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Pharm > Exam 2: Cholingerics/Adrenergics > Flashcards

Exam 2: Cholingerics/Adrenergics Flashcards

1
Q

Phentolamine

A

Alpha Antagonist

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2
Q

Phenoxybenzamine

A

Long acting alpha antagonist. Used for pheochromocytoma

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3
Q

Esters of Choline

A

ACh, succinylcholine, methacholine, carbachol, bethanochol

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4
Q

Alkaloids

A

Muscarine, nicotine, pilocarpine, lobeline

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5
Q

Classes of direct acting cholinergics

A

Esters of Choline and Alkaloids

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6
Q

Indirect acting Cholinergics Classes

A

Simple alcohols, carbamic acid esters of alcohol, organic derivatives of phosphoric acid.

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7
Q

Simple alcohol indirect AChE inhibitor

A

Edrophonium

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8
Q

Carbamic acid esters of alcohol AChE inhibitors

A

Carbamate, neostigmine, pyridostigmine

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9
Q

AChE inhibitor, long acting, covalently bound.

A

Organophosphates

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10
Q

Antimuscarinic drugs

A

Atropine, tropicamide, scopolamine

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11
Q

Reversal agent for organophosphate

A

2-PAM (Pralidoxine)

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12
Q

Neuromuscular junction blocker

A

Succinylcholine and Curare derivatives (pancuronium)

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13
Q

Difference between depolarizing and non depolarizing muscle relaxants?

A

Depolarizing bind to ACh receptors, cause depolarization, and do not immediately release from receptor. Not broken down by AChE.

Non depolarizing muscle relaxants bind to ACh receptor and block depolarization.

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14
Q

Main side effects of depolarizing muscle relaxants?

A

Malignant hyperthermia and hyperkalemia.

Minor side effects include muscle pain, fasciculation, apnea (expected for intubation)

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15
Q

Reversal agent for NMB, muscle relaxants?

A

Neostigmine (many side effects)
Sugammadex (only works with some curare derivatives)

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16
Q

Antimuscarinic used for routine eye exam

A

Tropicamide

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17
Q

Cholingeric used for Dx of Myasthenia Gravis?

A

Edrophonium

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18
Q

Cholinergic drug used for bladder dysfunction?

A

Bethanocol

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19
Q

Cholinergic drug used to decrease IOP?

A

Carbachol

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20
Q

Carbamates are generally associated with what diseases/disorders?

A

Glaucoma, post op ileus, myasthenia gravis

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21
Q

Side effects of Atropine

A

BRAND. Blind, red, absence bowels sounds, nuts (AMS), dry.

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22
Q

Meds used for atropine toxicity

A

Physostigmine or neostigmine

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23
Q

Mushroom that does not respond to atropine

A

A. Phalloides. Deadly night cap. Inhibits mRNA. Leads to renal/liver failure.

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24
Q

What was the plant that atropine was derived from initially used for (Atropa belladona)

A

Pupil dilation.

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25
Q

Fatal dose of nicotine? What is treatment for nicotine toxicity?

A

40 mg.
Inducing vomiting.

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26
Q

What medications work on organophosphates after the aging process?

A

None. Important to give pralidoxine any time muscarinic excess is seen in case organophosphate is the cause. Aging strengthens the covalent bond and prevents breakdown.

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27
Q

S/s of mycetism (muscarinic excess)

A

SLUDGE- M
Salivation, lacrimation, urination, defecation, GI motility increased, emesis and myosis (pupil construction).

28
Q

Muscarinic used to dx asthma?

A

Methacholine

29
Q

Direct Adrenergic Agonist

A

NE, EPI, Dobutamine, dopamine, isoproterenol, phenylephrine, midodrine, clonidine.

30
Q

Indirect acting adrenergic agonist

A

Amphetamine and cocaine.

31
Q

Catecholamine components

A

Catechol and amine group

32
Q

What inactivates catecholamines in the gut?

A

COMT catechol-O-methyltransferase

33
Q

How does substitution at Benzene ring affect metabolism/inactivation?

A

Non-catecholamines are not broken down in the gut. Therefore their bioavailability is higher and can be given PO.

34
Q

Give an example of a non catecholamine that is given PO and explain its use?

A

Phenylephrine can be given PO as a nasal decongestant. It constricts vessels in mucous membrane decreasing mucous production.

35
Q

How can you identify the alpha carbon?

A

Alpha carbon is the Carbon nearest to the amine group.

36
Q

How does altering the alpha carbon affect drug metabolism?

A

It alters the drug in a way that makes MAO ineffective. Longer during of drug effect.

37
Q

List drugs that possess an alpha carbon substitution

A

Ephedrine and amphetamines.

38
Q

Irreversible Alpha antagonist? What is the indication for this drug?

A

Phenoxybenzamine. This drug is used to treat pheochromocytoma, an adrenal medulla tumors that causes over production of epi.

39
Q

List Alpha antagonists

A

Phentolamine, Phenoxybenzamine, the -zosin drugs.

40
Q

Phentolamine used for

A

HTN r/t pheochromocytoma. ED although not commonly used d/t direct injection administration

41
Q

Prazosin drug indication

A

Used for HTN and primarily used for BPH. Alpha 1 selective.

42
Q

Alpha 2 selective antagonist

A

Yohimbine

43
Q

1st Beta blocker, non selective

A

Propranolol.

44
Q

What disease processes can non selective beta blockers worsen

A

Respiratory diseases. Specifically COPD d/t increases airway resistance seen with blocking of Beta 2.

Worsen obesity and high cholesterol thru inactivation of beta 3.

45
Q

Beta 1 selective drugs

A

Metoprolol, atenolol, esmolol, nebivolol.

46
Q

Beta 1 selective agonist

A

Dobutamine.

47
Q

Pure alpha agonist

A

Phenylephrine

48
Q

Midodrine used primarily for

A

Orthostatic hypotension

49
Q

Non catecholamine that crosses BBB

A

Ephedrine

50
Q

How do cocaine and amphetamines affect NET?

A

Cocaine blocks the NET, causing NE to remain in synapse longer.
Amphetamines reverse the NET and fluid the synapse with increased levels of NE.

51
Q

Sympathomimetic that is found in fermented food

A

Tyramine

52
Q

How do MAOIs effect blood pressure?

A

MAOI block the oxidation of catecholamines thru MAO, thereby increasing blood pressure.

53
Q

How is NE formed? How is it stored and released?

A
  1. Tyrosine is transported into presynaptic membrane via an amino acid transporter. (This isn’t a target for drugs as AA are vital to functioning)
  2. Tyrosine is converted to NE (via tyrosine hydroxylase…FYI)
  3. NE is transported to vesicle via Vesicular Mona amine transporter VMAT.
  4. Voltage gated Ca enters presynaptic vesicle and initiates fusion of vesicle to membrane.
  5. SNAPS and VAMPS anchor vesicle to membrane.
54
Q

How is NE degraded

A

NE diffuses away to neighboring cells, is taken back up into presynaptic vesicle via NET. NE does not get degraded in synapse. The degradation can take place inside the presynaptic vesicle via MAO.

55
Q

What drugs target the NE transmission and what steps in NE transmission do they work on?
(Not on test?)

A

Metyrosine acts on the tyrosine hydroxylase step where tyrosine is converted to NE.
Reserpine blocks the storage of NE into vesicle, VMAT.
Bretylium and guanethidine inhibit NE release.

56
Q

Explain the disease process of myasthenia gravis

A

Myasthenia Gravis is an autoimmune disease where the body develops antibodies to the ACh receptors. The antibodies bind to the receptor, causing endocytosis of the receptor itself. Over time the amount of ACh receptors diminishes leading to impaired muscle contraction

57
Q

Alpha 1 agonist uses which G Protein and which effect

A

Gq. Therefore it activates phospholipase C to increase IP3 and DAG.

58
Q

Alpha 2 agonist uses which G Protein and which effect

A

Gi therefore it decreases cAMP.

59
Q

Beta agonist uses which G Protein and which effect

A

Gs stimulates increase in cAMP

60
Q

Alpha agonist effects

A

Increased PVR, decrease heart rate d/t vagal reflex, increased BP

61
Q

Beta agonist effects

A

Decreased PVR, increased contractility, increased heart rate, blood pressure decreased

62
Q

Alpha 1 locations and effect

A

Most vascular smooth muscle, prostrate, heart.
Effect: contraction.

63
Q

Alpha 2 locations and effect

A

Adrenergic and cholinergic nerve terminals.
Inhibition of transmitter release.

64
Q

Beta 1 location and effect

A

Heart/juxtaglomerular cells
Effect: increased force and rate of contraction. Increased Renin release.

65
Q

Beta 2 location and action

A

Respiratory, uterine and vascular smooth muscle.

Effect: bronchodilator. Smooth muscle relaxation.

66
Q

Dopamine 1 location and effect

A

Smooth muscle.
Effect: dilates renal blood vessels, decreasing blood pressure. Increased doses increased blood pressure.

Pharm (8 decks)

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