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521-Pharmacology > Final Exam Review > Flashcards

Final Exam Review Flashcards

1
Q

direct acting cholinomimetics

A

-drug binds and activates muscarinic or nicotinic receptors
-mimics effects of ACh on peripheral organs

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2
Q

Indirect-acting cholinomimetics

A

-inhibits AChE
-drug that amplifies the effects of endogenous ACh

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3
Q

Nicotine

A

nicotinic receptor

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4
Q

varenicline

A

nicotinic receptor

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5
Q

Bethanechol

A

-muscarinic agonist
-treats atony and urinary retention
-side effects: diarrhea and urinary urgency

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6
Q

Carbachol

A

-nicotinic and muscarinic agonist
-glaucoma

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7
Q

pilocarpine

A

-muscarinic agonist
-glaucoma
-increase salivary secretion

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8
Q

CEVIMELINE

A

-muscarinic agonist
-for dry mouth associated with Sjogren syndrome or radiation damage

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9
Q

organophosphates

A

-indirect acting cholinomimetics
-very long acting

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10
Q

Pyridostigmine

A

-indirect acting cholinomimetics
-intermediate to long acting

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11
Q

Edrophonium

A

-indirect acting cholinomimetics
-short acting

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12
Q

Muscarinic agonists

A

-act at M2 and M3 receptors
-parasympathetic

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13
Q

M3 receptor activation

A

-stimulates smooth muscle contraction
-gland secretion

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14
Q

M2 receptor activation

A

decreases heart rate

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15
Q

effects of muscarinic agonists in glaucoma

A

-pupillary circular and ciliary muscle contraction
(miosis and cyclospasm)
-open angle of the anterior chamber
-facilitate outflow of aq humor
-reduce IOP

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16
Q

Physostigmine

A

-indirect acting cholinomimetics
-intermediate to long acting
-glaucoma

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17
Q

Atony

A

-paralysis of the stomach, bowel, bladder following surgery

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18
Q

Urinary retention

A

postoperative or postpartum or secondary to spinal
cord injury or disease (neurogenic bladder)

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19
Q

Neostigmine

A

-indirect acting cholinomimetics
-intermediate to long acting
-treats atony and urinary retention
-side effects: diarrhea and urinary urgency

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20
Q

Sjögren syndrome

A

-autoimmune disease where glands are attacked by antibodies
-causes dry mouth and dry eyes

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21
Q

toxicity of muscarinic agonists

A

-cyclopsam of accommodation
-bronchospasm in asthmatics
-diarrhea
0urinary urgency
0sweating
-vasodilation (hypotension: M3 activation)
-reflex tachycardia
-bradycardia (large dose, direct M2 activation)

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22
Q

AChE inhibitors MOA

A

-increase levels of AChE at synaptic cleft and neuroeffector junctions
-Enhance responses in organs
innervated by parasympathetic
nerves

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23
Q

how do cholinesterase inhibitors treat glaucoma?

A

-contract ciliary body
-facilitate outflow of aq humor
-reduce IOP

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24
Q

Edrophonium

A

diagnostic test for myasthenia gravis

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25
Q

long term therapy treatments for myasthenia gravis

A

-pyridostigmine
-neostigmine is an alternative

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26
Q

neuromuscular blockade

A

-produced as an adjunct to surgical anesthesia
-using NONDEPOLARIZING neuromuscular relaxants such as PANCURONIUM

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27
Q

pancuronium

A

-NONDEPOLARIZING neuromuscular relaxant used in surgery
-form of paralaysis

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28
Q

how do you reverse neuromuscular blockade(surgical paralysis)?

A

-with cholinesterase inhibitors
-neostigmine and edrophonium

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29
Q

treatment for antimuscarinic (atropine) poisoning

A

-physostigmine (AChE inhibitor)
-works in CNS and peripheral
-reverses signs of muscarinic blockade

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30
Q

Anti-cholinesterase toxicity: muscarinic excess

A

-miosis
-salivation
-bronchial constriction
-vomiting
-diarrhea

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31
Q

Anti-cholinesterase toxicity: depolarizing neuromuscular blockade

A

respiratory arrest

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32
Q

Anti-cholinesterase toxicity: CNS involvement

A

-cognitive disturbances
-convulsions
-coma

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33
Q

Anti-cholinesterase toxicity: cause of death

A

respiratory failure

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34
Q

treatment of AChE toxicity

A

-atropine: antagonizes muscarinic receptor sites in both CNS and peripheral organs
-Pralidoxime(2-PAM): cholinesterase regenerator (prevent aging)

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35
Q

Therapy considerations for AChE toxicity

A

-early treatment is important
-continue drug therapy fir a week or longer

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36
Q

Anticholinesterases for myasthenia gravis testing

A

Edrophonium (short acting)

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37
Q

Anticholinesterases for myasthenia gravis therapy

A

-neostigmine: intermediate
-pyridostigmine: long acting

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38
Q

Anticholinesterases for reversal of NM blockade of nondepolarizing neuromuscular relaxants

A

-edrophonium
-neostigmine
-pyridostigmine

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39
Q

Anticholinesterases for reversal atropine (antimuscarinic) poisoning

A

-Physostigmine
-lipid soluble
-reverse both central and peripheral muscarinic blockade

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40
Q

Anticholinesterases for glaucoma

A

-Physostigmine
-lipid soluble

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41
Q

Anticholinesterases for bowel and urinary atony(after surgery or spinal cord injury)

A

-Neostigmine

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42
Q

Anticholinesterase effects on Neuromuscular junction

A

-stimulate skeletal muscle contraction
-low dose: prolong and intensity contraction

-high dose: FASCICULATION
-toxic dose: muscle paralysis

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43
Q

Anticholinesterase effects on the eye

A

-miosis (pupillary circular Ms. Contraction)
-cyclopsam( due to contraction)
-decrease IOP
-

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44
Q

Anticholinesterase effects on the GI

A

-Increase GI motility: relax sphincter
-increase GI secreation
-side effects: DIARRHEA

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45
Q

Anticholinesterase effects on the genitoururinary tract

A

-increase detrusor contraction
-relax sphincter
-side effects: URINARY URGENCY

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46
Q

Anticholinesterase effects on the heart/blood vessel

A

-Side effect: bradycardia(M2 activation)
-no effect on blood vessel

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47
Q

antimuscarinic MOA

A

-reversible blockade of cholinomimetic action at muscarinic receptors
-m1-m5

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48
Q

anti-muscarinics for motion sickness

A

Scopolamine
-lipid soluble

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49
Q

anti-muscarinics for retina examination and how long they last

A

-atropine: long
-scopolamine: long
-homatropine: short
-cyclopentolate: short
-tropicamide: SHORTEST PREFERRED IN PATIENTS WITH NARROE ANTERIOR CHAMBER

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50
Q

anti-muscarinics to prevent synechia formation (tissue adhesion)

A

-homatropine
-long acting

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51
Q

anti-muscarinics for asthma and COPD

A

-ipratropium: short
-tiotropium: longer
-aclidinium: longer
-umeclidium: longer

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52
Q

anti-muscarinics for routine preoperative medications (Prevent laryngospasm and
bronchial secretion caused by
inhaled anesthetics)

A

-atropine
-scopolamine: also has sedative effect

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53
Q

anti-muscarinic effects on the eye

A

-Mydriasis: pupil dilation
-cycloplegia: relaxation of cilliary muscle

-SIDE EFFECTS: BLURRED VISION (BLIND AS A BAT), INCREASED IOP, DRY EYES

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54
Q

anti-muscarinic effects on the respiratory system

A

-bronchodilation
-reduce bronchial secretion

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55
Q

anti-muscarinic effects on the GI tract

A

-reduced motility
-reduced salivation

CONSTIPATION

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56
Q

anti-muscarinic effects on the urinary tract

A

-relax bladder wall
-side effects: URINARY RETENTION IN BPH PATIENTS

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57
Q

anti-muscarinic effects on the heart

A

-TACHYCARDIA (due to block of M2 activation in the SA node)

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58
Q

anti-muscarinic effects on the glands (sweat, salivary, lacimal…)

A

-reduced secretions

-HYPERTHERMERIA(atropine fever in children, hot as hare)

-dry as bone

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59
Q

anti-muscarinic effects for cholinergic poisoning

A

-block muscarinic excess at both peripheral and CNS

60
Q

antimuscarinics for IBS and minor diarrhea

A

-dicyclomine
-hyoscyamine

61
Q

antimuscarinics for overactive bladder (postoperative spasm, urge incontinence)

A

-oxybutynin
-darifenacin, solifenacin
-tolterodine, fesoterodine
-trospium, atropine

62
Q

antimuscarinics for reflex vagal discharge

A

atropine

63
Q

antimuscarinics for cholinergic poisoining(insectisides)

A

-atropine
-pralidoxime

64
Q

antimuscarinics for mushroom poisoning

A

atropine

65
Q

Depolarizing NMJ Blocker (Succinylcholine) MOA

A

Binds to NM nicotinic receptor and acts like Ach, depolarizing the muscle

66
Q

Phase I block (Depolarizing)

A

Membrane depolarizes for a longer period, resulting in an
initial fasciculation (twitching) followed by flaccid/paralysis

67
Q

Phase II block (Desensitizing):

A

Membrane repolarized; Receptors are desensitized to
further stimulation, causing flaccid/paralysis.

68
Q

Depolarizing NMJ Blocker (Succinylcholine) pharmacokinetics

A

Rapid onset, short duration; metabolized mainly by pseudocholinesterase in the plasma

69
Q

Depolarizing NMJ Blocker (Succinylcholine) reversal

A

*Phase I block is augmented, not reversed, by cholinesterase inhibitors *

70
Q

Side effects of succinylcholine

A

-hyperkalemia: on patients with burns or trauma, extra N ACh receptor
-increased intragastric pressure
-muscle pain(Myalgias)
-cardiac arrhymias
-malignant hyperthermia

71
Q

Non-Depolarizing NMJ Blockers MOA at low doses

A

-act as competitive blockers
-interact with the nicotinic receptors on muscles and prevent Ach from binding
-prevent depolarization
-can be REVERSED by AChE inhibitors (neostigmine,edrophonium, pyridostigmine)

72
Q

Nondepolarizing NM blocking drugs drug interactions

A

-NM blockade effect potentiated by inhaled anesthetics (such as isoflurane)
-antibiotics: aminoglycosides
-local anesthetics and antiarrhythmic drugs

73
Q

Nondepolarizing NM blocking drugs disease/age interactions

A

-myasthenia gravis: need lower doses
-aging: need lower dose
-patients with severe burns: need higher dose

74
Q

Depolarizing NM blocking drug (Succinylcholine) drug interactions

A

antibiotics
-local anesthetics
-anti-arrythmias: potentiate NMB blocking effects

75
Q

MOA of tubocurarine, cistracurium, rocuronium

A

competitive antagonist at nACH receptors, especially at neuromuscular junctions

76
Q

Effect of succinylcholine

A

-initial depolarization causes transient contractions followed by prolonged flaccid paralysis
-depolarization followed by repolarization then paralysis

77
Q

clinical applications of succinylcholine

A

-placement of ET tube
-control of muscle contractions in status epilepticus

78
Q

clinical applications of tubocuraine

A

-prolonged relaxation for surgical procedures
-superseded by newer nondepolarizing agents

79
Q

clinical applications of cistricurium

A

-prolonged relaxation for surgical procedures
-relaxation for respiratory muscles to facilitate ventilation in ICU

80
Q

clinical applications of rocuronium

A

-prolonged relaxation for surgical procedures
-relaxation for respiratory muscles to facilitate ventilation in ICU
-USE IN PATIENTS WITH RENAL INPAIRMENT

81
Q

midodrine MOA and organ system effects

A

-a1 agonist
–vascular smooth muscle Ms. contraction
-increase BP

82
Q

midodrine clinical application

A

-orphostatic hypotension

83
Q

midodrine side effects

A

-supine hypertension
-urinary retention
-piloerection

84
Q

Phenylephrine MOA and organ system effects

A

-a1 agonist
-vascular smooth muscle contraction: increase BP
-local vasoconstriction
-mydriasis: pupillary radial MS contraction

85
Q

Phenylephrine clinical applications

A

-acute hypotension
-nasal decongestant
-eye exam

86
Q

clonidine, methyldopa, guanfacine, guanabenz MOA and organ system effects

A

-a2 agonist
-decrease sympathetic outflow(if taken orally)
-lower BP and bradycardia

87
Q

clonidine, methyldopa, guanfacine, guanabenz clinical application

A

hypertension

88
Q

clonidine, methyldopa, guanfacine, guanabenz side effects

A

-sedation
-dry mouth

89
Q

dexmedetomidine MOA and organ effects

A

-a2 agonist
-CNS effects

90
Q

dexmedetomidine clinical application

A

-induce sedation before anesthesia
-combine with opioids

91
Q

Apraclonidine, brimonidine MOA and organ effects

A

-a2 agonist
-reduce NE release from presynatic nerves, reduces aq humor production, decrease IOP pressure

92
Q

Apraclonidine, brimonidine clinical application

A

glaucoma

93
Q

Oxymetazoline MOA and organ effects

A

-a1 and a2 agonist
-local vasoconstriction

94
Q

Oxymetazoline clinical applications

A

-nasal decongestants
-facial erythema

95
Q

Xylometazoline MOA and organ effects

A

-a1 and a2 agonist
-local vasoconstriction

96
Q

Xylometazoline clinical applications

A

-nasal decongestants

97
Q

Prazosin, Doxazosin, terazosin, alfuzosin MOA and organ effects

A

-a1 antagonist
-vasodilation: lowers BP

98
Q

Prazosin, Doxazosin, terazosin, alfuzosin clinical applications

A

-mild to moderate hypertention

99
Q

Prazosin, Doxazosin, terazosin, alfuzosin side effects

A

-orthostatic hypotension after the first few doses

100
Q

Prazosin, Doxazosin, terazosin, tamsulosin, silodosin MOA and organ effects

A

-a1 antagonist
-relaxation of smooth muscle in prostate glands

101
Q

Prazosin, Doxazosin, terazosin, tamsulosin, silodosin clinical application

A

-urinary obstruction in BPH
-very useful in patients with both BPH and hypertension

102
Q

prazosin MOA and organ effects

A

-a1 antagonist
-vasodilation
-relaxes smooth muscle

103
Q

prazosin clinical applications

A

-PVD decreased Raynaud’s phenominom
-hypertension
-urinary obstruction in BPH

104
Q

Yohimbine MOA and organ effects

A

-a2 antagonist
-increase sympathetic outflow

105
Q

Yohimbine clinical application

A

dietary and health supplement

106
Q

Phenoxybenzamine MOA and organ effects

A

-irreversible a1 and a2 antagonist
-vasodilation: lower BP
-exaggerate reflex tachycardia

107
Q

Phenoxybenzamine clinical applications

A

-hypertension in pheochromocytoma
-PVD (Raynaud’s phenominon)

108
Q

Phenoxybenzamine side effects

A

-orthostatic hypotension
-reflex tachycardia(severe)

109
Q

Phentolamine MOA and organ effect

A

-reversible a1 and a2 antagonist
-vasodilation: lower BP
-exaggerate reflex tachycardia

110
Q

Phentolamine clinical applications

A

-hypertension in pheochromocytoma

111
Q

Phentolamine side effects

A

-orthostatic hypotension
-reflex tachycardia(severe)

112
Q

Dobutamine MOA and organ effects

A

-B1 agonist
-positive iontropic
-positive chronotropic
-positive dromotropic

113
Q

Dobutamine clinical application

A

cardiogenic shock
-acute heart failure

114
Q

albuterol, terbutaline, metaproterenol MOA and organ effects

A

-B2 agonist: short acting
-bronchodilation

115
Q

albuterol, terbutaline, metaproterenol clinical applications

A

acute asthma syndromes: acute bronchospasms

116
Q

Almenterol, formoterol MOA and organ effects

A

-B2 agonist: long acting
-bronchodilation

117
Q

Almenterol, formoterol clinical applications

A

-chronic asthma (with steriods)
-COPD

118
Q

Indacaterol, Olodaterol, vilanterol MOA and organ effects

A

-B2 agonist: ultralong acting
-bronchodilation

119
Q

Indacaterol, Olodaterol, vilanterol clinical applications

A

-chronic asthma (with steriods)
-COPD

120
Q

Ridodrine, terbutaline MOA and organ effects

A

-B2 agonist
-uterus relaxation

121
Q

Ridodrine, terbutaline clinical applications

A

-suppress premature labor

122
Q

Mirabegron MOA and organ effects

A

-B3 agonist
-bladder wall relaxation
-stimulate lipolysis

123
Q

Mirabegron clinical application

A

-urinary urgency

124
Q

Dopamine MOA and organ effects

A

-D1, b, and a agonist
-vasodilation of renal blood vessels(D1)
-increase C.O(B1)
-both increase renal blood flow

125
Q

Dopamine clinical applications

A

-oliguria
-shock with renal failure(avoid overdose)

126
Q

Fenoldopam MOA and organ effects

A

-D1 agonist
-vasodilation of renal blood vessels

127
Q

Fenoldopam clinical applications

A

-hypertensive emergency (severe hypertension)

128
Q

Epinephrine MOA and organ effects

A

-a and b agonist
-local vasoconstriction(a1)
-brochodilation(b2)
-vasoconstriction(a1)
-cardiac stimulant(B1)

129
Q

Epinephrine clinical application

A

-used with local anesthetics
-anaphylactic shock
-resuscitation after cardiac arrest

130
Q

Norepinephrine MOA and organ effects

A

-a and b agonist
-vasoconstriction(a1)
-mild cardiac stimulant(B1)

131
Q

Norepinephrine clinical application

A

acute hypotension and shock

132
Q

labetalol and carvedilol MOA and organ effects

A

-B> a1 blocker
-lowers BP with limited HR increase

133
Q

labetalol and carvedilol clinical applications

A

hypertension
heart failure

134
Q

propranolol, nadolol, timolol MOA and organ effects

A

-block B1 and B2
-lower heart rate and BP
-reduce renin

135
Q

propranolol, nadolol, timolol clinical applications

A

-hypertension
-angina pectoris
-arrhythmia
-migraine
-hyperthyroidism
-glaucoma(topical timolol)

136
Q

propranolol, nadolol, timolol side effects

A

-bradycardia
-worsened asthma
-fatigue
-vivid dreams
-cold hands

137
Q

metoprolol, atenolol, betaxolol, nebivolol MOA and organ effects

A

-block B1>B2
-block HR and BP
-reduce renin
-may be safer in asthma

138
Q

metoprolol, atenolol, betaxolol, nebivolol clinical application

A

-angina pectoris
-hypertension
-arrhythmias
-glaucoma(topical betaxolol)

139
Q

metoprolol, atenolol, betaxolol, nebivolol side effects

A

-bradycardia
-fatigue
-vivid dreams
-cold hands

140
Q

Butoamine MOA and organ effects

A

-blocks B2>B1
-increases peripheral resistances

141
Q

Butoamine clinical application

A

none
-makes asthma worse

142
Q

pindolol, acebutolol, carteolol, MOA and organ effects

A

-B1, B2, with intrinsic sympathomimetic (partial agonist) effect
-lower BP
-modestly lower HR

143
Q

pindolol, acebutolol, carteolol, clinical applications

A

-hypertension
-arrhythmias
-migraine
-may avoid worsening of bradycardia

144
Q

pindolol, acebutolol, carteolol, side effects

A

fatigue
-vivid dreams
-cold hands

145
Q

Esmolol MOA and organ effects

A

-B1>B2 blocker
-very brief cardiac B blockade

146
Q

Esmolol clinical applications

A

-rapid control of BP and arrhythmias
-thyrotoxicosis
-myocardial ischemia intraoperatively

521-Pharmacology (11 decks)

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