Pharm Flashcards
What is a cholinergic or cholinomimetic drugs?
stimulates the parasympathetic nervous system
Pilocarpine
Cholin agonist
Treats glaucoma + used to treat xerostomia after radiotherapy
Bethenacol
Cholin agonist
stims urination
Succinylcholine
Cholin antagonist
Muscle relaxant for surgery
Mecamylamine
Cholin antag
Treats hypertension
Carbachol
Treats closed angle glaucoma
Methacholine
test reactivity of airway
Cevimeline
cholin agonist
increase salivary flow
Nicotine
smoking cessation
what are 2 anti-muscarinics ? or anti-muscarinics?
atropine
scopolamine
what are the effect of anti- muscarinics?
dry mouth, blurry vision, urinary retention, constipation
what is pralidoxime?
a cholinesterase reactivator; use to treat organophosphate poisoning (found in pesticides); relives paralysis of the muscles of respiration.
What is glycopyrrolate (Robinul)
synthetic anticholinergic
Inhibit salivation pre-operatively; control upper airway secretions
What is benztropine mesylate (Cogentin)?
synthetic anticholinergic
Anti-Parkinsonism
What is Propantheline bromide (Pro-Banthine)?
synthetic anticholinergic
Traveler’s diarrhea
What is Trihyxphenidyl HCl (Artane)?
synthetic anticholinergic
Anti-Parkinsonism
List the alpha 1 agonists
Epi > NE
phenylephrine
List alpha 2 agonists
Epi > NE
clonidine
guanfacine
List beta 1 agonist
Epi = NE
isoprotenerol
dobutamine
list beta 2 agonist
Epi»_space; NE
isoprotenerol
albuterol
terbutaline
What are the tissues that alpha 1 agonists affect?
radial muscle of the eye
vasculature
genitourinary/GI sphincters
What are the tissues that alpha 2 agonists affect?
vasculature
brainstem
NE terminals
What are the tissues that beta 1 agonists affect?
Heart
What are the tissues that beta 2 agonists affect?
lungs
vasculature to muscle
ciliary muscle of the eye
genitourinary/uterus
what is the antagonist for alpha 1?
prazosin; terazosin
what is the antagonist for alpha 2?
yohimbine
what is the antagonist for beta 1?
propranolol
atenolol
metoprolol
what is the antagonist for beta 2?
propranolol
What are the common medications for Parkinson’s Disease?
L-dopa and carbidopa Benztropine Trihexyphenidyl Selegiline Entacapone Azilect Pramipexole
What are common drugs that are used in combo with carbidopa-levodopa?
Azilect and Entacapone
What is azilect?
Used in conjunction with carbidopa and levodopa (Parkinsons disease) to prevent DA breakdown.
What is entacapone?
Used in conjunction with carbidopa and levodopa (Parkinsons disease) to improve carbidopa and levodopa effectiveness
It does this by being an inhibitor of COMT (catechol o methyltransferase); slows down break down of DA
What is levodopa?
used to treat parkinson’s disease but effectiveness diminishes as disease progresses;
controls the shake, tremors, shuffling
What do we combo levodopa with carbidopa?
The problem with levodopa on its own is that it gets metabolized before it gets into the brain by enzymes.
Large doses of L-DOPA = worked but affected other organs, and changed from LDOPA to NE
Resolution was to add Carbidopa to the mix because it is not permeable to the BBB and blocks LDOPA metab occuring outside the blood brain barrier. allowing conversion of LDOPA to DA in the blood brain barrier ie CNS.
What are side effects of levodopa and carbidopa?
dyskinesia - abnormal movements
If you have a patient that is taking LDOPA and Carbidopa, what should you be concerned with in the dental office?
Be concerned with administering local anesthetics with epinephrine due to the conversion of LDOPA to NE. Synergistic effects of NE and EPI. Avoid epinephrine when possible. But can limit to 3 cartidges of lidocaine 1:100,000 epi per 30 min period to avoid tachycardia and hypertension
What is benztropine (cogentin)?
an anticholinergic, to help with sialorrhea since these patients tend to excessively drool
what is trehexyphenidyl?
an anticholinergic; to help with sialorrhea since these patients tend to excessively drool
what is Pramipexole
D2 agonist
what is selegiline?
an MAO (monoamine oxidase inhibitor) used to increase dopaminergic activity
MAO plays an important role in the catabolism of catecholamines (dopamine, norepinephrine and epinephrine) and serotonin.
what is pramipexole?
A D2 agonist. Dopamine agonists may be used first to avoid some of the side effects seen with levodopa-carbidopa therapy. Due to breakdown of levodopa into NE during metabolism
what are the D1 agonists?
DA
fendolapam
what are the D2 agonists?
DA
selegiline
What tissues do D1 agonists affect?
kidney
vasculature
heart
CNS
What tissues do D1 agonists affect on the kidney?
Heart?
Vasculature?
Kidney- increase renal blood volume, GFR, and sodium excretion
Heart/vasculature- vasodilation in renal, cerebral, cardiac, and mesenteric vasculature
What tissues do D2 agonists affect?
Post ganglionic sympathetic nerve terminals
Chemoreceptor trigger zone
CNS
What tissues do D2 agonists affect on the:
Post ganglionic sympathetic nerve terminals
Chemoreceptor trigger zone
CNS
Post ganglionic sympathetic nerve terminals - decrease NT release
Chemoreceptor trigger zone - nausea/vomitting
what is halperidol?
A D2 antagonist
Treats schizophrenia
What should you do if your parkinson’s patient is taking selegiline?
do not administer agents with epinephrine because of adverse interactions, causing hypertension
What are side effects of L-dopa?
glossodynia (burning tongue), trismus, sialorrhea, dark saliva, dysphagia, bruxism, trismus
what are side effects of selegiline?
sublingual oral ulcerations, burning lips, mouth, facial grimacing and supraorbital pain
Explain Parkinson’s disease
involves degeneration of dopaminergic neurons in the nigral-striatal pathway in the basal ganglia, cause is unknown, but typically associate with hypoxia, toxic chemicals, cerebral infections, and head trauma
Histology: those with parkinson’s find lewy bodies
What is the strategy behind treating Parkinson’s?
- increase DA in basal ganglia
- Block muscarinic receptors in the basal ganglia ince cholinergic functions opposes the actions of dopamine in the basal ganglia
What system does Huntington’s disease affect?
GABA pathways
What are the clinical manifestations of huntington’s disease?
Abnormal moves (ie corea form) sudden large movements, lack of control with sudden jerky movements.
Cognitive systems begin to deteriorate; progressive intellectual dysfunction
What is the pathophysiology of huntington’s disease?
Affects GABA and cholinergic striatal cells
Excessive dopamine activity
Medications for huntingtons disease
Antipsychotics (DA antagonists)
Reserpine (DA depletion for choreiform movement)
SSRIs (target seratonin) for depression
Heloperidol (Haldol)- D2 antagonist and antipsychotc
Olanzepine (antipsychotic, binds to DA receptors not just D2)
What are the clinical manifestations of early Alzheimer’s disease?
short term memory loss; can fake really well, they still value and prioritize information – determines how well they remember that piece of info
Get lost frequently
Still functional
What are the clinical manifestations of moderate Alzheimer’s disease?
decrease functions, difficulty doing jobs, almost impossible to work ability to cope and be productive is gone at this stage –> stop working
This occurs even in the home
What are the clinical manifestations of late Alzheimer’s disease?
decrease motor function; no judgement; routine doesn’t work, need assistance from family
Eventually they become immobile and stop eating
Most wil ldie via cachexia
What is the pathophysiology of Alzheimer’s disease?
Beta amyloid (senile palques) form and becomes sticky Neurofibrillary tangles – clusters of tau protein- it’s a microtuble protein that transports
App (amyloid precursor protein)that has been abnormally formed from genetic factors which causes to form sticky Beta amyloid which decrease Ach
What type of drugs are used to treat alzheimer’s disease?
cholinesterase inhibitors- targets cognitive and functional decline
What are examples of cholinesterase inhibitors used for alzheimer’s?
donepezil
galantamine
rivastigmine
What is multiple sclerosis?
A demyelinating disease, An autoimmune disease that destroys myelin, decreasing action potentials thus becoming less functional.
What are the clinical manifestations of MS?
Not all the neurons in the brain are demyelinated but can have multiple sites affected.
Its progressive and relapsing – means a lot of on and off, remission varies in time; with each cycle it gets worse, worse and worse
Diverse effects- dependent on where the damage is located
Autonomics- alters cardio, breathing, GI (super serious)
Senses- hearing, taste, vision
Cognition- ant. Cortex affects how you think and make decisions
Mood- depression, fatigue
What medications treat MS?
Steroids to treat inflammation
ex. Prednisone
What is myasthenia gravis?
a chronic autoimmune neuromuscular disease that causes weakness in the skeletal muscles, which are responsible for breathing and moving parts of the body, including the arms and legs.
Myasthenia gravis is caused by an error in the transmission of nerve impulses to muscles. It occurs when normal communication between the nerve and muscle is interrupted at the neuromuscular junction—the place where nerve cells connect with the muscles they control.
In myasthenia gravis, antibodies block, alter, or destroy the receptors for acetylcholine at the neuromuscular junction, which prevents the muscle from contracting.
What is the treatment for myasthenia gravis?
Acetylcholinesterase inhibitors such as prostigmine and neostigmine