test 2 misc

Question 1

what pt populations are muscarinic agonists contraindicated

Answer 1

Asthma

urinary or GI obstruction

hyperthyroidism - muscarinic agonist causes bradycardia and hypotension, baroreceptor reflex attempts to return the BP back to normal so it causes the release of norepinephrine from sympathetic nerves that regulate heart rate. In hyperthyroidism, norepinephrine has a larger risk of induce cardiac dysrhythmias bc they are very sensitive to the effects of norepienephrine.

pt with hypotension

peptic ulcer disease - stimulates acid production in GI

Question 2

Bethanechol
Cevimeline
pilocarpine

Answer 2

muscarinic agonists

Question 3

muscarinic agonist used in xerostomia (dry mouth) and Sjorgren syndrome

Answer 3

Cevimeline

Question 4

Muscarinic agonist used in glaucoma

Answer 4

Pilocarpine

Question 5

resp bronchospasm
excessive bronchial secretions
bradycardia
hypotension
Profuse salivation
n/v
abd pain
diarrhea
fecal incontinence
diaphoresis
lacrimation
miosis

can lead to cardiovascular collapse if not treated

Answer 5

muscarinic Poisoning (Tox)

Question 6

treatment of muscarinic poisoning

Answer 6

Atropine

Question 7

what is the drug of choice for Myasthenia Gravis

Answer 7

Pyridostigmine which is a reversible cholinesterase inhibitor

Question 8

responses to cholinesterase inhibitor

Answer 8

bradycardia
bronchial constriction
urinary urgency
increased glandular secretions
increased tone and motility of gI
miosis
focusing on the lens for near vision

Question 9

at therapeutic doses , cholinesterase inhibitors due what to skeletal muscle

Answer 9

increase force of contraction

Question 10

at toxic doses, cholinesterase inhibitors due what to skeletal muscle

Answer 10

reduce force of contraction

Question 11

if administered in toxic doses cholinesterase inhibitors can produce ________ _________.

Answer 11

Neuromuscular blockade which can cause paralysis of the resp muscles and can be fatal

Question 12

what is the drug of choice for treating poisoning caused by atropine and other drugs that cause muscarinic blockade including antihistamines and phenothiazine antipsychotics but NOT tricyclic antidepressants because this can cause seizures and cardiotoxicity

Answer 12

Physostigmine (cholinesterase inhibitor)

Question 13

what 3 cholinesterase inhibitors are approved for Alzheimers Disease

Answer 13

Donepezil (Aricept)
Galantamine (Razadyne)
Rivastigmine (Exelon)

Question 14

what cholinesterase inhibitor is approved for dementia of Parkinson disease

Answer 14

Rivastigmine (Exelon)

Question 15

what is the only indication for using a irreversible cholinesterase inhibitor (organophosphate cholinesterase inhibitors) and what drug is it?

Answer 15

glaucoma
echothiophate (Phospholine Iodide)

this class of drugs was used in WWII for nerve agents

Question 16

Cholinesterase reactivator used to reverse the inhibition of cholinesterase specific to organophosphates

this will not work for reversal of poisonings from reversible cholinesterase inhibitors

Answer 16

Pralidoxime

Question 17

toxic doses of irreversible cholinesterase inhibitors produce what time of effects (cholinergic crisis)

Answer 17

excessive muscarinic, nocotinic and CNS effects

profuse secretions from salivary and brochial glands
involuntary urination
involuntary deification
laryngospasm
bronchoconstriction

nicotinic effects
muscle weakness
cramps
twitching

Question 18

what are common means of poisoning my a cholinesterase inhibitor

Answer 18

insectasides

Question 19

treatment for cholinergic crisis from toxicity of cholinergic inhibitors

Answer 19

atropine ->reduce muscarinic stimulation
Pralidoxime ->reverse inhibition of cholinesterase
benzodiazepine (diazepam) to suppress convulsions
mechanical ventilation and oxygen for resp depression/failure

Question 20

treatment for Myasthenia Gravis

Answer 20

Reversible cholinesterase inhibitors
Pyridostigmine

only symptom relief - will need to be on this long term

Question 21

a neuromuscular disorder characterized by fluctuating muscle weakness and a predisposition to rapid fatigue

symptoms
ptosis (drooping eyelids)
difficulty swallowing
weakness of skeletal muscles

severe symptoms
difficulty breathing from weakness of resp muscles

Answer 21

Myasthenia Gravis

Question 22

why does MG occur

Answer 22

autoimmune process pt immune system attacks nicotinic M receptors

Question 23

dosing for MG

Answer 23

pt taught to adjust doses

signs of undermedication - ptosis, difficulty swallowing

signs of over med -excessive salivation and other muscarinic responses

may need more 30-60 min prior to exertion such as eating or shopping

balance to prevent myasthenic crisis to cholinergic crisis

Question 24

what is myasthenic crisis

Answer 24

pt who are not adequately medicated

extreme muscle weakness caused by insufficient ACh at the NMJ - can result in death if not treated by paralysis of resp muscles

Question 25

what is given for myasthenic crisis

Answer 25

neostigmine (cholinesterase inhibitor)

Question 26

what is given to an MG pt for muscarinic poisoning

Answer 26

resp support plus atropine

Question 27

what do you do if you cant tell if its myasthenic crisis or cholinergic crisis since the symptoms overlap. Lets say you don’t have a story to go with the symptoms

Answer 27

challenge dose of edrophonium (ultrashort acting cholinesterase inhibitor)

if it alleviates symptoms, the crisis is myasthenic
if it intensifies symptoms the crisis is cholinergic

have oxygen and atropine ready - this is controversial and could be very dangerous

Question 28

What is the EF for heart failure with systolic dysfunction

Answer 28

usually less than 40% (reduced left ventricular function)

Question 29

What is the EF for heart failure with diastolic dysfunction

Answer 29

usually its normal. This is a stiffening of the left ventricle

Question 30

stretch of the ventricle prior to contraction. created by blood filling the ventricle prior to the contraction

Answer 30

preload

Question 31

resistance the left ventricle has to overcome to empty its contents into peripheral circulation

Answer 31

afterload

Question 32

pressure within the periphery that the left ventricle must overcome with each contraction

Answer 32

peripheral vascular resistance

Question 33

Pt teaching for HF

Answer 33

importance of med compliance
pt participation in treatment plan
Daily weights (if they gain 3-5 lbs in a week - report) 
healthy diet
fluid restriction when applicable