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CRNA School > Pharm exam #2 > Flashcards

Pharm exam #2 Flashcards

1
Q

Sympathetic Activity of β1

A

Renin release.
Accelerates SA node.
Increases heart contractility.
Relaxes skeletal blood vessels.

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2
Q

Sympathetic Activity of β2

A 
Relax GI smooth muscle wall.
Relax bladder.
Glycogenolysis (glycogen converted to glucose) in liver.
Accelerates SA node.
Increases heart contractility.
Relax bronchiolar smooth muscle.
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3
Q

Sympathetic Activity of α1

A

Contract smooth muscle vessels.
Glycogenolysis in liver.
Contract GI sphincter.
Contract urinary sphincter.

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4
Q

Sympathetic Activity of α2

A

Contract smooth muscle vessels.
Glycogenolysis in liver.
Relax wall of GI smooth muscles.

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5
Q

Parasympathetic activity of M2

A

Decelerates SA node.

Decreases heart contractility.

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6
Q

Parasympathetic activity of M3.

A 
Relax smooth muscle of blood vessels.
Contract bronchiolar smooth muscle.
Contract wall of GI smooth muscles.
Relaxt GI sphincter.
Increase GI tract secretions.
Contract bladder.
Relax urinary sphincter.
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7
Q

SNS origin of fibers

A

Thoracolumbar region of spinal cord

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8
Q

SNS length of fibers

A

Short pre-ganglionic and long post-ganglionic; Has chain ganglion that can effect multiple effector organs with one stimulus

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9
Q

SNS Location of ganglia

A

Close to the spinal cord

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10
Q

PSNS origin of fibers

A

Brain and sacral spinal cord; craniosacral

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11
Q

PSNS length of fibers

A

long preganglionic and short postganglionic

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12
Q

PSNS location of ganglia

A

in the visceral effector organs

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13
Q

Acetylcholine

A

Direct cholinomimetic (parasympathomimetic).
Ester of choline. Made from acetyl Coa and choline, formed by CHAT (Choline acetyl transferase).
All pre-ganglia release this.
Permanently charged, so insoluble in lipids. Has to be given injected bc it cannot be absorbed very easily.
Miosis (pupillary constriction, short term- metabolism is 5-20 seconds), decreases IOP, (Binds to M1 sphincter receptor on eye); Contraction- prolonged can cause flaccid paralysis (On Nm of NMJ)

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14
Q

Methacholine

A

Direct cholinomimetic (parasympathomimetic).
Ester of choline (poor absorption & distribution in CNS).
Permanently charged, so insoluble in lipids. Has to be given injected bc it cannot be absorbed very easily.
Dx of asthma.
Sticks around (3x) longer than Ach bc it is not broken down as readily by enzymes.

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15
Q

Carbachol

A

Direct cholinomimetic (parasympathomimetic).
Ester of choline, derivative of Methacholine.
Resistant to hydrolysis
Miosis, decreases IOP (Binds to M1 sphincter receptor on eye)

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16
Q

Bethanechol

A

Direct cholinomimetic (parasympathomimetic).
Ester of choline, derivative of Methacholine.
Works on M3 receptor in GU, causes contraction of bladder, opens sphincter.
Resistant to hydrolysis.
Bladder dysfunction, GERD.

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17
Q

Muscarine

A 
Direct cholinomimetic (parasympathomimetic).
Less completely absorbed than other alkaloids bc it is charged. Elimination is enhanced in the kidneys by acidity.

Plant Alkaloids.

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18
Q

Pilocarpine

A

Direct cholinomimetic (parasympathomimetic).
Well absorbed. Elimination is enhanced in the kidneys by acidity.
Plant Alkaloids.

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19
Q

Edrophonium

A

Indirect cholinomimetic (parasympathomimetic).
Blocks acetylcholinesterase.
Simple Alcohol - fast duration 5-15 minutes
Acts on M3 receptor in GI; increases digestion, improves illius.
Myasthenia Gravis diagnosis

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20
Q

Neostigmine, Physostigmine

A

Indirect cholinomimetic (parasympathomimetic).
Blocks acetylcholinesterase.
Carbamates - moderate
Acts on M3 receptor in GI; increases digestion, improves illius (post op bc it out competes paralytics).
Treatment of Myasthenia Gravis, surgical paralysis reversal
Duration 0.5 to 2 hours

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21
Q

Echothiophate

A

Indirect cholinomimetic (parasympathomimetic).
Blocks acetylcholinesterase.
Organophosphates - days
Glaucoma, only useful drug to help bc the duration of action is 100+ hours compared to other drugs- it is irreversibly bound to that receptor

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22
Q

Atropine

A

Cholinoreceptor blocker (parasympatholytic)
Antimuscarinic
Plant-based alkaloid from the belladona plant or jimsomweed.
L-isomer is 100x more potent than D-isomer
Use: Organophosphate poisening (with pralidoxime), bradycardia.
Blocks nicotinic-muscarinic receptors so that they cannot lose their fluid through the canal of schlemm by relaxing cilliary muscles- so be careful with giving this with glaucoma, especially closed-angle. Also be careful with elderly men and those with a history of BPH, as atropine can prevent urination.

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23
Q

Scopolamine

A

Cholinoreceptor blocker (parasympatholytic)
Antimuscarinic
Plant-based alkaloid from henbane. Similar in chemical nature to atropine.
Use: Motion sickness.

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24
Q

Tropicamide

A 
Cholinoreceptor blocker (parasympatholytic)
Antimuscarinic
Mydriasis (cilliary muscle dilation- what you'd use at eye doc bc duration is 1/4 of a day and not DAYS like other drugs) and cycloplegia diagnosis
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25
Q

Ipratromine

A

Cholinoreceptor blocker (parasympatholytic)
Antimuscarinic
Atrovent
Asthma

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26
Q

Phentolamine

A

Sympatholytic
Alpha Blocker
Reversible
alpha 1, alpha 2 non selective
reduces peripheral resistance, some cardiac stimulation (due to blocking of alpha 2 receptors on nerves, limiting reuptake of NE and increasing NE)
Hypertension (r/t Pheochromocytoma), cardiac stimulent
Can also be used to treat male erectile dysfunction, but only if nothing else works. Not front line for this. You could directly inject it into the penis, but that could cause priapism.

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27
Q

Prazosin

A 
Sympatholytic
Alpha Blocker
Reversible
Alpha 1 highly selective
Low affinity to alpha 2
Relaxes arterial and venous smooth muscle
Hypertension, BPH
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28
Q

Yohimbine

A

Sympatholytic
Alpha Blocker
Reversible
alpha 2, sexual dysfunction

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29
Q

Lebetalol

A

Sympatholytic
Alpha Blocker
Reversible
Both alpha and beta

30
Q

Phenoxybenzamine

A

Sympatholytic
Alpha Blocker
Irreversible- non-competitive antagonist
Pheochromocytoma

31
Q

Propanolol

A

Sympatholytic
Beta Blocker - Cardioprotective, hypertension
β1, β2

32
Q

Metoprolol

A

Sympatholytic
Beta Blocker - Cardioprotective, hypertension
β1
Safer in diabetics

33
Q

Lebetalol

A

Sympatholytic
Beta Blocker - Cardioprotective, hypertension
α1, β1, β2
Hypertension (preeclampsia), Pheochromocytoma

34
Q

Esmolol

A

Sympatholytic
Beta Blocker - Cardioprotective, hypertension
β1
Surgical tachycardia (fast)

35
Q

Clonidine

A

SNS Sympathoplegic

36
Q

Methyldopa

A

SNS Sympathoplegic

37
Q

Dexmedetomidine

A

Precedex

SNS Sympathoplegic

38
Q

Hexamethonium

A

Antinicotinic, cholinoreceptor blocker (parasympatholytic)
Ganglion blocker (Nn)
Refractory hypertension

39
Q

Succinylcholine

A 
Antinicotinic, cholinoreceptor blocker (parasympatholytic)
NMJ Blocker (Nm); Depolarizing
Prolonged fasciculations (muscle twitches). 
Suxx is not broken down by achesterase, so after fasciculation occurs the muscle cannot repolarize and you will have flaccid paralysis (phase 1 block).
Phase 2 block is undesirable- excessive amounts eof suxx in bloodstream, so effects are prolonged, they wont be able to breathe (bad).
Duration: v short, 5 minutes
Use: Main use is to facilitate intubation; also used in electroconvulsive therapy so they dont hurt themselves from muscle clenching. 
Side effects: muscle pain, hyperkalemia.
Watch for malignant hyperthermia! (autosomal dominant disorder or gene defect on the RyR1 receptor). Tx for this is Dantrolene.
40
Q

Derivatives of curare

A

Antinicotinic, cholinoreceptor blocker (parasympatholytic)
NMJ Blocker (Nm)
Causes flaccid paralysis
Non- depolarizing, these compete with acetylcholine.

41
Q

Epinephrine

A

Sympathomimetic
Direct Agonist
α1, β1, β2
Treat hypotension, cardiac, respiratory

42
Q

Norepinephrine

A

Sympathomimetic
Direct Agonist
α1, β1
Cardiac

43
Q

Isoproterenol

A

Sympathomimetic
Direct Agonist
β1, β2
Cardiac

44
Q

Dopamine

A

Sympathomimetic
Direct Agonist
D, β1
Dose dependent (vasodilation, Vasoconstriction, Cardiac)

45
Q

Dobutamine

A

Sympathomimetic
Direct Agonist
β1
Cardiogenic shock

46
Q

Phenylephrine

A 
Sympathomimetic
Direct Agonist
α
Raise bp by constricting peripheral bvs
Decongestant- shrinks the blood vessels going to the nose.
Treatment in the tetralogy of fallot
47
Q

Midodrine

A

Sympathomimetic
Direct Agonist
α1
Orthostatic hypotension

48
Q

Clonidine (catapres)

A

Sympathomimetic
Direct Agonist
α2
Hypertension, hemodynamic instability

49
Q

Ephedrine

A

Sympathomimetic
Direct Agonist
BOTH DIRECT AND INDIRECT
decongestant

50
Q

Albuterol, Salmeterol, Formoterol

A

Sympathomimetic
Direct Agonist
β2 Selective

51
Q

Amphetamine

A

Sympathomimetic
Indirect Agonist
Displacement of NE, reverse NET, Block DAT- diet ,ADHD, recreational

52
Q

Cocaine

A

Sympathomimetic
Indirect Agonist
Block NET (NE transporter back into pre-synapse), DAT (Dopamine transporter back into pre-synapse), recreational

53
Q

Hydralazine

A

Vasodilator

54
Q

Minoxidil

A

Vasodilator

55
Q

Nitroprusside

A

Vasodilator

56
Q

Fenoldepam

A

Vasodilator

57
Q

Verapamil

A

Vasodilator; CCB

58
Q

Dilatiazem

A

Vasodilator; CCB

59
Q

Dihydropyridines

A

Vasodilator; CCB

60
Q

Aliskiren

A

Angiotensin inhibitor

61
Q

Captopril

A

Angiotensin inhibitor

ACEi

62
Q

Losartan

A

Angiotensin inhibitor

ARB

63
Q

Valsartan

A

Angiotensin inhibitor

ARB

64
Q

Bosentan

A

Endothelin Receptor Antagonist

65
Q

Nitroglycerin

A

Decrease myocardial oxygen demand by decreasing heart rate/ventricular volume/BP/contractility
Nitrate/Nitrite
Large veins- best response
Increase venous capacitance, decrease ventricular preload
NO release in vascular smooth muscle - SL
Mononitro forms (isosorbide dinitrate)
Amyl Nitrite
Onset: 1-3 minutes, duration 20-30 minutes

66
Q

Neurotransmitter Classes

A 
Esters- Ach
Monoamines - Amino acid derivatives, specifically the AA tyrosine; Ne, serotonin, dopamine
Amino Acids- Glutamate, GABA
Purines - Adenosine, ATP
Peptides- Substance P, Endorphins
Inorganic gases - Nitric Oxide (NO)
67
Q

Acrecholine

A

Alkaloid from the Patel nuts.
Very similar to nicotine, crushed and used as a psychostimulant. (Red stain in mouth).
Higher incidence of oral and esophageal CA.

68
Q

Nicotine

A

Alkaloid, Nicotinic

69
Q

Suggamadex

A

Instead of outcompeting atropine or other cholinoreceptor blocking agents, it traps the derivatives inside a molecular tube, making it inactive.
Nearly 100% reversal, but the drug is expensive.

70
Q

Activity of D1

A

dilates renal blood vessels/smooth muscle

CRNA School (2 decks)

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