Pharmacology V Flashcards by Tim Agee

Antianxiety Medications are also known by what 2 other names?

Sedative hyponotics

Minor tranquilizers

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What class of drugs, among the most widely used in medicine, is diazepam (Valium) a part of?

Benzodoazepines

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Valium

diazepam

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T/F

All benzodiazepines have the same basic structure of 2 nitrogens (diazo) and a benzene ring that binds GABA receptors

True

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Name 4 Benzodiazepines used in Dentistry for pre-op anxiety:

diazepam (Valium)

lorazepam (Ativan)

alprazolam (Xanax)

midazolam (Versed)

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Benzodiazepines are Schedule _____ opiates in the US, are highly addictive and also exhibit _______.

IV/V

Tolerance

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Name 3 distinct effects of Benzodiazepines:

Effects on behavior

Anticonvulsant effects

Muscle relaxation

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Benzodiazepines have ________ effects at low doses and ________ at high doses.

Anxiety reduction

Drowsiness/depression

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Anesthetic-induced seizures in dentistry can be prevented by and arrested by what 2 Anticonvulsants?

diazepam (Valium)

midazolam (Versed)

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What are the 2 most potent Benzodiazepines?

diazepam (Valium)

chlordiazepoxide (Librium)

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Aside from depressing motor nerve and muscle function in healthy pts and ones with skeletal muscle disorders, Benzodiazepines are predatory drugs that cause _______.

Anterograde Amnesia

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Describe the mechanism of the Benzodiazepines.

3 things

Enhances inhibitory effect of GABA on neuronal excitability

Causes hyperpolarization (less excitable state)

Neuronal stabilization

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What does GABA do to the brain?

Inhibitory

Decreases Excitation

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At the level of the synapse, the GABA receptor binds both ______ and ______.

GABA

Benzodiazepines

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What can enhance the binding effect of Benzodiazepines at the synapse?

Presence of GABA

*binding is rapid, reversible, stereospecific, and saturable

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Most Benzodiazepines have very long _______ and are metabolized in the ______ compounds

half lives

active

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Due to the fact the drug is metabolized rapidly to inactive compounds, what Benzodiazepine is a very good choice for Dentistry?

lorazepam (Ativan)

*No significant accumulation of drug do to rapid metabolization

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What Benzodiazepine has the shortest half life of the Oral meds and has increased psychomotor impairment and risk of oversedation in the elderly?

triazolam (Halcion)

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Name 5 uses of Benzodiazepines in Medicine:

Anxiety relief

Muscle relaxant

Insomnia

Alcohol withdrawal

Pre-op med

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What are 3 used of Benzodiazepines in Dentistry:

Pre-op med (for anxiety)

IV sedation (and amnesia)

Emergency intervention for seizures

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Name 4 adverse side affects of Benzodiazepines:

CNS depression

Xerostomia

Abuse/addiction

Additive with other CNS depressants (alcohol)

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T/F
Parenteral administration of Benzodiazepines causes acute hypotension, muscle weakness, apnea, and can cause cardiac arrest

True

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When using Benzodiazepines in conjunction with Opiates, how much should the normal dose of the Opiate be reduced?

1/3

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What DDI is most dangerous with Benzodiazepines, resulting in significant Respiratory Depression?

Alcohol

*must be avoided

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Why must alcohol be avoided for days after taking a dose of Benzodiazepine?

long half lives

What is the 1/2 life of Valium? active metabolite of desmethyldiazepam?

20-50 hrs 50-100 hrs *why EtOH must be avoided

What is the antidote for Benzodiazepine Overdose? *this antidote will not block CNS effects from other drugs

Flumazenil

Flumazenil (antidote for Benzodiazepine overdose) may not reverse ________. It may cause _______ as a side effect.

Respiratory depression seizures

Name a "miscellaneous Anti-anxiety Agent" used to manage generalized anxiety disorder (no known mechanism)

buspirone (BuSpar)

buspirone (BuSpar) causes many DDI's in dentistry (antibiotics, antifungals) that will increase its concentration and is considered a ________ in dentistry

Red Flag Drug

Antidepressants and Anti-anxiety meds cause ________, which is particular interest in dentistry

Xerostomia

Throwback: SSRI's cause what to the teeth?

Bruxism

Major Tranquilizers are known as ________ medications and the older term is ________ drugs.

Antipsychotic Neuroleptic

Name 2 indications for the use of a Major Tranquilizer:

Psychotic disorders (pchizophrenia, paranoia) Demetia

What is a side effect to Major Tranquilizers?

Severe nausea and vomiting

Major Tranquilizers act as _______ to a swath of neurotransmission (dopaminergic, alpha 1 and 2 adrenergic, srotonergic, muscarinic, H1 histamine, sigma opioid)

Antagonists

T/F | The primary mechanistic action of Major Tranquilizers is the blockage of dopaminergic transmission

True *one hypothesis is that Schizophrenia is caused by an overactivity of the dopaminergic system

The blockage of Dopamine by Major Tranquilizers has what 3 important effects?

Antipsychotic Extrapyramidal side effects Antiemetic (anti-vomit)

Antipsychotic medications reduce Dopaminergic activity by blocking _____ receptors

T/F | All Major Tranquilizers are strong D2 dopamine receptor agonists with one exception - clozapine (Clozaril)

False Antagonists

If the receptors are blocked within 2-4 hours after Major Tranquilizers are administered, what is then the problem with the Dopaminergic Hypothesis? Aside from this, schizophrenia is also associated with alterations in neural structure in the limbic system and the ______.

Therapeutic activity takes weeks for full effect Prefrontal cortex

The new thought is that Major Tranquilizers, instead of acting to alleviate schizophrenia by turning down dopamine, helps to recover normal cell ________.

Morphology

T/F | All Major Tranquilizers have similar pharmokinetics and Efficacy

True 1/2 life = 18-40 hrs, once daily dosing

Name 5 Extrapyramidal side effect of Antipsychotic Drugs:

Parkinsonism (akinesia - difficult initiating movement) Akathisia (restless leg) Dystonia (sustained muscle contraction) Tardive Dyskinesia (abnormal face/tongue movements) Sedation

_________ drugs can treat most Extrapyramidal side effects of Antipsychotic Drugs

Anticholinergic

The Sedation side effect of Antipsychotic Drugs manifests itself how (as a result of histamine, cholinergic, and adrenergic blockage)

Autonomic Side Effects

Antipsychotics potentiate (exacerbate) the ________ caused by opioids. ***potentiate CNS effects of all analgesics

Respiratory Depression

Name 3 Dental considerations with Antipsychotics?

Hematologic (WBC count may be low) Heart (arrhythmias - caution with epi) Extrapyramidal (movement)

An episode of neurologic dysfunction, often accompanied by motor activity such as convulsions, and emotional/sensory change *may contain visual, auditory, and olfactory hallucinations

Seizure

The majority of patients suffering from seizures have _______ epilepsy.

Idiopathic *no known cause

Drugs improve epilepsy in __-__% of cases

70-80%

What are 2 broad groups of epilepsy?

Partial Generalized

What are the 2 subtypes of Partial Epilepsy Briefly describe them:

Simple Partial - Single group hyperactive neurons. Few seconds, no loss of consciousness, often single limb/muscle group abnormal Complex Partial - Hallucinations, Mental distortion, AURA (lasting 3-5 minutes). Full consciousness slow to return

In a Complex Partial Seizure, the Aura lasts for _____ minutes. They are also known as ________ seizures _____% of people with complex partial epilepsy experience their initial seizure prior to 20

3-5 temporal lobe 80

What are the 2 types of Generalized Epilepsies?

Tonic-clonic (grand mal) Absence (petit mal)

In both Tonic-clonic (grand mal) and Absence (petit mal) Generalized Epilepsies, _______ is lost.

Consciousness

______ is producing/restoring normal tone of continuous tension, _______ is contraction/relaxation of muscles.

Tonic Clonic

In a Tonic-Clonic (grand mal) seizure, Major Motor Activity is involved and during the seizure ________, and consciousness returns with exhaustion, headache, drowsiness, and _______.

Comatose Confusion

A brief period of heightened sensory activity prior to the onset of a seizure characterized by numbness, nausea, or sensitivity to light, odor, or sound.

Aura

Absence (petit mal) seizures are usually found in what demographic? Describe a petit mal seizure:

Childred 3-5 yrs No aura, rapid eye blinking 3-5 seconds, quickly return to normal

What life-threatening condition is characterized by seizures that are continuous or rapidly recurrent? If this occurs in a dental office, what should be given?

Status Epilepticus diazepam (Valium) injection *lorazepam (Ativan) and midazolam (Versed) also can be used

T/F | Drugs have variable efficacy in the treatment of seizures

True

Drugs for Epilepsy are generally ___________, and prevent the spread of abnormal electric discharges in the brain without causing excessive drowsiness

CNS depressants

Most anticonvulsants have a Narrow/Large therapeutic index. They tend to stimulate ________ enzymes, thus these drugs are known as _______.

Narrow Liver microsomal Inducers ***the addition of an anticonvulsant will change the metabolism of all anticonvulsants

T/F Metabolism of anticonvulsants can saturate liver microsomal enzymes * low dose - 1st order * saturation - zero order * thus at saturation, even a small change in dose can leade to large increase in blood level of dose

True

Name 2 major side effects of Anticonvulsants: Name 2 ways these side effects affect Dental Decisions:

CNS depression, GI effects Opioids and Benzodiazepines Additive (CNS), NSAIDS may exacerbate GI irritation

What drug that blocks Sodium channels is highly effective for simple and complex partial seizures?

carbamazepine (Tegretol)

carbamazepine (Tegretol) blocks _____ channels and is highly effective for ______ and _______ seizures.

sodium simple complex partial

Other than treating seizures, carbamazepine (Tegretol) has what 3 clinical uses? (One of very special interest in Dentistry)

Bipolar depression Chronic pain Trigeminal neuralgia (tic douloureux)

What are 4 side effect of carbamazepine (Tegretol)?

Hematologic Liver Toxicity Congestive heart (altered BP) Xerostomia

carbamazepine (Tegretol) is a classic Inducer, which means...

Decreases effectiveness of a variety of drugs | warfarin, doxycycline, oral contraceptives, asthma bronchodilators

T/F carbamazepine (Tegretol) DDI's include macrolides, which increase the former's blood levels and the hepatotoxicity of acetaminophen

True

What drug reduces the frequency of seizures by decreasing neuronal membrane passage of sodium ions thereby having a stabilizing effect?

phenytoin (Dilantin) ***remember, carbamazepine (Tegretol) blocks Na channels completely

What are 3 anticonvulsant applications of phenytoin (Dilantin)? ***What is 1 Dental Application?

Partial seizures Tonic-Clonic seizures Status Epilepticus ***Trigeminal neuralgia

Other than Gingival Hyperplasia, what are 2 dental side effects of phenytoin (Dilantin)? (1 has to do with Vitamin D/folate deficiencies, which leads to osteoporosis)

Loss of taste oral mucosal ulceration or glossitis from Folate deficiency

What % of pts taking phenytoin (Dilantin) experience Gingival Overgrowth? What reduces the severity?

50-60% Good Oral Hygiene

phenytoin (Dilantin) is Teratogenic category D, and causes what? How does this manifest?

Fetal Syndrome cleft lip, palate, congenital heart disease

phenytoin (Dilantin) has many DDI's, ______ the metabolism of many drugs, and is a ________ of cytochrome P450

Increases Inducer

What type of agents Inhibit the release of Acetylcholine from the presynaptic neuron? What do they release?

GABAmimetic Agents GABA from presynaptic interneurons

How do GABAmimetic agents prevent seizures?

Prevent acetylcholine release *many seizures caused by tremendous release of acetylcholine

GABA is Inhibitory/Excitatory?

Inhibitory

Anticonvulsant that reduces the Na and K transport along axonal membranes and Potentiates the Inhibitory effects of GABA-mediated neurons?

phenobarbital (Luminal)

What is the most common barbiturate used as an anticonvulsant?

phenobarbital (Luminal sodium)

What types of seizures dos phenobarbital (Luminal sodium) prevent?

Tonic-clonic Partial seizures

The most common side effect of phenobarbital (Luminal sodium) is sedation, but what rarely happens? In this rare instance, what should be done?

Skin rxns - stomatitis Discontinue ***some cutaneous rxns from this drug have been fatal

phenobarbital (Luminal sodium) has many DDI's, meaning it's a strong ______. It also enhances hepatotoxicity of acetaminophen, and additive CNS effects

Inducer

What drug, related to phenobarbital, is metabolized to phenobarbital in the Liver? What is it used to treat?

primidone (Mysoline) *it is phenobarbital's precursor Partial seizures, Tonic-clonic seizures

Describe the mechanism of action of Valproates (valproic acid, Depakene, etc.)

Increases GABA

``` T/F valproic acid (Depakene) is used for Tonic-clonic seizures and Generalized seizures (absence, myoclonic) ```

True

What are 2 adverse rxns of Valproates?

Hepatotoxicity Platelet aggregation inhibition - bleeding

What 2 DDI's do Valproates have?

macrolide antibiotics (mycins) Aspirin (other salicylates)

What is the 1st choice in absence seiures (petit mal)? *remember - the children

ethosuximide (Zarontin)

phenytoin (Dilantin) works on absence seizures

False *does not work - prescribe ethosixumide (Zarontin)

ethosuximide (Zarontin) is prescribed for Absence Seizures in children and has what side effects (2) of interest to Dentistry?

Gingival hyperplasia Tongue swelling

Of the Benzodiazepines, ________ has an unknown mechanism and is used for all seizure types. _______ is used for seizures caused by Local Anesthetic and is the drug of choice for status epilepticus

clonazepam (Clonipin) diazepam (Valium)

gabapentin (Neurontin) has an unknown mechanism and is used for _____ and ______ seizures and also ______, related to shingles.

Partial Tonic-clonic Chronic Pain

What anticonvulsant's major advantage is that the drug is NOT metabolized? *therefore lacks DDI's, doesn't affect liver enzymes

gabapentin (Neurontin)

What anticonvulsant used for partial and grand mal seizures inhibits the release of glutamate? *remember, glutamate is excitatory

lamotrigine (Lamictal)

lamotrigine (Lamictal) ____ inhibits _____ receptors and is used to treat ______ disorder. *secondarily - primarily this drug inhibits glutamate

weakly serotonin bipolar

6 drugs that treat Tonic-clonic (grand mal) seizures:

valproic acid phenytoin phenobarbital primodone gabapentin lamotrigine

2 drugs that treat Absence seizures:

ethosuximide valproic acid

6 drugs that treat Partial seizures:

carbamazepine phenytoin phenobarbital primidone gabapentin lamotrigine

What is used instead of phenytoin to avoid gingival hyperplasia?

carbamazepine

T/F | Always ask pts when they had their seizure meds last and about known triggers

True

T/F | phenytoin (Dilantin) and phenobarbital are classic...

P450 inducers

Liver toxicity is a concern with what 2 drugs?

carbamazepine (Tegretol) valproic acid (Depakene) *all valproates

Local anesthetic OD will trigger a ______

seizure

What Convulsant is used as a provocative to diagnose epilepsy?

pentylenetetrazole (Metrazole)

What chemical causes generalized convulsion and causes OD's when added to heroin?

Strychnine | rat poison

T/F | picrotoxin blocks GABA and causes convulsions

True

Stimulants are used as a restorative "analeptic," can be used to alleviate depression, but are Primarily used to reverse _____, ______, and ______.

Respiratory Cardiac CNS

What stimulants are primarily used for asthma? What stimulants are Centrally Acting Sympathomimetics? What are used for diagnostics?

Xanthenes Amphetamine Convulsants

caffeine is a ______.

Xanthene

Name 2 Xanthenes used for asthma, chronic bronchitis, COPD:

aminophylline theophylline

How many mg of caffeine or theophylline is needed to increase cortical activity? OTC stimulants have how many mg?

50-200 100-200

The cerebral cortex is stimulated at ______ mg of Xanthenes Brainstem: Spinal cord (this can lead to convulsions, shakiness):

50-200 mg greater than 250 mg 1000 mg

Coronary and peripheral blood vessel dilation and Constriction of cerebral blood vessels are hallmarks of what class of drug?

Xanthenes

_____ is more potent than caffeine

theophylline

Xanthenes have a Beta 1 effect, which does what?

stimulates heart (increases output)

Caffeine will cause arrhythmias in a normal heart

False *cause them if at risk

How does caffeine cause hypotension?

peripheral smooth muscle relaxation | w/ normal heart rate

Aside from relaxing smooth muscle, the Beta 2 effect of caffeine and theophylline dos what?

Dilates bronchioles *increases lung capacity - used as asthma med

T/F Xanthenes can cause muscle contraction and pain, stiffness, and psychic tension in the neck, and Diuresis, which increases GFR and inhibits ADH

True

Where is the potency of caffeine equal to theophylline? Where is caffeine stronger? Everywhere else?

CNS Sk muscle theophylline

How many mg of caffeine is required to produce toxicity?

300 mg

T/F 600 mg caffeine a day produces physical dependence, Withdrawal begins within 24 hours, and Tolerance develops to caffeine

True

Xanthenes can be used to treat ______ poisoning by blocking adenosine receptors, which increases respiration.

Opioid

What do Xanthenes treat in infants (2 things)?

Acute pulmonary edema Apnea

CNS Sympathomimetics ______ fatigue. Best example of a drug class:

Decrease Amphetamines

T/F | CNS Sympathomimetics like Amphetamines reduce REM, appetite, and may produce depression and paranoia

True

Amphetamines (CNS Sympathomimetics are indicated for what 2 conditions?

Narcolepsy Hyperkinetic syndromes

What drug blocks Na/K ATP-ase reuptake and causes Dopamine and Norepinephrine to remain in the synapse?

Cocaine

Name an Adrenergic agonist drug for ADHD:

methylphenidate (Ritalin)

Name a Stimulant for ADHD that blocks the reuptake of dopamine and NE:

dextroamphetamine (Dexadrine)

What drug for ADHD is a Selective norepinephrine reuptake inhibitor?

atomoxetine (Straterra)

Available Amphetamines include amphetamine (Benzadrine), dextroamphetamine (Dexadrine) - the latter for narcolepsy, and what drug (used for cough/cold decongestant)?

ephedrine

Name 2 Amphetamines pulled from the market:

phenylpropanolamine (PPA) ephedra *both "diet" pills

Why must we use caution when administering local anesthetics + vasoconstrictors to pts using Amphetamines?

Cardiac effects

What stimulant is sold as a parenteral drug to reverse general anesthesia or drug-induced respiratory depression?

doxapram (Dopram)

Even at low doses, nicotine stimulates nicotinic receptors in the ____ and ______. Higher concentrations can cause ______

brain stem, cortex convulsions

In both Sympathetic and Parasympathetic neurons, Preganglionic fibers terminated at ______ receptors and both use _____ as a neurotransmitter

Nicotinic Ach

Sympathetic Postganglionic fibers terminate using _______ (neurotransmitter) that stimulates either ______ or ______, ______ receptors.

NE Alpha, Beta, Adrenergic

Parasympathetic Postganglionic fibers terminate at ______ receptors using ______ as neurotransmitter.

Muscarinic Ach

T/F Somatic fibers have no ganglia and terminate at a Nicotinic Receptor on striated muscle ***there are different subtypes of Nicotinic receptors (N1 is for NMJ)

True

What are the 4 groups of drugs that alter the ANS?

PANS stimulatory PANS inhibitory SANS stimulatory SANS inhibitory

A drug that acts where Ach is released is... A drug that acts where NE is released is...

cholinergic adrenergic

A drug that acts where PANS action occurs... A drug that acts where SANS action occurs...

parasympatho sympatho

If a drug has the same effect as a neurotransmitter at an ANS site (sympathetic or parasympathetic), its suffix is... aka...

mimetic agonist

If a drug blocks the action of a neurotransmitter in the ANS its suffix is either _____ or ______ aka...

lytic, blocker antagonists *don't produce effect - plugs site

Cholinergics and parasympathomimetics are ________. Anticholinergics, parasympatholytics, and cholinergic blockers are ________.

Stimulatory Inhibitory

Adrenergics and Sympathomimetics are _______. Adrenergic blockers, sympathetic blockers, and sympatholytics are ________

Stimulatory Inhibitory

What are the 2 types of Cholinergic Agonists and which is more predictable?

Direct acting (agonists) - more predictable Indirect acting - cause release or accumulation of Ach

What type of Indirect acting Cholinergic Agonist cause an accumulation of Ach thereby stimulating PANS?

Cholinesterase inhibitors

T/F | Direct acting Cholinergic Drugs (agonists) have Longer action, are More Selective, and Stimulate the PANS

True

Subtypes of Ach receptors are located in different synapses, so Ach must fit ______ and ______ at the receptor.

Physically Chemically

3 areas affected by Cholinergic Drugs;

CV Eye GI

CV effects of Cholinergic drugs: Eye: GI:

bradycardia miosis (decrease pressure) Increase activity (motility and secretion - excites smooth muscle)

What are 2 Primary indications for the use of Direct Acting Cholinergic Drugs:

Glaucoma Myasthenia gravis (autoimmune) (also, GI disorders and reversed urinary retention after surgery)

What are 2 examples of Direct Acting Cholinergic Agonists: *both are used for Sjogren's, which is used for Glaucoma?

cevimeline (Evoxac) pilocarpine (Salagen) *glaucoma

pilocarpine is primarily used for ________, and acts by decreasing ________. pilocarpine is used for what in Dentistry?

Glaucoma Intraocular pressure (allows drainage) Xerostomic intervention (stimulates saliva)

Indirect Acting Cholinergic Drugs, aka ________, stop the breakdown of _______, thereby producing _______

cholinesterase inhibitors Ach PANS stimulation

Primary Indications for Indirect-Acting Cholinergic Agonists (Cholinesterase inhibitors) includes Glaucoma, post-op urinary retention, Paralytic ileus, and _______

Antidotes ***poisons produce neuromuscular blockade

Indirect-Acting Cholinergics are divided based on what?

Degree of reversibility (of attachment to enzyme) * Reversible * Irreversible

Reversible Indirect-Acting Cholinergics are used to treat ________ and _______. *remember, these increase Ach by binding Cholinesterase

myasthenia gravis Glaucoma

Name 3 Reversible Indirect-Acting Cholinergics and what they're used for:

edrophonium (Enlon) - reverses rapidly physostigmine - reverses anticholinergic OD (atropine, Benadryl) pyridostigmine (Mestinon) - myasthenia gravis, nerve gas

What would Reversible Ach-esterase inhibitors that act Centrally do? What are these used for? Drug?

raise Ach in brain Dementia/Alzheimer's donepezil (Aricept)

Irreversible Ach-esterase Inhibitors include _______ and _______

Insecticides (organophosphates) Nerve gas (chem. warfare)

What 2 antidotes can be used in case of OD with insecticides/organophosphates?

pralidoxime atropine (antimuscarinic)

What are the side effects of Cholinergic drugs?

SLUD Salivation Lacrimation Urination Defecation *compliance often low

Aside from SLUD, what are some side effects to Direct and Indirect Acting Cholinergic Drugs?

Bradycardia Bronchoconstriction Miosis Paralysis at high doses

What are 3 names for Cholinergic Antagonists?

Anticholinergics Antimuscarinics Parasympatholytics

Anticholinergic Drugs (parasympatholytics) _______ the receptor site for ______.

Block Ach *Ach is released but cannot act

Anticholinergic Drugs have central effects determined by ________.

Dose

Scopolamine, a CNS acting Anticholinergic, is used for what 2 purposes?

Sedation Motion Sickness

Atropine, a CNS acting Anticholinergic, causes what?

Stimulation, delirium, hallucinations, convulsions, coma

What are Anticholinergics effects on Exocrine Glands? How is this used in Dentistry? What drug?

Decreases Secretion Decrease Salivation Atropine

What are Anticholinergics effects on the lungs? GI tract?

Bronchodilators Decrease gut motility *Affects smooth muscle

What are 2 Anticholinergic effects on the Eye? *How is this used in medicine?

mydriasis (dilated pupils) cycloplegia (near vision blurred - distance vision awesome) *opthamologic exam

What do Anticholinergics do to PANS?

Reduce activity

What can Anticholinergics do in Large Therapeutic doses?

Tachycardia *vagal blockade

How do Anticholinergics affect Parkinson's disease? How do they affect Urinary disorders?

Reduce tremors/muscle rigidity Can treat overactive bladder

The Anticholinergic ________ is used for Motion sickness The Anticholinergic ________ is used in Dentistry to maintain a dry field

Scopolamine Atropine

________ = anticholinergic = ________ salivation ________ = cholinergic = _________ salivation

atropine, stops salivation pilocarpine, increases salivation

What is the drug of choice for emphysema (stops bronchial secretion - anticholinergic)?

ipratropium (Atrovent)

Name 4 contraindications to Anticholinergics:

Glaucoma Prostatic hypertrophy Intestinal/urinary retention CV disease *anticholinergics can cause tachycardia

What is the mnemonic for Atropine Toxicity?

Dry as a Bone Red as a Beet Blind as a Bat Mad as a Hatter

T/F | Neuromuscular Blocking Drugs can either be Antagonists or Agonists

True *non-depolarizing or depolarizing

What is an example of a Non-depolarizing (competitive) neuromuscular blocking agent? What does it inhibit at the NMJ? Is it reversible?

Curare Nicotinic Receptors yes

How can the effects of Curare be reversed?

Cholinesterase Inhibitors *so, blocking the receptors can be overcome by throwing more Ach at it.

What is a Depolarizing NMJ blocking agent? What does it cause?

succinylcholine flaccid paralysis

How long does flaccid paralysis caused by succinylcholine last? What is a clinical use?

few minutes intubation

Where does the Botulinum Toxin (from C. botulinum) work? What does it do there?

Presynaptic Prevents Ca++ dependent Ach release ***new NMJ plates must grow to replace

_____ is a powerful Ganglionic Blocking Agent, and inhibits nicotinic receptors blocking both PANS and SANS. Another one, outdated, might be on boards:

Nicotine Trimethaphan

The endogenous Adrenergics are known as ________

catecholamines

Name 3 catecholamines (endogenous adrenergics)

Epinephrine Norepinephrine Dopamine

Name an exogenous Adrenergic neurotransmitter:

isoproterenol

What types of receptors do Adrenergics work on? What do they control?

Alpha - smooth muscle contraction Beta - heart muscle contraction, smooth muscle relaxation

Adrenergics are classified by their mechanisms, which are (3):

Direct acting Indirect acting Mixed action

T/F | Adrenergics can be alpha/beta agonists, or apha/beta antagonists

True

T/F | Alpha receptors are found in the Skin and cause vasoconstriction (via smooth muscle contraction)

True

How are Beta Receptors divided and what do they do?

Beta 1: rate/force heart Beta 2: vasodilation of Skeletal muscle, bronchodilation

What might be a reason not to use Adrenergic Agonists on Diabetics?

Peripheral vasoconstriction *exacerbates

9 Adrenergic Agonists:

Albuterol Amphetamine Clonidine Dopamine Oxymetazoline (Afrin) Phenylephrine (Sudafed PE) Phentermine (diet pills) Pseudoephedrine (Sudafed) Tetrahydrozoline (Visine)

Albuterol is included in all dental emergency kits for asthma and is a ______ agonist

Beta 2

What can be used as a 2nd line intervention for hypertension?

Alpha Antagonists *decreases total peripheral resistance

Name 4 uses for Alpha Antogonists:

Hyptertension Peripheral vascular disease (Raynaud's) pheochromocytoma diagnostic Prostatic Hypertrophy

What are the most widely used Beta Blocking drugs in the US?

Selective Beta 1 only (fewer side effects, DDI's) *non-selective's block both

Beta Antagonists (blockers) are used for Cardiac arrhythmias, Angina, Hypertension, Hyperthyroidism, Anxiety, Glaucoma, Parkinson's, and Migraine

True

Selective Beta blockers are alphabetically ______. Non-selective Beta blockers are ______

A through M N-Z

What can pts taking Non-Selective Beta blockers experience when given epinephrine? (2-4 fold increase of this occurring)

Pressor response

The Pressor Response includes what 2 things?

Hyptertension Reflex bradycardia

Epinephrine given to those taking Non-selective Beta blockers must be limited to ____ mg, which is ___ cartridges of epi 1:100,000.

0.04 mg 2 cartridges