Midterm 1 Flashcards
Which of the following is not a monoamine
Serotonin
Dopamine
Histamine
Acetylcholine
Acetylcholine
List of monoamines
Serotonin
Dopamine
Histamine
Catecholamines: Epi, Norepi, Dopamine
Effect of Dopamine beta hydroxylase insufficiency
Severe orthostatic hypotension
Need it to make Epi and Norepi
Side effects of monoamine oxidase inhibitor
Orthostatic hypotension
Weight gain
Autonomic activity altered
(dopamine beta hydroxylase insufficiency?)
Function of tryptophan hydroxylase
tryptophan to 5HTP
Pheochromocytoma
Tumor of adrenal gland, medulla
Hypertension
Treatment of pheochromocytoma causes hypotension
Propranolol administration
what is it
effects
Non selective beta antagonist
decreased HR and contractility
Increase TPR (baroreceptor?)
Inhibits renin
What is responsible for the degradation of dopamine
Monoamine oxidase
degrades serotonin, epi, norepi, and histamine - NOT ACh
Function of tyrosine hydroxylase
tyrosine to DOPA
A farm worker is poisoned by a pesticide, presents in emergency room with blurred vision, excess salivation, twitching, and decreased heart rate.
What was the poison
Treat with what category and examples
Muscarinic agonist
Treat with Muscarinic antagonist: Atropine, scopolamine
Nicotinic antagonists
Succinylcholine - depolarizer/desensitizer, not blocked by acetylcholinesterase inhibitor
d-Tubocurarine - competes with ACh, reversed by acetylcholinesterase inhibitor
No transmitter pathways from week one
pathways
Preganglionic sympathetic neurons are where
Thoracolumbar
Sympathetic preganglionic neurons act upon what receptors where
nicotinic receptors in adrenal medulla
All preganglionics act on what receptors with what neurotransmitter
nicotinic receptors, ACh
Motor neurons innervating skeletal muscle act via what receptors
Nicotinic
Ach
Postganglionic sympathetic neurons can release what transmitters
Dopamine (D1) - Renal vascular smooth muscle
ACh - (M) Sweat glands
NE (alpha and beta) - cardiac and smooth muscle, glands nerve terminals
All parasympathetic post ganglionic neurons release what on what receptor
ACh
Muscarinic
Adrenergic receptors
Receptors that take catecholamines
NE, Epi, Dopamine
Bethanechol administration causes
increased gastric acid secretion
Cholinomimetic
acts on muscarinic receptor
Rest and digest effects
Other than rest and digest, muscarinic receptors can activate what
Sympathetic sweat glands
What causes increased heart rate
Beta 1 agonists
isoproterenol
Epi or NE
What causes urinary retention
Alpha 1 agonists contracts sphincters - phenylephrine, Phentolamine (non selective)
Beta 2 agonists relaxes bladder wall - Isoproterenol, Albuterol, Terbutaline
Dry mouth from
Anti-cholinergics/Muscarinic antagonist
Atropine
Scopolamine
The cardiovascular effects of epinephrine in a person treated with propranolol and prazosin will most likely resemble the response of what drug
Pilocarpine
Phenylephrine
Clonidine
Isoproterenol
Propranolol - Beta 1 and 2 blocker
Prazosine - Alpha 1 antagonist
Answer: Clonidine
Clonidine
Alpha 2 agonist
Decreases B.P. by shutting down NE release in brainstem (auto-receptor)
Can constrict vasculature
other alpha 2: guanfacine
Pilocarpine
Cholinesterase inhibitor
Cholinomimetic
Muscarinic receptor agonist
Rest and digest effects
Phenylephrine
what
uses/effects
Alpha 1 agonist vasoconstriction Nasal decongestant Cause mydriasis for eye exams Radial muscle contraction
Isoproterenol
what
uses/effects
Beta (non selective) AGONIST
treat asthma - airway relaxation
treat bronchospasms, COPD
Relaxes uterus
Which is most likely used to treat chronic asthma
epinephrine
albuterol
phentolamine
atenolol
Albuterol
Albuterol
Beta 2 agonist
The relaxer: ciliary muscle (far vision), vasculature in muscle, uterus and bladder
Epinephrine effects
Constricts radial muscle - mydriasis constricts sphincters constricts vasculature can relax airways increase outflow of aqueous humor relax bladder - B2
phentolamine
alpha antagonist (non selective)
vasodilator
increased HR - baroreceptors
Treats pheochromocytoma/hypertensive emergencies
atenolol
B1 blocker
Turns the heart down
Which of the following would be the most effective decongestant
alpha-1 agonist
alpha-1 antagonist
beta-1 agonist
muscarinic agonist
alpha - 1 agonist - vasoconstrictors
muscarinic - increase secretions - not good
Which of the following are most likely to be used by an ophthalmologist for a retinal exam
beta-1 agonist or a muscarinic antagonist
alpha-1 antagonist or a muscarinic agonist
alpha-1 agonist or a muscarinic agonist
alpha-1 agonist or a muscarinic antagonist
alpha-1 agonist or a muscarinic antagonist
alpha 1 agonist - radial muscle
muscarinic antagonist - opens circular muscle
Which antiseizure drug is FDA-approved as a monotherapy for generalized tonic-clonic seizures but also has indications for uncomplicated absence seizures, atypical absence seizures, simple and complex partial seizures
Ethosuximide
Perampanel
Carbamazepine
Valproic acid
Valproic acid
Ethosuximide
treats absence only - a generalized seizure
Carbamazepine
treats all partial seizures (simple complex, secondarily generalized) and Tonic-clonic generalized
Valproic acid
broad spectrum, all seizures
This type of seizure is characterized by a localized focus, minimal spread, short duration and maintenance of awareness, consciousness, and memory of seizure event
complex partial
Generalized Absence
Generalized tonic-clonic
Simple partial
Simple partial
Complex partial seizure
localized onset, can spread bilaterally
loss of awareness, memory, or conciousness
Generalized tonic-clonic
tonic - stiff
clonic - jerking
Postictal - lethargy after
Generalized absence seizure
vacant stare
good before and after
spike wave
Simple partial
retain awareness, consciousness, and memory
Common seizure precipitants
Sedative or ethanol withdrawal Metabolic and/or electrolyte imbalance Lack of sleep Concussion and/or head injury Reduction of medication Hormone variation stress Fever/systemic infection Stimulant
Carbamazepine
uses
side effects
all partial
tonic-clonic generalized
Steven-Johnson syndrome
blurred/double vision
CYP3A4
Grapefruit increases drug amount
Phenytoin
uses
side effects
all partial
tonic-clonic generalized
Gingival hyperplasia
zero-order kinetics at higher doses
Ethosuximide
uses
side effects
absence only
anorexia
blood dyscrasia
SLE-like reaction
Which of the following processes is least likely to cause a degenerative CNS disorder
enhanced GABA receptor activity
Enhanced NMDA receptor activity
Abnormal intracellular protein aggregation
Excessive calcium influxes into the neuron
Enhanced GABA receptor activity
inhibitory
Processes that cause degenerative CNS disorder
Enhanced NMDA receptor activity - glutamate , excitatory Abnormal intracellular protein aggregation Excessive calcium influxes into neuron Hypoxia Ree radicals Immune response Infections Apoptosis
Which of the following drugs is least likely to be prescribed to treat the symptoms associated with parkinson’s disease
L-dopa + carbidopa
Selegiline
Haloperidol
Pramipexole
Haloperidol - Butyrophenone, treats schizophrenia
L-dopa and carbidopa
L-dopa crosses BBB
Carbidopa blocks metabolism
Treats Parkinson’s
Selegiline
blocks MAO from breaking down dopamine
Treats Parkinson’s
Haloperidol
a butyrophenone
treats schiz
Pramipexole
Dopamine agonist
D2 agonist
treats Parkinson’s
Which of the following disorders is mostly likely to be associated with excessive dopamine and diminished GABA activity in the striatum
Multiple sclerosis
Huntington’s disease
Bipolar disorder
Major anxiety disorder
Huntington’s disease
excessive DA, decreased GABA
Multiple sclerosis
Inflammation auto-immune Oligodendrocytes lose myelin sheath virus trigger
Huntington’s disease
excessive DA
decreased GABA
Bipolar disorder
Manic-depression
imbalance of catecholamines, DA, NE, Epi, 5HT
Major anxiety disorder
possibly adrenal gland problem or sympathetic excess
constant fight/flight response
Parkinsons
not enough dopamine
Which of the following is not associated with Alzheimer’s disease
Abnormal amyloid precursor protein
Beta amyloid plaques/APP plaques
Neurofibrillary tangles - tao proteins
Alpha synuclein Lewy bodies
Alpha synuclein Lewy bodies
alpha synuclein lewy bodies
Parkinson’s
inside nerve cells
Which of the psychiatric conditions is least likely to have a significant impact on dental care/management
schizophrenia
bipolar disorder
cyclothymia
autism spectrum disorder
cyclothymia
cyclothymia
minor bipolar
cycles from depression/dysthymia to manic
A patient experiencing major psychosis caused by an automobile accident is most likely to be classified in which psychiatric dimensional axis
Axis I
II
III
IV
Axis III
Axis I
Everything but mental retardation and personality disorders and injuries
depression, anxiety, bipolar, autism, anorexia and bulimia, schiz, drug dependence?
Axis II
Personality disorders
Axis III
Brain injuries
Other medical/physical disorders which may aggravate existing conditions
Axis IV
Psychosocial and environmental factors contributing to disorder
Best prognosis for Schizophrenia
Temporary cause related positive symptoms later onset female no family history
Bad prognosis for Schiz
Institutionalized Longer in residual state Negative symptoms worse in men Family history
Entacapone
treats what
mech
treats parkinson’s
COMT inhibitor - prevents L-dopa from breaking down in G.I. tract
Prednisone
treats what
mech
Multiple sclerosis
anti-inflammatory steroid
Bupropion (Buspar)
treats what
used as what
Severe anxiety
non-addicting substitute for sedatives
chlorpromazine
treats what
category and mech
treats schizophrenia
Phenothiazine
D2 antagonist
Donepezil
Treats what
mech
Alzheimer’s disease
cholinesterase inhibitor
Fluoxetine
treats what
type of drug
treats bulimia
an SSRI drug
Clozapine
treats what
mech
treats schiz
Atypical D2 and 5HT2A antagonist
Modafinil
treats what
Mech
Treats ADHD
DAT and/or NET blocker but mostly a non-stimulant
Carbamazepine
treats what
mech
treats bipolar mania
antiseizure medication
Lithium carbonate
treats what
mech
treats bipolar mania
an element that laters G proteins
Alprazolam
treats what
mech
treats severe anxiety
agonist at benzodiazepine receptor
Of the following issue with the woman with Alzheimer’s, which is least likely to cause significant problems for dental management of this patient
Xerostomia
Patient’s endurance
Stage of disease
Use of Sertraline
Use of Sertraline - selective serotonin re-uptake inhibitor for depression and anxiety (SSRI)
Side effect of Benztropine
xerostomia
used to treat excess salivation
Which of the following is most likely responsible for a worsening of the patient’s memory
Sertraline
Benztropine
Ibuprofen
Vitamins
Benztropine
How does benztropine worsen memory loss for Alzheimer’s
Alzheimers is a lack of ACh action
benztropine causes low ACh (anticholinergic)
usually used to treat Parkinson’s tremors
Which of the following drugs is most likely to be neurotoxic b/c of its ability to dramatically alter the intracellular and extracellular release patterns of dopamine
heroin
nicotine
methylphenidate
methamphetamine
methamphetamine
Mech of meth
Released DA from vesicles and reverses re-uptake transporter of DA
Mech of nicotine
activates nicotinic receptors, DA release, not intra/extra cellular pattern
Mech of methylphenidate
Ritalin
Stimulant
blocks re-uptake of DA
Which behavioral therapies for treating drug addiction most likely affects the frontal cortex
Motivational enhancement
adverse therapy
urine drug checks
Cognitive therapy
Cognitive therapy - frontal cortex
motivational enhancement therapy
orbital frontal cortex
priority list changes
Contingency Management
Cortex to amygdala
rewards for good behavior towards addictions
Which of the following has been shown to most likely be a genetic explanation for elevated risk of becoming addicted to cocaine
elevated activity of GABA receptors
diminished activity of D2 receptors
diminished activity of D1 receptors
elevated activity of NMDA receptors
diminished activity of D2 receptors
action of diminished D2 receptors
D2 deactivates other euphoric processes
diminished D2 means more action is required to get to the same euphoric state?
Side effects of Aspirin
G.I. irritation (acetylsalicylic acid)
Anti-clotting
Tinnitus
Reye’s syndrome
How to treat neuropathic pain (diabetic foot)
Lyrica - GABApentin
anticonvulsant
Anacin
Aspirin and caffeine
Side effects of ibuprofen
G.I. and anti-clotting
Indomethacin
non-selective NSAID
bad side effects
Celecoxib (Celebrex)
Cox 2 inhibitor
Cardo effects but no G.I. problems and no anti-clotting
Pathway of pain sensation
Transduction (nerve endings)
Transmission (DRG)
Modulation (dorsal horn of spinal cord)
Perception (cortex)
which of the following is considered to be a modulating receptor on the free endings of sensory nerve terminals
Prostaglandin receptors
Thermo-nociceptors
Chemo-nociceptors
Mechanical-nociceptors
Prostaglandin receptors
Thermo-nociceptors
transduction receptor
Chemo-nociceptors
pH - transduction
Mechanical-nociceptors
ATP related - transduction
Neuropathic pain
occurs without activation of receptors on the free endings of sensory nerve terminals
Somatic pain typically responds to
NSAID analgesics
Visceral pain typically responds to
opioid narcotic analgesics
Allodynia
Pain evoked by not normally painful stimuli
Allogesia
super pain from a normally painful stimuli
Nerves associated with dental pulp
Plexus of Raschkow
A delta fibers
small and myelinated and associated with sharp localized pain
C fibers
small and non-myelinated and associated with dull diffuse pain
What molecules alter Modulation
Prostaglandins
Bradykinins?
Substance P.
glutomate
Sensitization
doesn’t need as big an action potential to get response
Differences in Cox 1 and Cox 2 side effects
Cox 1 Prostaglandins G.I. Renal function Anti-clotting Vasoconstriction
Cox 2 Prostaglandins Renal function Vasodilation cardiovascular side effects
Salicylates (aspirin)
Cox 1 and 2
Ibuprofen
Cox 1 and 2
Acetaminophen (tylenol)
not cox 1 or 2
Opioid peptide that primarily activates kappa receptors
Dynorphins
Encephaline
mu and delta receptors
b-endorphins
mu and delta receptors
Substance P
causes sensitization
Which of the following is not an NSAID
Indomethacin
Diflunisal
Naprosyn
Meperidine
Meperidine - opioid narcotic
Meperidine
opioid narcotic
Indomethacin
non-selective NSAID with bad side effects
Diflunisal
NSAID for bone pain
Naprosyn
Aleve, long lasting NSAID
Most potent narcotic analgesic
Fentanyl
Morphine
least potent of ‘phines, phones’
Hydrocodone
Order from least to most potent of ‘codones’
Codein, hydrocodone, oxycodone
Tramadol
Opioid narcotic
non addictive
Which is least likely a side effect of potent narcotic analgesic
diarrhea
reduced pulmonary reflex
additive/synergic interaction with other CNS depressants
euphoria
diarrhea
usually causes constipation
