Exam 2 Quick Study Flashcards
What does activation of the nicotinicN receptors promote?
Ganglionic transmission at all ganglia of SNS and PNS
Release of EPI from adrenal medulla
What do alpha 1 receptors cause?
Vasoconstriction
Contraction of bladder neck and prostate
Where are alpha 2 receptors located?
Presynaptic nerve terminals
What do alpha 2 receptors cause?
Inhibition of neurotransmitter release
What does activation of beta 2 receptors cause?
Bronchial dilation
Vasodilation
Relaxation of uterine muscle
Glycogenolysis
Main adverse effects of bethanechol
Hypotension
Increased tone and motility of GI
Exacerbation of asthma
Dysrhythmias in people with hyperthyroidism
Symptoms of muscarinic poisoning
Lacrimation
Visual disturbances
Profuse salivation
Bronchospasm
Bradycardia
Hypotension with possible CV collapse
Diarrhea
What does atropine cause in the CNS
Mild excitation at therapeutic doses
Hallucinations and delirium at toxic doses
Therapeutic uses of atropine
Preanesthetic
Eye disorders
Bradycardia
GI hypermotility
Peptic ulcer disease
Biliary colic
Asthma
Muscarinic agonist poisoning
Adverse effects of atropine
Xerostomia
Blurred vision and photophobia
Elevation of intraocular pressure
Urinary retention
Constipation
Anhidrosis
Tachycardia
Asthma
3 drugs that cause prominent antimuscarinic actions
Antihistamines
Tricyclic antidepressants
Phenothiazine antipsychotics
Main anticholinergic drug for OAB
Oxybutynin
Forms of oxybutynin
Syrup
ER tablets
Patch and gel
Main side effects of oxybutynin
Constipation
Urinary retention
Dry eyes
Symptoms of antimuscarinic poisoning
Dry mouth
Blurred vision
Photophobia
Hyperthermia
CNS effects
Hot, dry, flushed skin
Death from respiratory depression
Treatment for antimuscarinic poisoning
Physostigmine
(Inhibits acetylcholinesterase)
Uses for adrenergic agonists
CHF
Asthma
Preterm labor
Differences between catecholamines and noncatecholamines
Catecholamines cannot be used orally
Catecholamines have brief duration of action
Catecholamines cannot cross BBB
Activation of alpha 1 receptors elicits which 2 therapeutic responses?
Vasoconstriction
Mydriasis
Therapeutic applications of alpha 1 activation
Hemostasis
Nasal decongestion
Adjunct to local anesthesia
Elevation of blood pressure
Mydriasis
Adverse effects of alpha 1 activation
Hypertension (from widespread vasoconstriction)
Necrosis
Bradycardia
What does activation of alpha 2 receptors in the CNS cause?
Reduction of sympathetic outflow to the heart and blood vessels
Relief of severe pain
Therapeutic applications of beta 1 activation
Heart failure
Shock
AV heart block
Cardiac arrest
Use of beta 1 activation and what does it cause?
Hypotension and greatly reduced perfusion:
- Increase in heart rate and force of contractions
- Increased cardiac output
Adverse effects of beta 1 activation
Dysrhythmias
Angina pectoris
Adverse effects of beta 2 activation
Hyperglycemia
Tremors
How does activation of dopamine receptors enhance cardiac performance?
Activates beta 1 receptors in the heart
Adverse effects of epi
Hypertensive crisis
Dysrhythmias
Angina
Necrosis on extravasation
Hyperglycemia
Types of drugs epi interacts with
MAO inhibitors
Tricyclic antidepressants
General anesthetics
Alpha or beta adrenergic blocking agents
Therapeutic uses for Isoproterenol
AV block
Cardiac arrest
Uses of dopamine
Shock
Heart failure
Acute renal failure
Adverse effects of dopamine
Tachycardia
Dysrhythmias
Angina
Necrosis on extravasation
How is dopamine administered
IV
Adverse effects of albuterol
Tremor
Tachycardia
Uses of alpha blockade
Essential hypertension
Reversal of toxicity from alpha 1 agonists
BPH
Pheochromocytoma
Raynaud’s disease
If pheochromocytoma is inoperable, what is the treatment?
Use of alpha 1 antagonists to suppress hypertension
Adverse effects of alpha 1 blockade
Orthostatic hypotension
Reflex tachycardia
Impotence in males
Sodium retention and increased blood volume
Most significant adverse effect associated with alpha 2 blockade
Reflex tachycardia
What does Prazosin cause?
Dilation of arterioles and veins
Relaxation of smooth muscle in bladder neck and prostatic capsule
Adverse effects of Prazosin
Orthostatic hypotension
Reflex tachycardia
Nasal congestion
What is phentolamine use for?
Diagnosis and treatment of pheochromocytoma
Prevention of tissue necrosis after extravasation of drugs that produce alpha 1 mediated vasoconstriction
Main adverse effect of phentolamine
Reflex tachycardia
Routs for phentolamine
IV
IM
Therapeutic applications of beta-adrenergic antagonists
Angina
HTN
Cardiac dysrhythmias
MI
Heart failure
Hyperthyroidism
Migraine
Stage fright
Pheochromocytoma
Glaucoma
Adverse effects of beta 1 blockade
Bradycardia
Reduced cardiac output
Precipitation of heart failure
AV heart block
Rebound cardiac excitation
What does propanolol do when it blocks cardiac beta 1 receptors?
Decreases heart rate
Decreases force of ventricular contractions
What does propanolol do when it blocks beta 2 receptors?
Bronchoconstriction
Vasoconstriction
Therapeutic uses for propanolol
Hypertension
MI
Angina
Adverse effects of propranolol
Bradycardia
AV heart block
Heart failure
Rebound cardiac excitation
Bronchoconstriction
Inhibition of glycogenolysis
CNS effects
What types of patients should avoid propranolol?
Asthma
Diabetes
Cardiac, respiratory, psychiatric disorders
Which drugs interact with propranolol
Calcium channel blockers
Insulin
Adverse effects of metoprolol
Bradycardia
Decreased cardiac output
Hypoglcemia
What do third generation beta blockers do?
Dilate blood vessels
What do indirect acting antiadrenergic agents do
Prevent stimulation of peripheral adrenergic receptors
2 groups of indirect acting antiadrenergic agents
Adrenergic neuron blocking agents
Centrally acting alpha 2 agonists
What do adrenergic neuron blocking agents do
Decrease norepinephrine release
What do centrally acting alpha 2 agonists do
Reduce impulses along the sympathetic nerves
2 prototype drugs for centrally acting alpha 2 agonists
Clonidine (Catapres)
Methyldopa (Aldomet)
Effects of Clonidine
Bradycardia
Reduced cardiac output
Minimal orthostatic hypotension
Therapeutic uses of Clonidine
PO
Transdermal
(Lipid soluble)
Use for Guanfacine (Intuniv)
Hypertension
Adverse effects of Guanfacine
Xerostomia
Sedation
Rebound hypertension if not weaned off
Action of methyldopa
Reduces BP by acting at sites within CNS
Cause alpha 2 activaiton
Effects of methyldopa
Vasodilation
Lowers BP
Adverse effects of methyldopa
Positive coomb’s test
Hemolytic anemia
Hepatotoxicity
Prototype adrenergic neuron blocking agent
Reserpine
Action of reserpine
Depletion of NE which causes effects similar to alpha and beta blockade
Overuse of reserpine can lead to:
Depletion of neurotransmitters like serotonin and catecholamines
Effects of reserpine
Slows heart rate and reduces CO
Sedation and state of indifference
Uses of reserpine
Hypertension
Psychotic states
Adverse effects of reserpine
Depression
Bradycardia
Orthostatic hypotension
Nasal congestion
GI involvement
Main categories of drugs used to treat PD
Dopaminergic agents
Anticholinergic agents
Prototype anticholinergic agent used to treat PD
Benztropine (Cogentin)
What does Levadopa do?
Restores balance between dopamine and ACh
Cause of neurological side effects of Levadopa
Activation of dopamine receptors
Drug interactions of Levodopa
First generation antipsychotic drugs
MAO inhibitions
Anticholinergic drugs
How do first generation antipsychotic drugs interact with levodopa?
Block receptors for dopamine and reduce therapeutic effects
How do MAOIs interact with levodopa?
Can cause hypertensive crisis
How do anticholinergic drugs interact with levodopa?
Excessive stimulation of cholinergic receptors contributes to dyskinesias
Blocking these receptors by anticholinergic agents can enhance responses to levodopa
What can foci result from?
Congenital defects
Hypoxia at birth
Head trauma
Brain infection
Stroke
Cancer
Genetic disorders
2 main categories of seizures
Focal onset
Generalized
How is epilepsy diagnosed?
Physical, neurologic, and lab evals
Thorough history
EEG
What occurs during evaluation for epilepsy
Anti seizure drug trial period
Dosage adjustment
Seizure frequency chart
Therapeutic considerations for epilepsy
Monitor plasma drug levels
Promote pt adherence to taking meds
Withdraw slowly from meds
Suicide risk
Action of dilantin
Selective inhibition of sodium channels
Half life of dilantin
8-60 hours
Adverse effects of dilantin
Nystagmus
Sedation
Ataxia
Diplopia
Cognitive impairment
Skin rash
Gingival hyperplasia
Drugs that interact with dilantin
Decreases effects of: contraceptives, warfarin, glucocorticoids
Increases effects of: diazepam, isoniazid, simetidine, alcohol, valporic acid
Adverse effects of Tegretol
Nystagmus
Ataxia
Leukopenia
Anemia
Thrombocytopenia
Spina bifida
Hypoosmolarity
Rash
Photosensitivity reactions
What receptors does phenobarbital work on?
GABA
3 newer antiepileptic drugs we talked about in class
Gabapentin
Lycia
Keep praying
Topamax
What is generalized convulsive status epilepticus?
Tonic clonic seizures that last 20-30 mins
Medical emergency
Treatment for status epliepticus
Maintain ventilation
Lorazepam/Ativan
Diazepam/Valium
Begin/continue long-term suppression drugs
Treatment uses for morphine
Analgesic action
Moderate to severe pain
Preoperational treatment of anxiety
Onset of respiratiory depression caused by morphine
IV: 7 min
IM: 30 min
SQ: 90 min
(May persist 4-5 hrs)
Pts we need to be particularly careful with when giving morphine
Conditions that compromise pulmonary function like asthma
Side effects of morphine
Respiratory depression
Constipation
Orthostatic hypotension
Cough suppression
Hilary colic
Emesis
Urinary retention
Euphoria/Dysphoria
Sedation
Miosis
Neurotoxicity
ICP
Birth defects
Dependency
Routes for morphine
PO
IM
SQ
IV
Epidural
Intrathecal
Drugs that interact with morphine
CNS depressants
Anticholinergic drugs
Hypotensive drugs
MAOIs
Agonist-antagonist opioids
Opioid antagonists
General guidelines for treating patients with morphine
Monitor full vitals before giving
Give on fixed schedule
Assess pain before giving and 1 hour after
Routes for fentanyl
Parenteral (surgical anesthesia)
Intra nasal
Transdermal
Transmucosal
Strong opioid that can be used if pt is allergic to morphine
Demerol
Severe side effect of Demerol
Toxic metabolite accumulation
Purpose of REMS
Reduce opioid related injuries
Principle uses of opioid antagonists
Treatment of opioid overdose
Relief of opioid constipation
Reversal of post-op opioid effects
Management of opioid addiction
