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Step 1 Pharm > SNS/PNS drugs > Flashcards

SNS/PNS drugs Flashcards

1
Q

Used for post op Ileus;, neurogenic ileus and urinary retention via Activating bowel and bladder smooth muscles.

A

Bethanechol

Direct Ach Agonists or Cholomimetic

Bethany activates your Bowels and Bladder

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2
Q

What drug can we use for Gluacoma because it cause pupillayr contriction and provides relief of introcular pressure?

A

Carbachol

= Carbon copy of acetycholine

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3
Q

Used to treat people with Open angle and Closed angle glaucoma but causes stimulation of sweat, tears and saliva

A

Pilocarpine

Ach Direct agonist; contracts ciliary mucle of the eye (for open angle)

in closed angle is causes pupillary CONSTRICTION

You cry, sweat, and drool on your PILlow

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4
Q

Stimulates the muscarinic receptors in airway when inhaled

used to dx asthma

A

Methacholine

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5
Q

Drug used post-operatively for neurogenic ileus and urinary retention.

Helps with mysethenia gravis

What is it’s mechanism?

A

Neostigmine

Indirect agnosist or Achecholinesterase Inhibitor

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6
Q

What is the MOA of Neostigmine?

When do we use it?

What are it’s limitiation?

A

Neostigmine = Acetylcholinesterase inhibitor thus INCREASE endogenous Ach

Uses: Post op ileus and to Tx urinary retention, Myasthenis Gravis

Neo or NO ≠CNS penetration

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7
Q

If you wanted to give someone medication for Myasthenia Gravis that they didn’t have to take often, what would it be?

MOA?

A

Pryidostigmine (long acting)

Acetlcholinesterase inhibitor, Increase Ach and increase pts Strength

PyRIDostiGMine gets RID of Myasthenia Gravis

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8
Q

What NT is low in Alzeihmers? How can help with this?

A

Alzeihmers have Low Ach: give acetycholinesterase inhibitor

Donepezil, Rivastigmine, Galatamine

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9
Q

Old man comes in after working outside. He’s flushed, red and very aggitated. He has dry oral mucosal membranes and cycloplegia (loss of ability to accomidate with ciliary musl).

What could he have been exposed to while outiside to cause symptoms?

What is the treatement and why?

A

Think Jimsonweed = alkaloid which causes ATROPINE overdose

Give pts PHysiostigmine

Physiostigmine, phyxes atropine OD (it’ an acetlycholinesterase inhibitor)

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10
Q

When do we use PHysiostigmine?

What’s it’s mechanism of action?

A

Used for Anticholinergic toxicity (like atropine overdose)

Acetycholinesterase inhibitor

will cross the BBB

may be used for glaucoma

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11
Q

What once use to dx Myasthenia Gravis?

What the MOA?

A

Edrophoinum

short acting acetycholinesterase inhibitor to increase endogenouch Ach

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12
Q

What is the clinical applicaiton of Doneprizil?

A

Used for Alzheihmers: it’s and Acetycholinesterase inhibitor

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13
Q

What is a side affect we need to be aware of when prescribing Acetycholinesterase inhibitors?

A

Exacerbation of COPD, asthma and Peptic ulcers

” most end in imine”

Neostigmine, Pyridostigmine, Physostigmine, Edrophinium and Donepezil, rvastigmine, galantamine

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14
Q

Pt comes in with Diarrhea, cough, excessive sweating and his eyes are tearing

HR: 55 but he feels very jittery.

What did he OD on?

What do you rx?

A

DUMBELLS for too much Ach: seen in organophosphate poisoning = acetycholinesterase inhibitor

Tx = Atropine (competitive inhibitor) + Pralidoxime (regenerates AchE if given early)

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15
Q

What two meds do we rx for pt with Acetycholinesterase inhibitor poisoning?

A

Give atropine (muscarininc antagonist) which is a competitive inhibitor

*Atropine will not correct skeletal muscle excitation)

And Pralidoxine which can regenerate AchE (this will correct skeletal muscle excitation)

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16
Q

What is the action you see with Atropine, Homotropoine and Tropicamide?

What receptor do they act on?

A

Used as eye drops to cause Mydriasis or pupil dialation

Blocks binding of Ach to the Muscarinic receptor thus NO pupil constriction

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17
Q

What different actions does pilocarpine and atropine have on the eye?

A

Pilocarpine is a cholimimetic or Ach drug. Binds to M3 to cause pupil cnx

Atropine is an muscarininic competitive antagonist; blocks site where Ach thus INHIBITING the pupil constriction

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18
Q

When would you give a patient Benztropine?

What is it’s mechanism of action?

A

Benztropine is used in Parkinosns

muscarining antagonist on the GABA receptor

“Park my Benz”

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19
Q

When would we prescribe Scopolamine?

How does it work?

A

Scopolamine is motion sickness pathc

muscarinic antagonist (targets M1 in CNS)

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20
Q

Why would we prescribe Ipratropium or Tiotriupium to asthmatic patient?

A

Ipratropium and Tiotropium are muscarinic antagonists

compete at M3 receptor = Bronsoconstriciton which asthmatics don’t like

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21
Q

What is teh clincal application of Oxybutynin?

What is it’s MOA?

A

Oxybutynin is muscarinig antagonist

Used to tx OVERACTIVE bladder (when Ach binds M3 receptores = bladder cnx)

Oxybutynin is competitive antagonist to inhibit binding

Oxybutynin = OxybuTOILET

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22
Q

What drugs are used to treat Spastic bladder?

How do they work?

A

Oxybutynin, Tolterodine, Darfenacin and Trospium

= On The Darn Toilet

musc. antagonist at the M3 receptors to decreased bladder tone.

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23
Q

This drug is used pre-op to reduce drool in pts

A

Glycopyrrolate (muscarinic antagonist)

24
Q

What affect does Atropine have on the body?

When do we use it?

A

Pupil Dilation/ cycloplegia

Decrease Airway secreations

Decrease stomach secreation

Decrease gut motility

Decreast bladder ugency

Blocks the DUMBBeLSS : but NO effect on skeletal muscle

Use: Organophasphate poisoning (too much AchE inhibitor) or to dialate the eye

25
Q

What is the toxicity profile of Atropine?

What pts should NOT be given atropine?

A

Causes acute close angle glaucoma in elderly

Urinary retention in men with BPH

Hyperthermia in infants

Hot (decreased sweating), rapid pulse, dry mouth, flushed skin, cycoplegia, constipation and disorientation

Phix with Physiostigmine

26
Q

Why is Epinephrine used to treat cardiac arrest and dyssrhythmias?

A

increase peripheral resistance via α1receptor-dependent vasoconstriction

and to increase cardiac output via its binding to β1 receptors.

The goal of reducing peripheral circulation is to increase coronary and cerebral perfusion pressures and therefore increase oxygen exchange at the cellular level.

27
Q

What receptors does Epinephrine have the most effect on?

What about at high doses?

A

B1 > a1

B1 = Increase HR, Increases cnx thus Increase CO

High doses ALPHA predominates

28
Q

What is the most common use of epinephrine?

What are some other uses for epinephrine?

A

Use for anaphylaxsis

Used for ashtma as well (B2 causes bronchodiation)

For open angle glaucoma

29
Q

What receptors does Nepi act on?

When do we use it?

A

Alpha 1> Alpha 2 > Beta 1

epinEVERYYTHING

Used for Hypotention or SHOCK

It’s a sympathomimetic

30
Q

Where is epinephrine made?

What is it’s precursor?

When is it released?

A

Made in Noradrenergic axons

Tyrosine—-> DOPA—–> Dopamine—-> to vesicle

Made to Nepi in vesicle then released from Ca+ influx

31
Q

How does Reserpine inhibit the release of Norepinerphrine (and other neurotransmiters?)

A

Blocks VMAT which normally transports free intracellular norepinephrine, serotonin, and dopamine in the presynaptic nerve terminal into presynaptic vesicles for subsequent release into the synaptic cleft

32
Q

What is the effect of drugs like TCAs, Cocaine and Amphetamines on Nepi?

A

All block the reuptake of Nepi into the presynpatic cleft

33
Q

How does Guanethidine decrease release of Norepinphrine

A

Guanethidine is transported by uptake into the presynaptic terminal transported by (NET). + competes with Nepi

It becomes concentrated in Nepi transmitter vesicles, replacing Nepi in these vesicles. –> gradual depletion of norepinephrine stores in the nerve endings. Once inside the terminal it blocks the release of norepinephrine in response to arrival of an action potential

34
Q

Compare and Contrast Nepi and Isoproteroals affect on Blood pressure and heart rate?

****

A
  1. Norepinephrine will INCREASE ? systolic and diastolic pressures as a result of α1-mediated vasoconstriction–> INCREASE ??mean arterial pressure?

Result = reflex bradycardia.

  1. Isoproterenol has little α effect but causes β2-mediated vasodilation, resulting in? DECREASED and? INCREASED _HR t_hrough β1 and reflex activity.
35
Q

What receptors does Isoproteronol act on?

A

B1= B2

Actions: B1 which causes INCREASE heart rate and vaso constriction while B2 causes vasodialation

Overall see Decreaesd Blood pressure (B2 effects)

36
Q

Dopamine acts on what receptors in the body?

What is it used for?

A

D1=D2 >B>a

D1: relax kidney

D2: modulates release of NT in brain

Uses: Unstable bradycardia, heartfail; shock;

inotropic and chornotropic Alpha effects which predominate at HIGH doses

37
Q

What B1 sympathomimetic would use use on Heart Fail pts or in a Stress test?

A

Dobutamine! B1> B2

or Dobutam1ne (for B1 selectivity)

B1= increase HR, vasoconx, increase renin release

38
Q

What receptor does phenyephrine work on?

What does it do?

A

Phenylephrine: Alpha 1 > alpha 2

alpha 1: increas vas sm sml cx, Pupil dilation, Increase bladder sphinter

39
Q

Sympathomimetic that prefers Alpha 1 R

use for Hypotension (cause vasocnx)

Ocular procedures (results in mydriasis)

rhinitis (decongestant)

A

Phenylephrine

40
Q

What B2 sympathomimetics can be used for long acting asthma control or COPD control?

What about acute asthma?

A

B2 sympathomimetic short acting = Albuterol

B2 long acting = Salmeterole for long acting and COPD

41
Q

B2 sympathomimetic used to DECREASE premature UTERINE contractions

A

Terbultaline

bc it’s TWO soon

B2: decreases uterine tone

42
Q

When would we prescribe Amphetamines to a pt?

Whats the MOA?

A

Amphetmaines for Narcolepsy, Obesity, ADD

MOA: indirect sympathomimetic agonist via blocking reuptake and encouraging release of stored cathecolamines

43
Q

Sympathomimetic used to tx nasal decongestion, Urinary incontincenc and Hypotension

A

Ephedrine

Indirect general agonist of cathecholamines: causes release of stores

Nasal decongestion and hypotension: via vasocnx

Urinary incontisnece: increase bladder tone

44
Q

What is the mechanism of action of Cocaine?

What should we avoid giving to someone who has taken cocaine to decrease their HR?

A

Cocain is indrect general agonist: inhibits reuptake of cathecholamines

Causes vasocnx adn local anesthesia;

but B-blocker can lead to UNAPPOSED Alpha 1 activation and e_xtreme HYPERTENSION_

45
Q

Drug used for : ADHD, Tourette syndrome

Hypertensive urgency (limited situations); does not decrease renal blood flow

MOA?

Toxicity?

A

Clonidine

Its an alpha 2 agonist: autoregulation, Decreases SNS

Toxicty: CNS depression, Bradycardia, Hypotension, Respiritory depression and small pupils

46
Q

What drug can you give to pt that is pregnant and has Hypertension?

MOA of drug?

What side effect do we need to be careful for?

A

Methyldopa: a-2 agonist

: thus decreases SNS

Toxicity: Direc Coombs + hemolytic anemia and SLE-like syndrome

47
Q

What is Direct Coombs + Hemolytic anemia?

What drug may cause this rxn?

A

Warm antibody hemolytic anemia

Warm antibody hemolytic anemia is the most common form of autoimmune hemolytic anemia (AIHA); it is more common among women. Autoantibodies in warm antibody hemolytic anemia generally react at temperatures ≥ 37° C.

Stimulate production of autoantibodies against Rh antigen: hemolysis occurs primarily in the spleen.

Methyldopa does this!

48
Q

What drug would you give pre-op to a pts with pheochromocytoma?

What is it’s MOA?

What about toxicity?

A

Phenoxybenzamine to tx pheo!

IRREVERsible Alpha BLOCKER

Toxcity: orthostatic hypotension, reflex tachycardia

49
Q

What could you give to pts that are on MAOIs that ate tyramine because they are idiots?

A

Phentolamine

Alpha-2 Blocker and reversible

50
Q

Alpha 2 blocker used to treat depression

Increases appetite but causes sedation and increased cholesterol

A
51
Q

What effect does a large dose of Epinephrine have on blood pressure BEFORE and AFTER Alhpa blockade?

A

The epinephrine response exhibits reversal of the mean blood pressure change, from a net increase BP (the α response) —-> net decrease BP(the β2 response)

after alpha blockade

Goes from

52
Q

What effect does PHenylephrine have on Blood pressure before and after Alhpa blockade?

A

Phenylephrine has net pressor or INCREASE in Blood Pressure

after alpha blockade

Phenylephrine is suppressed but NOT reveresed (like Ephinenphrine) because it only has Alpha activity

53
Q

Why do we give Beta blockers to patients with Angina Pectoris?

A

B1: Increases HR and Increase muscle contraction

BB will Decrease HR, Decrease Contractility resulting in less O2 conumption by the heart

54
Q

What B blockers are recommened to tx MI?

A

Metoprolol, Carvedilol and Bisoprolol

BB will DECREASE mortality

55
Q

What medications can we give to pt with Supraventricular Tachycardia?

How will they work?

A

Metoprolol or Esmolol (class II antiarrythmics)

DECREASE AV conductance

56
Q

Why do we use B blockers to treat hypertension?

What is the reason we give B blockers to Heart Fail pt?

A

?DECREASE cardiac output,? DECREASE renin secretion (due to β1-receptor blockade on JGA cells)

Decrease Mortality HF pts.

57
Q

What B blockers are B1 selective?

A

β1-selective antagonists (β1 > β2)—acebutolol (partial agonist),

Atenolol, Betaxolol, Esmolol, Metoprolol

*Selective antagonists mostly go from A to M (β1 with 1st half of alphabet)

Step 1 Pharm (15 decks)

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