Module4Pharm Flashcards
Which medications are approved for hypertension during pregnancy?
a) metoprolol
b) guanfacine
c) methyldopa
d) methyldopate
Answer: c) methyldopa
Others include labetalol and nifedipine
Parasympathetic drugs excess (cholinergic response is best known by what acronym)?
SLUDGE: salivation, lacrimation, urination, defecation, gastric upset, emesis
What does SLUDGE refer to?
EXCESS cholinergic response
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
Answer: d) lacrimation and emesis
Remember: muscarinic agonists are generating cholinergic responses so they are the same as SLUDGE.
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
Answer: a) urinary retention
Think opposite of SLUDGE.
S&S include: dry eyes, constipation, dry skin, urinary retention, blurred vision
Which of the following is a side effect of oxybutynin?
a) CNS stimulation
b) bradycardia
c) diarrhea
d) dry mouth
Answer: d) dry mouth
Other SE: blurred vision, urinary retention, constipation, tachycardia, hallucination
Which is not a drug for overactive bladder (OAB)?
a) oxybutynin
b) prazosin
c) fesoterodine
d) darifenacin
Answer: b) prazosin
Prazosin is used for HTN and BPH
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
answer: 3,1,4,5,2 (synthesis, storage, release, binding, termination)
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
Answer: a) regulation of heart and d)regulation of secretory glands
Other function is regulation of SMOOTH muscles
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
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
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
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
The baroreceptor reflex is an example of what mechanism involving a sensor, effector, and neurons connecting the two?
Feedback.
The baroreceptor reflex involves blood pressure regulation.
Which part of the ANS implements fight or flight?
a) sympathetic
b) parasympathetic
c) somatic
d) none of the above
a) sympathetic
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
Answer: f) two or more of the above
Contraindications are peptic ulcer disease, urinary tract obstruction, GI obstruction, coronary insufficiency, hypotension, asthma, hyperthyroidism
What treats anti-muscarinic (muscarinic antagonist) poisoning?
a) atropine
b) pyridostigmine
c) physostigmine
d) pralidoxime
Answer: c) physostigmine
Note: pyridostigmine is used for M. gravis
What can treat irreversible cholinesterase inhibition?
a) atropine
b) pyridostigmine
c) physostigmine
d) pralidoxime
Answer: d) pralidoxime
Will not reduce CNS depression (mechanical ventilation required)
Atropine needed to reduce muscarinic stimulation
Which OAB drug has the most M3 receptor selectivity?
a) oxybutynin
b) darifenacin
c) solifenacin
d) trospium
Answer: b) darifenacin
Which is NOT a drug for OAB?
a) trospium
b) pralidoxime
c) darifenacin
d) fesoterodine
Answer: b) pralidoxime
“Our Darling Son Tinkles Frequently (on) Trips”
^mnemonic for OAB drugs
Which OABs are selective (choose all that apply):
a) tolterodine
b) solifenacin
c) oxybutynin
d) fesoterodine
e) trospium
Answer: b,c are selective
Selective OAB: oxybutynin, darifenacin, solifenacin
Nonselective: Tolterodine, fesoterodine, trospium
Which OAB drug can prolong the QT interval?
a) tolterodine
b) solifenacin
c) oxybutynin
d) fesoterodine
e) trospium
Answer: b) solifenacin (at high doses)
Note: tolterodine can also prolong the QT
What are the normal functions of alpha 1?
vasoconstriction, ejaculation, bladder neck contraction and prostate
What are the normal functions of alpha 2?
Presynaptic junction-minimal clinical use
What are the normal functions of beta 1?
Heart (increases HR/force of contraction/velocity of conduction in AV); stimulates renin in kidney
What are the normal functions of beta 2?
Bronchodilation, uterine muscle relaxation, vasodilation, glycogenolysis (glycogen –> glucose)
What is the normal function for dopamine?
Dilates renal blood vessels.
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
Answer: c)two or more of the above.
MAO-Is inhibit norepinephrine and epinephrine.
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
Answer: f) two or more of the above
Bechanechol is used for urinary retention and GI reflux.
What is not a side effect of muscarinic agonists?
a) dysrhythmias
b) asthma exacerbation
c) constipation
d) increased salivation
Answer: c) constipation
Muscarinic agonists “rest and digest” or think “SLUDGE”
Note: dysrhythmias occur in patients with HYPERTHYROIDISM
The other 3 choices are correct.
What site do muscarinic antagonists work?
a) all cholinergic receptors
b) adronergic receptors
c) muscarinic receptors
d) one or more of the above
Answer: c) muscarinic receptors
Note: they block both Ach and muscarine at the MUSCARINIC sites
Which is a use for Cevimeline?
a) Sjogren’s syndrome
b) urinary retention
c) topical glaucoma
d) rapid miosis
Answer: a) Sjogren’s syndrome
treats dry mouth
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
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.
What are the effects of atropine?
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)
What type of drug is atropine considered?
a) muscarinic agonist
b) muscarinic antagonist
c) cholinesterase inhibitor
d) adrenergic agonist
Answer: b)muscarinic antagonist
Used to reverse muscarinic AGONIST poisoning
Dicyclomine is used for what?
a) OAB
b) Sjogren’s syndrome
c) pre-anesthesia secretion drying
d) IBS
Answer: d) IBS
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
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
What is the drug of choice to treat anti-muscarinic poisoning?
a) atropine
b) pyrimidine
c) oxybutynin
d) physostigmine
Answer: d) physostigmine
It inhibits acetylcholinesterase which increases available Ach
Ipratropium bromide uses include:
a) asthma
b) COPD
c) rhinitis
d) nasal congestion
e) one or more of the above
Answer: e) one or more of the above
Answers a,b,c are correct.
Mydiratic cycoplegics are used for:
a) eye constriction
b) eye dilation
Answer: b) eye dilation in eye surgery
Oxybutynin is used for:
a) OAB
b) Sjogren’s syndrome
c) pre-anesthesia secretion drying
d) mydriasis
Answer: a) OAB
True or false, most OAB drugs will cause anticholinergic effects?
True
Side effects of oxybutynin include:
a) bradycardia
b) bronchodilation
c) tachycardia
d) hallucination
e) one or more of the above
Answer: e) one or more of the above
Oxybutynin (OAB drug) has SE: tachycardia and hallucination
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
Answer: c) Darifenacin
Which drugs are used in M. Gravis to strengthen muscles?
a) pralidoxime
b) neostigmine
c) isoproterenol
d) pyridostigmine
Answer: b&d
Neostigmine and pyridostigmine
They are both REVERSIBLE cholinesterase inhibitors
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
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),
What is the origin of most irreversible cholinesterase inhibitors?
Pesticides
Only clinical use is glaucoma
What are the treatment basics for irreversible cholinesterase inhibitors?
a) mechanical ventilation
b) acetylcholine
c) fluids
d) atropine
Answer: a & d
Treatment basics for irreversible cholinesterase inhibitors (pesticides) is atropine and mechanical ventilation
Which adrenergic agonist has the benefit of crossing the BBB and is not metabolized by COMT?
a) catecholamines
b) noncatecholamines
Answer: b) noncatecholamines
They are also metabolized slower and can be given orally.
Which receptors is epinephrine effective at?
a) alpha 1
b) alpha 2
c) beta 1
d) beta 2
Answer: a,b,c,d
Which receptors is norepinephrine effective at?
a) alpha 1
b) alpha 2
c) beta 1
d) beta 2
Answer: a,b,c
Alpha 1, alpha 2, beta 1
Which receptors is isoproterenol effective at?
a) alpha 1
b) alpha 2
c) beta 1
d) beta 2
Answer: c, d
Beta 1 and beta 2
“Every every night I deliver dogs peanut-butter apples”
Is the acronym to remember the sequence of adrenergic agonists. See answer slide.
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)
At low doses, dopamine activates ___ receptors. At moderate doses, dopamine activates ____ receptors. At high doses dopamine activates ___ receptors.
Answer: At low doses, dopamine activates dopmaine receptors. At moderate doses, dopamine activates beta 1 receptors. At high doses dopamine activates alpha 1 receptors.
What are uses for dopamine?
a) hypotensive state
b) shock
c) epistaxis
d) decrease BP
Answer: b) shock
Also used for heart failure. It stimulates various receptors depending on the dose.
What are uses for dobutamine?
a) hypotensive state
b) shock
c) epistaxis
d) heart failure
Answer: d) heart failure
It stimulates beta 1
What are uses for isoproterenol?
a) AV block
b) epistaxis
c) bronchodilation
d) cardiac arrest
e) one or more of the above
Answer: e) one or more of the above
It is used for: AV block, cardiac arrest, increase cardiac output after shock
What is a side effect of alpha 2 blockade?
a) liver failure
b) hepatotoxicity
c) reflex tachycardia
d) rebound hypertension
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
Activation of alpha 2 receptors can achieve:
a) reduced sympathetic outflow
b) pain relief
c) vasoconstriction
d) urinary retention
Answer: a & b
What is an adverse effect of alpha 1 activation?
a) bronchoconstriction
b) urinary retention
c) bradycardia
d) myosis
Answer: c) bradycardia
Due to baroreceptor reflex
Pre-surgical treatment of pheochromocytoma should be achieved with what medication?
a) atropine
b) alpha 1 antagonist
c) alpha agonist
d) cholinesterase inhibitor
Answer: b) alpha 1 antagonist to help prevent massive release of catecholamines during the tumor removal from the adrenal medulla
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
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)
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
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
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
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),
Which beta blockers are safe in asthma (cardioselective)?
ABEAM: atenolol, bisoprolol, esmolol, acebutolol, and metoprolol
Which patients should we be careful with our selection of a beta blocker?
a) asthmatics
b) COPD
c) diabetics
d) immunocompromised
Answer: a & c
Which of these are non-selective beta blockers?
a) metoprolol
b) bisprolol
c) bismoprolol
d) carvedilol
Answer: d) carvedilol
Other non-selective beta blockers include propranolol and nadolol
True or false, alpha 1 is blocked with carvedilol and labetolol ( in addition to beta 1 and beta 2)?
True.
Best beta-blockers for heart failure include:
a) acebutolol
b) carvedilol
c) propranolol
d) metoprolol succinate
e) atenolol
f) bisoprolol
g) esmolol
Answer: b, d, f
Carvedilol, metoprolol succinate, bisoprolol
Heart failure MNEUMONIC for beta blockers:
“My Cardiac Beats”?
Adverse effects of beta 1 adrenergic blocking:
a) heart failure
b) tachycardia
c) rebound excitation
d) sodium retention
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)
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
Answer: d) block CNS transmission ( they act indirectly)
What are therapeutic uses for cloinidine?
a) HTN
b) smoking cessation
c) Tourettes
d) severe pain
e) one or more of the above
Answer: a&d
Therapeutic uses are HTN, severe pain, ADHD
Off label uses include: opioid/methadone withdrawal, smoking cessation, Tourettes
Which is not a side effect of Clonidine?
a) abuse potential
b) seizures
c) rebound HTN
d) gynecomastia
Answer: b) seizures
Other SE: drowsiness, impotence, CNS, xerostomia, constipation, teratogen
Uses for Guanabenz and Guanfacine:
a) HTN
b) smoking cessation
c) ADHD
d) severe pain
e) one or more of the above
Answer: e) one or more of the above
Uses are HTN and ADHD
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
Answer: d) hemolytic anemia
Other SE: hepatic necrosis
Which medication is the only one indicated for depression in Parkinson’s?
a) Fluoxetine
b) Amantidine
c) Amitryiptyline
d) Sertraline
Answer: c) Amitriptyline
SSRIs cause psychosis
Parkinson’s is characterized by a deficiency of what transmitter?
Dopamine (note: excess Ach and insufficient dopamine)
What is the most effective treatment for Parkinson’s disease?
a) pramipexole+ropinirole
b) Selegiline+ dopamine
c) Levodopa+Carbidopa
d) Bromocriptine
Answer: c) levodopa+carbidopa
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.
True
What are the cardinal signs of Parkinson’s disease (4).
Tremor at rest, rigidity, postural instability, bradykinesia
True or false, Carbidopa has no side effects on its’ own.
True. The side effects from the Levo/Carbidopa combination come from Levo.
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
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.
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
Answer: c & d
Give amantidine (antiviral found to be beneficial in PD), surgery, and REDUCE the Levo dosage.
SE of Levo/Carbidopa:
a) orange secretions
b) hepatotoxic
c) dark sweat
d) constipation
Answer: c) dark sweat
Other se: dark urine, and activates malignant melanoma
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
Answer: b) mild stage
These drugs include pramipexole and ropinirole
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
Answer: b) mild stage
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
Answer: a) risk taking behavior
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
Answer: c) Rasagiline (and selegiline) and d)pramipexole (and ropinirole)
Which medications can be given for mild Parkinson’s?
a) pramipexole
b) rasagiline
c) benztropine
d) bromocriptine
Answer: All
What are side effects of selegiline and rasagiline?
a) risk taking behavior
b) liver failure
c) hyperprolactinemia
d) increased suicidal thoughts
Answer: d) increased suicidal thoughts when used with SSRI in adolescents/children
Other SE: fatal serotonin syndrome if given with SSRI
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
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”
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
Answer: a) any stage
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
Answer: d) to treat hypomobility in “off” periods
What is the benefit of Stalevo?
It is a combo pill of Levodopa/Carbidopa/Entacapone but it is only immediate release and 3 strengths.
What is used to treat psychosis in Parkinson’s?
a) SSRIs
b) amitryptyline
c) 1st generation antipsychotic
d) 2nd generation antipsychotic
Answer: d) second generation antipsychotic
Nonmotor symptoms of Parkinson’s disease:
Sleep issues, periodic limb movement, depression, psychosis
For limb movement issues in Parkinson’s disease, what can we use?
a) pramipexole/ropirinole
b) levodopa/carbidopa
c) amitryptyline
d) benztropine
Answer: a) pramipexole/ropirinole
What can manage insomnia in Parkinson’s?
a) melatonin
b) pramipexole/ropirinole
c) levodopa/carbidopa
d) apomorphine
Answer: a & c
Cholinesterase inhibitors are appropriate for which stage of Alzheimers?
a) mild to moderate
b) moderate to severe
Answer: a) mild to moderate
Memantine, an NMDA receptor antagonist is appropriate for which stage of Alzheimer’s?
a) mild to moderate
b) moderate to severe
Answer: b) moderate to severe
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
Answer: d) HL-B1502
