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OCHT Term II > PHARM - Test 1 (CNS, Routes of Entry, Medical Math, Generic vs Trade) > Flashcards

PHARM - Test 1 (CNS, Routes of Entry, Medical Math, Generic vs Trade) Flashcards

1
Q

ac

A

before meals (ante cibum)

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2
Q

bid

A

twice a day (bis in die)

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3
Q

cap

A

capsule

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4
Q

d

A

d (24 hours)

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5
Q

Exlir.

A

liquid or syrup

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6
Q

g

A

gram - dry measure used in tablets

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7
Q

gr

A

grains - dry weight of medication

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8
Q

gt

A

drop (gt means “guttae”)

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9
Q

h

A

hour

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10
Q

hs

A

at bedtime (hora somni)

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11
Q

IM

A

intramuscular

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12
Q

mg

A

milligram - dry weight measure

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13
Q

mL

A

milliliter - liquid volume measure

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14
Q

PO

A

“per os” - by mouth

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15
Q

pc

A

after meals (post cibum)

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16
Q

pil

A

pill

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17
Q

prn

A

as needed (pro re nata)

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18
Q

q

A

every

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19
Q

q2h

A

every 2 hours (quaque 2 hora)

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20
Q

qd

A

every day (quaque die)

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21
Q

qh

A

every hour

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22
Q

Sig

A

patient instructions (“write”) - signa

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23
Q

qid

A

4 times a day (quater in die)

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24
Q

Supp.

A

medications inserted rectally (“suppository”)

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25
Q

Ṫ

A

one tablet

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26
Q

tab

A

tablet

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27
Q

tid

A

3 times a day (ter in die)

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28
Q

U

A

Unit

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29
Q

brand name

A

the trade name of a drug; created by pharmaceutrical companies so that they are able to make money off of the drug

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30
Q

Tylenol is a (brand/generic) name

Acetaminophin is a (brand/generic) name

A

brand

generic

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31
Q

Prior to a drug arriving on shelves, what processes does it have to go through to ensure it is safe and effective?

A

1) pharmaceutical company conducts a series of lab studies (takes years)
2) studies are then performed at approved clinical research facilities across the country (drug is administered with strict protocols)
3) Food and Drug Administration (FDA) reviews lab and clinical trial findings, assesses manufacturing processes, and verifies drug’s purity, stability, and strength before approving medication
4) one FDA approved, given a brand name

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32
Q

True or False. The brand is protected by a patent so other drug manufacturers cannot copy the formula and duplicate the drug.

A

True. Other drug manufacturers can buy the generic formula but cannot sell it under the same brand name (but once the patent has expired)

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33
Q

True or false. Other pharmaceutical companties may apply to the FDA for permission to manufaacture and sell a generic version of the original compound once the original patient expires.

A

True

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34
Q

When developing a generic drug, what must the manufacturers ensure is kept the same as the original brand name drug?

A
  • same active ingredient(s)
  • same form (liquid, pill, capsule, injectable, topical)
  • concentration
  • dosage
  • as pure and stable as original drug
  • same distribution patterns and be metabolized and eliminated from the body
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35
Q

True or False. Generic drugs can have different inactive ingredients such as preservatives or fillers along with the same active ingredients.

A

True

Trademark laws prevent generic drugs from looking just like the brand name drug, so the color and size may be different (or the product size like the number of capsules in the package may be different)

BUT THE ACTIVE INGREDIENTS WOULD BE ABSOLUTELY THE SAME (it’s the law)

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36
Q

Which are cheaper: Generic or brand name drugs. Why?

A

Generic - because they don’t have to do all that initial work of developing the drug so they’ve got their work cut out for them and don’t need to invest as much money in the first place. This means they can sell it at a lower cost and still make a profit

Generic drugs may cost 30-80% less than original versions

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37
Q

susp

A

suspension

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38
Q

How do you calculate medication dosage?

A

WANT/HAVE x quantity

WANT: the amount desired

HAVE: how much supply is on hand (amount per item of med that is available)

quantity: the form of medication (tablet, capsule, milliliter, etc.)

*notes: units must be the same (mL for mL, gr. for gr.) and medicate as per a patient’s WEIGHT not age

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39
Q

Dosage

A

the amount of medication to be given in one dose

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40
Q

John was prescribed Amoxicillin 500mg capsule po tid x 10d. The pharmacist’s supply includes 500mg per capsule. Provide the single dose, daily dose, and total amount that John needs to take.

A

Single dose: 1 capsule (500mg)

Daily dose: 3 capsules (1500mg)

Total amount: 30 capsules (15 000mg)

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41
Q

Maya the dog was prescribed Trazadone 750mg po qd x 10d. The pharmacist’s supply includes 500mg per scored tablet. Provide the single dose, daily dose, and total amount that Maya needs to take.

A

Single dose: 1.5 tablets (750mg)

Daily dose: 1.5 tablets (750mg)

Total amount: 15 tablets (7500mg)

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42
Q

Kyle was prescribed Digoxin elixir 150 mcg po tid x 10d. The pharmacist at the hospital has 50mcg/mL available. Calculate the single dose, daily dose, and total amount that Kyle needs to take.

A

Single dose: 3mL (150mcg)

Daily dose: 9mL (450mcg)

Total amount: 90mL (4500mcg)

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43
Q

Pharmacology

A

the scientific study of the effects of drugs and chemicals on living organisms

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44
Q

Drugs

A

any chemical or substance that is natural or synthetic that affects a biological system

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45
Q

Food and Drugs Act (FDA)

A

primary legislation governing the safety and nutritional quality of food an drugs sold in Canada

Role is to protect public against health hazards and fraud from the sale of food (and beverages), drugs, medical devices and cosmetics

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46
Q

Scope of Food and Drug Act (FDA) (10):

A
  • food labelling
  • advertising and claims
  • food standards and compositional requirements
  • fortification
  • foods for special dietary uses
  • food additives
  • chemical and microbial hazards
  • vet drug residues
  • packaging material
  • pesticides
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47
Q

Controlled substance

A

drug/chemical whose manufacture, posession, or use if regulated by a government (such as illicitly used drugs or prescription medications that are designated by law)

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48
Q

Prescription Drugs

A

medications that need supervision (i.e. prescription label on how to ake the medication) or those that are at risk of being misused or abused

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49
Q

True or False. Over the counter (OTC) meds can be just as dangerous as prescribed ones.

A

True

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50
Q

The most common OTC medication used is:

A

tylenol

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51
Q

All drugs at least ____ names. They are __________ and ________ name.

A

two; generic vs brand/trade name

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52
Q

True or False. Trade names will only start with lowercase letters.

A

False. Always starts with capital letter

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53
Q

The category of drugs with nonproprietary names is known as

A

generic drugs

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54
Q

True or false. Generic drugs usually are an abbreviated version of the drug’s chemical name and is registered wth the FDA.

A

True

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55
Q

True or False. Insurance would always cover the cost of the brand name drug even if the generic drug is available, as long as the patient requests the brand name.

A

False. Generic drugs are normally always covered, but brand name drug is only covered by insurance if no generic form exists

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56
Q

What is the difference in FDA approval re: inactive ingredients in brand vs generic name?

A

Brand name: inactive ingredients are tested and approved by the FDA

Generic: may differ - but proven to be acceptable by the FDA (such as the coating on easy swallow drugs)

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57
Q

Drugs that are standard in size, color, and packaging fall under the which category of drugs (brand/generic)?

A

brand name

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58
Q

Paramedics carry (generic/brand name) drugs.

A

generic

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59
Q

OTC medications also have generic counterparts. Provide the generic name for the following OTC medications.

a) Aspirin
b) Benadryl
c) Gravol
d) Advil (NSAID)

A

a) Acetylsalicylic Acid
b) Diphenhydramine
c) Dimenhydrinate
d) Ibuprofen

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60
Q

What are the 5 rights of drug administration?

A

1) Drug - is this the right drug?
2) Dose - is this the right dose?
3) Route - is this the right route?
4) Time - is this the right time?
5) Patient - is this the right patient?

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61
Q

What are the 7 routes/categories of entry for drugs?

A

1) oral
2) nasal/intranasal
3) sublingual/buccal
4) transdermal/topical
5) rectal/vaginal
6) inhalation
7) parenteral IM, IV, SQ

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62
Q

The #1 route of entry for medication is:

A

orally

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63
Q

Oral route of entry

A
  • Taken by mouth through the alimentary (GI) tract (the ACTUAL act of swallowing not just putting it in your mouth - see other forms of entry such as sublingual)
  • must travel to stomach before being broken down
  • absorbed in intestine and passed into the blood stream
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64
Q

Onset time for oral method of drug administration

A

20-60 minutes

*note: this can change with factors such as stomach contents (i.e. milk can coat your stomach so decreased absorption; empty stomach means faster absorption because less things to fight for its efficacy)

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65
Q

Enteral medications

A

meds that are absorbed through the GI tract

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66
Q

Nasal vs intranasal drug administration route

A

Nasal: through the nose in the form of drops or gels

Intranasal: the use of aerosols

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67
Q

Why are powder forms of drugs not prescribed and not an acceptable form of route of entry?

A

Because drugs can be extremely acidic/basic and will burn mucosa lining

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68
Q

Onset time of Nasal/Intranasal route administration

A

~10 min (5-15 min range)

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69
Q

Sublingual/Buccal

A

Sublingual: under the tongue

Buccal: between cheek and teeth

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70
Q

Onset time and peak effect time for sublingual/buccal medications

A

Onset: quickly (~15 min)

Peak effect: 30 mins

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71
Q

How does sublingual/buccal medications get into the body?

A

Diffusion into the bloodstream from tissues under the tongue or side of the mouth (use of spray of dissolving tablet)

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72
Q

True or False. The effectiveness of medication taking sublingually/bucally can be altered if taken after large meals.

A

False. Sublingual/buccal routes of administration override enteral system

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73
Q

Transdermal route of administration

A

Medication is applied to the skin and enters circulatory system through diffusion

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74
Q

Instructing a patient to chew a baby aspirin and make it into a paste, and then place it under the tongue/between cheek and teeth is known as what route of entry for the medication?

A

sublingual/buccal

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75
Q

A patient with a nicotine patch is receiving medication via what route of entry?

A

Transdermal

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76
Q

Where are transdermal patches usually placed on the body. Why?

A

usually placed on chest or front of of shoulder because if it’s anywhere else, the chance of forgetting it increases (out of sight, out of mind). People may forget and continuously add on more patches which can increase risk of OD

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77
Q

What do transdermal controlled-release forms of medications do?

A

They are designed to release the drug for extended periods, sometimes for several days

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78
Q

Topical

A

A cream or gel applied to top layer of skin; usually short-lasting

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79
Q

Do topical drugs enter the circulation?

A

No. They just work at site of action

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80
Q

Rectal medications are also known as:

A

suppositories

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81
Q

Once in the systemic circultory system, drug distribution is influenced by _____________.

A

Tissue/organ blood flow

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82
Q

Rectal medications are typically in the form of:

A

tablet/capsule

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83
Q

onset time for rectal/vaginal route of drug entry

A

10-15 minutes (quick because ++vascular so east to get into bloodstream)

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84
Q

The number one route of medication administration for children is:

A

rectally

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85
Q

True or False. You can typically take all oral medications rectally/vaginally

A

True

*walls of vagina have the same cellular make up as esophagus so effect is similar

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86
Q

True or False. Medications for sex organs can be administerd through the genitalia of males and females.

A

False. Vagina is the only genital that can accept medications for sex organs (penis does not work)

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87
Q

Vaginal medications are usually in what form?

A

cream or gel, but capsule and tablet can also be administered

88
Q

Inhalation route of entry

A

via aerosol - works directly into respiratory system

89
Q

Onset time/absorption rate for inhalation

A

immediately (within 5 min)

90
Q

Parenteral IM, IV, SQ entry route

A

Injectable medications - directly into muscle (IM), blood stream (IV), or skin (SQ)

No GI first pass effect

91
Q

What is hepatic metaoblism/hepatic first pass effect?

A

Phenomenon where the amount of a drug that is actually delivered to your general circulation is less than the total amount you initially took by mouth (due to having to pass through GI tract and then via portal vein into the liver where some drugs are metabolized)

92
Q

Medications given IM, IV, SQ are known as ____________.

A

Parenteral medications

93
Q

Which of the following work best with the quickest onset?

a) IM injections
b) IV injections
c) SQ injections
d) all are equal in onset time

A

b) IV injections - directly into blood stream; effect is almost immediate

94
Q

Pharmokinetics

A

refers to how a medication acts, how it is moved through the blood stream (absorption, distribution, biotransformation, and excretion)

95
Q

Pharmacodynamics

A

How a drug works and interacts with other drugs and various receptor sites within the body

96
Q

adverse effect vs side effect

A

Adverse effect: an undesirable/unintended pharmacologic effect resulting from a medication or intervention that has been administered correctly. Mild, moderate, or severe

Side effect: a secondary unwanted effect that occurs with taking a medication/drug therapy

97
Q

True or False. All medications have an adverse effect

A

True

98
Q

Re: pharmacokinetics, the goal of drug therapy is:

A

to obtain a desired clinical effect while minimizing the likelihood of an adverse effect

99
Q

Rule of First Order Kinetics

A

constant fraction (%) of medication is absorbed into the blood stream per unit of time

  • 50% and 50% waiting (think half life)
  • applies to every route of entry EXCEPT IV
100
Q

Zero order Kinetics

A

100% of the medication is absorbed in the brief period of administration

101
Q

What are the 4 methods that medications are absorbedinto the body’s various membranes (cellular level)?

A

1) passive diffusion
2) carrier-mediated facilitated diffusion
3) active transport
4) endocytosis

102
Q

Passive diffusion

A

chemicals moving from high to low concentration across a semi-permeable membrane without expenditure of energy

ex. structure of blood placenta barrier

103
Q

Carrier-mediated Facilitated Diffusion

A

PASSIVE TRANSPORT - movement of molecules/drug components across cell membrane via special transport proteins that are embeeded within cellular membrane

ex. structure of blood brain barrier

104
Q

Active transport

A

movement of drug molecules across a cell membrane from lower to higher concentration (against the concentration gradient) - energy required

105
Q

Endocytosis/Phagocytosis

A

cell forming a sac around a drug molecule with the cell’s membrane, which is then folded inwards bringing the drug into the cell (via drug receptors)

106
Q

What are the two major proteins in plasma that are responsible for binding of most drug compounds in the systemic circulation?

A

albumin

alpha-acid glycoprotein

107
Q

Metabolism/Absorption

A

breakdown and changing of a drug by various chemical reactions throughout the body

typically happens in liver, lungs, and kidneys

108
Q

Biotransformation

A

process of breaking down an active drug into an inactive compound (*inactive compound is still potent, just doesn’t get used)

109
Q

The #1 method of excretion is through ______ for removal of drugs and durg byproducts. To a lesser extent, the _____ may also aid in elimination.

A

kidneys; liver

110
Q

What substance transports byproducts to the gut to be excreted?

A

bile

111
Q

True of False. Excretion can be done through urine, feces, sweat, and lactating breast milk

A

True

112
Q

What potential problems may occur with inappropriate excretion of drugs/drug byproducts?

A

may lead to kidney damage (those with urinary retention)

accidental OD (those with constipation that cannot pass the drug byproducts)

113
Q

What are the 3 mechanisms describing how drugs work in the body (i.e. interactions)

A

1) drug receptor interactions
2) drug enzyme interactions
3) non-specific drug interactions

114
Q

Drug receptor interactions

Also give an example

A

When the drug is introduced to the cell, starts working. When removed, the effects of the durg on the cell also stops.

Reversible binding, no change in cellular structure

Eg. morphine IV for pain

115
Q

Drug Enzyme Interactions

give an example

A

Enzyme is the drug target. When drugs interact with enzymes and will either increase or decrease the enzyme mediated chemical reactions (making substrate/metabolite)

an irreversible change

ex. ASA overdose causing increased liver damage even after drug is removed/metabolized

116
Q

Therapeutic index

A

a quantitative measurement of the relative safety of a drug (a comparison of the amount of a therapeutic agent that cause the therapeutic effect to the amount that causes toxicity)

ex. when it says don’t take more that _____ in a 24 h period due to toxicity concerns beyond that

117
Q

Non specific drug interactions

give an example

A

occurs when drug acts on a target organ or tissue in a way that does not require binding to a receptor/enzyme

no change to cell structure

eg. neutralization of stomach acids by antacids

118
Q

Describe the following interactions between food and drugs:

a) food’s effect on drug side effects
b) taking meds at the same time as food
c) milk
d) grapefruit juice

A

a) food can enhance side effect profiles of many drugs
b) meds + food at the same time can cause your body not to absorb the meds
c) milk coats the stomach and can change a drug’s absorption
d) grapefruit juice adverses many cardiac drugs (cardiac glycoside) - may lead to toxicity

119
Q

True or False. The dose required to produce the desired result does not depend on route since it’s going to end up in your system regardless.

A

False. Dose required DOES depend on route

120
Q

Increasing the dose of a medication increases the physiological effect - up until a point where an increase in dose will not result in any further increase in disred physiological effect. This is called __________ and can be demonstrated on a graph known as ____________.

A

ceiling effect

drug response curve

121
Q

Modifying factors of drug dosage

A
  • age
  • body weight
  • time of administration
  • route of administration
  • excretion routes
  • hepatic or renal failure

*note that a toxic dose is also dependent on weight

122
Q

What is dosage form?

A

The physical form of a dose of drug (tablets, capsules, creams, ointments, aerosols, and patches)

123
Q

Affinity vs Efficacy

A

Affinity: ability for a drug to bind to its receptor

Efficacy: ability for the drug to evoke a response after binding to its receptor

124
Q

True or false. A drug can have no affinity/efficacy, have either or, or have both affinity and efficacy.

A

True

125
Q

A drug that has high affinity but no efficacy can be labeled as:

A

antagonist - purpose of binding to receptors to block them and not allow further activation of receptors

126
Q

A drug that has high affinity and high efficacy is known as:

A

agonist - can be used to activate receptors to evoke a response

127
Q

True or False. CNS and PNS are always constantly working together to balance each other

A

True

128
Q

Briefly describe how a drug would make its way down to the foot (target action site)

A

Drugs go through blood via CNS and travel through the main “central highway” (aka the spinal cord) ⇒ branches off to PNS and then goes where it needs to go to bind to the local receptors

129
Q

Which nervous system division is “arousing”? Describe physiological changes that occur when this system is primarily activated.

A

Sympathetic NS

  • Pupil dilation
  • increased HR
  • inhibits digestion
  • stimulates glucose release by liver
  • stimulates secretion of E, NE, cortisol
  • relaxes bladder
  • stimulates ejaculation in male (& preparation of sex)
130
Q

Which nervous system division is “calming”? Describe physiological changes that occur when this system is primarily activated.

A

Parasympathetic NS

  • contracts pupils
  • slows HR
  • stimulates digestion
  • stimulates gallbladder
  • contracts bladder (to tell you to pee)
  • allows blood flow to sex organs - you cannot ejaculate/orgasm unless parasympathetic NS kicks in
  • decreased glucose release
  • calms liver
  • ACh release
131
Q

Name the divisions of the nervous system and their subdivisions.

A
132
Q

CNS vs PNS

A

CNS: receives and processes information, initiates action

PNS: transmits signals between the CNS and the rest of the body

133
Q

PNS functional divisions: Motor neurons vs sensory neurons

A

Motor neurons: carry signals from CNS that control activities of muscles/glands

Sensory neurons: carry signals to the CNS from sensory organs

134
Q

Motor neuron division of PNS is further divided into:

A

Somatic Nervous System: controls voluntary movements by activating skeletal muscles

Autonomic Nervous System: controls involuntary responses by influencing organs, glands, and smooth muscle

135
Q

Sympathetic and parasympathetic division branch from what nervous system? Briefly describe sympathetic vs parasympathetic

A

ANS

Sympathetic Division: prepares body for fight or flight (stressful or energetic activity)

Parasympathethic Division: dominates during times of “rest and relaxation”; directs maintenance activities

136
Q

Sympathetic division has ___________ receptors while parasympathethic dividion has ____________ receptors.

A

adrenergic; cholinergic

137
Q

Adrenergic receptors branch off into:

A

alpha (a-1 and a-2) and beta (b1 and b2) receptors

138
Q

Cholinergic receptors branch off into

A

nicotinic and muscarinic receptors

139
Q

Somatic Nervous System (SoNS) innervates part of what system?

What are the two main functions of SoNS?

A
  • innervates part of sympathetic NS

Two main functions: skeletal movement and reflexes

  • carries information via nerve fibers to the brain and spinal cord
  • voluntary control of body movements via skeletal muscles
  • reflexes: lash, patellar, touching a hot stove and reflexively pulling away (occurs when you are not mentally preparing for it), falling
140
Q

True or False. SoNS has nociceptors.

A

True

141
Q

Nociceptors

A
  • pain receptors found all over body and act as injury prevention (especially in muscle fibers)
  • activated in response to potentially damaging stimuli (heat, cold, extreme forces)
  • prevents us from hyperextending joins, overstretching msucles and protects from other injuries
  • more found in feet (so more sensitive to pain stimuli)
142
Q

Toxic Dose

A

a dose that will cause death; a poisonous amount of a drug

143
Q

Half life

A

the time required for the concentration of a drug in the bloodstream to drop to half of its original level (this is when the medication has reached its peak and will now start to have reduced effect)

144
Q

Onset of Action

A

referred to as the latent period (the time it takes for a medication to start working)

*Important to know for patient tx for meds with slower onset of action

145
Q

Indication

A

use of a drug for treating a particular disease or condition of a patient

146
Q

Duration of Action

A

amount of time a single dose of medication produces the desired effect (measured from the time the desired effect is first observed until it is no longer perceptible)

147
Q

Peak Concentration

A
  • the highest concentration of a drug in the blood, CSF, or target organ after a dose is given
  • a pharmacokinetic measure used to determine drug dosing
148
Q

Contraindication

A

a specific situation in which a drug should not be used or administered as it may be harmful to the patient

149
Q

od

A

right eye (oculus dexter)

150
Q

os

A

left eye (oculus sinister)

151
Q

Four categories of adverse effects include:

A

Teratogenicity: the ability to cause defects in a developing fetus

Mutagenicity/Carcinogenicity: ability to mutate cell structure or cause cancer

Idiosyncrasy: happens for unknown reason

Drug dependance/addiction

152
Q

Describe knee jerk reflex/response

COME BACK TO THIS AND FINISH IT

A

initial stimulus ⇒ stretch receptor in quad sends afferent impulses to spinal cord ⇒

153
Q

Vital processes (HR, blood pressure, respiratory effect) are normally controlled by __________ and is (involuntary/voluntary)

A

Autonomic Nervous System; involuntary

154
Q

Two divisions of ANS

A

sympathetic nervous system (SNS)

parasympathetic nervous systerm (PNS)

155
Q

Determine which of the following is innervated by the sympathetic nervous system or parasympathetic nervous system, or both.

a) heart
b) vascular smooth muscle
c) sweat glands
d) bronchial smooth muscle
e) iris
f) salivary glands
g) urinary bladder

A

a) both
b) SNS
c) SNS
d) both
e) both
f) both
g) both

156
Q

Describe the follow characteristics of somatic motor systems.

a) myelination of axon
b) number of neurons from CNS to effector organ
c) effector organ(s)
d) neurotransmittor at effector
e) effect: (stimulatory/inhibitory/both)

A

a) highly myelinated
b) single neuron from CNS to effectors
c) skeletal muscle
d) ACh
e) stimulatory (+)

157
Q

Describe the follow characteristics of autonomic parasympathetic motor systems.

a) myelination of axon
b) number of neurons from CNS to effector organ
c) effector organ(s)
d) neurotransmittor at effector
e) effect: (stimulatory/inhibitory/both)

A

a) lightly myelinated preganglionic axons ⇒ unmyelinated postganglionic axon
b) singl eneuron chain from CNS to effector organs
c) smooth muscle, glands, cardiac muscle
d) ACh at pre-ganglionic axon and then ACh at post-ganglionic axon
e) stimulatory or inhibitory, depending on NT and receptors on effector organs

158
Q

Describe the follow characteristics of autonomic sympathetic motor systems.

a) myelination of axon
b) number of neurons from CNS to effector organ
c) effector organ(s)
d) neurotransmittor at effector
e) effect: (stimulatory/inhibitory/both)

A

a) lightly myelinated preganglionic axons ⇒ unmyelinated postganglionic axon
b) two-neuron chain from CNS to effector organs
c) smooth muscle, glands, cardiac muscle
d) ACh at pre-ganglionic axon and then NE at post-ganglionic axon (this also occurs when pre-ganglionic axon directly stimulates the adrenal gland to release E and NE into blood vessel)
e) stimulatory or inhibitory, depending on NT and receptors on effector organs

159
Q

Adrenergic agonists

A

medications that influence SNS using adrenergic receptors

160
Q

Adrenergic antagonists

A

medications that block or inhibit the SNS adrenergic receptors

ex. epinephrine for anaphylaxis

161
Q

_________ mimic SNS neurotransmitters as they are hormones that function as neurotransmitters. What 3 hormones within the SNS fall under this category?

A

Catecholamines

Examples: Epinephrine, Norepinephrine, dopamine

162
Q

Adrenergic drugs

A

medications that simulate certain nerves and receptors in the body by:

a) mimicking the action of the chemical messengers E or NE

OR

b) by stimulating their release

*these drugs are used in many life-threatening conditions (cardiac arrest, shock, asthma attack, or allergic reaction)

163
Q

Adrenergic agonists are also known as

A

sympathomimetics

164
Q

Adrenergic antagonists are also known as

A

sympatholytics

165
Q

Medications may manipulate these receptors in the sympathetic nervous system to manage heart rate, blood pressure, and respiratory effeort. What are these receptors?

A

alpha and beta adrenergic receptors

166
Q

Chronotropic

A

changes in heart rate

167
Q

A patient with SVT (high HR) would benefit from a (positive/negative) chronotropic medication

A

negative (decreases HR)

168
Q

A medication that has a positive chronotropic effect would result in what?

A

increased HR

169
Q

Inotropic

A

Changes in contractility (i.e blood volume/BP)

170
Q

+ve inotropic vs -ve inotropic

A

+ve ionotropic: increases BP

-ve ionotropic: decreases BP

171
Q

Dromotropic

A

changes in conduction (i.e. rhythm)

can be +ve or -ve ⇒ to help return to normal rhythm

172
Q

The body’s natural production of sympathomimetic hormones include:

A

dopamine

norepinephrine

epinephrine

173
Q

What effects do adrenergic drugs have?

A
  • increase BP
  • constrict blood vessels
  • open airways leading to the lungs
  • increase HR
  • stop bleeding
174
Q

Stimulation of alpha-adrenergic receptors on smooth muscles reuslts in what changes?

A
  • vasoconstriction of blood vessels
  • relaxation of GI smooth muscles (decreased motility)
  • constriction of bladder sphincter
  • contraction of uterus
  • male ejaculation
  • contraction of pupillary muscles of the eye (dilated pupils)
175
Q

Stimulation of beta-1 adrenergic receptors on the myocardiu, AV node, and SA node result in what?

A

cardiac stimulation

  • increased force of contraction (positive inotropic effect)
  • increased heart rate (positive chronotropic effect)
  • increased conduction through AV node (positive dromotropic effect)
176
Q

Alpha 1 adrenergic receptors is located where?

What is its effect?

A

peripheral blood vessels

Stimulation results in vasoconstriction (/smooth muscle contraction) and elevation of systemic BP

177
Q

How are alpha adrenergic receptors stimulated?

A

by norepinephrine mostly (and then epinephrine too)

178
Q

How are beta adrenergic receptors activated?

A

predominantly epinephrine (and lesser extent, norepinephinre)

179
Q

Stimulation of beta adrenergic receptors result in

A

smooth muscle relaxation

180
Q

Alpha 2 adrenergic receptors are located where and what is their function?

A
  • Location: nerve endings (presynaptic terminal)
  • Function: provide negative feedback to nerves in SNS
  • signals process when goal/target is reached
  • leaads to vasodilation, decrease BP
181
Q

Beta 1 receptors are located where and have what function?

A
  • Location: found in the heart
  • Function: when stimulated, increases HR and contractility, increases cardiac output
182
Q

Beta 2 adrenergic receptors are located where and have what function?

A
  • Location: bronchial smooth muscle (and uterus)
  • Function: when stimulated, relaxes bronchial smooth muscles (opens airways); increases diameter of bronchial tree
183
Q

Beta 1 blocker example

A

metoprolol

decreases both BP and HR therefore is a -ve chronotropic and ionotropic medication

184
Q

Beta 2 blocker example

A

salbutamol

185
Q

There are 3 mechanisms of drugs acting on receptors. They are:

A

1) Direct Acting Sympathomimetic
2) Indirect Acting Sympathomimetic
3) Mixed Acting Sympathomimetic

186
Q

Direct Acting Sympathomimetic

A

Binds directly to receptor and causes a physiologic response

187
Q

Indirect Acting Sympathomimetic

A
  • causes a release of catecholamines (so other sympathomimetics) from other storage sites (vesicles) in nerve endings which then bind to receptors to cause a physiological response
188
Q

Mixed Acting Sympathomimetic

A
  • Directly stimulates the receptor by binding to it and,
  • indirectly stimulates receptor by causing the release of stored NTs from vesicles in the nerve ending into the receptor site so that alpha and beta responses can be targeted together
189
Q

The nervous system that performs the housekeeping chores of the body (eat, sleep, rest) and brings the body back to normal routine after events is known as:

A

parasmypathetic nervous system

190
Q

Cholinergic agonists

A

medications that act on/influence PNS (mimic/enhance effect of ACh)

191
Q

Cholinergic antagonists

A

medications that inhibit parasympathetic NS receptors

192
Q

What are the two cholinergic receptors that are found within the SNS/PNS?

A

muscarinic and nicotinic

*note that muscarinic and nicotinic receptors are found within the sympathetic and parasympathetic nervous systems as they work both but are PRIMARILY parasympathetic driven which means they are mostly stimulated by acetylcholine

193
Q

Atropine blocks muscarine receptors, inhibiting them. Thus, atropine is a:

A

a muscarinic receptor antagonist

194
Q

Low dose ACh stimulates what receptors and causes what effects?

A
  • stimulates muscarine receptors
  • causes “WET” symptoms
  • bradycardia
  • bronchoconstriction
  • increase in GI motility (wet stool, diarrhea)
  • bladder constriction
  • fall in BP
  • salivation (which helps with vomiting)
  • lacrimation (tearing - different than emotion induced)
195
Q

High dose ACh stimulates what receptors and causes what effects?

A
  • stimulates nicotinic receptors - high doses of ACh can trigger SNS
  • causes “DRY” symptoms
  • CNS stimulation
  • ganglionic stimulation
  • release of adrenaline
  • rise in BP
196
Q

Drugs that block or inhibit the actions of ACh in parasympathetic nervous system are known as:

A

anticholinergics

parasympatholytics

antimuscarinic drugs

197
Q

Parasympathomimetic drugs

A

Drugs that mimic the action of ACh

198
Q

Examples of anti-cholinergic drugs (4)

A

1) anti-psychotics
2) diphenhydramine (Benadryl) /gastrointestinal (dimenhydrinate)
3) parkinson’s medications
4) muscle relaxants

199
Q

Anti-cholinergic drug effects

A
  • Cardiovascular:
    • small doses would decrease HR; large doses increase HR
  • CNS: small doses would decrease muscle rigidity and tremors
    • large doses: drowsiness, disorientation, hallucinations
  • Eyes: dilated pupils (mydriasis)
    • Decreased accommodation caused by paralysis of ciliary muscles (cycloplegia)
  • GI: Relax smooth muscle tone of GI tract
    • Decrease intestinal and gastric secretions
    • decrease motility and peristalsis
  • Respiratory: decrease bronchial secretions (dries up wet cough)
200
Q

Where are nicotinic receptors found?

A

CNS, autonomic ganglia, striated muscle

201
Q

Where are muscarinic receptors found?

A

cardiac smooth muscle, exocrine glands, brain

202
Q

Anticholinergic toxidrome mneumonic

A
  1. Dry as a bone (dry mucous membranes)
  2. Hot as a hare (febrile (fever) - anhydrosis)
  3. Mad as a hatter (hallucinations/altered mental status)
  4. Blind as a bat (significant pupil constriction/dilation - mydriasis)
  5. Red as a beet (flushed skin)

Can’t see, can’t pee, can’t spit, can’t shit

203
Q

Cholinergic toxidrome

A

Cholinergic toxicity occurs when too much acetylcholine is present in the receptor synapse leading to excessive parasympathetic effects.

204
Q

Cholinergic Toxidrome symptoms (mneumonic)

A

SLUDGE DUMBELS

S - salivation/spit

L - lacrimation/ ++ tears in eyes and nasal drips

U - urination

D - defecation/diarrhea

G - GI upset

E - emesis/vomit

M - from DUMBELS (myosis - pin point pupils)

B - from DUMBELS (bradycardia - also brings BP down)

205
Q

Cholinergic drug

A

Any drug that inhibits, enhances, or mimics the action of NT ACh

206
Q

Oral or rectal application of medication (i.e. application of enteral medications) is the preferred route for what kinds of situatinos?

A

stable/chronic conditions or acute non-life threatening conditions

207
Q

Advantages of Enteral Medications

A
  • Safest and most common
  • no need for sterile environment, supplies or training
  • slow absorption
208
Q

Disadvantages of Enteral Medication

A
  • variable rates of absorption
  • irritation of mucous linings of stomach and intestine
  • patient status/compliance
  • most have to pass through liver first (First Pass Metabolism)
209
Q

Advntages of parenteral administration route (IM, IV, SQ)

A

rapidly available for immediate circulation to cause desired result

210
Q

disadvantages of parenteral administration (IM, IV, SQ)

A
  • specialized training and equipment required for administration
  • delay in administering (takes time to set up)
  • greater chance of detrimental outcome if administration is done incorrectly
211
Q

Inhalation route of entry: Advantages and Disadvantages

A

Advantages:

  • activates rapidly
  • easy to administer
  • convenient and easily accessible
  • targets receptors in the lungs

Disadvantages:

  • environmental limitation
  • contamination
212
Q

In the absence of an IV loading dose, how many half lives must past in order to achieve a steady state of medication in the bloodstream?

A

5

213
Q

Where are dopamine receptors and what is their effect when stimulated?

A

Location: various tissues and organs

Function: causes dilation of renal mesenteric, coronary and cerebral arteries

214
Q

Taking adrenergic medication would cause what symptoms?

A
  • increased HR, BP
  • decreased gastric motility
  • increased alertness
  • restlessness, irritability, anxiety, pallor
215
Q

Adverse reactions to adrenergic blockers include:

A
  • drowsiness, fatigue
  • bradycardia
  • hypotension
  • orthostatic hypotension
  • diarrhea
216
Q

What are clinical uses for cholinergic drugs (to increase ACh in synapse)? There are 4.

A
  1. Glaucoma - reduce intraocular pressure
  2. myasthenia gravis - disease caused by lack of ACh at the synapse
  3. relief of urinary retention
  4. increase GI motility

OCHT Term II (31 decks)

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