High Yield Pharm Flashcards by Kyle Plante

Which neurotransmitter is responsible for activating sweat glands in a sympathetic response?

ACh

How well did you know this?

Not at all

Perfectly

Which of the following conditions can only be treated with an indirect cholinergic drug?
A. Glaucoma
B. Myasthenia Gravis
C. Urinary retention
D. Xerostomia

Myasthenia gravis

Needs Edrophonium to differentiate (AChE inhibitor)

How well did you know this?

Not at all

Perfectly

What drug is used to differentiate Myasthenia gravis

Edrophonium

It is a AChE inhibitor

How well did you know this?

Not at all

Perfectly

Pralidoxime could theoretically treat an overdose of which of the following?
Scopolamine
Echothiophate
Pilocarpine
Bethanacol

Echothiophate
Pralidoxime: regenerates AChE
Scopolamine is a cholinergic receptor inhibitor
Echothiophate is an AChE inhibitor used to treat glaucoma, therefore pralidoxime will reverse these effects
Pilocarpine is a a muscarinic agonist used for pupillary construction
Bethanacol is a cholinomimmetic

How well did you know this?

Not at all

Perfectly

Why can benztropine have CNS effects?

it can cross the BBB

used to treat parkinsons

How well did you know this?

Not at all

Perfectly

Which of the following drugs is used to induce mydriasis?
Tubocurarine
Tiotropium
Tolterodine
Tropicamide

Tropicamide

How well did you know this?

Not at all

Perfectly

Which drug reduces motion sickness?
Scopolamine
Benztropine
Atropine
Tolterodine

Scopolamine

How well did you know this?

Not at all

Perfectly

Which drug can produce mydriasis (pupillary dilation)?
Scopolamine
Benztropine
Tropicamide
Atropine
Tolterodine

Tropicamide (shorter acting-used more often)

Atropine (longer acting-less-used)

How well did you know this?

Not at all

Perfectly

Which drugs cause bronchodilation in asthma and cOPD?
Tropicamide
Atropine
Ipratropium
Tolterodine
Tiotroprium

Ipratropium (shorter)
Tiotroprium (longer acting)

Muscarinic recetpor blocker

How well did you know this?

Not at all

Perfectly

Which drug reduces transient gastric hypermotility?
Atropine
Ipratropium
Tolterodine
Tiotroprium
Glycopyrrolate

Glycopyrrolate
Blocks muscarinic recetpors

Gastric –> G(lycopyrrolate)

How well did you know this?

Not at all

Perfectly

Which drug treats transient cystitis, post-op bladder spasms, or incontinence?
Tolterodine
Tiotroprium
Glycopyrrolate
Benztropine

Tolterodine

muscarinic blocker

How well did you know this?

Not at all

Perfectly

Which adrenergic receptor acts to increase HR and increase force of contraction?

How well did you know this?

Not at all

Perfectly

Which adrenergic receptor acts to increase renin secretion?

How well did you know this?

Not at all

Perfectly

Which adrenergic receptor acts to dilate arterioles?

How well did you know this?

Not at all

Perfectly

Which adrenergic receptor acts to relax bronchial smooth muscle?

How well did you know this?

Not at all

Perfectly

Which NDRI is used to treat depression?
Fluoxetine
Bupropion
Aripiprazole
Venlafaxine
Mirtazapine

Bupropion
NDRI=Norepiephrine/Dopamine Reuptake inhibitor
Major side effect=seizures!!
Can be used to augment therapy
Useful in helping people to quit smoking

How well did you know this?

Not at all

Perfectly

What is a major side effect of bupropion?

Major side effect=seizures!!
It is a NDRI used for depression and smoking cessation
all antidepressants lower seixure threshold but buproprion is worst

How well did you know this?

Not at all

Perfectly

What 2 SSRIs are potential p450 inhibitors?

Other side effectS?

Fluoxetine and paroxetine
Inhibit P450 enzymes and therefore can cause higher levels of other drugs that patient is taking concurrently
Sexual dysfunction is a SE

Which antidepressant has weight gain as a side effect and is not a good choice for DMII, or obese patients?
Fluoxitine
Mirtazapine
bupropion
venlafaxine

Mirtazapine-atypical
Indirectly release of NEand to a much lesser extent, 5HT
Anti-histamine (sedation effects)

What are the 3 non-addicting meds that are used to tx ADHD in adults?

-Atomoxetine (NRI)
-Guanfacine (ER)
-Clonidine (ER)
Guanfacine and Clonidine are alpha2 agonists

In adults we generally start ADHD tx with non-addicting drugs (non-stimulants)
In kids and young adults you use _______ as first line tx

Stimulants :

amphetamines (NDRI), methylphenidate (NDRI)

ADHD- hypoactive/hyperactive ACC?

hypoactive ACC

Why is atomoxetine used as first line tx in adults for ADHD

no addictive potential

Does not alter DA in mesolimbic area (no reward associated-addiction)

Bupropion is contraindicated in patients with eating disorders because it causes
Hypertension
Seizures
Decreased appetite
Hypokalemia
Hyponatremia

Seizures

``` Which is least likely to cause sexual side effects? Paroxetine Fluoxetine Venlafaxine Bupropion Sertraline ```

Bupropion SSRI cause sexual dysfunction and myoclonus SNRIs can also (venlafaxine)

Tyrosine is converted to dopamine and transported into the vesicle by ______, which can be blockd by the drug _____

VMAT resperpine Same carrier transports NE (blocked by cocaine) DA is converted into NE

____ receptors are Gq and involved in smooth muscle contraction ____ receptors are Gi and involved in inhibitioin of NT release

alpha 1- smooth muscle contraction such as in arterioles to increase TPR, diastolic BP, afteload, also contraction of veins to increase venous return Alpha2- inhibition of NT release at prejunctional nerve terminals

____ receptors are Gs and involved in increase in force and rate of contraction of heart ____ receptors are Gs and involved in smooth muscle relaxation

Beta1- increase fore and rate of heart contraction via SA note (increase HR) and AV node (increase conduction velocity) Beta2- relaxation of SM to cause vasodilation (decrease TPR, decrease diastolic pressure, decrease afterload), relax uterus, bronchodilation

Reserpine can block the activity of VMAT and guanethidine can block vesicle release. Administering these two drugs will have more effect on direct or indirect acting sympathomimmetics?

Indirect, because the indirect acting agents involve the concentrations of NTs in synapse [cocaine (uptake inhibitor), amphetamine (blocks DA reuptake), selegiline (MOAI)] Direct acting agents will act directly on the post synaptic receptor and will not be affected by the concentration of NT in the synapse

What is the affinity for of NE for the adrenergic receptors? | A1, A2, B1, B2

a1=a2 B1>>B2 NE doesnt have much affinity for B2

What is the affinity for of Epi for the adrenergic receptors? A1, A2, B1, B2

a1=a2 | B1=B2

Which has greater affinity for B2 receptors? | Epi or NE?

Epi activates B2 | NE does not

Your patient received injections of Botulinum toxin type A (BTx, Botox) to cosmetically treat frown lines on her forehead. Her frown lines improve, but the injections also produced ptosis (drooping) of the eyelid. Which one of the following statements best accounts for the BTx mechanism that produced these effects? A. Blocks the synthesis of acetylcholine B. Interferes with acetylcholine release from neurons C. is a competitive inhibitor of cholinergic receptors D. Is a non-competitive inhibitor of cholinergic receptors E. Is a competitive inhibitor of acetylcholinesterase

``` B. Interferes with acetylcholine release from neurons Botulinum toxin (BTx, from Clostridium botulinum) blocks neuromuscular conduction and causes flaccid paralysis by cleaving proteins needed for acetylcholine release. ```

``` Pre-treatment with which one of the following agents would prevent the expected effect on blood pressure from an injection of tyramine? A. Propanolol B. A monoamine oxidase inhibitor C. Atenolol D. Cocaine E. Atenolol ```

Answer: D. Cocaine Tyramine enters the presynaptic varicosity via uptake; in doing so, it causes the release of cytoplasmic norepinephrine, resulting in a spike in blood pressure. Cocaine block uptake.

``` Which of the following have the greatest effect on B1 receptors and can be used to increase HR A. Terbutaline B. Epinephrine C. Norepinephrine D. Dopamine E. Alpha–methyltyrosine (metyrosine) ```

Of the drugs listed epinephrine has the greatest effect on beta1-receptors, which are responsible for increasing heart rate. Terbutaline is beta2-selective agonist. Norepinephrine is a less potent agonist. Dopamine can stimulate beta-receptors but is much less effective than epinephrine.

pramipexole and ropinirole work as a receptor agonist in treating restless leg syndrome?

D2 Also used to treat REM sleep disorder (loss of sleep paralysis)

If you have a patient with liver damage (alcoholism) which benzos will you be able to perscribe?

Oxazepam and lorazepam because they do not need to be oxidized (metabolism by liver) and can be conjugated (not by liver) and metabolized safely

How do you reverse benzo effects or overdose?

Flumazenil | This is very short acting and you must repeat often

which has a longer half life, phenobarbitaol or thiopental?

pheno has long half life | All barbs are p450 inducers

If a patient has has problem sleeping through the entire night which of the follwing is best to give? Antihistamine Diphenhydramine Doxylamine

Doxylamine has the longest half life If patient says they want to wake up and not feel groggy or tired, then use diphenhydramine (shorter t1/2)

``` Which of the following drugs are used for sleep in people who are non-24 (blind) Doxylamine Ramelteon Tasimelteon Zolpidem ```

``` Tasimelteon melatonin agonist (MT 1&2 agonist)...No risk for addiction ``` Rasmelteon is also a melatonin agonist used for insomnia Zolpidem (ambien) is BDZ1 selective

``` Which of the following drugs are antihistamine used for sleep? Ramelteon Tasimelteon Doxepin Zolpidem ```

Doxepin H1 receptor antagonist No risk for addiction

``` Which drugs have addictive properties? What class of drug are they? Ramelteon esZopiclone Tasimelteon Zaleplon Doxepin Zolpidem ```

The Z drugs are Benzodiazepine receptor AGONIST (BDZ-1 selective sites) Zolpidem Zaleplon esZopiclone (longest t1/2)

Orexins generally keep you awake, which drug blocks orexin and promotes sedation?

Suvorexant | antagonizes OX1 and OX2