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Tim's Cards > Pharmacology V > Flashcards

Pharmacology V Flashcards

1
Q

Antianxiety Medications are also known by what 2 other names?

A

Sedative hyponotics

Minor tranquilizers

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2
Q

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

A

Benzodoazepines

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3
Q

Valium

A

diazepam

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4
Q

T/F

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

A

True

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5
Q

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

A

diazepam (Valium)

lorazepam (Ativan)

alprazolam (Xanax)

midazolam (Versed)

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6
Q

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

A

IV/V

Tolerance

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7
Q

Name 3 distinct effects of Benzodiazepines:

A

Effects on behavior

Anticonvulsant effects

Muscle relaxation

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8
Q

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

A

Anxiety reduction

Drowsiness/depression

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9
Q

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

A

diazepam (Valium)

midazolam (Versed)

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10
Q

What are the 2 most potent Benzodiazepines?

A

diazepam (Valium)

chlordiazepoxide (Librium)

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11
Q

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

A

Anterograde Amnesia

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12
Q

Describe the mechanism of the Benzodiazepines.

3 things

A

Enhances inhibitory effect of GABA on neuronal excitability

Causes hyperpolarization (less excitable state)

Neuronal stabilization

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13
Q

What does GABA do to the brain?

A

Inhibitory

Decreases Excitation

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14
Q

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

A

GABA

Benzodiazepines

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15
Q

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

A

Presence of GABA

*binding is rapid, reversible, stereospecific, and saturable

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16
Q

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

A

half lives

active

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17
Q

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

A

lorazepam (Ativan)

*No significant accumulation of drug do to rapid metabolization

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18
Q

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

A

triazolam (Halcion)

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19
Q

Name 5 uses of Benzodiazepines in Medicine:

A

Anxiety relief

Muscle relaxant

Insomnia

Alcohol withdrawal

Pre-op med

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20
Q

What are 3 used of Benzodiazepines in Dentistry:

A

Pre-op med (for anxiety)

IV sedation (and amnesia)

Emergency intervention for seizures

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21
Q

Name 4 adverse side affects of Benzodiazepines:

A

CNS depression

Xerostomia

Abuse/addiction

Additive with other CNS depressants (alcohol)

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22
Q

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

A

True

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23
Q

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

A

1/3

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24
Q

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

A

Alcohol

*must be avoided

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25
Q

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

A

long half lives

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26
Q

What is the 1/2 life of Valium?

active metabolite of desmethyldiazepam?

A

20-50 hrs

50-100 hrs

*why EtOH must be avoided

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27
Q

What is the antidote for Benzodiazepine Overdose?

*this antidote will not block CNS effects from other drugs

A

Flumazenil

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28
Q

Flumazenil (antidote for Benzodiazepine overdose) may not reverse ________.

It may cause _______ as a side effect.

A

Respiratory depression

seizures

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29
Q

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

A

buspirone (BuSpar)

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30
Q

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

A

Red Flag Drug

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31
Q

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

A

Xerostomia

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32
Q

Throwback: SSRI’s cause what to the teeth?

A

Bruxism

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33
Q

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

A

Antipsychotic

Neuroleptic

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34
Q

Name 2 indications for the use of a Major Tranquilizer:

A

Psychotic disorders (pchizophrenia, paranoia)

Demetia

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35
Q

What is a side effect to Major Tranquilizers?

A

Severe nausea and vomiting

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36
Q

Major Tranquilizers act as _______ to a swath of neurotransmission

(dopaminergic, alpha 1 and 2 adrenergic, srotonergic, muscarinic, H1 histamine, sigma opioid)

A

Antagonists

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37
Q

T/F

The primary mechanistic action of Major Tranquilizers is the blockage of dopaminergic transmission

A

True

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

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38
Q

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

A

Antipsychotic

Extrapyramidal side effects

Antiemetic (anti-vomit)

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39
Q

Antipsychotic medications reduce Dopaminergic activity by blocking _____ receptors

A

D2

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40
Q

T/F

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

A

False

Antagonists

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41
Q

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 ______.

A

Therapeutic activity takes weeks for full effect

Prefrontal cortex

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42
Q

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

A

Morphology

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43
Q

T/F

All Major Tranquilizers have similar pharmokinetics and Efficacy

A

True

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

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44
Q

Name 5 Extrapyramidal side effect of Antipsychotic Drugs:

A

Parkinsonism (akinesia - difficult initiating movement)

Akathisia (restless leg)

Dystonia (sustained muscle contraction)

Tardive Dyskinesia (abnormal face/tongue movements)

Sedation

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45
Q

_________ drugs can treat most Extrapyramidal side effects of Antipsychotic Drugs

A

Anticholinergic

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46
Q

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

A

Autonomic Side Effects

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47
Q

Antipsychotics potentiate (exacerbate) the ________ caused by opioids.

***potentiate CNS effects of all analgesics

A

Respiratory Depression

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48
Q

Name 3 Dental considerations with Antipsychotics?

A

Hematologic (WBC count may be low)

Heart (arrhythmias - caution with epi)

Extrapyramidal (movement)

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49
Q

An episode of neurologic dysfunction, often accompanied by motor activity such as convulsions, and emotional/sensory change

*may contain visual, auditory, and olfactory hallucinations

A

Seizure

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50
Q

The majority of patients suffering from seizures have _______ epilepsy.

A

Idiopathic

*no known cause

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51
Q

Drugs improve epilepsy in __-__% of cases

A

70-80%

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52
Q

What are 2 broad groups of epilepsy?

A

Partial

Generalized

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53
Q

What are the 2 subtypes of Partial Epilepsy

Briefly describe them:

A

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

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54
Q

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

A

3-5

temporal lobe

80

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55
Q

What are the 2 types of Generalized Epilepsies?

A

Tonic-clonic (grand mal)

Absence (petit mal)

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56
Q

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

A

Consciousness

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57
Q

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

A

Tonic

Clonic

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58
Q

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

A

Comatose

Confusion

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59
Q

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.

A

Aura

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60
Q

Absence (petit mal) seizures are usually found in what demographic?

Describe a petit mal seizure:

A

Childred 3-5 yrs

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

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61
Q

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?

A

Status Epilepticus

diazepam (Valium) injection

*lorazepam (Ativan) and midazolam (Versed) also can be used

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62
Q

T/F

Drugs have variable efficacy in the treatment of seizures

A

True

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63
Q

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

A

CNS depressants

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64
Q

Most anticonvulsants have a Narrow/Large therapeutic index.

They tend to stimulate ________ enzymes, thus these drugs are known as _______.

A

Narrow

Liver microsomal

Inducers

***the addition of an anticonvulsant will change the metabolism of all anticonvulsants

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65
Q

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
A

True

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66
Q

Name 2 major side effects of Anticonvulsants:

Name 2 ways these side effects affect Dental Decisions:

A

CNS depression, GI effects

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

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67
Q

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

A

carbamazepine (Tegretol)

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68
Q

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

A

sodium

simple

complex partial

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69
Q

Other than treating seizures, carbamazepine (Tegretol) has what 3 clinical uses?

(One of very special interest in Dentistry)

A

Bipolar depression

Chronic pain

Trigeminal neuralgia (tic douloureux)

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70
Q

What are 4 side effect of carbamazepine (Tegretol)?

A

Hematologic

Liver Toxicity

Congestive heart (altered BP)

Xerostomia

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71
Q

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

A

Decreases effectiveness of a variety of drugs

warfarin, doxycycline, oral contraceptives, asthma bronchodilators

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72
Q

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

A

True

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73
Q

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

A

phenytoin (Dilantin)

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

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74
Q

What are 3 anticonvulsant applications of phenytoin (Dilantin)?

***What is 1 Dental Application?

A

Partial seizures

Tonic-Clonic seizures

Status Epilepticus

***Trigeminal neuralgia

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75
Q

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)

A

Loss of taste

oral mucosal ulceration or glossitis from Folate deficiency

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76
Q

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

What reduces the severity?

A

50-60%

Good Oral Hygiene

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77
Q

phenytoin (Dilantin) is Teratogenic category D, and causes what?

How does this manifest?

A

Fetal Syndrome

cleft lip, palate, congenital heart disease

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78
Q

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

A

Increases

Inducer

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79
Q

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

What do they release?

A

GABAmimetic Agents

GABA from presynaptic interneurons

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80
Q

How do GABAmimetic agents prevent seizures?

A

Prevent acetylcholine release

*many seizures caused by tremendous release of acetylcholine

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81
Q

GABA is Inhibitory/Excitatory?

A

Inhibitory

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82
Q

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

A

phenobarbital (Luminal)

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83
Q

What is the most common barbiturate used as an anticonvulsant?

A

phenobarbital (Luminal sodium)

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84
Q

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

A

Tonic-clonic

Partial seizures

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85
Q

The most common side effect of phenobarbital (Luminal sodium) is sedation, but what rarely happens?

In this rare instance, what should be done?

A

Skin rxns - stomatitis

Discontinue

***some cutaneous rxns from this drug have been fatal

86
Q

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

A

Inducer

87
Q

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

What is it used to treat?

A

primidone (Mysoline)

*it is phenobarbital’s precursor

Partial seizures, Tonic-clonic seizures

88
Q

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

A

Increases GABA

89
Q 
T/F
valproic acid (Depakene) is used for Tonic-clonic seizures and Generalized seizures (absence, myoclonic)
A

True

90
Q

What are 2 adverse rxns of Valproates?

A

Hepatotoxicity

Platelet aggregation inhibition - bleeding

91
Q

What 2 DDI’s do Valproates have?

A

macrolide antibiotics (mycins)

Aspirin (other salicylates)

92
Q

What is the 1st choice in absence seiures (petit mal)?

*remember - the children

A

ethosuximide (Zarontin)

93
Q

phenytoin (Dilantin) works on absence seizures

A

False

*does not work - prescribe ethosixumide (Zarontin)

94
Q

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

A

Gingival hyperplasia

Tongue swelling

95
Q

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

A

clonazepam (Clonipin)

diazepam (Valium)

96
Q

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

A

Partial

Tonic-clonic

Chronic Pain

97
Q

What anticonvulsant’s major advantage is that the drug is NOT metabolized?

*therefore lacks DDI’s, doesn’t affect liver enzymes

A

gabapentin (Neurontin)

98
Q

What anticonvulsant used for partial and grand mal seizures inhibits the release of glutamate?

*remember, glutamate is excitatory

A

lamotrigine (Lamictal)

99
Q

lamotrigine (Lamictal) ____ inhibits _____ receptors and is used to treat ______ disorder.

*secondarily - primarily this drug inhibits glutamate

A

weakly

serotonin

bipolar

100
Q

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

A

valproic acid

phenytoin

phenobarbital

primodone

gabapentin

lamotrigine

101
Q

2 drugs that treat Absence seizures:

A

ethosuximide

valproic acid

102
Q

6 drugs that treat Partial seizures:

A

carbamazepine

phenytoin

phenobarbital

primidone

gabapentin

lamotrigine

103
Q

What is used instead of phenytoin to avoid gingival hyperplasia?

A

carbamazepine

104
Q

T/F

Always ask pts when they had their seizure meds last and about known triggers

A

True

105
Q

T/F

phenytoin (Dilantin) and phenobarbital are classic…

A

P450 inducers

106
Q

Liver toxicity is a concern with what 2 drugs?

A

carbamazepine (Tegretol)

valproic acid (Depakene)

*all valproates

107
Q

Local anesthetic OD will trigger a ______

A

seizure

108
Q

What Convulsant is used as a provocative to diagnose epilepsy?

A

pentylenetetrazole (Metrazole)

109
Q

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

A

Strychnine

rat poison

110
Q

T/F

picrotoxin blocks GABA and causes convulsions

A

True

111
Q

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

A

Respiratory

Cardiac

CNS

112
Q

What stimulants are primarily used for asthma?

What stimulants are Centrally Acting Sympathomimetics?

What are used for diagnostics?

A

Xanthenes

Amphetamine

Convulsants

113
Q

caffeine is a ______.

A

Xanthene

114
Q

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

A

aminophylline

theophylline

115
Q

How many mg of caffeine or theophylline is needed to increase cortical activity?

OTC stimulants have how many mg?

A

50-200

100-200

116
Q

The cerebral cortex is stimulated at ______ mg of Xanthenes

Brainstem:

Spinal cord (this can lead to convulsions, shakiness):

A

50-200 mg

greater than 250 mg

1000 mg

117
Q

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

A

Xanthenes

118
Q

_____ is more potent than caffeine

A

theophylline

119
Q

Xanthenes have a Beta 1 effect, which does what?

A

stimulates heart (increases output)

120
Q

Caffeine will cause arrhythmias in a normal heart

A

False

*cause them if at risk

121
Q

How does caffeine cause hypotension?

A

peripheral smooth muscle relaxation

w/ normal heart rate

122
Q

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

A

Dilates bronchioles

*increases lung capacity - used as asthma med

123
Q

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

A

True

124
Q

Where is the potency of caffeine equal to theophylline?

Where is caffeine stronger?

Everywhere else?

A

CNS

Sk muscle

theophylline

125
Q

How many mg of caffeine is required to produce toxicity?

A

300 mg

126
Q

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

A

True

127
Q

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

A

Opioid

128
Q

What do Xanthenes treat in infants (2 things)?

A

Acute pulmonary edema

Apnea

129
Q

CNS Sympathomimetics ______ fatigue.

Best example of a drug class:

A

Decrease

Amphetamines

130
Q

T/F

CNS Sympathomimetics like Amphetamines reduce REM, appetite, and may produce depression and paranoia

A

True

131
Q

Amphetamines (CNS Sympathomimetics are indicated for what 2 conditions?

A

Narcolepsy

Hyperkinetic syndromes

132
Q

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

A

Cocaine

133
Q

Name an Adrenergic agonist drug for ADHD:

A

methylphenidate (Ritalin)

134
Q

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

A

dextroamphetamine (Dexadrine)

135
Q

What drug for ADHD is a Selective norepinephrine reuptake inhibitor?

A

atomoxetine (Straterra)

136
Q

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

A

ephedrine

137
Q

Name 2 Amphetamines pulled from the market:

A

phenylpropanolamine (PPA)

ephedra

*both “diet” pills

138
Q

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

A

Cardiac effects

139
Q

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

A

doxapram (Dopram)

140
Q

Even at low doses, nicotine stimulates nicotinic receptors in the ____ and ______.

Higher concentrations can cause ______

A

brain stem, cortex

convulsions

141
Q

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

A

Nicotinic

Ach

142
Q

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

A

NE

Alpha, Beta, Adrenergic

143
Q

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

A

Muscarinic

Ach

144
Q

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)

A

True

145
Q

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

A

PANS stimulatory

PANS inhibitory

SANS stimulatory

SANS inhibitory

146
Q

A drug that acts where Ach is released is…

A drug that acts where NE is released is…

A

cholinergic

adrenergic

147
Q

A drug that acts where PANS action occurs…

A drug that acts where SANS action occurs…

A

parasympatho

sympatho

148
Q

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

aka…

A

mimetic

agonist

149
Q

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

aka…

A

lytic, blocker

antagonists

*don’t produce effect - plugs site

150
Q

Cholinergics and parasympathomimetics are ________.

Anticholinergics, parasympatholytics, and cholinergic blockers are ________.

A

Stimulatory

Inhibitory

151
Q

Adrenergics and Sympathomimetics are _______.

Adrenergic blockers, sympathetic blockers, and sympatholytics are ________

A

Stimulatory

Inhibitory

152
Q

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

A

Direct acting (agonists) - more predictable

Indirect acting - cause release or accumulation of Ach

153
Q

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

A

Cholinesterase inhibitors

154
Q

T/F

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

A

True

155
Q

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

A

Physically

Chemically

156
Q

3 areas affected by Cholinergic Drugs;

A

CV

Eye

GI

157
Q

CV effects of Cholinergic drugs:

Eye:

GI:

A

bradycardia

miosis (decrease pressure)

Increase activity (motility and secretion - excites smooth muscle)

158
Q

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

A

Glaucoma

Myasthenia gravis (autoimmune)

(also, GI disorders and reversed urinary retention after surgery)

159
Q

What are 2 examples of Direct Acting Cholinergic Agonists:

*both are used for Sjogren’s, which is used for Glaucoma?

A

cevimeline (Evoxac)

pilocarpine (Salagen) *glaucoma

160
Q

pilocarpine is primarily used for ________, and acts by decreasing ________.

pilocarpine is used for what in Dentistry?

A

Glaucoma

Intraocular pressure (allows drainage)

Xerostomic intervention (stimulates saliva)

161
Q

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

A

cholinesterase inhibitors

Ach

PANS stimulation

162
Q

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

A

Antidotes

***poisons produce neuromuscular blockade

163
Q

Indirect-Acting Cholinergics are divided based on what?

A

Degree of reversibility (of attachment to enzyme)

  • Reversible
  • Irreversible
164
Q

Reversible Indirect-Acting Cholinergics are used to treat ________ and _______.

*remember, these increase Ach by binding Cholinesterase

A

myasthenia gravis

Glaucoma

165
Q

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

A

edrophonium (Enlon) - reverses rapidly

physostigmine - reverses anticholinergic OD (atropine, Benadryl)

pyridostigmine (Mestinon) - myasthenia gravis, nerve gas

166
Q

What would Reversible Ach-esterase inhibitors that act Centrally do?

What are these used for?

Drug?

A

raise Ach in brain

Dementia/Alzheimer’s

donepezil (Aricept)

167
Q

Irreversible Ach-esterase Inhibitors include _______ and _______

A

Insecticides (organophosphates)

Nerve gas (chem. warfare)

168
Q

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

A

pralidoxime

atropine (antimuscarinic)

169
Q

What are the side effects of Cholinergic drugs?

A

SLUD

Salivation

Lacrimation

Urination

Defecation

*compliance often low

170
Q

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

A

Bradycardia

Bronchoconstriction

Miosis

Paralysis at high doses

171
Q

What are 3 names for Cholinergic Antagonists?

A

Anticholinergics

Antimuscarinics

Parasympatholytics

172
Q

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

A

Block

Ach

*Ach is released but cannot act

173
Q

Anticholinergic Drugs have central effects determined by ________.

A

Dose

174
Q

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

A

Sedation

Motion Sickness

175
Q

Atropine, a CNS acting Anticholinergic, causes what?

A

Stimulation, delirium, hallucinations, convulsions, coma

176
Q

What are Anticholinergics effects on Exocrine Glands?

How is this used in Dentistry?

What drug?

A

Decreases Secretion

Decrease Salivation

Atropine

177
Q

What are Anticholinergics effects on the lungs?

GI tract?

A

Bronchodilators

Decrease gut motility

*Affects smooth muscle

178
Q

What are 2 Anticholinergic effects on the Eye?

*How is this used in medicine?

A

mydriasis (dilated pupils)

cycloplegia (near vision blurred - distance vision awesome)

*opthamologic exam

179
Q

What do Anticholinergics do to PANS?

A

Reduce activity

180
Q

What can Anticholinergics do in Large Therapeutic doses?

A

Tachycardia

*vagal blockade

181
Q

How do Anticholinergics affect Parkinson’s disease?

How do they affect Urinary disorders?

A

Reduce tremors/muscle rigidity

Can treat overactive bladder

182
Q

The Anticholinergic ________ is used for Motion sickness

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

A

Scopolamine

Atropine

183
Q

________ = anticholinergic = ________ salivation

________ = cholinergic = _________ salivation

A

atropine, stops salivation

pilocarpine, increases salivation

184
Q

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

A

ipratropium (Atrovent)

185
Q

Name 4 contraindications to Anticholinergics:

A

Glaucoma

Prostatic hypertrophy

Intestinal/urinary retention

CV disease

*anticholinergics can cause tachycardia

186
Q

What is the mnemonic for Atropine Toxicity?

A

Dry as a Bone

Red as a Beet

Blind as a Bat

Mad as a Hatter

187
Q

T/F

Neuromuscular Blocking Drugs can either be Antagonists or Agonists

A

True

*non-depolarizing or depolarizing

188
Q

What is an example of a Non-depolarizing (competitive) neuromuscular blocking agent?

What does it inhibit at the NMJ?

Is it reversible?

A

Curare

Nicotinic Receptors

yes

189
Q

How can the effects of Curare be reversed?

A

Cholinesterase Inhibitors

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

190
Q

What is a Depolarizing NMJ blocking agent?

What does it cause?

A

succinylcholine

flaccid paralysis

191
Q

How long does flaccid paralysis caused by succinylcholine last?

What is a clinical use?

A

few minutes

intubation

192
Q

Where does the Botulinum Toxin (from C. botulinum) work?

What does it do there?

A

Presynaptic

Prevents Ca++ dependent Ach release

***new NMJ plates must grow to replace

193
Q

_____ is a powerful Ganglionic Blocking Agent, and inhibits nicotinic receptors blocking both PANS and SANS.

Another one, outdated, might be on boards:

A

Nicotine

Trimethaphan

194
Q

The endogenous Adrenergics are known as ________

A

catecholamines

195
Q

Name 3 catecholamines (endogenous adrenergics)

A

Epinephrine

Norepinephrine

Dopamine

196
Q

Name an exogenous Adrenergic neurotransmitter:

A

isoproterenol

197
Q

What types of receptors do Adrenergics work on?

What do they control?

A

Alpha - smooth muscle contraction

Beta - heart muscle contraction, smooth muscle relaxation

198
Q

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

A

Direct acting

Indirect acting

Mixed action

199
Q

T/F

Adrenergics can be alpha/beta agonists, or apha/beta antagonists

A

True

200
Q

T/F

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

A

True

201
Q

How are Beta Receptors divided and what do they do?

A

Beta 1: rate/force heart

Beta 2: vasodilation of Skeletal muscle, bronchodilation

202
Q

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

A

Peripheral vasoconstriction

*exacerbates

203
Q

9 Adrenergic Agonists:

A

Albuterol

Amphetamine

Clonidine

Dopamine

Oxymetazoline (Afrin)

Phenylephrine (Sudafed PE)

Phentermine (diet pills)

Pseudoephedrine (Sudafed)

Tetrahydrozoline (Visine)

204
Q

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

A

Beta 2

205
Q

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

A

Alpha Antagonists

*decreases total peripheral resistance

206
Q

Name 4 uses for Alpha Antogonists:

A

Hyptertension

Peripheral vascular disease (Raynaud’s)

pheochromocytoma diagnostic

Prostatic Hypertrophy

207
Q

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

A

Selective

Beta 1 only

(fewer side effects, DDI’s)

*non-selective’s block both

208
Q

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

A

True

209
Q

Selective Beta blockers are alphabetically ______.

Non-selective Beta blockers are ______

A

A through M

N-Z

210
Q

What can pts taking Non-Selective Beta blockers experience when given epinephrine?

(2-4 fold increase of this occurring)

A

Pressor response

211
Q

The Pressor Response includes what 2 things?

A

Hyptertension

Reflex bradycardia

212
Q

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

A

0.04 mg

2 cartridges

Tim's Cards (140 decks)

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