Pharm Exam II Flashcards by Abagayle Moody

Q

Which of the following is a symptom of acute cholinergic toxicity?

A

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

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Q

A drug that has an effect of increasing gastric emptying:

A

increased absorption

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Q

GI absorption is ____ by meds that inhibit gastric emptying (Examples: atropine, anticholinergics, opiates)

A

slowed

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Q

GI absorption is ____ by meds that increase gastric emptying (Examples: Metoclopramide, Reglan)

A

increased

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Q

Competition for protein binding sites
Alterations in “free” drug concentrations
Impact secondarily on elimination

A

Distribution

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Q

Enzyme induction (phenytoin, carbamazepine, rifampin, theophylline)
Enzyme inhibition (allopurinol, ciprofloxacin, paroxetine, fluoxetine, cimetidine)

A

Metabolism

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Q

Tubular secretion
Altered urine flow and urine pH

A

Excretion

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Q

What ions are associated with phase 0?

A

sodium

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Q

What ions are associated phase 1?

A

sodium

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Q

What ions are associated with phase 2?

A

calcium

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Q

What ions are associated with phase 3?

A

calcium & potassium

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Q

What ions are associated with phase 4?

A

calcium

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Q

What phase of cardiac action potential is being described?

RAPID DEPOLARIZATION- sodium channels open:

A

phase 0

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Q

What phase of cardiac action potential is being described?

PARTIAL REPOLARIZATION- sodium channels close

A

phase 1

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Q

What phase of cardiac action potential is being described?

PLATEAU- calcium channel open

A

phase 2

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Q

What phase of cardiac action potential is being described?

REPOLARIZATION
- calcium channels close
- potassium channels open

A

phase 3

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Q

What phase of cardiac action potential is being described?

PACEMAKER/RESTING
- degradation of membrane potential
- slowly calcium channels

A

phase 4

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Q

Refractory period in which the heart CANNOT be stimulated:

A

absolute refractory period

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Q

Refractory period in which a greater than normal stimulus may initiate a response:

A

relative refractory period

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Q

Which of the following medications has a high risk of QT prolongation and TDP?

A

Amiodarone
Bretylium
Dofetilide
Ilbutilide
Dronedarone
Sotalol

(A Big Dog Is Darn Scary)

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Q

What is TDP?

A

Torsades De Pointes (A specific type of ventricular tachycardia that begins in your heart ventricles)

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Q

Which of the following is an “irreversible” indirect cholinergic agent?

A

Novichok agents

(Organophosphates which include Novichok agents, insecticides, and nerve agents)

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Q

Which of the following is an arrhythmia that results in a HR of less than 60 beats per minute?

A

bradycardia

(tachycardia is greater than 100 bpm)

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Q

Vaughn-Williams Classifies:

A

Antiarrhythmic medications

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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 1. Cardiac glycosides (digoxin) inhibits NA-K ATPase 2. DOBUTamine- Beta 1 adrenoreceptor agonist 3. 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)