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NURS 5334 > Module4Pharm > Flashcards

Module4Pharm Flashcards

1
Q

Which medications are approved for hypertension during pregnancy?

a) metoprolol
b) guanfacine
c) methyldopa
d) methyldopate

A

Answer: c) methyldopa

Others include labetalol and nifedipine

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2
Q

Parasympathetic drugs excess (cholinergic response is best known by what acronym)?

A

SLUDGE: salivation, lacrimation, urination, defecation, gastric upset, emesis

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3
Q

What does SLUDGE refer to?

A

EXCESS cholinergic response

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4
Q

Muscarinic agonist symptoms would be similar to which of the following?

a) dry mouth and defecation
b) GI upset and constipation
c) salivation and blurred vision
d) lacrimation and emesis

A

Answer: d) lacrimation and emesis

Remember: muscarinic agonists are generating cholinergic responses so they are the same as SLUDGE.

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5
Q

Muscarinic antagonist symptoms might include:

a) urinary retention
b) secretions
c) defecation
d GI upset
e) one or more of the above
f) none of the above

A

Answer: a) urinary retention

Think opposite of SLUDGE.

S&S include: dry eyes, constipation, dry skin, urinary retention, blurred vision

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6
Q

Which of the following is a side effect of oxybutynin?

a) CNS stimulation
b) bradycardia
c) diarrhea
d) dry mouth

A

Answer: d) dry mouth

Other SE: blurred vision, urinary retention, constipation, tachycardia, hallucination

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7
Q

Which is not a drug for overactive bladder (OAB)?

a) oxybutynin
b) prazosin
c) fesoterodine
d) darifenacin

A

Answer: b) prazosin

Prazosin is used for HTN and BPH

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8
Q

Sequence the following steps of synaptic transmission:

1) transmitter storage
2) transmitter termination
3) transmitter synthesis
4) transmitter release
5) transmitter binding to receptor cell

A

answer: 3,1,4,5,2 (synthesis, storage, release, binding, termination)

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9
Q

What are the roles of the autonomic nervous system?

a) regulation of heart
b) regulation of skeletal muscles
c) regulation of smooth & skeletal muscle
d) regulation of secretory glands
e) one or more of the above

A

Answer: a) regulation of heart and d)regulation of secretory glands

Other function is regulation of SMOOTH muscles

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10
Q

The parasympathetic nervous system does which of the following:

a) vasoconstict
b) slows HR
c) pupil dilation
d) bronchial constriction
e) decrease gastric secretion
f) one or more of the above

A

Answer: f) one or more of the above

Functions: slow HR, bronchial constriction, increase gastric secretions, empty bladder/bowel, pupil constrict to facilitate near vision

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11
Q

What are functions of the sympathetic nervous system:

a) vasoconstrict at skin level
b) vasoconstrict at skeletal muscles
c) increase HR
d) bronchial dilation
e) mobilize stored energy
f) one or more of the above

A

Answer: f) one or more of the above

Functions are: vasoconstriction at skin level, vasoDILation at skeletal muscles, increase HR/BP (increases CO), bronchial dilation, mobilize stored energy, dilate pupils

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12
Q

The baroreceptor reflex is an example of what mechanism involving a sensor, effector, and neurons connecting the two?

A

Feedback.

The baroreceptor reflex involves blood pressure regulation.

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13
Q

Which part of the ANS implements fight or flight?

a) sympathetic
b) parasympathetic
c) somatic
d) none of the above

A

a) sympathetic

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14
Q

Which condition is a contraindication for bethanechol (muscarinic agonist)?

a) asthma
b) renal failure
c) peptic ulcer disease
d) hypertension
e) one or more of the above
f) two or more of the above

A

Answer: f) two or more of the above

Contraindications are peptic ulcer disease, urinary tract obstruction, GI obstruction, coronary insufficiency, hypotension, asthma, hyperthyroidism

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15
Q

What treats anti-muscarinic (muscarinic antagonist) poisoning?

a) atropine
b) pyridostigmine
c) physostigmine
d) pralidoxime

A

Answer: c) physostigmine

Note: pyridostigmine is used for M. gravis

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16
Q

What can treat irreversible cholinesterase inhibition?

a) atropine
b) pyridostigmine
c) physostigmine
d) pralidoxime

A

Answer: d) pralidoxime

Will not reduce CNS depression (mechanical ventilation required)

Atropine needed to reduce muscarinic stimulation

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17
Q

Which OAB drug has the most M3 receptor selectivity?

a) oxybutynin
b) darifenacin
c) solifenacin
d) trospium

A

Answer: b) darifenacin

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18
Q

Which is NOT a drug for OAB?

a) trospium
b) pralidoxime
c) darifenacin
d) fesoterodine

A

Answer: b) pralidoxime

“Our Darling Son Tinkles Frequently (on) Trips”
^mnemonic for OAB drugs

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19
Q

Which OABs are selective (choose all that apply):

a) tolterodine
b) solifenacin
c) oxybutynin
d) fesoterodine
e) trospium

A

Answer: b,c are selective

Selective OAB: oxybutynin, darifenacin, solifenacin

Nonselective: Tolterodine, fesoterodine, trospium

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20
Q

Which OAB drug can prolong the QT interval?

a) tolterodine
b) solifenacin
c) oxybutynin
d) fesoterodine
e) trospium

A

Answer: b) solifenacin (at high doses)

Note: tolterodine can also prolong the QT

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21
Q

What are the normal functions of alpha 1?

A

vasoconstriction, ejaculation, bladder neck contraction and prostate

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22
Q

What are the normal functions of alpha 2?

A

Presynaptic junction-minimal clinical use

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23
Q

What are the normal functions of beta 1?

A

Heart (increases HR/force of contraction/velocity of conduction in AV); stimulates renin in kidney

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24
Q

What are the normal functions of beta 2?

A

Bronchodilation, uterine muscle relaxation, vasodilation, glycogenolysis (glycogen –> glucose)

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25
Q

What is the normal function for dopamine?

A

Dilates renal blood vessels.

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26
Q

MAO-I’s inhibit which of the following:

a) acetylcholine
b) norepinephrine
c) epinephrine
c) two or more of the above
d) none of the above

A

Answer: c)two or more of the above.

MAO-Is inhibit norepinephrine and epinephrine.

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27
Q

Which of the following is an indicated use for Bechanechol?

a) urinary retention
b) mydriasis
c) myosis
d) GI reflux
e) one of the above
f) two or more of the above

A

Answer: f) two or more of the above

Bechanechol is used for urinary retention and GI reflux.

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28
Q

What is not a side effect of muscarinic agonists?

a) dysrhythmias
b) asthma exacerbation
c) constipation
d) increased salivation

A

Answer: c) constipation

Muscarinic agonists “rest and digest” or think “SLUDGE”

Note: dysrhythmias occur in patients with HYPERTHYROIDISM

The other 3 choices are correct.

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29
Q

What site do muscarinic antagonists work?

a) all cholinergic receptors
b) adronergic receptors
c) muscarinic receptors
d) one or more of the above

A

Answer: c) muscarinic receptors

Note: they block both Ach and muscarine at the MUSCARINIC sites

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30
Q

Which is a use for Cevimeline?

a) Sjogren’s syndrome
b) urinary retention
c) topical glaucoma
d) rapid miosis

A

Answer: a) Sjogren’s syndrome

treats dry mouth

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31
Q

Which is a use for Pilocarpine?

a) Sjogren’s syndrome
b) urinary retention
c) topical glaucoma
d) rapid miosis
e) one or more of the above

A

Answer: e) one or more of the above

It is used for topical glaucoma and dry mouth due to Sjogren’s syndrome.

Rapid miosis is achieved with acetylcholine for after cataract sx.

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32
Q

What are the effects of atropine?

A

Increased HR, decreased secretions, bronchodilation, decreased bladder tone of detrusor, decreased tone/motility of GI, mydriasis (pupil dilation) and cycloplegia

(Hot as a hare=increased temp and decreased sweating, mad as a hatter, red as a beet=tachycardia+sweating, dry as a bone=decreased secretions)

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33
Q

What type of drug is atropine considered?

a) muscarinic agonist
b) muscarinic antagonist
c) cholinesterase inhibitor
d) adrenergic agonist

A

Answer: b)muscarinic antagonist

Used to reverse muscarinic AGONIST poisoning

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34
Q

Dicyclomine is used for what?

a) OAB
b) Sjogren’s syndrome
c) pre-anesthesia secretion drying
d) IBS

A

Answer: d) IBS

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35
Q

Symptoms of anti-muscarinic poisoning?

a) SLUDGE
b) Can’t see can’t pee can’t spit can’t shit
c) respiratory depression
d) seizures, respiratory depression

A

Answer: b) excess ANTIcholinergic so think Can’t see can’t pee can’t spit can’t shit.

Caused by belladonna, anti-musarinic drugs, anti-histamines

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36
Q

What is the drug of choice to treat anti-muscarinic poisoning?

a) atropine
b) pyrimidine
c) oxybutynin
d) physostigmine

A

Answer: d) physostigmine

It inhibits acetylcholinesterase which increases available Ach

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37
Q

Ipratropium bromide uses include:

a) asthma
b) COPD
c) rhinitis
d) nasal congestion
e) one or more of the above

A

Answer: e) one or more of the above

Answers a,b,c are correct.

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38
Q

Mydiratic cycoplegics are used for:

a) eye constriction
b) eye dilation

A

Answer: b) eye dilation in eye surgery

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39
Q

Oxybutynin is used for:

a) OAB
b) Sjogren’s syndrome
c) pre-anesthesia secretion drying
d) mydriasis

A

Answer: a) OAB

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40
Q

True or false, most OAB drugs will cause anticholinergic effects?

A

True

41
Q

Side effects of oxybutynin include:

a) bradycardia
b) bronchodilation
c) tachycardia
d) hallucination
e) one or more of the above

A

Answer: e) one or more of the above

Oxybutynin (OAB drug) has SE: tachycardia and hallucination

42
Q

Which OAB drug has the greatest degree of M3 selectivity (acts without impacting brain or heart receptors)?

a) Tolterodine
b) Trospium
c) Darifenacin
d) Solifenacin

A

Answer: c) Darifenacin

43
Q

Which drugs are used in M. Gravis to strengthen muscles?

a) pralidoxime
b) neostigmine
c) isoproterenol
d) pyridostigmine

A

Answer: b&d

Neostigmine and pyridostigmine

They are both REVERSIBLE cholinesterase inhibitors

44
Q

What are side effects of cholinesterase inhibitors such as neostigmine and pyridostigmine?

a) salivation
b) dry mouth
c) urinary elimination
d) bradycardia
e) one or more of the above

A

Answer: e) one or more of the above

SE: Think normal parasympathetic functions (bradycardia, bronchoconstriction, urinary urgency, increased secretions, increased GI mobility/tone, focus eye for near vision),

45
Q

What is the origin of most irreversible cholinesterase inhibitors?

A

Pesticides

Only clinical use is glaucoma

46
Q

What are the treatment basics for irreversible cholinesterase inhibitors?

a) mechanical ventilation
b) acetylcholine
c) fluids
d) atropine

A

Answer: a & d

Treatment basics for irreversible cholinesterase inhibitors (pesticides) is atropine and mechanical ventilation

47
Q

Which adrenergic agonist has the benefit of crossing the BBB and is not metabolized by COMT?

a) catecholamines
b) noncatecholamines

A

Answer: b) noncatecholamines

They are also metabolized slower and can be given orally.

48
Q

Which receptors is epinephrine effective at?

a) alpha 1
b) alpha 2
c) beta 1
d) beta 2

A

Answer: a,b,c,d

49
Q

Which receptors is norepinephrine effective at?

a) alpha 1
b) alpha 2
c) beta 1
d) beta 2

A

Answer: a,b,c

Alpha 1, alpha 2, beta 1

50
Q

Which receptors is isoproterenol effective at?

a) alpha 1
b) alpha 2
c) beta 1
d) beta 2

A

Answer: c, d

Beta 1 and beta 2

51
Q

“Every every night I deliver dogs peanut-butter apples”

Is the acronym to remember the sequence of adrenergic agonists. See answer slide.

A 
Epinephrine-A1,A2,B1,B2
Ephedrine- all but poorly selective
Isoproterenol-B1, B2
Dopamine-depends on dose (low-dop; moderate-b1, high-a1)
Dobutamine-B1
Phenylephrine-A1
Albuterol-B2 (asthma=think two lungs)
52
Q

At low doses, dopamine activates ___ receptors. At moderate doses, dopamine activates ____ receptors. At high doses dopamine activates ___ receptors.

A

Answer: At low doses, dopamine activates dopmaine receptors. At moderate doses, dopamine activates beta 1 receptors. At high doses dopamine activates alpha 1 receptors.

53
Q

What are uses for dopamine?

a) hypotensive state
b) shock
c) epistaxis
d) decrease BP

A

Answer: b) shock

Also used for heart failure. It stimulates various receptors depending on the dose.

54
Q

What are uses for dobutamine?

a) hypotensive state
b) shock
c) epistaxis
d) heart failure

A

Answer: d) heart failure

It stimulates beta 1

55
Q

What are uses for isoproterenol?

a) AV block
b) epistaxis
c) bronchodilation
d) cardiac arrest
e) one or more of the above

A

Answer: e) one or more of the above

It is used for: AV block, cardiac arrest, increase cardiac output after shock

56
Q

What is a side effect of alpha 2 blockade?

a) liver failure
b) hepatotoxicity
c) reflex tachycardia
d) rebound hypertension

A

Answer: c) reflex tachycardia

Remember: BP is low due to vasodilation which is “sensed” and the compensatory measure is to increase HR to perfuse the organs)note the inhibition of alpha 2 increases the release of NE which further potentiates reflex tachycardia

57
Q

Activation of alpha 2 receptors can achieve:

a) reduced sympathetic outflow
b) pain relief
c) vasoconstriction
d) urinary retention

A

Answer: a & b

58
Q

What is an adverse effect of alpha 1 activation?

a) bronchoconstriction
b) urinary retention
c) bradycardia
d) myosis

A

Answer: c) bradycardia

Due to baroreceptor reflex

59
Q

Pre-surgical treatment of pheochromocytoma should be achieved with what medication?

a) atropine
b) alpha 1 antagonist
c) alpha agonist
d) cholinesterase inhibitor

A

Answer: b) alpha 1 antagonist to help prevent massive release of catecholamines during the tumor removal from the adrenal medulla

60
Q

Which of these are uses for alpha-adrenergic antagonists?

a) Raynauds
b) BPH
c) angina
d) essential HTN
e) one or more of the above

A

Answer: e) one or more of the above

Uses include (think block alpha 1 and alpha 2): Raynauds, BPH, essential HTN, reversal of toxicity of alpha agonists, and pheochromocytoma (tumor on adrenal medulla)

61
Q

Side effects of alpha-adrenergic antagonists?

a) sodium retention
b) sodium excretion
c) orthostatic hypotension
d) nasal decongestion
e) one or more of the above

A

Answer: e) one or more of the above

Think (block alpha 1 and alpha 2): SE: orthostatic hypotension (due to vasodilation), nasal congestion, impaired ejaculation, impotence, sodium and water retention due to reduced blood pressure

62
Q

Which is a use for beta-adrenergic blocking agents?

a) BPH
b) hypothyroidism
c) heart failure
d) HTN
e) one or more of the above

A

Answer: e) one or more of the above

Uses include: HTN, angina, cardiac arrhythmias, MI, hyperthyroidism, migraine prevention, glaucoma, pheochromocytoma, heart failure (carvedilol, metoprolol succinate, bisoprolol),

63
Q

Which beta blockers are safe in asthma (cardioselective)?

A

ABEAM: atenolol, bisoprolol, esmolol, acebutolol, and metoprolol

64
Q

Which patients should we be careful with our selection of a beta blocker?

a) asthmatics
b) COPD
c) diabetics
d) immunocompromised

A

Answer: a & c

65
Q

Which of these are non-selective beta blockers?

a) metoprolol
b) bisprolol
c) bismoprolol
d) carvedilol

A

Answer: d) carvedilol

Other non-selective beta blockers include propranolol and nadolol

66
Q

True or false, alpha 1 is blocked with carvedilol and labetolol ( in addition to beta 1 and beta 2)?

A

True.

67
Q

Best beta-blockers for heart failure include:

a) acebutolol
b) carvedilol
c) propranolol
d) metoprolol succinate
e) atenolol
f) bisoprolol
g) esmolol

A

Answer: b, d, f

Carvedilol, metoprolol succinate, bisoprolol

Heart failure MNEUMONIC for beta blockers:

“My Cardiac Beats”?

68
Q

Adverse effects of beta 1 adrenergic blocking:

a) heart failure
b) tachycardia
c) rebound excitation
d) sodium retention

A

Answer: a & c

SE: bradycardia, reduced CO (due to decreased HR and force), cause heart failure (EDUCATE YOUR PATIENT ABOUT S&S), AV heart block, rebound excitation (taper these drugs)

69
Q

What mechanism do clonidine, guanabenz, guanfacine, and methyldopate work?

a) block alpha 1
b) block beta 1
c) block alpha 1 & beta 1
d) block CNS transmission

A

Answer: d) block CNS transmission ( they act indirectly)

70
Q

What are therapeutic uses for cloinidine?

a) HTN
b) smoking cessation
c) Tourettes
d) severe pain
e) one or more of the above

A

Answer: a&d

Therapeutic uses are HTN, severe pain, ADHD

Off label uses include: opioid/methadone withdrawal, smoking cessation, Tourettes

71
Q

Which is not a side effect of Clonidine?

a) abuse potential
b) seizures
c) rebound HTN
d) gynecomastia

A

Answer: b) seizures

Other SE: drowsiness, impotence, CNS, xerostomia, constipation, teratogen

72
Q

Uses for Guanabenz and Guanfacine:

a) HTN
b) smoking cessation
c) ADHD
d) severe pain
e) one or more of the above

A

Answer: e) one or more of the above

Uses are HTN and ADHD

73
Q

Which is a side effect of methyldopa (IV) or methyldopate?

a) xerosomia
b) opioid and methadone withdrawal
c) rebound HTN
d) hemolytic anemia
e) one or more of the abovce

A

Answer: d) hemolytic anemia

Other SE: hepatic necrosis

74
Q

Which medication is the only one indicated for depression in Parkinson’s?

a) Fluoxetine
b) Amantidine
c) Amitryiptyline
d) Sertraline

A

Answer: c) Amitriptyline

SSRIs cause psychosis

75
Q

Parkinson’s is characterized by a deficiency of what transmitter?

A

Dopamine (note: excess Ach and insufficient dopamine)

76
Q

What is the most effective treatment for Parkinson’s disease?

a) pramipexole+ropinirole
b) Selegiline+ dopamine
c) Levodopa+Carbidopa
d) Bromocriptine

A

Answer: c) levodopa+carbidopa

77
Q

True or false, the combination of Levodopa/Carbidopa causes dyskinesias and psych issues which occur sooner and are more intense than when Levodopa is given alone.

A

True

78
Q

What are the cardinal signs of Parkinson’s disease (4).

A

Tremor at rest, rigidity, postural instability, bradykinesia

79
Q

True or false, Carbidopa has no side effects on its’ own.

A

True. The side effects from the Levo/Carbidopa combination come from Levo.

80
Q

How can we manage the “off” periods associated with Parkinson’s disease drugs?

a) increase dose interval
b) give a dopamine antagonist
c) Give a COMT inhibitor
d) Give a MAO-B inhibitor
e) one or more of the above

A

Answer: c &d

Giving a COMT inhibitor (increases half life and level of Levodopa) and MAO-B inhibitor. We can also shorten the drug interval and give a dopamine AGONIST.

81
Q

To makage dyskinesias seen in Parkinson’s disease we can:

a) increase the Levo dosage
b) give with a COMT inhibitor
c) surgery
d) give Amantidine
e) one or more of the above

A

Answer: c & d

Give amantidine (antiviral found to be beneficial in PD), surgery, and REDUCE the Levo dosage.

82
Q

SE of Levo/Carbidopa:

a) orange secretions
b) hepatotoxic
c) dark sweat
d) constipation

A

Answer: c) dark sweat

Other se: dark urine, and activates malignant melanoma

83
Q

When would the use of a dopaminergic drug be appropriate in manging Parkinson’s disease?

a) any stage
b) mild stage
c) severe stage
d) any time but as an adjunct to other therapy

A

Answer: b) mild stage

These drugs include pramipexole and ropinirole

84
Q

When would pramipexole or Ropinirole be used in Parkinson’s disease?

a) any stage
b) mild stage
c) severe stage
d) any time but as an adjunct to other therapy

A

Answer: b) mild stage

85
Q

What is a SE of pramipexole and ropinirole?

a) risk taking behavior
b) liver failure
c) fatal serotonin syndrome if given with SSRI
d) seizures

A

Answer: a) risk taking behavior

86
Q

For a patient with mild symptoms of Parkinson’s, which drug is FIRST LINE (choose all that apply)

a) Benztropine
b) Entacapone
c) Rasagiline
d) Pramipexole

A

Answer: c) Rasagiline (and selegiline) and d)pramipexole (and ropinirole)

87
Q

Which medications can be given for mild Parkinson’s?

a) pramipexole
b) rasagiline
c) benztropine
d) bromocriptine

A

Answer: All

88
Q

What are side effects of selegiline and rasagiline?

a) risk taking behavior
b) liver failure
c) hyperprolactinemia
d) increased suicidal thoughts

A

Answer: d) increased suicidal thoughts when used with SSRI in adolescents/children

Other SE: fatal serotonin syndrome if given with SSRI

89
Q

COMT inhibitors side effects include:

a) risk taking behavior
b) liver failure
c) hyperprolactinemia
d) increased suicidal thoughts
e) two or more of the above

A

Answer: e) two or more of the above

SE: liver failure BBW- tolcapone; risk taking behavior; impulse control; hallucinations; orthostatic hypotension

COMT inhibitors work to increase levels of Levo and Levo’s half life

“Al capone Killed COMT”

90
Q

When can rotigotine be used in Parkinson’s disease?

a) any stage
b) mild stage
c) severe stage
d) any time but as an adjunct to other therapy

A

Answer: a) any stage

91
Q

Apomorphine is used:

a) for pain in Parkinson’s disease
b) to decrease dyskinesias
c) to prolong life of Levo
d) to treat hypomobility in “off” periods

A

Answer: d) to treat hypomobility in “off” periods

92
Q

What is the benefit of Stalevo?

A

It is a combo pill of Levodopa/Carbidopa/Entacapone but it is only immediate release and 3 strengths.

93
Q

What is used to treat psychosis in Parkinson’s?

a) SSRIs
b) amitryptyline
c) 1st generation antipsychotic
d) 2nd generation antipsychotic

A

Answer: d) second generation antipsychotic

94
Q

Nonmotor symptoms of Parkinson’s disease:

A

Sleep issues, periodic limb movement, depression, psychosis

95
Q

For limb movement issues in Parkinson’s disease, what can we use?

a) pramipexole/ropirinole
b) levodopa/carbidopa
c) amitryptyline
d) benztropine

A

Answer: a) pramipexole/ropirinole

96
Q

What can manage insomnia in Parkinson’s?

a) melatonin
b) pramipexole/ropirinole
c) levodopa/carbidopa
d) apomorphine

A

Answer: a & c

97
Q

Cholinesterase inhibitors are appropriate for which stage of Alzheimers?

a) mild to moderate
b) moderate to severe

A

Answer: a) mild to moderate

98
Q

Memantine, an NMDA receptor antagonist is appropriate for which stage of Alzheimer’s?

a) mild to moderate
b) moderate to severe

A

Answer: b) moderate to severe

99
Q

Carbamezpine is linked to an increased risk of SJS in Asians with what genetic marker?

a) HL-B1504:01
b) HLA-B5801
c) HLA-B5802:01
d) HL-B1502

A

Answer: d) HL-B1502

NURS 5334 (12 decks)

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