High Yield Pharm Flashcards
Which neurotransmitter is responsible for activating sweat glands in a sympathetic response?
ACh
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)
What drug is used to differentiate Myasthenia gravis
Edrophonium
It is a AChE inhibitor
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
Why can benztropine have CNS effects?
it can cross the BBB
used to treat parkinsons
Which of the following drugs is used to induce mydriasis? Tubocurarine Tiotropium Tolterodine Tropicamide
Tropicamide
Which drug reduces motion sickness? Scopolamine Benztropine Atropine Tolterodine
Scopolamine
Which drug can produce mydriasis (pupillary dilation)? Scopolamine Benztropine Tropicamide Atropine Tolterodine
Tropicamide (shorter acting-used more often)
Atropine (longer acting-less-used)
Which drugs cause bronchodilation in asthma and cOPD? Tropicamide Atropine Ipratropium Tolterodine Tiotroprium
Ipratropium (shorter)
Tiotroprium (longer acting)
Muscarinic recetpor blocker
Which drug reduces transient gastric hypermotility? Atropine Ipratropium Tolterodine Tiotroprium Glycopyrrolate
Glycopyrrolate
Blocks muscarinic recetpors
Gastric –> G(lycopyrrolate)
Which drug treats transient cystitis, post-op bladder spasms, or incontinence? Tolterodine Tiotroprium Glycopyrrolate Benztropine
Tolterodine
muscarinic blocker
Which adrenergic receptor acts to increase HR and increase force of contraction?
B1
Which adrenergic receptor acts to increase renin secretion?
B1
Which adrenergic receptor acts to dilate arterioles?
B2
Which adrenergic receptor acts to relax bronchial smooth muscle?
B2
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
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
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
