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PTVI > PCOL Test 3 > Flashcards

PCOL Test 3 Flashcards

1
Q

In COPD what are the primary pathophysiologic components of Emphysema? (Select All)

A. Increased Mucus

B. Alveolar Wall Destruction

C. Productive cough

D. Hyperinflation

A

B,D

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2
Q

How does emphysema cause hyperinflation?

A. Reduction in number of alveoli.

B. Alveolar walls are damaged and destroyed.

C. Elasticity of alveolar sacs are lost

D. All of the above

A

D

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3
Q

The collapsing of airways in emphysema is a ____ condition that is _____.

A. Acute, Reversible

B. Acute, Irreversible

C. Chronic, Reversible

D. Chronic, Irreversible

A

D

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4
Q

Which of the following is true regarding Nicotine absorption? (Select All)

A. When nicotine is placed in an acidic media it is more readily absorbed.

B. When nicotine is placed in a basic media it is more readily absorbed

C. Nicotine absorption and bioavailability is pH-dependent

D. At a pH of 7.3-7.5 nicotine is more readily absorbed.

E. Nicotine is a weak base (Alkaloid)

A

B, C, D, E

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5
Q

A patient who recently drank coffee or orange juice will experience a ___ in nicotine absorption.

A. Increase

B. Decrease

A

B

Acidic beverages such as coffee or orange juice will decrease absorption due to lowering the pH and causing nicotine to become ionized and less bioavailable.

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6
Q

All of the following statements are true regarding nicotine EXCEPT:

A. Nicotine is readily absorbed through intact skin

B. Bioavailability of nicotine in the GI tract is limited

C. Absorption of nicotine across the GI is poor due to low pH

D. Nicotine is well absorbed in the small intestine but still has limited bioavailability due to first pass effects of the liver

E. Nicotine is more readily absorbed in the stomach due to the lower pH, causing it to become ionized.

A

E

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7
Q

Why don’t we have nicotine tablet/capsule formulations?

A. Oral ingestion of nicotine is extremely poisonous

B. Oral ingestion of nicotine does not undergo first pass metabolism, leading to increased serum levels of nicotine and side effects.

C. Oral ingestion of nicotine is not well absorbed due to being ionized in the low gastric pH.

D. Oral ingestion of nicotine is not recommended since it is impossible for it to pass the small intestine into circulation.

A

C

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8
Q

T/F

Nicotine can reach the brain within 11 seconds and this is why it is so addicting.

A

T

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9
Q

Nicotine is responsible for activating __ and __ receptors

A. Adrenergic, Cholinergic

B. Nn, Adrenergic

C. Nn, Nm

D. Nm, Adrenergic

E. Alpha, Beta

A

C

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10
Q

What are possible drug targets that can affect nicotinic receptors?

A. Receptor Antagonists

B. Receptor Agonsits

C. Enzyme inhibitors (Cholinesterase inhibitors)

D. All of the above

A

D

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11
Q

Nn nicotinic receptors are located in the ___

A. Nerves

B. Muscle

C. Periphery

D. Heart

A

A

The small “n” in Nn means neural

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12
Q

Nm nicotinic receptors are located in the___

A. Nerves

B. CNS

C. Brain

D. Muscle

A

D.

The “m” in Nm means muscle

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13
Q

An overdose of nicotine at the Nm receptors can cause____

A. Neuronal damage

B. Paralysis

C. Enzyme inhibition

D. Little-to-no effect on muscles

A

B

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14
Q

What type of channels are nicotinic receptors bound to?

A. Chemically-gated chanels

B. Mechanical channels

C. Ion-Channels (ligand-gated)

A

C

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15
Q

What are some of the INITIAL positive effects of nicotine in the brain?

A. Improved cognition and memory

B. Improved learning/ memory

C. Cell viability

D. Analgesia

E. All of the above

A

E

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16
Q

What are some of the negative effects of nicotine?

A. Reward (causes addiction)

B. Increased chances of seizures

C. Vasoconstriction

D. GI distrubances (increased motility) and Emesis (vomiting)

E. Respiratory paralysis

F. All of the above

A

F

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17
Q

T/F

If a patient has an ulcer it is highly encouraged to stop the use of nicotine

A

T

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18
Q

What receptors does Chantix bind to? (Select All)

A. Nm receptors

B. Alpha Adrenergic receptors

C. Nn Receptors

D. 5-HT3 Receptors

A

C, D

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19
Q

What is the Mechanism of action of Chantix? (Select All)

A. Partial a4ß2 Nn receptor agonist

B. Acts as an antagonist to nicotine since they compete for the same receptor.

C. Partial Nm receptor antagonist

D. Full Nn receptor agonist

A

A, B

Chantix binds to Nn receptors and acts as a partial agonist. This will cause only partial stimulation of the receptor and lead to only a small amount of dopamine release in comparison to a full agonist such as nicotine that will lead to a very large release of dopamine. It also antagonizes nicotine by competing for the same Nn receptor that nicotine uses and prevents a larger spike in dopamine.

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20
Q

Chantix has moderate affinity for the 5-HT3 receptor and is associated with the side effect_____.

A. Vomiting

B. Flatulence

C. Constipation

D. Blurry vision

A

A

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21
Q

Why is chantix (varenicline) start off as a small dose and build up to a larger dose over a period of time?

A. Drug is expensive and should start at lower less expensive dosage to minimize costs.

B. Chantix is a full agonist at the Nn receptor and can cause major side effects when starting at the high dosage.

C. Chantix also has moderate affinity for the 5-HT3 receptors and low doses must be started to avoid the higher probability of vomiting that is experienced at higher dosages.

D. Chantix does not have a lower dosage and only has one universal dosage.

A

C

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22
Q

At low dosages of nicotine what effects will be seen on the cardiovascular system? (Select All)

A. Increased HR and Cardiac Output (CO)

B. Increased vasoconstriction

C. Increased BP

D. Increased Oxygen demand

E. Decreased Oxygen demand

A

A, B, C, D

23
Q

At low doses of nicotine what effects will be seen on the respiratory system? (select all)

A. Increased Respiration rate

B. Increased saliva and bronchial secretions

C. Respiratory muscle paralysis

D. Decreased Respiration rate

E. Deeper breaths

A

A, B, E

24
Q

T/F

Paralysis of respiratory muscles is only seen at high doses of nicotine

A

T

25
Q

What CNS effects are seen in low doses of nicotine? (Select All)

A. Increased Respiration rate

B. Increased cognition and alertness

C. Decreased cognition

D. Decreased Respiration rate

A

A, B

26
Q

T/F

High doses of nicotine produce CNS effects such as tremors, seizures and delirium

A

T

27
Q

Low doses of nicotine cause ____in skeletal muscle and high doses will cause _____

A. Relaxation, Paralysis

B. Contraction, Paralysis

C. Relaxation, Relaxation

D. Paralysis, Relaxation

A

A

28
Q

Low doses of nicotine cause GI effects such as a(n) ____ in tone and motility and and _____ N/V/D. It also acts as a local irritant of the GI

A. Decrease, Decrease

B. Increase, Decrease

C. Increase, Increase

D. Decrease, increase

A

C

29
Q

Other effects of nicotine include:

A. Increase in ADH (antidiuretic hormone) activity

B. Increase in alcohol metabolism

C. Nausea at high doses

D. All of the above

A

D

30
Q

Nicotine causes the release of:

A. Dopamine and serotonin

B. Norepinephrine and Acetylcholine

C. B-Endorphines

D. GABA

E. Glutamate

F. All of the above

A

F.

Remember the term GG BANDS

Glutamate

GABA

B-Endorphin

Acetylcholine

Norepinephrine

Dopamine

Serotonin

31
Q

Nicotine causes the release of Norepinephrine which leads to ___ and ___

A. Arousal, appetite suppression

B. Learning, Memory enhancement

C. Arousal, appetite induction

A

A.

This is a common reason why smokers don’t want to stop smoking. When nicotine is no longer present the appetite suppression caused by NE will no longer be there and they will eat more.

32
Q

Nicotine causes the release of Dopamine and leads to the feelings of ___ and ___

A. Uneasiness, Stress

B. Pleasure, Reward

C. Appetite suppression, Arousal

D. Modd modulation, Appetite suppression

A

B

33
Q

Nicotine causes the release of Acetylcholine which is responsible for ___ and ____

A. Arousal, Learning

B. Arousal, Cognitive function

C. Reduction of anxiety, Tension

D. Mood modulation, Appetite suppression.

A

B

34
Q

Nicotine causes the release of Glutamate which is responsible for ___ and ___

A. Learning, Memory enhancement

B. Mood Modulation, Appetite suppression.

C. Arousal, cognitive enhancement

D. Reduction of anxiety, tension

A

A

35
Q

Nicotine causes the release of Serotonin which is responsible for ___ and ___

A. Arousal, Appetite suppression

B. Learning, Memory enhancement

C. Mood Modulation, Appetite suppression

D. Reduction of anxiety, tension

A

C

36
Q

Nicotine causes the release of B-Endorphins and GABA which is responsible for ___ and ___.

A. Pleasure, reward

B. Arousal, Apetite suppression

C. Mood modulation, appetite suppression

D. Reduction of anxiety and tension

A

D

37
Q

T/F

The definitino of Addiction is “compulsive drug use, without medical purpose, in ghe face of negative consequences”

A

T

In other words its people who do drugs even though they know it is hurting them.

38
Q

What did the U.S Surgeon General Report of 1988 conclude?

A. Cigarettes and other forms of tobacco are addicting

B. Nicotine is the drug in tobacco that causes addiction

C. Pharmacologic and behavioral processes determine that tobacco addiction is similar to heroine and cocaine addiction.

D. All of the above

A
39
Q

Based on the picture provided what should be the order of the phrases going from top to bottom?

A. Pleasureable feelings (Reward)/ Tolerance develops/ Repeat administration

B. Tolerance develops (Reward)/ Pleasureable feelings/ Repeat administration

C. Pleasurable feelings (Reward)/ Repeat administration/ Tolerance develops

A

C

You will only develop a tolerance after repeated administration since your body will not be as sensitive after continued use of tobacco and nicotine exposure.

40
Q

Why is the First Cigarette of the Day the most difficult cigarette to quit?

A. Provides the most arousal out of any other cigarette during the day.

B. Smokers become tolerant to the effects of nicotine as the day goes on in comparison to initial exposure in the morning.

C. Upon waking up the next day the sensitivity to nicotine is reset and the effects of the cigarette are more pronounced.

D. All of the above

A

D

41
Q

Any cigarettes that are smoked AFTER the first cigarette of the day…(select all)

A. Are meant to provide the same arousal and pleasure as the first one of the day.

B. Produce only limited pleasure and arousal

C. Are meant to prevent withdrawal symptoms from occuring rather than give pleasure or arousal

D. Are meant to keep serum nicotine at a certain level to maintain pleasure and modulate mood

A

B,C,D

42
Q

How do tobacco uses try to “self-titrate” nicotine intake?

A. Smoking/Dipping more frequently

B. Smoke more intensly

C. Obstruct vents on low-nicotine brand cigarettes

D. All of the Above.

A

D

43
Q

If the main concern for smoking/chewing tobacco is cancer then why not just stay on nicotine replacement therapies (NRT) permanently instead of completely quitting nicotine?

A

Nicotine can still cause heart disease by increasing HR, CO, BP O2 Demand and vasoconstriction. It can also cause other things such as Respiratory/skeltal muscle paralysis, tremors, seizures and delirium when overdoeses (toxicities) occur. For these reasons it is important to inform the patient that they must stop nicotine intake and therapy is not meant to be permanent.

44
Q

T/F

Nicotine Chewing gum will provide the same rapid satisfaction that smoking provides.

A

F

45
Q

Chewing Nicotine-containing gum too rapidly causes all of the following to occur EXCEPT:

A. Lightheadedness

B. Irritaiton of throat and mouth

C. Large salivation, leading to swallowing of nicotine and causing N/V

D. Hiccups

E. Increased buccal mucosa absorption at an unsafe level

A

E.

There will be less delivery because the increased salivation from rapid chewing will lead to increased swallowing of nicotine-containing saliva. This increases GI side effects such as N/V and any nicotine swallowed is nicotine that is lost.

46
Q

What are some of the common side effects of Nicotine gum?

A. Mouth soreness and jaw muscle pain

B. Hiccups

C. Dyspepsia

D. Damage to dental work

E. All of the above

A

D

47
Q

Which of these statements regarding Nicotine transdermal patches is true? (Select All)

A. Gives a slow delivery of nicotine to the blood stream

B. Gives rapid delivery of nicotine to the blood stream

C. Relieves withdrawal symptoms and has low potential for dependence compared to rapid delivery systems.

D. Delivery through the skin avoids the first-pass effect

E. They are associated with lower plasma levels of nicotine and fluctuate less than with smoking.

A

A, C, D, E

48
Q

All of the folowing are possible side effects of transdermal nicotine patches EXCEPT:

A. Mild itching

B. Burning and tingling

C. Skin appears red after patch removal

D. Large flucuations in delivery of nicotine can unstable serum concentrations.

A

D

49
Q

What is the unique side effect of Nicotine Patches?

A. Vivid dreams/ sleep disturbances

B. Nausea

C. Delerium

D. Vomiting

A

A

50
Q

What kind of side effects will you see when taking a nicotine nasal spray?

A. Hot peppery feeling in nose/ back of throat

B. Sneezing and coughing

C. Watery Eyes

D. Runny nose

E. All of the above.

A

E

However some of these effecs should lessen after a few days with regular use. The inhaler has similar side effects but can be worse.

51
Q

Which of these statements is true regarding Bupropion (zyban)?

A. It is a non-nicotine cessation aid

B. It is a sustained release antidepressant.

C. Increases levels of Dopamine and NE in the blood by inhibiting their reuptake.

D. Decreases craving for cigarettes and symptoms of nicotine withdrawal.

E. All of the above

A

E.

52
Q

T/F

The major side effects of bupropion include Insomnia and dry mouth

A

T

53
Q
A

PTVI (5 decks)

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