Pharm NMJ part II

Question 1

what are the clinical uses of NMJ blocking drugs

Answer 1

surgical relaxation
endotracheal intubation
control of ventilation

Question 2

how do NMJ blockers help control ventilation

Answer 2

reduce chest wall R and improve thoracic compliance
permit adequate gas exchange and prevents atelectasis in patients who have ventilatory failure
pancuronium and vecuronium most common if >24 hours

Question 3

MOA dantrolene

Answer 3

inhibition of RYR Ca Ch blocking release of Ca from SR and so no muscle contraction

Question 4

side effects dantrolene

Answer 4

generalized muscle weakness, sedation, and occasionally hepatitis

Question 5

what is dantrolene used for

Answer 5

Tx for spascitiy associated with UMN disorders and management of malignant hyperthermia

Question 6

what patients are at risk for malignant hyperthermia

Answer 6

hereditary mutations in RyR gene
permits excessive Ca release from SR under certain triggering agents
increase Ca, increase lactic acid, increase temperature

Question 7

what do we use to reduce Ca in malignant hyperthermia

Answer 7

IV dantrolene

Question 8

MOA botulinum toxin

Answer 8

cleaves SNARE and blcoks release of ACh by preventing vesicle exocytosis

Question 9

what is botulinum used for

Answer 9

generalized spastic disorders, cervical dystonia and blepharospasm

Question 10

what are direct acting cholinomimetics

Answer 10

bind and activate mAChR and nAChR

Question 11

what are indirect acting cholinesterase inhibitors

Answer 11

inhibit AChE increasing ACh in the celft

Question 12

where is butyrylcholinesterase made

Answer 12

liver and found inliver and plasma

Question 13

AChE is found where

Answer 13

highly [ ] postsynaptic end plate and prevents lateral diffusion from adjacent nAChRs

Question 14

primary target for cholinesterase inhibiting drugs

Answer 14

AChE but also block BuChE

Question 15

3 chemical groups of cholinesterase inhibitors

Answer 15

Alcohols
Carbamic acid esters
Organophosphates

Question 16

how does alcohol work as AChE inhibitor

Answer 16

+ charged quaternary ammonium that binds to AChE noncovalently

Question 17

how do carbamic acid esters work like AChEI

Answer 17

quaternary and tertiary ammonium groups that bind to AChE noncovalently

Question 18

which AChEI are carbacmic acid esters

Answer 18

neostigmine, pyridostigmine, physostigmine, carbaryl

Question 19

what AChEI are alcohols

Answer 19

edrophonium

Question 20

what AChEI are organophosphates

Answer 20

echothiophate, parathion and malathion, sarin, soman, tabun

Question 21

what is a precaution with organophosphates

Answer 21

CNS toxicity since neutrally charged and lipid soluble

Question 22

bond between organophosphates and AChE

Answer 22

covalent and irreversible

Question 23

what is preferred administration for the AChE I with quaternary ammoniums

Answer 23

parenteral

no CNS distribution

Question 24

What are the tertiary uncharged AChE I and distribution?

Answer 24

physostigmine, donepezil, tacrin, rivastigmine, glantamine

CNS distrivution

Question 25

what organophosphate is safe for use as insetidiced

Answer 25

malation

Question 26

what is "aging" or organophosphates

Answer 26

phosphorylated enzyme will break one of the O-PO4 bonds of inhibitor and strenghten the bond

Question 27

high [ ] effects of AChEI on CNS

Answer 27

generalized convulsions d/t neuronal hyperstimulation

Question 28

effects of AChE I on eyes

Answer 28

contraction of iris | contraction of ciliary muscle

Question 29

AChE I effects on hearat

Answer 29

Sympathetic and Parasympathetic parasympathetic dominates and CO decreases bradycardia

Question 30

Tx myasthenia gravis

Answer 30

pyridostigmine, neostigmine and ambenonium do not cross bbb repeated dose every 2-8 hours

Question 31

what is favored test for myasthenia gravis

Answer 31

ice pack test

Question 32

Myasthenic crisis

Answer 32

life threatening condision defined as weakness from acquired myasthenia gravis that is severe enough to necessitate intubation

Question 33

excessive AChE I use can lead to what

Answer 33

cholinergic crisis

Question 34

Sx cholinergic crisis

Answer 34

muscle weakness

Question 35

how to differentiate cholinergic crisis from myasthenic crisis

Answer 35

edrophonium test myasthenic crisis Sx will get better cholinergic crisis will remain unchanged

Question 36

what AChE I are pregerred to reverse paralysis induced by NMJ blockers

Answer 36

neostigmine and edrophonium

Question 37

Tx paralytic ileus, atony urinary bladder and congenital megacolon

Answer 37

AChE I

Question 38

What is glaucoma

Answer 38

increased intraocular P

Question 39

how do AChE I help with glaucoma

Answer 39

reduce intraocular P by stimulating mACHRs of ciliary body and cause contraction which facilitates outflow of aqueous humor

Question 40

what is preferred Tx for glaucoma

Answer 40

topical beta blockers and PG derivatives

Question 41

What is used to Tx dementia

Answer 41

donepezil, rivastigmine, glantamine and physostigmine

Question 42

intoxication from anticholinergic Sx

Answer 42

cutaneous vasodilation, anhidrosis, anhydrotic hyperthermia, nonreactive mydirasis, delerium, hallucinations, reduction or elimination of desire to urinate

Question 43

reversal of antimuscarinc toxicity

Answer 43

physostigmine because crosses bbb

Question 44

what occurs if combine succinylcholine with AChE I

Answer 44

enhance phase I block and antagonize phase 2 block

Question 45

effects of beta blocker with AChE I

Answer 45

bradycardia

Question 46

Sx AChE intoxication

Answer 46

miosis, salivation, sweating, bronchial constriction, vomiting, diarrhea

Question 47

what are the CNS involvements of AChE intoxication

Answer 47

confusion, ataxia, generalized convulsions, coma and respiratory paralysis

Question 48

what causes death in AChE intoxication

Answer 48

respiratory failure

Question 49

Dx AChE intoxication

Answer 49

measure AChE activity in RBCs and plasma

Question 50

antidote for AChE intoxication

Answer 50

atropine | except is ineffective in peripheral NMJ, need cholinesterase regenerators

Question 51

pralidoxime

Answer 51

cholinesterase regenerator

Question 52

what is window frame for effective use of pralidoxime against organophosphate toxicity

Answer 52

before aging has occured

Question 53

does pralidoxime cross bbb

Answer 53

no

Question 54

pyridostigmine is used in military for what

Answer 54

prophylaxis AChE inhibitor posioning | nerve gas

Question 55

side effects of pyridostigmine

Answer 55

stomach cramps, diarrhea,nausea, urination, HA, dizziness, SOB, worsening peptic ulcer, blurred vision, watery eyes