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A. Pharm II > EXAM 1 > Flashcards

EXAM 1 Flashcards

1
Q

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

A

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.

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2
Q

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

A

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.

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3
Q

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

A

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

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4
Q

What are the names of the Cholinergic Agonist prototypes?

A

bethanechol and pyridostigmine.

bethanechol activate muscarinic receptors.

pyridostigmine is an indirect acting cholinergic agonist.

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5
Q

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

A

carbachol.

Given ophthalmically.

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6
Q

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

A

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
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7
Q

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

A

It is a Cholinergic Agonist.

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

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8
Q

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

A

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.

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9
Q

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

A

neostigmine is used for MG if pyridostigmine is not working.

It is also a cholinergic agonist.

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10
Q

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

A

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.

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11
Q

These molecules activate receptors:

A

Agonist molecules.

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

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12
Q

These molecules prevent receptor activation:

A

Antagonist.

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

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13
Q

This is the highest effect a drug can produce:

A

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).

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14
Q

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

A

Calcium.

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15
Q

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

A

Grapefruit juice.

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16
Q

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

A

Tyramine.

Can lead to hypertension crisis.

17
Q

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

A

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.

18
Q

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

A

Warfarin / Coumadin

19
Q

What is the antidote for digoxin toxicity?

A

Digbind

20
Q

What is the antidote for benzodiazepine toxicity?

A

flumazenil (Romazicon)

Titrate as needed in 0.2 mg doses.

21
Q

What is the antidote for narcotic overdose?

A

Narcan 0.4 mg over 30 seconds.

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

22
Q

What class of drugs involve muscarinic and nicotinic receptor sites?

A

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.

23
Q

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

A

Salicylates (aspirin).

24
Q

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

A
  • Tachypnea (part due to increased metabolism, part due to “blowing off” the acid.
  • Diaphoresis
  • Hyperthermia
  • Tinnitus
25
Q

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

A
  • Altered LOC
  • Coagulation abnormalities
  • Hemorrhagic gastritis: can cause an immediate ulcer and then consequent bleeding from the ulcer.
26
Q

How to Tx a salicylate over dose:

A

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.
27
Q

Why do we want to avoid alcohol when taking aspirin?

A

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.

28
Q

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

A
  • N/V
  • Anorexia
  • Lethargy/ Malaise
29
Q

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

A

Maybe ruq pain.

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

30
Q

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

A
  • LOC (confusion)
  • Lethargy
  • Coma
  • Jaundice
  • Ruq pain

Significant liver damage at this point.

31
Q

What is the treatment of an acetaminophen over dose?

A
  • 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.
32
Q

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

A

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.

33
Q

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

A

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.

34
Q

What drug do you use to treat orthostatic hypotension?

A

midodrine.

35
Q

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

A

droxidopa.

36
Q

What is mydriasis?

A

Pupil dilation.

37
Q

What non-catecholamine drug is a tocolytic?

A

Terbutaline.

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

38
Q

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

A

phentolamine.

A. Pharm II (7 decks)

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