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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
Characterisitics of Carbamates? (4)
Quaternary or tertiary amine group Temporary covalent modification to AChE Reversible Dissociates in 0.5-0.8 hours
26
Main difference between physostigmine and neo/pyridostygmine?
Physostigmine enters CNS while Neo/Pyridostygmine is peripherally restricted
27
Pyrido word root means?
Orally available, so Pyrido can be taken orally for fewer side effects and longer duration
28
Organophosphates irreversible or reversible acetylcholinesterase inhibitors?
Irreversible
29
How long do Organophosphates last?
Longer than a week
30
What are organophosphates used to treat on occasion?
Glaucoma
31
What else irreversibly binds to acetylcholinesterase? (2)
Nerve Gas | Insecticides
32
What is antidote for Acetylcholinesterase inhibitor poisoning?
Pralidoxime Chloride (2-PAM)
33
When is Pralidoxime Chloride antidote most effective?
Within a few hours of exposure
34
What do you give for symptoms of Acetylcholinesterase inhibitor poisoning?
Atropine due to fast acting nature
35
Effect of Pralidoxime Chloride on organophosphate?
Organophosphate bond to AchE is broken and Acetylcholinesterase is regenerated
36
Mnemonic for symptoms of Acetylcholinesterase inhibitor poisoning?
``` 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
Who is Acetylcholinesterase inhibitor poisoning most common in?
Farmers
38
What quaternary ammonium alcohol is used for diagnosis of myasthenia gravis?
Edrophonium (Tensilon)
39
What happens in Myasthenia Gravis?
Antibodies block Nicotinic acetylcholine receptors at the postsynaptic neuromuscular junction
40
What does Myasthenia Gravis cause?
Muscle weakness
41
What does Edrophonium test differentiate between?
Myasthenia Gravis and Lambert Eaton
42
How does the Edrophonium differ between the two?
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
How do you treat MG?
Neostigmine/pyridostigmine
44
Effect of Edrophonium between cholinergic crisis and myasthenia crisis?
In CC Edro has no effect, maybe small muscle decrease | In MG Edro improves muscle strength
45
When do you want to avoid the use of parasympathomimetic drugs? (5)
``` Asthma/COPD Coronary deficiency Peptic Ulcer Obstruction of urinary or GI tract Epilepsy ```
46
Cholinergic centers in the CNS? (2)
``` Nucleus Basalis of Meynert/medial septal nuclei (basal forebrain) Mesopontine tegmentum (brain stem) ```
47
Adrenergic centers in brain (1)?
Locus Coeruleus
48
What does Locus Coeruleus produce?
Norepinephrine
49
Alzheimer's disease is due to deficits in what?
Cholinergic
50
Most common cause of dementia after age 50?
Alzheimers
51
What brain changes are there in Alzheimer's?
Widening of sulk and thinning of gyri
52
What malfunction causes alzheimer's?
Improper processing of b-amyloid precursor protein (b-APP) leads to toxic form (b-A42) that promotes apoptosis
53
What pathologies will you see in Alzheimer's? (2)
B-amyloid plaques | Neurofibrillary tangles
54
What do you treat alzheimer's with?
ACHE inhibitors
55
What specific drugs can you give for Alzheimer's?
Donepezil Rivastigmine Galanthamine
56
What is Donepezil?
ACHE inhibitor Reversible Enhances cognitive ability Doesn't slow disease
57
What is Rivastigmine?
Reversible carbamate ACHE inhibitor Loses effectiveness as disease progresses Replaced by Eptastigmine
58
What is Galanthamine?
Reversible competitive ACHE inhibitor Nicotinic receptor agonist use with Inhibitors of P450 enzymes (increases bioavailability)

Pharm Exam 3 (10 decks)

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