Quizzes - Chapter 1 & 2 Flashcards
1
Q
Epinephrine (Adrenalin)
A
Hormone released by the adrenal gland
2
Q
Autonomic Nervous System
A
Controls involuntary actions
3
Q
Alpha 1 Blocker
A
Causes peripheral vasodilation
4
Q
Absorption
A
When the drug enters the blood stream
5
Q
Norepinephrine
A
Neurotransmitter for flight or fight
6
Q
Adrenergic Receptors
A
Associated with the sympathetic nervous system
7
Q
Acetylcholine
A
Neurotransmitter for rest and digest
8
Q
Agonist
A
Binds with receptors and mimics the natural respose
9
Q
Acetylcholinesterase
A
Destroys acetylcholine in the synapse
10
Q
Atenolol (Tenormin)
A
Prototype of beta 1 selective blocker
11
Q
Propranolol (Inderal)
A
Non-selective beta adrenergic antagonist
12
Q
Alpha 1 Agonist
A
Causes peripheral vasoconstriction
13
Q
Beta 1 Agonist
A
Enhances cardiac chronotropy and inotropy
14
Q
Beta 2 Agonist
A
Causes bronchodilation
15
Q
Metabolism
A
Breakdown of a drug in the liver
16
Q
Rhabdomyolysis
A
Destruction of skeletal muscle as a side effect of statins
17
Q
Cholinergic drugs
A
Stimulate the parasympathetic nervous system
18
Q
Cholestyramine (Questran)
A
Binds to bile acids in GI tract requiring liver to pull cholesterol from blood stream
19
Q
Hydrochlorothiazide (HCTZ)
A
Drug of choice to treat long term hypertension
20
Q
Atorvastatin (Lipitor)
A
Slows production of cholesterol in liver
21
Q
Preload
A
Central Venous pressure - volume of blood returning to the heart
22
Q
Afterload
A
Pressure needed to eject blood from the heart
23
Q
Angiotensin II
A
Extremely powerful vasoconstrictor that also effects angiogenesis
24
Q
First-pass effect
A
Oral drug concentration greatly reduced before reaching systemic circulation
25
Spironolactone (Aldactone)
Still get diuresis but don't lose potassium
26
Valsartan (Diovan)
ARB. Blocks angiotensin II
27
Digoxin (Lanoxin)
Positive inotropic effect, negative chronotropic effect.
28
Lisinopril (Zestril)
ACE; Blocks production of angiotensin II and prevents breakdown of bradykinin
29
Diltiazem (Cardizem)
Slows smooth muscle contraction dilating coronary & peripheral blood vessels
30
Ototoxicity
Adverse effect of IV furosemide given too rapidly.
31
Agonist
Drug that binds a receptor and initiates a response that is the same (or greater) than the natural ligand (hormone, neurotransmitter)
32
Antagonist
Drugs that inhibit cell function by binding to a receptor and preventing interaction with the natural ligand (hormone)
33
Drug interactions: Additive
Two drugs with similar pharmacologic actions are taken together and the effect of each add together
34
Drug interactions: Synergistic
Two drugs taken together give a greater effect than either taken alone. (I.E.: Acetaminophen and codeine produce greater analgesia when combined than either agent alone)
35
Drug interactions: Antagonistic
Two drugs taken together results in a decreased effect
36
Adverse effects of drugs: Allergy
* Antigen antibody reactions, e.g. allergic reactions to penicillins and some types of local anesthetics.
* If a person is allergic to a particular drug, he/she may be allergic to many other drugs with chemical structures that are very similar to it
* Reports of prior allergic reactions to a drug (especially if self-reported by a patient) may or may not be accurate
* Exposing a patient to a drug (or chemically similar drug) to which he/she is allergic could trigger a serious or even fatal response (e.g. anaphylaxis).
37
Five Rights of Drug Administration
* Right drug
* Right dose
* Right client
* Right route
* Right Time
38
CNS: Autonomic Nervous System (ANS)
Roles:
* Control of "vegetative" processes of internal organs
* Adapting body to stresses (homeostasis) via controlling those organs
* INVOLUNTARY CONTROL OF EFFECTORS
* Two divisions of the ANS: Parasympathetic (rest and digest) and Sympathetic Nervous Systems (fight or flight)
* The effects of PNS activation and SNS activation are usually the opposite of one another on a given target: concept of "dual innervation"
* Opposing effects doesn't necessarily mean "equally opposing" effects - one branch of ANS may have greater resting influence on level of an organ's activity than the other ANS branch.
39
Parasympathetic Nervous System (PNS)
Main role is housekeeping - e.g. digestion, maintain or return to "normal state" of various organ systems or their structures
40
Sympathetic Nervous System (SNS)
Main role is enabling "fight or flight" responses - adaptation or response to stress.
* Pre-ganglionic fibers arise from the thoracic and lumbar regions of spinal cord.
* WIDESPREAD ACTIVATION: Virtually all structures under SNS control are affected when SNS "fires".
41
Effectors (target structures) controlled by the ANS
Smooth muscle
Cardiac muscle
Exocrine glands
42
SNS - Fight or Flight
* Increased arterial blood pressure and cardiac output
* Increased blood flow to the brain, heart, skeletal muscles
* Increased rate of cellular metabolism
* Increased breakdown of glycogen
* Increased mental activity
* Increased muscle strength
* Increased rate of blood coagulation
* Increased rate and depth of respiration
* Pupil dilation to aid vision
* Increased sweating (acetylcholine)
43
PNS - Rest and Digest
* Pre-ganglionic fibers arise from the cranial and sacral regions of the spinal cord.
* LOCALIZED ACTIVATION: When PNS is activated, the activity of 1 or a few structures can change without changing activity of all structures innervated by the PNS
44
Parasympathetic Nervous System:
* Dilation of blood vessels in the skin
* Decreased platelet aggregation
* Decreased heart rate
* Increased secretion of digestive enzymes
* Increased secretions from glands
* Increased motility of GI tract
* Constriction of bronchial smooth muscle
* Constricted pupils
* Contraction of smooth muscle of urinary bladder
45
Sympathetic Nervous System:
* Bronchodilation
* Increased heart rate and contractility
* Shunt blood from the GI tract and skin to the skeletal muscles and brain
* Glycogen breakdown increases in the liver
* GI motility and secretions decrease
* Pupils dilate
46
Parasympathetic Nervous System:
* Bronchioles are constricted
* Heart beat is SLOWED
* Blood flow is shunted to GI tract
* GI tract hogs all the energy for digestion
* Drooling because of increased secretions
* Defecating and urinating
47
Major Autonomic Nervous System Drug Classes: SNS Drugs
* Adrenergic agonists
* Alpha-adrenergic antagonists
* Beta-Adrenergic antagonists
48
Major Autonomic Nervous System Drug Classes: PNS Drugs
* Cholinergics
* Anticholinergics
* Cholinesterase Inhibitors
* Dopaminergics
49
Norepinephrine (NE)
Made in, released from, all postganglionic sympathetic nerves when the SNS is activated.
50
Epinephrine
Hormone - Made in, released from cells of the adrenal medulla (which are part of the "sympathoadrenal branch" of the SNS) when the SNS is activated.
51
Alpha-Adrenergic Receptors (Alpha-1 Receptors)
* Muscle contraction
* Vasoconstriction
* GI and bladder sphincter contraction
* Binds norepinephrine
52
Beta-Adrenergic Receptors: Beta-1 Receptors
Increases heart rate and force of myocardial contraction, automaticity and rate of AV conduction
53
Beta-Adrenergic Receptors: Beta-2 Receptors
* Bronchodilation
* Vasodilation
* Decreased GI motility and tone
* Relaxation of uterus and urinary bladder.
54
Epinephrine - Adrenergic Drug
* Increases systolic BP due to increased force of contraction of heart
* Vasodilation and increased BP to skeletal muscles, heart, and brain
* Vasoconstriction in peripheral blood vessels
* Relaxation of GI smooth muscle
* Dilation of bronchial smooth muscle
55
Epinephrine
Epinephrine injection, 1:1000 (1 mg/mL)
* SC 0.3-0.5 mg
* IV: Must use 1:10,000 solution
56
Pseudoephedrine (Sudafed)
* Adrenergic Drug
* Decongestant
* Can raise BP, use with caution in hypertensive patients
57
Phenylephrine (Neo-Synephrine)
* Adrenergic Drug
| * Acts on alpha-adrenergic receptors to produce vasoconstriction
58
Isoproterenol (Isuprel)
* Adrenergic Drug
| * Agonist at Beta-1 and Beta-2 receptors
59
Anti-adrenergic Drugs
* Alpha-1 receptor blocking agents (prazosin - Minipres)
* Non-selective Beta receptor blocking agents (B-1, B-2) (propranolol - Inderal)
* Cardioselective Beta blocking agents (B-1 selective) (atenolol - Tenormin)
60
Alpha-1 adrenergic blocking agents
* PREVENT alpha-1 receptor mediated vasoconstriction
* Dilation of arterioles and veins
* Increased local blood flow
* Decreased BP
* Constriction of pupils
* Increased motility of the GI tract
* Relax smooth muscle in non-vascular tissue
Used in BPH - Relaxes smooth muscle of bladder and prostate
61
Alpha-1 adrenergic blocking agents
* Prazosin (Minipres)
* Doxazosin (Cardura)
* Tamsulosin (Flomax)
* Terazosin (Hytrin)
* Dilation of arterioles and veins
* Increased local blood flow
* Decreased BP
* Constriction of pupils
* Increased motility of the GI tract
* Relax smooth muscle in non-vascular tissue
62
Beta-Adrenergic Blocking Agents
Propranolol (Inderal) - Prototype
* Decrease heart rate
* Negative chronotropy (Reduces rate @ which heart beats)
* Decrease force of myocardial contraction
* Negative ionotropy (Decreased force per BPM)
* Decreased blood pressure
* Decreased cardiac output
63
Beta-Adrenergic Blocking Agents
Clinical Uses:
* Hypertension
* Glaucoma
* Angina Pectoris
* MI
* Migraine prophylaxis
* Supraventricular tachycardia
* Ventricular arrhythmias
64
Beta-Adrenergic Blocking Agents
Receptor Selectivity:
* NONSELECTIVE: Block BOTH Beta-1 (Cardiac) and Beta-2 (Respiratory) receptors
* SELECTIVE: Block primarily Beta-1 receptors (CARDIAC)
65
Acetylcholine (ACh)
Synthesized and released from:
* All preganglionic nerves (SNS and PNS) when they are activated
* All postganglionic parasympathetic nerves when they are activated
* All somatic nerves (which are not part of the autonomic nervous system) when they are activated
* Different receptors. GI tract - peristalsis, etc. effected.
66
Direct-Acting Cholinergic Agents
* Synthetic derivatives of choline
* Lipid insoluble: Do NOT penetrate CNS
* Resistant to the action of acetylcholinesterase (enzyme)
* Decreased HR, vasodilation, unpredictable effect on BP
* Increased tone and contractility of smooth muscle (detrusor) in the urinary bladder and relaxation of the sphincter
* Increased tone and contractility of bronchial smooth muscle.
* Increased respiratory secretions
* Constriction of the pupils (miosis) and contraction of the ciliary muscle (near vision accommodation)
67
Bethanechol (Urecholine)
Stimulates cholinergic receptors:
* Contraction of urinary bladder
* Decreased bladder capacity
* Increased frequency of ureteral peristaltic waves
* Increased tone and peristalsis in GI tract
* Increased pressure in the lower esophageal sphincter
* Increased gastric secretions
INDICATIONS:
*Postpartum and postoperative nonobstructive urinary retention due to neurogenic bladder.
*Poorly absorbed from the GI tract
*PO: 10-50 mg 2-4 times/day. Maximum single dose is 50 mg.
Give before meals
SC: 2.5-5.0 mg 3-4 times/day
NEVER used IM or IV because of severe adverse effects - cardiac arrest possible.
68
Indirect-acting cholinergic agents
Anticholinesterase drugs
* Inhibit activity of acetylcholinesterase
* Decreases the inactivation of acetylcholine
* Increased transmission in the brain and muscle contraction in the peripheral tissues.
69
Reversible indirect-acting cholinergics
* Neostigmine (Prostigmin)
* Edrophonium (Tensilon)
* Ambenonium (Mytelase)
* Physostigmine (Antilirium)
* Pyridostigmine (Mestinon)
Myasthenia gravis
70
Neostigmine (Prostigmin)
* GI Side effects
* Inhibits the breakdown of acetylcholine so that it accumulates and has a prolonged effect
* Increased miosis, bronchial and ureteral constriction, bradycardia, increased salivation, lacrimation, and sweating
* Improved muscular function in myasthenia gravis
* For maximal effect, may be administered with atropine to block muscarinic effects
71
Pyridostigmine (Mestinon)
* Similar to neostigmine
* Longer acting
* INDICATIONS: Myasthenia gravis
* Adverse Effects:
* Excesssive stimulation of PNS
* N&V, Diarrhea, cramping, increased secretions
* Bradycardia, respiratory failure
* CNS: Drowsiness, dizziness, convulsions
72
Reversible Indirect-Acting Cholinergics for Alzheimer's Disease
* Donepezil (Aricept)
* Galantamine (Reminyl)
* Rivastigmine (Exelon)
* Tacrine (Cognex)
73
Cholinergic Drugs: Administer accurately
* Bethanechol (Urecholine) - give before meals
| * Pyridostigmine (Mestinon) - give drugs for myasthenia gravis at regular intervals
74
Cholinergic Drugs: Observe for Therapeutic Effects
* Bethanechol (Urecholine) - Micturition
* Pyridostigmine (Mestinon) or neostigmine (Prostigmin) for myasthenia gravis
* Increases muscle strength, tolerance of activity
* Decreased difficulty chewing, swallowing, and speech
* Decreased ptosis of eyelids
75
Cholinergic Drugs: Observe for Adverse Effects
*CNS: Convulsions, dizziness, drowsiness, headache, loss of consciousness
*Resp: Increased secretions, bronchospasm, respiratory failure
*CV: Dysrhythmias, hypotension, cardiac arrest
GI: N&V, diarrhea, increased peristalsis, cramping, increased secretions
76
Cholinergic Drugs: Observe for Drug Interactions
* Drugs that DECREASE the effect of cholinergic drugs:
* Anticholinergic drugs (atropine): Direct antagonist
* Antihistamines: Anticholinergic effects
77
Anticholinergic Drugs: Mechanism of Action and Effects
* Bind to ACh receptors and PSN endings
* CNS stimulation followed by depression
* Decreased CV response to parasympathetic (Vagal) stimulation
* Bronchodilation and decreased respiratory secretions**
* Antispasmodic effects in the GI tract due to decreased muscle tone and motility**
* Mydriasis and cycloplegia in the eye
* Decreased secretions from salivary and sweat glands, relaxation of ureters, urinary bladder, relaxation of smooth muscle in gallbladder.
GU Disorders: Relieves symptoms of urinary frequency and incontinence (Detrol, Detrol LA)
78
Anticholinergic Overdose Syndrome
* Hot, dry, flushed skin
* Dry mouth
* Mydriasis
* Delirium
* Tachycardia
* Ileus
* Urinary retention
* Myoclonic movements
* Seizures, coma, respiratory arrest
TREAT with physostigmine (acetylcholinesterase inhibitor)
