Midterm 1

Question 1

Pilocarpine

Answer 1

Selective muscarinic agonist.

Treats glaucoma by causing the contraction of ciliary muscles (M3 receptor) and increase in aqueous humor drainage.

Question 2

Bethanechol

Answer 2

Selective muscarinic agonist (synthetic analogue).

Used to increase GI motility and bladder tone after surgery.

Question 3

Atropine

Answer 3

Competitive muscarinic antagonist.

Used to dilate pupil, treat slow heart rate, and reduce secretion during surgery.

Question 4

Ipratropium bromide

Answer 4

Competative muscarininc antagonist (synthetic analogue).

Treats asthma and COPD by dilating bronchi.

Question 5

Muscarinic Agonists treat…

Answer 5

1. Glaucoma
2. Dry mouth
3. Stimulate tone in bladder after surgery
4. Increase gut motility

Question 6

Side effects of muscarinic agonists…

Answer 6

Stimulates all muscarinic receptors, GI disturbances (nausea and vomiting), CNS effects, bradycardia, salivation and bronchoconstriction.

Question 7

Nicotinic agonist uses and side effects

Answer 7

Used to treat nicotine addiction (patch, gum, aerosol).
Side effects (CNS): tremor, convulsions, coma

Question 8

Curare

Answer 8

Nicotinic antagonist - non-depolarizing (competative) antagonist.
You can overcome blockade by increasing ACh with AChE inhibitor.
Used to produce skeletal muscle paralysis during surgery and in ICU.
Side effects: paralysis

Question 9

Succinylcholine

Answer 9

Nicotinic antagonist - depolarizing (non-competative) antagonist.
You cannot overcome blockade by increasing ACh with AChE inhibitor.
Used to produce skeletal muscle paralysis during surgery and in ICU.

Question 10

Neostigmine, physostigmine

Answer 10

Indirect acting cholinergic agent.
Inhibits metabolism of ACh in synapse (increases ACh duration).
Reversible cholinesterase inhibitor (weakly binds).
Uses: increases gut and bladder motility, treats glaucoma, treats myasthenia gravis.
Side effects: salivation, miosis, bronchoconstriction, bradycardia, nausea.

Question 11

Insecticides (melathion) and nerve gases (sarin)

Answer 11

Irreversible cholinesterase inhibitor (covalent bond with AChE)
Effects at both muscarinic and nicotinic receptors.
Initial signs muscarinic (bronchoconstriction, salivation, GI symptoms, CNS symptoms). Followed byt CNS and PNS nicotinic signs (activation of skeletal muscle, paralysis).
Treatment: support respiration, decontamination, use muscarinic antagonist (atropine) and a compund that can break the covalent bond with the inhibitor (pralidoxime).

Question 12

Differences between the 3 types of muscle.

Answer 12

Smooth: single nucleus, non striated, in walls of vessels and hollow organs, involuntary.
Cardiac: striated, single nucleus, branched, involuntary.
Skeletal: striated, multi nucleated, voluntary.

Question 13

Types of receptors on presynaptic symp nerves, smooth muscles, heart, and other

Answer 13

Symp nerves: alpha 2
Smooth muscle: alpha 1 and beta 2
Heart: Beta 1
Other: alpha 2 and beta 2

Question 14

Phenylephrine

Answer 14

Direct adrenergic alpha 1 agonist.
Treats: Nasal congestion (constricts bvs in nasal mucosa), dilates pupils (activates alpha 1 receptors), combines with local anesthetic (constricts bvs and prolongs nerve block).
Side effects: can increase BP

Question 15

Clonidine

Answer 15

Direct adrenergic alpha 2 agonist.
Decreases release of NE via inhibition of AC and cAMP signalling.
Treats: hypertension
Side effects: sedation

Question 16

Dobutamine

Answer 16

Direct adrenergic beta 1 agonist.
Treats: heart failure (increases the ability of the heart to contract)
Side effects: increased Ca can trigger arrhythmias

Question 17

Salbutamol

Answer 17

Direct adrenergic beta 2 agonist.
Treats: asthma (relaxes smooth muscle via inhibition of MLCK phosphorylation and prevents bronchospasm), premature labour (relaxes pregnant uterus smooth muscle)
Side effects: increased HR (non specific activation of beta 1 in heart)

Question 18

Adrenaline/Epinephrine

Answer 18

Direct adrenergic agonists (at multiple receptor subtypes).
Treat: anaphylaxis, and used in combo with anaesthetics
Side effects: Increased Ca can trigger arrythmias

Question 19

Cocaine

Answer 19

Indirect adrenergic agonist.
Inhibits reuptake of NE.
Used for: anaesthetic (blocks Na channels in nerve), and topical anaesthesia in nasopharyngeal surgery
Side effects: CNS stimulant, increases HR/BP/FVC, arrhythmia

Question 20

Amphetamine/ephedrine

Answer 20

Indirect adrenergic agonist.
Causes release of NA.
Treats: narcolepsy, ADHD, appetite surpressant
Side effects: CNS stimulant, increased HR/BP/FVC, arrhythmias

Question 21

Phenoxybenzamine

Answer 21

Direct alpha adrenergic antagonist (block receptors in the SNS).
Non selective for a1 and a2.

Question 22

Prazosin

Answer 22

Direct alpha adrenergic antagonist (block receptors in the SNS).
Selective for a1.
Treats: High BP
Side effects: hypotension, nasal congestion

Question 23

Propanolol (non selective) and metroprolol (cardioselective b1)

Answer 23

Direct Beta antagonists.
Drugs that block B receptors in the SNS.
Treats: high BP, angina, arrhythmias, glaucoma (decrease aqueous humor secretion in eye).
Side effects: exercise tolerance, asthma

Question 24

Beta-AR blockers and glaucoma

Answer 24

Act at Beta-AR receptors on the epithelium and decrease aqueous humor secretion leading to a decrease in pressure in the eye.
Gold standard.
Ex: propranolol

Question 25

Cyclosporine

Answer 25

Given to people who have had an organ transplant to preserve the organ and stop their bodies from viewing it as foreign.
Increase susceptibility to infections (toxic reaction).
Kidney damage (side effect).
Rashes, hives, etc (allergic effect).
Inactivated by CP450

Question 26

NTs and Receptors for…

1. PNS
2. SNS
3. Somatic
4. Sweat glands (SNS)
5. Adrenal medulla (SNS)

Answer 26

1. Pre: ACh N. Post: Ach M.
2. Pre: Ach N. Post: NE alpha and beta.
3. One neuron: ACh N.
4. Pre: Ach N. Post: Ach M.
5. Pre: ACh N. Releases: NE and Adr.