Pharm Exam II Flashcards
Which of the following is a symptom of acute cholinergic toxicity?
Bradycardia
(Muscarinic symptoms)
SLUDGE: Salivation, Lacrimation, Urination, Diarrhea, GI discomfort, Emesis
DUMBBLESS: Diarrhea, Urination, Miosis, Bronchorrhea, Bradycardia, Emesis, Lacrimation, Salivation, Sweating
(Nicotinic symptoms)
Muscle cramps, Tachycardia, Weakness, Twitching, Fasciculations
A drug that has an effect of increasing gastric emptying:
increased absorption
GI absorption is ____ by meds that inhibit gastric emptying (Examples: atropine, anticholinergics, opiates)
slowed
GI absorption is ____ by meds that increase gastric emptying (Examples: Metoclopramide, Reglan)
increased
- Competition for protein binding sites
- Alterations in “free” drug concentrations
- Impact secondarily on elimination
Distribution
- Enzyme induction (phenytoin, carbamazepine, rifampin, theophylline)
- Enzyme inhibition (allopurinol, ciprofloxacin, paroxetine, fluoxetine, cimetidine)
Metabolism
Tubular secretion
Altered urine flow and urine pH
Excretion
What ions are associated with phase 0?
sodium
What ions are associated phase 1?
sodium
What ions are associated with phase 2?
calcium
What ions are associated with phase 3?
calcium & potassium
What ions are associated with phase 4?
calcium
What phase of cardiac action potential is being described?
RAPID DEPOLARIZATION- sodium channels open:
phase 0
What phase of cardiac action potential is being described?
PARTIAL REPOLARIZATION- sodium channels close
phase 1
What phase of cardiac action potential is being described?
PLATEAU- calcium channel open
phase 2
What phase of cardiac action potential is being described?
REPOLARIZATION
- calcium channels close
- potassium channels open
phase 3
What phase of cardiac action potential is being described?
PACEMAKER/RESTING
- degradation of membrane potential
- slowly calcium channels
phase 4
Refractory period in which the heart CANNOT be stimulated:
absolute refractory period
Refractory period in which a greater than normal stimulus may initiate a response:
relative refractory period
Which of the following medications has a high risk of QT prolongation and TDP?
- Amiodarone
- Bretylium
- Dofetilide
- Ilbutilide
- Dronedarone
- Sotalol
(A Big Dog Is Darn Scary)
What is TDP?
Torsades De Pointes (A specific type of ventricular tachycardia that begins in your heart ventricles)
Which of the following is an “irreversible” indirect cholinergic agent?
Novichok agents
(Organophosphates which include Novichok agents, insecticides, and nerve agents)
Which of the following is an arrhythmia that results in a HR of less than 60 beats per minute?
bradycardia
(tachycardia is greater than 100 bpm)
Vaughn-Williams Classifies:
Antiarrhythmic medications
List the following Vaughn-Williams Classifications:
Class 1:
Class 2:
Class 3:
Class 4
Class 5:
Class 1: Na+ channel blockers
Class 2: Beta-adrenoreceptor blockers
Class 3: K+ channel blockers
Class 4: Ca++ channel blockers
Class 5: Miscellaneous
Which receptor minimizes the potential for dry mouth?
M3- Glandular/smooth muscle; gastric acid; salivary secretion, GI contraction, ocular accommodation, and vasodilation
Which is a neurohormone?
- EPINEPHRINE
(any hormone produced and released by neuroendocrine cells into the BLOOD)
Which of the following drugs cause dry mouth & urinary hesitancy?
Dysopyramide (Norpace)- This is a class IA antiarrhythmic medication
- also causes constipation & QT prolongation
Which of the following medications is likely to cause dry mouth and sedation due to its affects at the histamine receptor?
Diphenhydramine (Benadryl)
Which medication increases cardiac contractility by inhibiting PDE3?
Milrinone
Positive Inotropic medications contribute to:
ability of the heart to contract
- Cardiac glycosides (digoxin) inhibits NA-K ATPase
- DOBUTamine- Beta 1 adrenoreceptor agonist
- Milrinone- phosphodiesterase inhibitor
Which of the following medications undergoes a pharmycodynamic interaction and negates the beneficial effect of albuterol?
Propranolol (inderal) a beta blocker
Which of the following is beta 1 specific?
Metoprolol
Which of the is considered a non-covalent type of interaction>
formation of hydrogen peroxide
Which of the following medications has a high risk of gingival hyperplasia?
Verapamil
Which of the following is most commonly associated with gingival hyperplasia
Phenytoin (dilantin)
POST-ganglionic SYMPATHETIC releases:
Norepi (NE)
POST- ganglionic PARASYMPATHETIC releases:
Ach
AUTONOMIC PRE-ganglionic releases:
Ach
Recognition of AchE:
Pralidoxime
First line of treatment for patient exposed to nerve gas:
Pralidoxime
What do you give a patient with anaphylaxis?
0.3 mg IM epinephrine
Short- acting beta 2 agonist in asthmatic patients
albuterol
Which drug metabolism phase functions impair with age?
phase 1
Blocks calcium from entering L type channels:
Nifedipine
What contributes to cardiac output?
stroke volume and heart rate
Which ion is required to bind actin and myosin to produce cardiac contractility?
calcium
Which drug inhibits the Na/K ATPase?
Digoxin
Which commonly occurs during pregnancy?
Increased renal blood flow and GFR
Which increases cardiac contraction by stimulating myocardial B1 receptors?
DOBUTamine
Which is a short-term temporizing agent of hypotension and also serves as a nasal decongestant?
Phenylephrine
What are the three endogenous catecholamines?
Dopamine, NE, and Epi
Myocardial oxgen teman is determiend by:
HR and myocardial contractility
Characteristic of alpha 1 adrenergic receptor activation:
increase sympathetic tone
Which of the following results from covalent modification and alteration of DNA?
mutagenesis
Adverse effect independent of drugs main mechanism:
aspirin & tinnitus
Meds most likely to be associated with development of anaphylactic shock?
PCN
Example of pharmacodynamics:
constipation from Ach block
Which of the following drugs has the greatest risk of causing orthostatic hypotension?
Terazosin
Ethnic variation, that some individuals of chinese… this is because of increased:
acetaldehyde
Acetylcholine is broken down by which of the following enzymes?
acetylcholinesterase
Which of the following does beta 1 NOT do?
bronchodilation
Fluoxetine is SSRI anti depression that inhibits cytochrome P450 2D6. Risperidone is antipsychotic and is substrate for P450 2D6. What effect would you expect fluoxetine to have on risperidone in terms of drug concentration?
Risperidone levels increase (he used different drug exmaples)
Atrial depolarization =
P wave
Which of the following is a depolarizing neuromuscular blocker?
Succinylcholine
What tertiary amine…
Attropine
A drug that treated cholinergic toxicity would NOT treat
paralysis
Prozac inhibits which liver enzyme?
2D6
Which type of blockade can cause a patient.. If they go from supine to immediately standing?
alpha 1 blockage; orthostatic hypotension
Which drugs are contraindicated in patients with asthma?
All of the above (opiates, aspirin, antihistamines)
