EXAM 1

Question 1

What class of drug is dopamine and what is its therapeutic use? What is the prototype?

Answer 1

dopamine is an Adrenergic Agonist.

Tx: Hypovolemic and cardiogenic shock, naturally occuring, brief duration of action (10 minutes).

Prototype is epinephrin (Adrenalin). Non selective, catecholamine.

Question 2

What is the prototype drug for the Selective Adrenergic Agonist class (alpha)? What is its therapeutic uses? Adverse effects?

Answer 2

phenylephrine is an alpha adrenergic agonist.

Tx of congestion due to colds and allergies. Constricts small blood vessels.

Adverse effects: stinging of mucosa, sneezing, rebound congestion. CONTRAINDICATED in pts with HTN.

Question 3

What is the prototype (beta) drug for Selective Adrenergic Agonists? What is its therapeutic use? Adverse effects?

Answer 3

Isoproterenol. Beta 1 and 2 adrenergic agonist, catecholamine.

Tx for increasing the strength of myocardial contraction and output in tx of shock.

Adverse effects: HA, N/V, tremors, anxiety, insomnia

Question 4

What are the names of the Cholinergic Agonist prototypes?

Answer 4

bethanechol and pyridostigmine.

bethanechol activate muscarinic receptors.

pyridostigmine is an indirect acting cholinergic agonist.

Question 5

This cholinergic agonist has the therapeutic use of lowering intraocular pressure in glaucoma:

Answer 5

carbachol.

Given ophthalmically.

Question 6

This cholinergic agonist has the therapeutic use of contraction of the detrusor muscle and relaxation of the trigone and sphincter of the bladder:

Answer 6

bethanechol.

Tx of urinary retention

Adverse Effects:

• Bradycardia
• Contraction of smooth muscle of the bronchi/GI tract
• Increase sweating
• Salivation
• Bronchial secretions
• Miosis (excessive pupil constriction) and contraction of the eyes
• Vasodilation

Question 7

What class is pilocarpine from? What is it used for?

Answer 7

It is a Cholinergic Agonist.

Used for glaucoma.
Given orally or by an ophthalmic (eye) solution.

Question 8

This indirect acting cholinergic agonist prototype has the therapeutic use of increasing muscle contraction and delaying fatigue:

Answer 8

pyridostigmine

Given for exposure to nerve gas.
It allows Ach to accumulate and have a greater effect.

Adverse effects: involuntary twitching, N/V, miosis, increased salivation.

Question 9

What is neostigmine used for? What class of drug is it?

Answer 9

neostigmine is used for MG if pyridostigmine is not working.

It is also a cholinergic agonist.

Question 10

What is a cholinergic drug? How about an adrenergic drug?

Answer 10

Cholinergic drugs act on receptors that are activated by acetylcholine.

Adrenergic drugs act on receptors that are activated by epinephrine or norepinephrine.

They both work by blocking or stimulating receptors of the autonomic nervous system.

Question 11

These molecules activate receptors:

Answer 11

Agonist molecules.

Affinity: allows binding, intrinsic (belonging naturally, essential) activity allows receptor activation.

Question 12

These molecules prevent receptor activation:

Answer 12

Antagonist.

Partial agonist: moderat intrinsic activity (agonist-antagonist).

Question 13

This is the highest effect a drug can produce:

Answer 13

Efficacy. We need not always use the strongest drug (morphine for HA).

Potency is the AMOUNT of drug required to elicit a response (not usually important but need to understand in order to explain to patients that just because they are receiving MORE of a certain drug, if the adverse effects remain the same, then it doesn’t matter).

Question 14

What does tetracycline bind with in our diet, inhibiting its absorption.

Answer 14

Calcium.

Question 15

What type of juice may inhibit the P450 system (metabolism), which may lead to toxicity levels?

Answer 15

Grapefruit juice.

Question 16

MAO (depression tx) inhibitors and ? combine and result in high BP:

Answer 16

Tyramine.

Can lead to hypertension crisis.

Question 17

Potassium sparing diuretics and ? Can result in high levels of K.

Answer 17

Salt substitutes (potassium chloride).

These are both risks for heart disease patients because these patients are more likely to need diuretics and substitutions for salt.

Question 18

Vitamin K, in excess, can interfere with the effectiveness of which drug?

Answer 18

Warfarin / Coumadin

Question 19

What is the antidote for digoxin toxicity?

Answer 19

Digbind

Question 20

What is the antidote for benzodiazepine toxicity?

Answer 20

flumazenil (Romazicon)

Titrate as needed in 0.2 mg doses.

Question 21

What is the antidote for narcotic overdose?

Answer 21

Narcan 0.4 mg over 30 seconds.

Or, less of an emergency, given in an IV bag.

Question 22

What class of drugs involve muscarinic and nicotinic receptor sites?

Answer 22

Those involve acetylcholine receptor sites… so the cholinergic class of drugs.

This is the smallest and least prescribed class of drugs… due to its diverse and more # side effects.

Question 23

What type of drug is an acid and can increase the body’s metabolism at high doses?

Answer 23

Salicylates (aspirin).

Question 24

What are the mild-moderate s/s of an OD of salicylates?

Answer 24

• Tachypnea (part due to increased metabolism, part due to “blowing off” the acid.
• Diaphoresis
• Hyperthermia
• Tinnitus

Question 25

What are the severe s/s of an OD of salicylates?

Answer 25

- Altered LOC - Coagulation abnormalities - Hemorrhagic gastritis: can cause an immediate ulcer and then consequent bleeding from the ulcer.

Question 26

How to Tx a salicylate over dose:

Answer 26

No antidote. Just supportive care... - cooling - hydration - electrolyte replacement Seizure precautions and repeatedly check salicylate levels to see them come down (hopefully). May give activated charcoal - possibly multiple doses. * One important task is to alkalize the urine to assist the kidney's elimination of the drug: IV sodium bicarbonate is given to the pt, which then alkalizes the blood which then alkalizes the urine which then ionizes the aspirin which then is more difficult to absorb and makes it easier to eliminate.

Question 27

Why do we want to avoid alcohol when taking aspirin?

Answer 27

When a healthy person consumes aspirin, it is metabolized on the major pathway system effectively and without harm. When we take too much or drink alcohol, it uses up our glutathione reserves that we need in order to successfully metabolize the drug and this leads to liver damage from the toxic metabolite byproduct.

Question 28

What s/s are to be expected within the 0-24 hour time-frame regarding an acetaminophen OD?

Answer 28

- N/V - Anorexia - Lethargy/ Malaise

Question 29

What s/s are to be expected within the 24-48 hour time-frame regarding an acetaminophen OD?

Answer 29

Maybe ruq pain. This is when the liver damage has begun but may not have any s or s.

Question 30

What s/s are to be expected within the 48+ hour time-frame regarding an acetaminophen OD?

Answer 30

- LOC (confusion) - Lethargy - Coma - Jaundice - Ruq pain Significant liver damage at this point.

Question 31

What is the treatment of an acetaminophen over dose?

Answer 31

- Activated charcoal (if within 1 hour of ingestion) - Possible gastric lavage. - N-acetylcysteine if nomogram suggests. This is to help protect the liver by replacing the glutathione in the body. It is given every 4 hours up to 12-17 doses.

Question 32

What test is given to the acetaminophen OD in order to guide the appropriate treatment?

Answer 32

The Four Hour Tylenol Level test. Compare results to the nomogram and administer N-acetylcysteine if indicated. Administer every 4 hours up to 12-17 doses.

Question 33

What test is given to determine if crisis is cholinergic crisis or a myasthenic crisis?a m

Answer 33

edrophonium test. This is an AchE inhibitor. If pt has myasthenia gravis and they do not have enough Ach, they will experience a myasthenic crisis. If they are given an AchE inhibitor then that means they should have more Ach available and would improve. If the pt is experiencing a cholinergic crisis then they have too much Ach available and would show signs of worsening after receiving the AchE inhibitor. Cholinergic crisis is an emergency and can lead to respiratory failure.

Question 34

What drug do you use to treat orthostatic hypotension?

Answer 34

midodrine.

Question 35

This medication if used to treat orthostatic hypotension in patients with neuro disorders such as Parkinson's disease:

Answer 35

droxidopa.

Question 36

What is mydriasis?

Answer 36

Pupil dilation.

Question 37

What non-catecholamine drug is a tocolytic?

Answer 37

Terbutaline. Tocolytics are drugs given to prevent preterm labor. This drug relaxes smooth muscle in the uterus.

Question 38

What is the antidote given for tissue injury (extravasation) regarding epinephrine, dopamine, and norepinephrine treatments for shock?

Answer 38

phentolamine.