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Med Pharm Block 1
Intro and ANS drugs
| Question | Answer |
|---|---|
| What the 4 primary DIRECT activators of the cholinergic receptors? | (M) bethanechol, (M and N) methacholine, (N) nicotine, (M) pilocarpine |
| Name the 3 main *reversible AChE inhibitors | edrophonium, physostigmine, and neostigmine |
| Which receptors do AChE inhibitors activate (INDIRECTLY)? | Cholinergic receptors |
| Which receptors are primarily linked to parasympathetic system? | Cholinergic |
| Which receptors are primarily linked to sympathetic system? | Adrenergic |
| Name the 3 main *irreversible AChE inhibitors | echothiophate, malathion, and parathion |
| Muscarinic and Ganglionic Blockers act as _______ Receptor Antagonists? | Cholinergic |
| List 4 common Muscarinic blockers | atropine, benxtropine, ipratropium, scopolamine |
| List 3 common Ganglionic blockers | hexamethonium, mecamylamine, trimethaphan |
| Name 2 alpha 1 agonists | phenylephrine, methoxamine |
| Name 2 alpha 2 agonists | clonidine, methyldopa |
| Name 2 beta (non specific) agonists | isoproterenol (B1=B2), dobutamine (B1>B2) |
| Name 4 beta 2 (specific) agonists | albuterol, ritodrine, terbutaline, salmeterol |
| _______, __________, and __________ are known as mixed adrenergic receptor activators. | dopamine, epinephrine, and norepinephrine |
| _______ is a D1, B1, a1 agonist | dopamine |
| _______ is a a1, a2, B1, B2 agonist | epinephrine |
| _______ is a a1, a2, B1 agonist | norepinephrine |
| Name 4 *INDIRECT-acting drugs acting on adrenergic receptors | cocaine, ephedrine, amphetamine, tyramine |
| Name 3 a1 antagonists | doxazosin, prazosin, terazosin |
| Name 2 a2 antagonists | yohimbine, mirtazapine |
| Name 2 non-selective alpha antagonists | phenoxybenzamine, phentolamine |
| Name 3 B1 (cardioselective) blockers | acebutolol, atenolol, metoprolol |
| Name 3 NON-selective beta (B1,B2) blockers | pindolol, propanolol, timolol |
| Name 2 mixed adrenergic receptor antagonists | carvedilol, libetalol |
| What is the drug that is a selective alpha 1A blocker? | tamsulosin |
| Which drug is recommended to use when desired effects act only on bladder? | alpha 1A blocker- tamsulosin |
| Which family of drugs to use when managing HTN? | Selective alpha 1 blockers |
| Which drug is known to cause floppy iris syndrome? | tamsulosin |
| Which beta blocker is water soluble and doesn't cross the BBB? | Atenolol |
| Use ______ to treat patients with cardiovascular shock. | beta 1 agonist |
| Which drug blocks uptake of choline which leads to decreased amount of ACh in system? | hemicholinium |
| Which drug suppresses ACh release into synapse by blocking synaptobrevin enzyme? | Botulinum toxin |
| In what clinical scenarios can botulinum toxin be used? | to decrease spasms in periphery post stroke; to decrease spasms in pt with cerebral palsy; to treat eye twitching |
| Which receptors control secretion? | Muscarinic |
| which receptors are NOT INNERVATED? | beta 2 |
| _______ is a hormone and therefore doesn't require receptor to be innervated | Epinephrine |
| ALL baroreceptor reflexes can be blocked using a __________ ganglionic receptor agonist | ganglionic (Nn) |
| Reflex bradycardia can be blocked by administering a ____________ | Muscarinic blocker |
| Reflex tachycardia can be blocked by administering a ____________ | beta 1 blocker |
| When treating high BP there is a risk of causing reflex __________ | bradycardia |
| When treating low BP there is a risk of causing reflex __________ | tachycardia |
| ________ are used to increase nicotinic and mucscarinic stimulation | AChE inhibitors |
| NEVER use _______ in Asthma pateints | muscarinic agonist |
| ________ act as negative feedback to decrease sympathetic drive, therefore, primary use is in HTN | alpha 2 agonist |
| Which drug is best used to treat HTN during pregnancy because of the fact that it is highly protein bound? | methyldopa |
| Methyldopa carries the risk of causing ________ | hemolytic anemia |
| __________ is an example of an amphetamine and is used in treatment of ADHD and narcolepsy | methylphenidate |
| Vd= | amt of drug (D)/plasma drug conc (Co) |
| CL= | rate of elimination/plasma drug conc |
| t1/2= | .7 x Vd/CL OR .7/k |
| LD= | Cp x Vd/f |
| MD= | Cp x CL/f OR CL x Css x dosing interval/f |
| extraction ratio= | C/Q OR Ci-Co/Ci |
| organ clearance= | Q x ER |
| Diffusion Rate= | (C1-C2) x permeability coefficient/thickness x Area |
| If patient overdoses on a weak acid drug, excretion can be accelerated by... | alkalinizing the urine (give BiCarb) |
| Competetive Nm blcoker can be reversed by giving _________ | Neostigmine |
| _________ AChE is the only active form | acetylated |
| Pre-treat with _________ to reduce Parasympathetic ANS side effects of AChE inhibitors | Muscarinic blockers-- atropine |
| Neostigmine will not act on ______ because lack of innervation | M3 in blood vessels |
| What is the best treatment for botulin toxin poisoning? | Calcium |
| Before doing surgery to remove a Pheocromocytoma tumor pre-treat with ________ | alpha blocker |
| What drug is prescribed for hypotension? | alpha 1 agonist |
| List 2 common uses of Phenylephrine | nasal decongestant and ophthalmologic use (mydriasis without cycloplegia) |
| What is the best drug to use to treat Cardiovascular shock? | beta 1 agonist |
| What drug is contraindicated in treatment of atherosclerotic patients? | Epinephrine |
| Activation of which receptors cause platelet aggregation? | alpha 2 |
| Activation of alpha 1 receptors leads to ________ in the eye | contraction of the radial muscle -- mydriasis without cycloplegia |
| _____ is known as the 'chief relaxer' when activated | beta 2 |
| alpha 1 agonists lead to reflex ________ | bradycardia |
| Methaoxamine causes an increase in ____ which may elicit a reflex ______ | BP, bradycardia |
| _________ cause an increase in SBP and a decrease in DBP | beta agonists (non-selective) |
| What is a drug that is a selective beta 1 agonist in which there is a greater effect on contractile force compared to HR? | Dobutamine |
| Selective beta 2 agonists are used in the treatment of _______ | asthma |
| When precribing medication to diabetic patients be cautious of _______ and _______ | beta 2 agonists and antagonists |
| If taking MAO inhibitors be cautious about taking eating __________and _________ because it could lead to hypertensive crisis | red wine and cheese-- they are high in tyramine |
| When using alpha antagonists to decrease BP--- to prevent reflex tachycardia pretreat with ________ and to prevent salt and water retention pretreat with ________ | beta blocker, diuretics |
| To treat anaphylaxis use __________ as it will _______ histamine, ________ BP and relieve __________ | epinephrine, increase, decrease, bronchospasm |
| Why is tyramine usually not harmful? | the bioavailability is limited by MAO-A metabolism in the gut and liver |
| Amphatamines are psychostimulants due to the central release of ____, ____, and ____ | DA, 5HT, NE |
| ________ is used as a cold medicine | Ephedrine |
| Indirect acting adrenergic receptor agonists act only in the effector tissue on receptors _______and _______ | alpha 1 and beta 1 |
| __________ is the drug of choice (doc) for pheochromocytoma | phenoxybenzamine |
| __________ is a non-selective noncompetitive irreversible alpha blocker | phenoxybenzamine |
| __________ is a non-selective competitive reversible alpha blocker | phentolamine |
| Phentolamine is used to treat ______________ | acute hypertension |
| List 2 common drugs used to treat Glaucoma | timolol, betaxolol |
| What anti-arrhythmic drug is used that blocks K+ channels and beta receptors? | Sotalol |
| What is the ONLY beta blocker used to treat hyperthyroidism? | propanolol |
| Why is propanolol used in the treatment of hyperthyroidism? | It inhibits deiodinase (req for the conversion of T4 to T3) |
| What receptor controls production of aqueous humor? | beta 1-- blocking it decreases production |
| Pilocarpine and Echothiopate are commonly used in he treatment of _____________ | closed- angle glaucoma |
| Alpha 1 agonists and Muscarinic blockers both cause ___________, which is contraindicated in patients with glaucoma. | Mydriasis |
| M agonists and beta blockers are used to treat ________ | glaucoma |
| __________ increase glycogenolysis, gluconeogenesis, and lipolysis | beta 2 agonists |
| _________ is used to treat shock | dopamine |
| _________ is used to inhibit the rate limiting step, Tyrosine hydroxylase, in the formation of dopamine form tyrosine | Met tyrosine |
| Name 3 known re-uptake blockers in the adrenergic neuroeffector junction | cocaine, TCA's, imipramine |
| alpha 2 receptors act in a feedback mechanism-- when blocked leads to _______ of NE and when activated leads to _______ of NE | increase, decrease |
| Guanethidine is contraindicated in ____________ | pheocromocytoma |
| What is the drug used to fill the storage vesicles and push NE out? | Reserpine |
| Muscarinic blockers cause ___________________ whereas alpha 1 agonists cause ______________ | mydriasis with cycloplegia, mydriasis without cyclopegia |
| Ipratropium and Triotropium are doc in treatment of __________ | asthma |
| __________ is used int he treatment for ophthalmology | Tropicamide |
| What drug used in treating motion sickness also causes sedation and anterograde amnesia? | Scopolamine |
| Name 2 drugs that are lipid-soluble (CNS) used in parkinsonism | Benztropine, trihexyphenidyl |
| Muscarinic blocker overdose causes _________, _________, and __________ | cardiotoxicity, convulsions, and coma |
| Use _________ to treat acute intoxication of atropine or any other M blocker | physostigmine |
| Ganglion blocking agents ___________ the dominant tone | decrease |
| For effector tissues with dual innervation _________ is dominant | parasympathetic |
| Sympathetic is dominant when it comes to _________ and _________ | vascular tone and thermoregulatory sweat glands |
| Chronic ___________ poisoning mimics MS and there is NO treatment | Organophosphate |
| To treat acute organophosphate toxicity use _________ | M blocker-- atropine |
| AChE inhibitor poisoning leads to excessive stimulation of the parasympathetic system which presents as ____________ | DUMBELSS, diarrhea, urination, miosis, bradycardia, bronchconstriction, muscle excitation, lacrimation, salivation, sweating |
| __________ and __________ DO NOT enter CNS because they are quaternary amines | Neostigmine, prydostigmine |
| St Johns Wart is a ____________ | reuptake inhibitor/inducer |
| Drugs that end in -osin are _____________ | alpha 1 blockers |
| Ergo derivatives are used after child birth to________ | stop bleeding-- hemorrhaging |
| DOC to stimulate peristalsis when gut isn't moving or relieve bladder in urinary retention | bethanechol |
| DOC in treatment of Sjrogen or sweat test in CF pt | Pilocarpine- M3 agonist |
| Drugs that act directly on the Nn receptors can cause | drug induced pheocromocytoma |
| Give a _________ blocker to cause paralysis for emergency, surgery, set a dislocated shoulder, etc | Nm blocker |
| _________ receptors have no 2nd messenger system other than Na/K channels | Nn and Nm |
| When treating with Epinephrine, if pre-treat with ________ it will __________ effect of epinephrine | reuptake inhibitor, increase |
| Name 3 drugs used in treatment of Alzheimer's | Tacrine, Donepzil, Rivastigmine |
| Why use AChE inhibitors to treat Alheimer's? | Alzheimer's is associated with loss of ACh neurons in Meynert's nuleus |
| Name 2 common organophasphates and 1 nerve gas | malathion, parathion sarin |
| Drugs that are ISA which is partial agonist | pindolol, acebutolol |
| Beta agonists such as __________ and __________ carry the risk of angina, flushing and arrhythmia | dobutamine and isoproterenol |
| name 2 drugs that go through enterohepatic circulation | digitoxin and indomethacin |
| CL= | free faction x GFR ff is %that is not protein bound-will be given |
| Continued or repeated exposure to agonists can desensitize receptors by changing binding affinity | Desensitization or tachyphylaxis |
| ________occurs after continued exposure to antagonists, which leads to up-regulation of receptors | super-sensitivity |
| ________ is decrease is number of receptors on cell wall and is responsible for drug tolerance | down-regulation |
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