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T2 CV > Pharm > Flashcards

Pharm Flashcards

1
Q

What reverses the central vs peripheral effects of anticholinesterase toxicity?

A

Atropine treats central

Pralidoxime treats peripheral

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2
Q

Symptoms of anti-muscarinic toxicity?

A

Blind as a bat (from mydriasis and lack of accom)
Dry as a desert (dry eyes/ mouth)
Hot as hell (from lack of being able to sweat)
Red as a beet (from above hyperthermia)
Mad as a hatter (confusion/agitation sx)
Full as a flask (from lack of being able to pee)

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3
Q

Symptoms of muscarinic agonist toxicity?

A

SLUDGE and Killer B’s

S- salivation
L- lacrimation
U- urinatino
D -diaphoresis 
G- GI stuff 
E- emesis

Bronochoconstriction, bronchospasm, bradycardia

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4
Q

Symptoms of anti-cholinesterase toxicity?

A

SLUDGE and Killer B’s

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5
Q

muscarinic agonist?

A

pilocarpine!

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6
Q

nicotinic agonist?

A

varenicline

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7
Q

cholinergic agonists (direct)

A

varenicline and pilocarpine

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8
Q

Muscarinic antagonists?

A

atropine and scopalamine

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9
Q

Nicotinic antagonists? (3-4)

A

Tubcurarine (curares and pancuronium)
Succinylcholine
Macamylamine
BOTOX

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10
Q

Cholinesterase inhibitors

A 
Quaternary alcohols (edrophonium)
Carbamates (neo/physo/pyridostimine, and donepazil/galantamine/rivostigmine)
Organophosphates (ectothiophates and nerve agents)
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11
Q

What drug class can exacerbate athsma or copd?

A

cholinergic agonists

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12
Q

Side effects of what drug class can cause acute angle-closure glaucoma?

A

antimuscarinics bc they dilate pupil and dry out eye decreasing outflow, thus increase IOP

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13
Q

Preferred MG tx?

A

pyridostigmine, which is an anticholinesterASE

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14
Q

what can TREAT open-angle glaucoma?

A

pilocarpine bc it increases aqueous humor outflow

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15
Q

which carbamates (anticholinesterases) penetrate the bbb?

A

the 3 alzheimer’s drugs + physostigmine

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16
Q

what do organophosphates do?

A

irreversibly bind to acetylcholinesterase and age the bond, unless pralidoxime breaks the bond first

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17
Q

what do antimuscarinics do to bronchiole airways and lung secretions?

A

they dilate bronchiole airways (for fight/flight) and reduce secretions

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18
Q

which cholinergic receptors are found on the NMJ vs effector organs?

A

nicotinic- nmj

muscarinic- effector organs

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19
Q

what do antimuscarinics do to sweating and why?

A

antimuscarinics cause hyperthermia due to inhibition of sweat glands, since muscarinic agonists cause sweating

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20
Q

what drug can treat atropine overdose?

A

physostigmine

21
Q 
What drug class is flaccid paralysis from NMJ block due to? 
What drug do you give to reverse it? What drug do you combine with it to prevent side effects from overcompensation?
A

Anti-nicotinics can cause NMJ block flaccid paralysis (lack of parasymp ACh). You can give neostigmine (an anticholinesterase) to reverse it (increasing ACh parasymp and thus some muscle mvmt). But you must give it with atropine/glyco so that you don’t get ACh cholinergic toxicity (SLUDGE BBB, prevent too much parasymp). Neo also treats post-up urinary retention.

Physostigmine is also a anticholinergic toxicity antidote.

22
Q

Which nerve agent organophosphate is the most volatile, and which has rapid aging? What drug can you give to prevent damage from the latter? What drug would you give otherwise?

A

Sarin- most volatile

Soman- camphor odor, rapid aging, thus use pyridostigmine to prevent damage (since oxime cant be fast enough)

23
Q

What antidote (cumulative) can be given in mild, moderate, and severe organophosphate toxicity?

A

mild- atropine to block muscarinic effects (CNS, BBB)
moderate- add 2PAM (pralidoxime) (NIC/MUSC BOTH) to regen AChE
severe- add scopalamine or benzos to the mix

24
Q

What does atropine do to pupil size, accomodation, and intraocular pressure/secretions?

A

it’s a muscarinic blocker so dilates pupils (mydriasis), prevents accommodation (fixed far vision, cycloplegia), and prevents secretions so increases IOP (glaucoma like effects, so don’t give if there’s narrow angle glaucoma bc fluid can’t leave when intraocular P increases since obstructed by angle)

25
Q

What is ipratropium bromide (and what does it tx)

Diphenhydramine

A

atropine analog to tx athsma
diphenhydramine is another muscarinic antagonist
(both this and scopalamine have drowsy/amnesia sxe)

26
Q

Why do nicotinic antagonists cause paralysis?

A

prevent ach at NMJ!

27
Q

What also blocks non-depol curares to unparalyze?

Which is depol and which is non-depol nic antagonists/NMJ blockers?

A

sugammadex undoes tubocuraine and pancuronium paralysis.
or give neo + atropine/glyco

non-depol: curares
depol: succinlycholine

28
Q

Succinylcholine toxicity besides the usual (nicotinic antagonist)

A

Hyperkalemia, increased IOP (so dont use on burn victims)

29
Q

What do you use succinylcholine for, what does it cause, and what can’t you treat it with?

A

Succinylcholine (nicotinic antagonist) is a DEPOL NMJ blocker used for quick flaccid paralysis for operation. You want to keep pt in the phase I block (so don’t treat this with neostigmine)

30
Q

What kind of drug is mecamyline, and what was it for?

+ questions

A

dinosaur drug that was used for HTN but blocked nic in symp and parasymp so had too many effects

  • **dont they all do this?
  • **why can’t you treat burn victims with drug that causes hyperkalemia?
  • **which drugs relax/contract the pupillary sphincter vs ciliary muscle?
31
Q

a-methyldopa

A

gold std for tx pregnant women who have ACE inhib etc for HTN

32
Q

reserpine

A

inhibits VMAT, preventing DA from being brought into terminal/converted to NE,

Used to treat HTN, but SxE of depression

33
Q

Pathway in symp pathway starting with tyrosine hydroxylase

A

Tyrosine taken up, converted by tyrosine hydroxylase (RDS) into DOPA, which is converted to dopamine.
Dopamine is taken up into pre syn vesicles by VMAT, then converted into NE in vesicle. Calcium influx causes NE release (controlled by alpha-2 receptors).
NE is taken back up by NET (cytoplasmic NE controlled by MAO)

34
Q

Indirectly acting amines (drugs that affect synaptic nerve terminals)

A

Phenelzine

Ephedrine, tyramine, amphetamines

35
Q

Reuptake blockers (drugs that affect synaptic nerve terminals)

A

Cocaine

TCAs e.g. Imipramine]SSRIs

36
Q

Phenelzine

A

MOA inhib, antidepressants with many SxE, also tx parkinsons to prevent dopamine breakdown
***thought it prevented tyramine breakdown?

37
Q

Why must wine and cheese be avoided on Phenelzine?

A

MOA inhibs can’t mix with wine/cheese bc
MOA breaks down tyramine, and if inhibited, too much tyramine will be in bloodstream, enter nerve terminal via NET, and push NE out of cytoplasm causing HTN crisis (pressor response)
***how will it push out NE?

38
Q

Ephedrine, tyramine, amphetamines

A

symp agonists
enter nerve terminals via reuptake transporters in EXCHANGE for release of cytoplasmic store of NE
-can dev tolerance when cytoplasmic pool is depleted (tachyphylaxis)
Amphetamines reverse NET/DAT/SERT transport, inhibits MAO at high doses

39
Q

Cocaine

A

blocks SERT DAT and NET at low doses, so nt’s stay in synpase and keep acting
NE pressor response, DA reward centers (addictive)
At high doses can block channels causing cardiotoxicicity

40
Q

Imipramine

A

a TCA

block NET and SERT (so can tx these deficiencies in depression)

41
Q

Tachyphylaxis

A

Acute/rapid onset tolerance
bc NE pool being depleted
Not receptor desensitization, so just let BP go back to baseline and then give again (eg epinephrine)

42
Q

How can you prophylactically prevent the action of ephedrine or tyramine

A

ephedrine: pretreat with reserpine so no NE will be in nerve terminal (bc reserpine block VMAT preventing DA from getting into nerve and being converted to DA), or pretreat with cocaine to block NET transporter (also prevents tyramine)
* **how?

43
Q

Trimethapan

A

ganglionic blocker that blocks nic receptors (both symp and parasymp), loss of both
LOSS OF BARO REFLEXES

44
Q

Pressor response

A

reversal of hypotension– things causing hypertension via alpha-1 stimulation of vessel constriction

45
Q

How does cocaine block tyramine from exerting is bp increasing effects?

A

Cocaine blocks NET (and DAT and SERT), and blocking NET prevents tyramine from being uptaken (in exchange for NE out)

46
Q

Epi reversal

A

when alpha receptors are blocked by something, injecting epi will DECREASE blood pressure because it will only stimulate beta receptors

47
Q

alpha agonists

beta agonists

A

phenylephrine- a1 (nasal spray)
clonidine- a2
a-methyldopa- a2 (tx HTN in pregnancy)

dobutamine- B1
isoproterenol- B1 and B2
tertbutaline- B2 (tx premature uterine contractions)

48
Q

both alpha and beta agonists

A

dopamine- a1 and B1 (and D)
NE: a1, a2, and B1
epi: ALL!

49
Q

alpha and beta blockers

A

prazosin- mostly a1 (treats BPH)
phentolamine- a1 and 2
phenoxybenzamine- a1 and 2
yohimbine- mostly a2

metoprolol- B1
propanolol- B1 and 2

T2 CV (1 decks)

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