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Pharmacology Exam - Flashcards > Nervous System > Flashcards

Nervous System Flashcards

0
Q

muscarinic antagonists

A

atropine

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1
Q

muscarinic agonists (parasympathomimetic)

A

bethanechol

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2
Q

ganglionic-stimulating agents

A

nicotine

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3
Q

cholinesterase inhibitors (ChE)

A

physostigmine, neostigmine

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4
Q

neuromuscular-blocking agents

A

tubocurarine

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5
Q

adrenergic agonists (sympathomimetic)

A

epinephrine (adrenaline)

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6
Q

adrenergic antagonists (block alpha and beta receptors)

A

prazosin (alpha adrenergic antagonist), propanolol (beta adrenergic antagonist)

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7
Q

nicotine receptors

A

release of epinephrine from adrenal medulla; located at neuromuscular junction of skeletal muscle; causes skeletal muscle contraction

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8
Q

muscarinic receptors

A

decreased secretions from lungs, stomach, intestines, sweat glands; decrease in HR; smooth muscle contraction in bronchi and GI tract; miosis (sphincter contraction) and accommodation (ciliary contraction); voiding due to contraction of detrusor muscle and relaxation of trigone and sphincter muscles

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9
Q

alpha 1 receptors

A

mydriasis d/t radial muscle contraction; veins and arterioles are activated to constrict; decreased peripheral resistance and increased blood pressure; male sex organs are activated to promote ejaculation; contraction of prostatic capsule, trigone, and sphincter muscles

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10
Q

dopamine receptors

A

dilates blood vessels in the kidneys

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11
Q

beta 1 receptors

A

predominant receptor found on the heart; decreased HR, increased contraction force, and increased conduction through AV node; increased lipolysis; release of renin by the kidneys

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12
Q

beta 2 receptors

A

dilates bronchi; relaxes uterine smooth muscle; vasodilation of arterioles in heart, lungs, and skeletal muscle; slightly decreased peripheral resistance; increased glycogenolysis in the liver and muscles; skeletal muscle contraction

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13
Q

medications affecting the nervous system: general points

A

adaptive changes within brain with prolonged exposure; increased therapeutic effect; decreased side effects; tolerance and physical dependence; do not stop abruptly

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14
Q

Parkinson’s disease

A

treatment uses two main classes: medications that activate dopamine receptors (directly or indirectly) and medications that block acetylcholine receptors

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15
Q

seizure disorders

A

different types of seizures respond to different medications; usually require life-long management; medications must be discontinued slowly over 6 weeks to several months

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16
Q

schizophrenia

A

clinical course includes semi-remission punctuated by acute exacerbations; positive symptoms (agitation, delusions) medications: conventional antipsychotic [thorazine], atypical antipsychotic [clozapine]; negative symptoms (social withdrawal, poor self-care) medications: atypical antipsychotic [clozapine]; cognitive symptoms (difficulties with memory and learning); initial doses are high and given throughout the day; Maintenon doses given at bedtime

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17
Q

depression

A

symptom relief can take 1 to 3 weeks and possibly 2 to 3 months; three main groups: tricyclic antidepressants (TCAs), selective serotonin reuptake inhibitors (SSRIs), and monoamine oxidase inhibitors (MAOIs)

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18
Q

bipolar disorder

A

typically managed with mood stabilisers; antipsychotics and antidepressants may be used during acute episodes of mania or depression; lithium, valproic acid [Depakote], and carbamazepine [Tegretol]

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19
Q

cholinesterase inhibitors: expected action

A

prevents ACh degradation; increased transmission of nerve impulses by increased ACh

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20
Q

cholinesterase inhibitors: therapeutic uses

A

increased muscle strength by increasing ACh at neuromuscular junction in myasthenia gravis; reversal of nondepolarising neuromuscular blocking agents (tubocurarine)

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21
Q

cholinesterase inhibitors: adverse effects

A

excessive muscarinic stimulation; increased GI motility and secretions, bradycardia, and urinary urgency (side effect can be treated with atropine); cholinergic crisis: above plus respiratory depression from neuromuscular blockade

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22
Q

cholinesterase inhibitors: contraindications and precautions

A

pregnancy C; CI in obstruction of GI and GU systems; caution with seizures, asthma, bradycardia, hypotension, and peptic ulcer disease

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23
Q

cholinesterase inhibitors: interactions

A

tubocurarine: neostigmine reverse blockade; atropine: counteracts; succinylcholine: increased neuromuscular blockade

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24
Q

cholinesterase inhibitors: education

A

wear medic-alert bracelet

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25
Q

cholinesterase inhibitors: prototypes

A

neostigmine, physostigmine

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26
Q

neuromuscular blocking agents: expected action

A

block ACh at neuromuscular junction (doesn’t cross blood-brain barrier)

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27
Q

neuromuscular blocking agents: prototypes

A

nondepolarising: tubocurarine, pancuronium; depolarising: succinylcholine

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28
Q

neuromuscular blocking agents: therapeutic uses

A

control spontaneous respiration in ventilated patients; adjuncts to general anaesthesia; diagnose myasthenia gravis; succinylcholine for: electroconvulsive therapy (ECT), intubation, and endoscopy

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29
Q

neuromuscular blocking agents: adverse effects

A

hypotension from histamine release and ganglionic blockade; respiratory arrest; bradycardia and dysrhythmias; succinylcholine: low pseudocholinesterase activity causing apnea, malignant hyperthermia (dantrolene), pain, and hyperkalaemia

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30
Q

neuromuscular blocking agents: contraindications

A

pregnancy C; SCh: CI for hyperkalaemia (trauma, burns)

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31
Q

neuromuscular blocking agents: interactions

A

general anaesthetics; aminoglycosides and tetracyclines causing increased NM blockade; neostigmine and ChE inhibitors causing decreased nondepolarising and increased alpha depolarising

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32
Q

dopaminergics (anti-Parkinson’s): expected action

A

levodopa taken up and converted to dopamine; carbidopa augments levodopa by preventing conversion to dopamine in intestine and periphery (increased DA in CNS)

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33
Q

dopaminergics (anti-Parkinson’s): prototypes

A

levodopa, carbidopa, sinemet

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34
Q

dopaminergics (anti-Parkinson’s): therapeutic uses

A

symptomatic relief from dyskinesias

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35
Q

dopaminergics (anti-Parkinson’s): adverse effects

A

dyskinesias; discolouration of sweat and urine; nausea and drowsiness; orthostatic hypotension; psychosis (clozapine); activation of malignant melanoma

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36
Q

dopaminergics (anti-Parkinson’s): contraindications and precautions

A

cardiac and psychiatric disorders; CI melanoma; 2 weeks from MAOI; pregnancy C

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37
Q

dopaminergics (anti-Parkinson’s): interactions

A

proteins interfere with absorption and transport; conventional antipsychotics (haldol, compazine) decreased alpha; pyridoxine decrease alpha; MAOI cause hypertension; carbidopa, dopamine agonists, anticholinergics, COMT inhibitors and dopamine tea leaders increase therapeutic effects

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38
Q

COMT (catechol O-methyltransferase)

A

catechol O-methyltransferase; deactivates catecholamines (e.g. dopamine, norepinephrine, acetylcholine, epinephrine, serotonin, histamine, etc); found in post-synaptic cell membranes of adrenergic neurons where it degrades norepinephrine; also found in the gut

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39
Q

dopamine agonists (antiparkinson’s): expected action

A

act directly on dopamine receptors

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40
Q

dopamine agonists (antiparkinson’s): prototype

A

pramipexole, ropinirole, bromocriptine

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41
Q

dopamine agonists (antiparkinson’s): therapeutic uses

A

monotherapy early; combined with levodopa in later stages

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42
Q

dopamine agonists (antiparkinson’s): adverse effects

A

orthostatic hypotension; psychosis; sleep attacks; daytime sleepiness; dyskinesias; nausea

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43
Q

dopamine agonists (antiparkinson’s): contraindications and precautions

A

pregnancy C; caution with liver and kidney impairment

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44
Q

dopamine agonists (antiparkinson’s): interactions

A

levodopa can decrease motor-control fluctuations permitting lower dose; levodopa can also increases risk of orthostatic hypotension and dyskinesias

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45
Q

centrally acting anticholinergics (antiparkinson’s): expected action

A

block ACh at muscarinic receptors which helps maintain ACh and dopamine balance

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46
Q

centrally acting anticholinergics (antiparkinson’s): prototype

A

benztropine [Cogentin], trihexyphenidyl [Artane]

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47
Q

centrally acting anticholinergics (antiparkinson’s): adverse effects

A

nausea (take with food); atropine-like effects (e.g. dry mouth, blurred vision, mydriasis, constipation); antihistamine effects (e.g. sedation, drowsiness)

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48
Q

centrally acting anticholinergics (antiparkinson’s): contraindications and precautions

A

CI in narrow-angle glaucoma

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49
Q

antiviral (antiparkinson’s): expected action

A

stimulate dopamine release; prevent dopamine reuptake; may block cholinergic and glutamate receptors

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50
Q

antiviral (antiparkinson’s): prototype

A

amantadine

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51
Q

antiviral (antiparkinson’s): therapeutic uses

A

Parkinson’s disease

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52
Q

antiviral (antiparkinson’s): adverse effects

A

CNS effects; discolouration of skin (temporary); atropine-like effects

53
Q

antiepileptic medications: barbiturates

A

phenobarbital [Luminal]

54
Q

antiepileptic medications: hydantoins

A

phenytoin [Dilantin]

55
Q

antiepileptic medications: benzodiazepines

A

diazepam [Valium], lorazepam [Ativan], carbamazepine [Tegretol], ethosuximide [Zarontin], valproic acid [Depakote], gabapentin [Neurontin]

56
Q

antiepileptic medications: other medications

A

lamotrigine [Lamictal], oxcarbazepine [Trileptal], clozanepam [Klonopin]

57
Q

antiepileptic medications: mechanisms

A

slow ca2+ and na+ reentry to neuron; potentiating inhibitory effect of GABA; suppress neuron firing

58
Q

barbiturate (antiepileptic): therapeutic uses

A

partial seizures and generalised tonic-clonic seizures; not effective against absence seizures

59
Q

barbiturate (antiepileptic): prototype

A

phenobarbital [Luminal]

60
Q

barbiturate (antiepileptic): adverse effects

A

CNS effects (e.g. adults as sedation and anxiety, kids as irritability and hyperactivity); toxicity: nystagmus, ataxia, respiratory depression, pinpoint pupils

61
Q

barbiturate (antiepileptic): contraindications and precautions

A

pregnancy D; CI with intermittent porphyria

62
Q

hydantoins (antiepileptic): therapeutic uses

A

effective against all major forms except absence seizures

63
Q

hydantoins (antiepileptic): prototype

A

phenytoin [Dilantin]

64
Q

hydantoins (antiepileptic): adverse effects

A

CNS effects; skin rash; teratogenic; gingival hyperplasia; cardiovascular;endocrine effects; vitamin D metabolism

65
Q

hydantoins (antiepileptic): contraindications and precautions

A

CI: sinus bradycardia, SA blocks, second and third degree AV blocks

66
Q

hydantoins (antiepileptic): interactions

A

oral contraceptives; warfarin; glucocorticoids, decrease alpha of these; EtOH, diazepam, cimetidine, valproic acid: increase phenytoin levels; carbamazepine, phenobarbital, chronic EtOH: decrease phenytoin levels; CNS depressants (e.g. barbiturates, EtOH): additive effects with concurrent use

67
Q

hydantoins (antiepileptic): education

A

use IV route for status epilepticus; antidysrhythmics

68
Q

carbamazepine (antiepileptic): therapeutic uses

A

partial seizures; tonic-clonic seizures; bipolar disorder; trigeminal neuralgia

69
Q

carbamazepine (antiepileptic): prototype

A

tegretol

70
Q

carbamazepine (antiepileptic): adverse effects

A

skin disorders; cognitive function is minimally affected but CNS effects can occur; blood dyscrasias; teratogenic; hypoosmolarity (increased ADH secretion)

71
Q

carbamazepine (antiepileptic): contraindications and precautions

A

CI: marrow suppression, bleeding disorders

72
Q

carbamazepine (antiepileptic): interactions

A

grapefruit juice (inhibits metabolism and increases carbamazepine); phenytoin and phenobarbital: decrease carbamazepine; oral contraceptives and warfarin: carbamazepine stimulates hepatic enzymes which decrease levels of these medications

73
Q

ethosuximide (antiepileptic): therapeutic uses

A

indicated only for absence seizures

74
Q

ethosuximide (antiepileptic): prototype

A

zarontin

75
Q

ethosuximide (antiepileptic): adverse effects

A

GI effects (take with food); CNS effects (fatigue, dizziness)

76
Q

valproic acid (antiepileptic): therapeutic uses

A

partial, generalised, and absence seizures; bipolar disorder; migraines

77
Q

valproic acid (antiepileptic): prototype

A

depakote

78
Q

valproic acid (antiepileptic): adverse effects

A

GI effects (take with food); hepatotoxicity; thrombocytopenia; pancreatitis as evidenced by nausea, vomiting, and abdominal pain

79
Q

valproic acid (antiepileptic): contraindications and precautions

A

avoid children younger than 3 (hepatotoxicity); liver disorders

80
Q

valproic acid (antiepileptic): interactions

A

phenytoin and phenobarbital: concurrent use increases these medications

81
Q

gabapentin (antiepileptic): therapeutic uses

A

single agent used for partial seizures; neuropathic pain; prevents migraines

82
Q

gabapentin (antiepileptic): prototype

A

neurontin

83
Q

gabapentin (antiepileptic): adverse effects

A

CNS effects (drowsiness, nystagmus)

84
Q

benzodiazepines (antiepileptic): therapeutic uses

A

status epilepticus

85
Q

benzodiazepines (antiepileptic): prototype

A

diazepam [Valium]

86
Q

benzodiazepines (antiepileptic): adverse effects

A

respiratory depression; anterograde amnesia; teratogenic

87
Q

muscle relaxants and antispasmodics: centrally acting muscle relaxants

A

diazepam [Valium], baclofen [Lioresal], cyclobenzaprine [Flexeril], metaxalone [Skelaxin]

88
Q

muscle relaxants and antispasmodics: peripherally acting muscle relaxants

A

dantrolene [Dantrium]

89
Q

diazepam (muscle relaxant and antispasmodic): expected action

A

acts in CNS to enhance GABA and produce sedation; acts in CNS to depress spasticity of muscles

90
Q

diazepam (muscle relaxant and antispasmodic): prototype

A

diazepam [Valium]

91
Q

diazepam (muscle relaxant and antispasmodic): therapeutic uses

A

relief of spasticity related to cerebral palsy and/or MS; anxiety and panic disorders; EtOH withdrawal; insomnia; status epilepticus; anaesthesia induction; relief of spasm related to injury

92
Q

diazepam (muscle relaxant and antispasmodic): adverse effects

A

CNS depression; physical dependence from long-term use

93
Q

diazepam (muscle relaxant and antispasmodic): interactions

A

CNS depressants (EtOH, opioids, antihistamines, barbiturates): addictive CNS depressive effect an with concurrent use

94
Q

diazepam (muscle relaxant and antispasmodic): contraindications and precautions

A

pregnancy D; caution with impaired liver or renal function

95
Q

centrally acting (muscle relaxant and antispasmodic): expected action

A

acts in CNS to depress spasticity of muscles

96
Q

centrally acting (muscle relaxant and antispasmodic): prototype

A

baclofen, cyclobenzaprine, metaxalone

97
Q

centrally acting (muscle relaxant and antispasmodic): therapeutic uses

A

relief of muscle spasm related to injury; relief of spasticity related to cerebral palsy or multiple sclerosis

98
Q

centrally acting (muscle relaxant and antispasmodic): adverse effects

A

CNS depression; physical dependence from long-term use; metaxalone: hepatotoxicity; baclofen: nausea, urinary retention, constipation

99
Q

centrally acting (muscle relaxant and antispasmodic): contraindications and precautions

A

caution in patients with impaired liver or renal function; baclofen: pregnancy C

100
Q

centrally acting (muscle relaxant and antispasmodic): interactions

A

CNS depressants (EtOH, opioids, antihistamines): additive CNS depressants effects with concurrent use

101
Q

cue (muscle relaxant and antispasmodic):

A

response

102
Q

peripherally acting (muscle relaxant and antispasmodic): expected action

A

only peripherally acting muscle relaxant; inhibits muscle contraction by preventing release of calcium in skeletal muscles

103
Q

peripherally acting (muscle relaxant and antispasmodic): prototype

A

dantrolene [Dantrium]

104
Q

peripherally acting (muscle relaxant and antispasmodic): therapeutic uses

A

relief of spasticity related to cerebral palsy or multiple sclerosis; treatment of malignant hyperthermia

105
Q

peripherally acting (muscle relaxant and antispasmodic): adverse effects

A

CNS depression; hepatic toxicity

106
Q

local anaesthetics: expected action

A

decreases pain by blocking local conduction of pain impulses

107
Q

local anaesthetics: amide type

A

lidocaine

108
Q

local anaesthetics: ester type

A

tetracaine, procaine

109
Q

local anaesthetics: adverse effects

A

CNS excitation: treat with midazolam [Versed] or diazepam; hypotension; bradycardia; heart block; cardiac arrest; allergic reactions (more likely with esters); decreased uterine contractibility; spinal headache (lay flat for 12 hours); freely cross placenta; urinary retention (call after 8 hours)

110
Q

local anaesthetics: contraindications and precautions

A

CI in dysrhythmias and/or heart block; caution with liver and kidney dysfunction, heart failure and myasthenia gravis

111
Q

general inhalation anaesthetics: expected action

A

loss of consciousness; loss of sensation; relaxation of muscles; amnesia

112
Q

general inhalation anaesthetics: prototype

A

halothane [Fluothane], isoflurane [Forane], nitrous oxide

113
Q

general inhalation anaesthetics: adverse effects

A

hepatotoxicity; gastric aspiration; hypotension; malignant hyperthermia (treatment: medications, ice or saline infusion, and dantrolene); respiratory and cardiovascular depression

114
Q

general inhalation anaesthetics: interactions

A

CNS depressants: additive effect; opioids: constipation and urinary retention

115
Q

general inhalation anaesthetics: education

A

succinylcholine: used as a muscle relaxant; encourage early ambulation; assist with lung expansion

116
Q

peripherally acting (muscle relaxant and antispasmodic): contraindications and precautions

A

pregnancy C; caution with impaired liver and renal function

117
Q

peripherally acting (muscle relaxant and antispasmodic): interactions

A

CNS depression: additive effects

118
Q

intravenous anaesthetics (key points): medications

A

barbiturates: thiopental [Pentothal]; ketamine [Ketalar]; benzodiazepines: diazepam [Valium], midazolam [Versed], lorazepam [Ativan]; propofol [Diprivan]

119
Q

intravenous anaesthetics (key points): therapeutic uses

A

adjunct to inhalation anaesthesia; induction and maintenance of anaesthesia; amnesia; midazolam and an opioid result in conscious sedation; ketamine can be used with children

120
Q

intravenous anaesthetics: adverse effects

A

respiratory and cardiovascular depression: propofol: bacterial infection (use opened vial with 6 hours); ketamine: psychologic reaction (premedicate with diazepam to decrease risk)

121
Q

intravenous anaesthetics: contraindications and precautions

A

ketamine should be avoided with psychiatric disorders

122
Q

intravenous anaesthetics: interactions

A

CNS depressants and stimulants: additive effects: opioid analgesics: constipation and urinary retention

123
Q

intravenous anaesthetics: education

A

midazolam [Versed]: inject over more than 2 minutes; propofol [Diprivan]: inject into large vein and prep site with lidocaine

124
Q

antipsychotics (conventional): expected action

A

dopamine, acetylcholine, histamine, and norepinephrine receptors in brain and periphery are blocked; symptom inhibition related to dopamine blockade in brain

125
Q

antipsychotics (conventional): prototype

A

⬇️ n: chlorpromazine [Thorazine], ⬆️ n: haloperidol [Haldol]; others: fluphenazine, molindone, perphenazine, thiothixene

126
Q

antipsychotics (conventional): therapeutic uses

A

tourette’s syndrome; delusional disorder; bipolar disorder; dementia; schizophrenia; schizoaffective disorder; Huntington’s chorea

127
Q

antipsychotics (conventional): adverse effects

A

agranulocytosis; sedation; photosensitivity; anticholinergic effects; orthohypotension; neurone doctrine effects; seizures; parkinsonism; sexual dysfunction; dysrhythmias; dystonia; akathisia; tardive dyskinesia; neuroleptic malignant syndrome

128
Q

antipsychotics (conventional): interactions

A

anticholinergics: increase n; CNS depressants: additive effects; levodopa: counteracts antipsychotics by stimulating dopamine receptors

129
Q

antipsychotics (conventional): education

A

consider depot preparations; protect liquid prep from the sun; early EPS symptoms with anticholinergics, beta blockers, and benzodiazepines

Pharmacology Exam - Flashcards (2 decks)

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