Pharm Study Guide 2

Question 1

Bethanechol indications:

Answer 1

Acute postoperative or postpartum nonobstruc- tive urinary retention; neurogenic atony of the bladder with retention

Question 2

Bethanechol therapeutic actions:

Answer 2

Acts directly on cholinergic receptors to mimic the effects of acetylcholine; increases tone of detrusor muscles and causes emptying of the bladder

Question 3

Bethanechol adverse fx:

Answer 3

Abdominal discomfort, salivation, nausea, vomiting, sweating, flushing

Question 4

Bethanechol expected outcomes:

Answer 4

Increased bladder fxn & tone

Question 5

Donepezil indications:

Answer 5

tx of mild to moderate AD

Question 6

Donepezil therapeutic actions:

Answer 6

Reversible cholinesterase inhibitor that causes ele- vated acetylcholine levels in the cortex, which slows the neu- ronal degradation of Alzheimer disease

Question 7

Donepezil adverse fx:

Answer 7

Insomnia, fatigue, rash, nausea, vomiting, diarrhea, dyspepsia, abdominal pain, muscle cramps

Question 8

Donepezil expected outcomes:

Answer 8

improvement of cognitive fxn

Question 9

Pyridostigmine indications:

Answer 9

Treatment of myasthenia gravis, antidote for nondepolarizing neuromuscular junction blockers, increased survival after exposure to nerve gas

Question 10

Pyridostigmine therapeutic actions:

Answer 10

Reversible cholinesterase inhibitor that increases the levels of acetylcholine, facilitating transmission at the neuro- muscular junction

Question 11

Pyridostigmine adverse fx:

Answer 11

Bradycardia, cardiac arrest, tearing, miosis, salivation, dysphagia, nausea, vomiting, increased bronchial secretions, urinary frequency, and incontinence

Question 12

Pyridostigmine expected outcomes:

Answer 12

Relief of ptosis and diplopia; improved chewing, swallowing, extremity strength, and breathing without the appearance of cholinergic symptoms.
Reversal of nondepolarizing neuromuscular blocking agents in general anesthesia.
Prevention of Soman nerve gas toxicity

Question 13

Atropine indications:

Answer 13

IM: Given preoperatively to decrease oral and respiratory secretions.
IV: Treatment of sinus bradycardia and heart block.
PO: Adjunctive therapy in the management of peptic ulcer and irritable bowel syndrome.
IV: Reversal of adverse muscarinic effects of anticholinesterase agents (neostigmine, physostigmine, or pyridostigmine).
IM, IV: Treatment of anticholinesterase (organophosphate pesticide) poisoning.
Inhaln: Treatment of exercise-induced bronchospasm

Question 14

Atropine actions:

Answer 14

Competitively blocks acetylcholine muscarinic receptor sites, blocking the effects of the parasympathetic nervous system

Question 15

Atropine adverse fx:

Answer 15

Blurred vision, mydriasis, cycloplegia, pho- tophobia, palpitations, bradycardia, dry mouth, altered taste perception, urinary hesitancy and retention, decreased sweat- ing, and predisposition to heat prostration

Question 16

Atropine expected outcomes:

Answer 16

Increase in heart rate.
Dryness of mouth.
Reversal of muscarinic effects

Question 17

What diagnostic agent is used to distinguish myasthenic crisis from cholinergic crisis?

Answer 17

The drug Edrophoniium

Question 18

Myasthenic crisis:

Answer 18

When the myasthenia gravis patient improves immediately after the edrophonium injection

Question 19

Tx of myasthenic crisis:

Answer 19

Administration of the cholinergic drug

Question 20

Cholinergic crisis:

Answer 20

When the myasthenia gravis pt gets worse after the edrophonium injection.
The pt has progressive muscle weakness & respiratory difficulty as accumulation of acetycholine at the cholinergic receptor site leads to reduced impulse transmission & muscle weakness

Question 21

Tx of cholinergic crisis:

Answer 21

W/drawal of the cholinergic drug w/ intense medical support

Question 22

Indication for tx of direct-acting cholinergic agents:

Answer 22

Increases tone of detrusor muscle & relaxes bladder sphincter to increase urinary flow.

Question 23

Actions of cholinergic drugs:

Answer 23

Mimics actions of the PSNS

Question 24

Fx of pilocarpine:

Answer 24

• Induces miosis (pupil constriction)
• Relieves intraocular pressure of glaucoma
• For use in certain surgical procedures
• Can increase GI secretions

Question 25

What is used to tx myasthenia gravis?

Answer 25

Acetycholinesterase inhibitors are used to tx myasthenia gravis bc it allows the accumulation of ACh in the synaptic cleft, prolonging stimulation of any ACh sites that remain

Question 26

Cholinergic drug use w/ ophthalmologic dz & procedures:

Answer 26

induce miosis to relieve the increased intraocular pressure of glaucoma

Question 27

Anticholinergic drug use w/ ophthalmologic dz & procedures:

Answer 27

It is used as an ophthalmic agent to cause mydriasis (pupil dilation) or cycloplegia (loss of visual accomodation)

Question 28

Symptoms of atropine toxicity:

Answer 28

Dry mouth & throat, pupil dilation, blurred vision, restlessness, fatigue, H/A, hot/dry skin, difficulty voiding, rapid/weak pulse, iris nearly gone, hallucinations, delirium, coma

Question 29

Atropine blocks which primary receptor?

Answer 29

It blocks the acetylcholine muscarinic receptor sites, blocking the fx of the PSNS

Question 30

Parasympatholytic:

Answer 30

Lysing or blocking parasympathetic fx (effects of ACh)

Question 31

Contraindications of anticholinergic drugs:

Answer 31

Glaucoma, stenosing peptic ulcer, intestinal atony, paralytic ileus, GI obstruction, severe ulcerative colitis, and toxic megacolon, prostatic hypertrophy and bladder obstruction, cardiac arrhythmias, tachycardia, and myocardial ischemia, impaired liver or kidney function, & myasthenia gravis

Question 32

Anticholinergic symptoms:

Answer 32

The more drug in the system, the greater the fx.

blurred vision, pupil dilation, and resultant photophobia, cycloplegia, and increased intraocular pressure, Weakness, dizziness, insomnia, mental confusion, dry mouth, Altered taste perception, nausea, heartburn, con- stipation, bloated feelings, and paralytic ileus, tachycardia, palpitations, urinary hesitancy/retention, decreased sweating

Question 33

Myasthenia gravis:

Answer 33

A chronic muscular dz caused by defect in neuromuscular transmission. It’s an autoimmune dz where pt’s make Abs to their own Ach receptors, gradually destroying them.

The disease is marked by progressive weakness and lack of muscle control, with periodic acute episodes.

Question 34

AD:

Answer 34

A progressive disorder involving neural degeneration in the cortex that leads to a marked loss of memory and inability to carry on ADL’s.

Cause of dz is unknown. There is a progressive loss of Ach-producing neurons & their target neurons in the CNS.

Question 35

4 cholinergic drugs to treat AD:

Answer 35

Tacrine, Galantamine, Rivastigmine, Donepezil

Question 36

Tacrine:

Answer 36

1st drug to treat Alzheimer’s dementia

Question 37

Galantamine:

Answer 37

used to stop progression of Alzheimer’s dementia

Question 38

Rivastigmine:

Answer 38

available in solution for swallowing ease; used to treat AD

Question 39

Donepezil:

Answer 39

once a day dosing for AD

Question 40

Nerve gases:

Answer 40

irreversible acetylcholinesterase inhibitors used in warfare to cause paralysis and death by prolonged muscle contraction and parasym- pathetic crisis

Use pyridostigmine to reverse fx

Question 41

Insulin glargine (Lantus) lasts in the body for ___ & its peak time is ___.

Answer 41

Lasts in the body for 20-26 hrs

Peak time is 4-8hrs

Question 42

Give lispro insulin during ___.

Answer 42

Mealtime to cover carb intake

Question 43

Lispro starts to work in ___ & lasts in the body for ___.

Answer 43

Starts to work in 10-15mins

Lasts in the body for 4-6hrs