the heart?
They work to slow conduction
152
What effect do beta blockers have on the heart?
They reduce adrenergic stimulation of the heart
153
What effect do potassium channel blockers have on the heart?
They increase the contractility
154
What effect do calcium channel blockers have on the heart?
They block inflow of calcium through cell membranes of cardiac/smooth muscle, and decrease contraction and conduction velocity
155
What is the official name of a drug?
Drugs listed in an official publication, followed by either USP or NF
156
pH of the small intestine is greater than pH of stomach---what effect will this have on alkaloid drugs?
Alkaloid drugs will be absorbed more quickly in the small intestine than the stomach
157
What effect will diarrhea have on medication primarily absorbed in the small intestine?
The medication will have decreased exposure and therefore decreased absorption
158
Fibers that release acetylcholine?
Cholinergic
159
Example of a synthetic catecholamine?
Levophed
160
Which medication was given as an example of one that prevents coagulation?
Warfarin
161
Primatene Mist---nonselective adrenergic respiratory medication---one undesirable side effect?
Muscle tremors
162
Side effect from "six hits" off Ventolin inhaler?
Muscle tremors
163
Pt taking Mucomyst likely has what condition?
COPD
164
Benzodiazepines include what actions on the body?
Muscle relaxation, anxiety reduction, sedative, and anticonvulsant
165
Norepinephrine will bind to both adrenergic receptor sites, but has an affinity for which?
Alpha
166
Barbiturates categorized based on what?
Duration of action
167
Benzodiazepines are listed as which category drug?
Schedule IV
168
Benadryl has some anticholinergic properties that may produce which effects?
Tachycardia, constipation, inhibition of secretions, and sedation
169
Beta-1 receptors located where?
Heart
170
Beta-2 receptors located where?
Lungs
171
Drugs cross cell membranes by which process?
Diffusion
172
Decreased physiological response to the repeated administration of a drug, necessitating an increase in dosage to maintain therapeutic effect is called ___.
Tolerance
173
The tendency for repeated doses of a drug to accumulate in the blood and organs, causing increased and sometimes toxic effects is called ___.
Cumulative action
174
How do ACE inhibitors work?
Inhibit conversion of angiotensin I to angiotensin II, renin-angiotensin system is suppressed and bp is lowered
175
Ischemia vs infarct
Ischemia is a state of insufficient perfusion of oxygenated blood to a body organ or part
Unchecked ischemia can lead to infarct (cell death)
176
How do loop diuretics reduce bp in patients?
Inhibit sodium and chloride reabsorption in the loop of Henle, causing excretion of sodium and water to increase
177
Digoxin - mechanism of action?
Digoxin increases calcium concentration to the contractile proteins
178
Parasympathomimetic vs parasympatholytic
- mimetic mimics the actions of the parasympathetic NS
| - lytic blocks the actions of the parasympathetic NS
179
Sympathomimetic vs sympatholytic
- mimetic mimics the actions of the sympathetic NS
| - lytic blocks the actions of the sympathetic NS
180
What actions do these receptors have? Alpha 1, alpha 2, beta 1, beta 2
Alpha 1 = vasoconstriction, increased bp
Alpha 2 = inhibit norepinephrine release, vasoconstriction, increase bp
Beta 1 = increased heart rate and contraction
Beta 2 = smooth muscle relaxation in bronchi
181
The propensity of a drug to bind or attach itself to a given receptor site is known as ___.
Affinity
182
Contraindications vs special considerations
Contraindications are conditions in which it may be harmful to administer the drug
Special considerations are how the drug may affect special groups (peds, pregnant, geriatric populations)
183
Example of a hypertonic solution
D50
184
What is an emulsion?
Fat or oil suspended in liquid with an emulsifier
185
What is a suspension?
Solid particles suspended in liquid (e.g. activated charcoal)
186
Principle cation in ECF?
Sodium
187
Define mitochondria
"Powerhouse of cell"
| Produce 95% of ATP in the cell
188
Define nucleus
Control center of the cell
189
Define cytoplasm
Fluid inside cells
190
What do lysosomes do?
Remove damaged organelles or pathogens inside the cells
191
What does the golgi apparatus do?
Packages and stores secretory products
| Produces lysosomes
192
What has the greatest potential to cause a positive outcome in hypoglycemia?
Dextrose
193
What class of drug is adenosine? Indication?
Antidysrhythmic
| Treats narrow complex
194
Lidocaine is what class of drug?
Sodium channel blocker
195
Concentration for Epi
1:1000
196
Albuterol sulfate works on what receptors?
Beta 2
197
A drug that combines with receptors and initiates the expected response is called ___?
Agonist
198
An agent that inhibits or counteracts effects produced by other drugs is called ___?
Antagonist
199
The ability of the drug to initiate biological activity as a result of binding to a receptor site is what?
Efficacy
200
The combined effect of two drugs such that the total effect equals the sum of individual effects is called what? 1 + 1 = 2
Summation
201
The combined effect of two drugs such that the total effect exceeds the sum of the individual drugs is called what? 1 + 1 = 3
Synergism
202
What would prevent an administered medication from having the desired effect to altering the binding site?
A non-competitive antagonist
203
What is not typically a consideration regarding proper storage of a medication?
Pressure
204
Your pt has WPW syndrome and your partner wants to administer 6 mg of adenosine, you suggest this is incorrect why?
Adenosine will block the AV node, allowing pt to go into v-fib
205
What affects the degree to which stress will cause or affect the pt's response to an illness?
Pt's perception of the stressor
206
What should you NOT expect to respond to a laceration you have sustained on your arm?
Eosinophils
207
Solutes moving from area of high concentration to area of low concentration is...?
Diffusion
208
Potassium ions enter cardiac cells through which process?
Osmosis
209
What systemic complication is associated with peripheral IV therapy?
Pulmonary embolism
210
What would NOT be a factor in determining whether a pt will develop coronary artery disease?
Regular physical activity
211
Atrophy vs hypertrophy
Atrophy is weakening/shrinking through lack of use
| Hypertrophy is enlargement of the cell
212
Compared to trade-name drugs, generic drugs:
Have the same therapeutic efficacy as the trade-name version
213
Act in 1906 that was enacted to protect the public from mislabeled or adulterated drugs?
Pure Food and Drug Act
214
Most absorption of drugs in an enteral route occurs in the ___.
Small intestine
215
Parental drugs are administered:
By injection
216
Lipid-soluble drugs tend to be stored in:
Fats
217
Primary organs of drug excretion are:
Kidneys
218
Removal or destruction of disease-causing organisms or infected material is known as:
Medical asepsis
219
Organ not used for drug excretion?
Liver
220
Which does not affect the drug absorption?
Temp of medication
221
Children are highly sensitive to drugs why?
Immature renal and hepatic systems
222
What two drugs crystallize?
Sodium bicarb and calcium chloride
223
A wide TI range indicates what?
Drug is fairly safe
224
Fibers that release acetylcholine?
Cholinergic
225
Drugs that mimic the action of the parasympathetic system?
Parasympathomimetics
226
Example of a synthetic catecholamine?
Levophed
227
Toradol is an example of what type of drug?
NSAID
228
Pavulon and Norcuron produce transient but total paralysis how?
By binding to the nicotinic receptor for ACh at the neuromuscular junction
229
Xanthines act how?
Promote diuresis
230
Benadryl has some anticholinergic properties that may produce ___?
Tachycardia, constipation, inhibition of secretions, sedation
231
Zantac, Tagamet, and Pepci all work because of antagonistic action at which receptor site?
H-2
232
Abuse of laxatives may result in..?
Electrolyte imbalance
233
Primary hormone that regulates glucose metabolism?
Insulin
234
Retrovir used to treat what?
HIV
235
Hormone that stimulates the liver to break down glycogen into glucose?
Glucagon
236
Parasympathetic stimulation of the heart results in?
Slowed rate
237
Lithium used to treat?
Manic disorders
238
Albuterol stimulates beta receptors, and results in what effects?
Stimulation of the heart (increased rate) and bronchial dilation
239
Emetics do what?
Induce vomiting to rid body of the drug
240
Immunosuppresant drugs work by?
Suppressing the activity of lymphocytes
241
Site most commonly used to start a peripheral IV?
Upper extremity
242
Proper application of a tourniquet should do what?
Occlude the vein but not the artery
243
Large lumen needles have ___?
Small numbers (12 gauge)
244
Which of the following is a site used for central venous cannulation?
Subclavian
245
As the levels of an unbound drug decrease:
More drug is released from plasma protein binding
246
When administering a water-soluble drug to a newborn, you can anticipate that:
Greater amounts of the drug may be necessary because of the proportionally higher volume of total body water in newborns
247
Two anatomical systems of the nervous system:
Central and peripheral nervous system
248
Neurotransmitter at the junction of the sympathetic postganglionic fiber and the effector cell is:
Norepinephrine
249
In parasympathetic nervous action, the binding of acetylcholine at nicotinic receptors produces:
An excitatory response in the effector organ
250
Patient responses to atropine include:
Increased heart rate and dilated pupils
251
Benzodiazepines have the following actions:
Muscle relaxation, anxiety reduction, sedative, and anticonvulsant
252
Barbiturates are divided into four categories based on their:
Duration of action
253
Elavil is an example of a what?
Tricyclic antidepressant
254
MAO inhibitors --- examples?
Marplan, Nardil, and Parnate
255
Neuromuscular blocking agents:
Cause complete paralysis
256
Electrolyte deficiency commonly associated with Lasix administration?
Potassium
257
Unit of measure most commonly used to measure body organs is the:
Centimeter
258
Microdrip administration set delivers:
60 drops/mL
259
Class I antidysrhymics are:
Sodium channel blockers
260
Class III produce what effect?
Increased contractility
261
Diuretics are commonly used with other antihypertensive medications to control bp effectively, resulting in a:
Loss of excess salt and water from the body by renal excretion
262
What classification of medication dissolves clots after their formation?
Fibrinolytics
263
Byproducts of parasympathetic stimulation?
Digestive ("rest and digest")
264
What drug has THC in it?
Marijuana
265
THC is what schedule drug?
Schedule I
266
Morphine is what class?
Schedule II
267
Activated charcoal is what form? (2)
Fine powder or suspension
268
Digoxin = wide or narrow TI?
Narrow, dangerous
269
Example of hypotonic solution?
D5W
270
Hypertonic solution does what to RBC's?
Shrinks (crenates) them
271
What are proteins that kill microorganisms?
Antibodies
272
What is hypercalcemia?
Elevated levels of calcium
273
Principle regulator of water retention and distribution?
ADH (vasopressin)
274
Your pt has normal heart rate, what medication would you give to lower blood pressure with minimal impact on the heart?
ACE inhibitor
275
What is a pH of 7.3?
Acidic
276
What is the renal response to metabolic acidosis?
Retention of sodium bicarb
277
What moves sodium out of the cell?
Sodium potassium pump
278
What is the most common reason for IV?
Fluid replacement
279
Where are alpha 1 and alpha 2 receptors located?
Alpha 1 = postsynaptic position, on effector organ
| Alpha 2 = both pre and postsynaptic nerves
