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Pharm Exam 3 > Neuromuscular and ganglionic blockers > Flashcards

Neuromuscular and ganglionic blockers Flashcards

1
Q

Ganglionic blockers block which reflexes? (2)

A

Baroreceptor

Pupillary

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2
Q

What are ganglionic blockers?

A

Nicotinic receptor antagonists

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3
Q

What is Trimethaphan used for?

A

Hypotension for surgery

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4
Q

What is Mecamylamine used for? (3)

A

Tourette’s
Smoking Cessation
Severe hypertension

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5
Q

Majority of vascular smooth muscle tone is what?

A

SANS more than PANS

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6
Q

Majority in rest of ANS is what system?

A

PANS more than SANS

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7
Q

What is Train of Four impulse?

A

Response of 4th twitch relative to first

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8
Q

What does Train of Four ratio of 0.25 mean?

A

75% of receptors blocked, but still near full muscle responses.

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9
Q

What ratio is needed before extubation?

A

Greater than 0.7

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10
Q

What ratio is classified as full clinical recovery?

A

0.9

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11
Q

At what point is the patient properly sedated?

A

When only 1-2 twitches are seen during a neuromuscular blockage

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12
Q

Sequence of muscle paralysis by curare/neuromuscular blocker OD?

A

Eye -> Speech -> Fingers -> Toes -> Limbs -> Intercostals -> Diaphragm

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13
Q

What disease is similar to curare paralysis?

A

Guillain-Barre Syndrome

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14
Q

Characteristics of Succinylcholine? (2)

A

Short duration 5-10 minutes

Fast onset

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15
Q

What metabolizes Succinylcholine?

A

Butyrylcholinesterase

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16
Q

What do you use Succinylcholine for? (3)

A

Trauma care
Intubation
Electro-convulsant therapy

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17
Q

When do you want to avoid Succinylcholine?

A

Hyperkalemia, due to risk of cardiac arrest

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18
Q

How does the depolarizing neuromuscular blocker Succinylcholine work?

A

It is an agonist which means it bind and depolarizes which due to persistence makes the muscle fiber resistant to further stimulation by Ach.

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19
Q

How does the non-depolarizing (curare-like) neuromuscular blocker work?

A

It is a nicotinic acetylcholine receptor antagonist

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20
Q

Benefits of Pancuronium? (3)

A 
Long duration (greater than 180 minutes)
Easily reversible
Widely used
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21
Q

What is neostigmine?

A

Reversible acetylcholinesterase inhibitor

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22
Q

Where is acetylcholinesterase located?

A

In the synapses

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23
Q

Where is Plasmacholinesterase located?

A

In plasma

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24
Q

What is a carbamate?

A

Acetylcholinesterase inhibitor

25
Q

Characterisitics of Carbamates? (4)

A

Quaternary or tertiary amine group
Temporary covalent modification to AChE
Reversible
Dissociates in 0.5-0.8 hours

26
Q

Main difference between physostigmine and neo/pyridostygmine?

A

Physostigmine enters CNS while Neo/Pyridostygmine is peripherally restricted

27
Q

Pyrido word root means?

A

Orally available, so Pyrido can be taken orally for fewer side effects and longer duration

28
Q

Organophosphates irreversible or reversible acetylcholinesterase inhibitors?

A

Irreversible

29
Q

How long do Organophosphates last?

A

Longer than a week

30
Q

What are organophosphates used to treat on occasion?

A

Glaucoma

31
Q

What else irreversibly binds to acetylcholinesterase? (2)

A

Nerve Gas

Insecticides

32
Q

What is antidote for Acetylcholinesterase inhibitor poisoning?

A

Pralidoxime Chloride (2-PAM)

33
Q

When is Pralidoxime Chloride antidote most effective?

A

Within a few hours of exposure

34
Q

What do you give for symptoms of Acetylcholinesterase inhibitor poisoning?

A

Atropine due to fast acting nature

35
Q

Effect of Pralidoxime Chloride on organophosphate?

A

Organophosphate bond to AchE is broken and Acetylcholinesterase is regenerated

36
Q

Mnemonic for symptoms of Acetylcholinesterase inhibitor poisoning?

A 
DUMBBELSS
D: Diarrhea
U: Urination
M: Miosis
B: Branchospasms
B: Bradycardia 
E: Excitation of skeletal muscle and CNS
L: Lacrimation
S: Sweating
S: Salivation
37
Q

Who is Acetylcholinesterase inhibitor poisoning most common in?

A

Farmers

38
Q

What quaternary ammonium alcohol is used for diagnosis of myasthenia gravis?

A

Edrophonium (Tensilon)

39
Q

What happens in Myasthenia Gravis?

A

Antibodies block Nicotinic acetylcholine receptors at the postsynaptic neuromuscular junction

40
Q

What does Myasthenia Gravis cause?

A

Muscle weakness

41
Q

What does Edrophonium test differentiate between?

A

Myasthenia Gravis and Lambert Eaton

42
Q

How does the Edrophonium differ between the two?

A

In MG exercise worsens muscle strength and Edro improves muscle strength while in Lambert Eaton exercise improves muscle strength while Edro has no effect on muscle strength

43
Q

How do you treat MG?

A

Neostigmine/pyridostigmine

44
Q

Effect of Edrophonium between cholinergic crisis and myasthenia crisis?

A

In CC Edro has no effect, maybe small muscle decrease

In MG Edro improves muscle strength

45
Q

When do you want to avoid the use of parasympathomimetic drugs? (5)

A 
Asthma/COPD
Coronary deficiency 
Peptic Ulcer
Obstruction of urinary or GI tract
Epilepsy
46
Q

Cholinergic centers in the CNS? (2)

A 
Nucleus Basalis of Meynert/medial septal nuclei (basal forebrain)
Mesopontine tegmentum (brain stem)
47
Q

Adrenergic centers in brain (1)?

A

Locus Coeruleus

48
Q

What does Locus Coeruleus produce?

A

Norepinephrine

49
Q

Alzheimer’s disease is due to deficits in what?

A

Cholinergic

50
Q

Most common cause of dementia after age 50?

A

Alzheimers

51
Q

What brain changes are there in Alzheimer’s?

A

Widening of sulk and thinning of gyri

52
Q

What malfunction causes alzheimer’s?

A

Improper processing of b-amyloid precursor protein (b-APP) leads to toxic form (b-A42) that promotes apoptosis

53
Q

What pathologies will you see in Alzheimer’s? (2)

A

B-amyloid plaques

Neurofibrillary tangles

54
Q

What do you treat alzheimer’s with?

A

ACHE inhibitors

55
Q

What specific drugs can you give for Alzheimer’s?

A

Donepezil
Rivastigmine
Galanthamine

56
Q

What is Donepezil?

A

ACHE inhibitor
Reversible
Enhances cognitive ability
Doesn’t slow disease

57
Q

What is Rivastigmine?

A

Reversible
carbamate ACHE inhibitor
Loses effectiveness as disease progresses
Replaced by Eptastigmine

58
Q

What is Galanthamine?

A

Reversible competitive ACHE inhibitor
Nicotinic receptor agonist
use with Inhibitors of P450 enzymes (increases bioavailability)

Pharm Exam 3 (10 decks)

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