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Body % water, % ICF, % ECF
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diphenylhydramine/ benedryl
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H&N Pharm

Pharm H&N, lecture 10

QuestionAnswer
Body % water, % ICF, % ECF 60% water, 40% ICF, 20% ECF
diphenylhydramine/ benedryl anti histamine Histamine type 1 receptor inverse agonist
Cimetidine Acid reducer H2 receptor blocker
Tamulosin increase urine flow
nifedipine -dipine decrease BP, anti-hypertensive block Ca channels
sildenafil treat erectile dysfunction increases cGMP
cholinergic nicotinic receptor type ligand gated ion channel
-caine local anesthetics block Na channels
-zepam (benzos) anti-anxiety drugs open Cl channels
tolbutamide -amide sulfonyl ureas treats Type 2 diabetes increase insulin from beta cells in pancreas close K channels
nitroglycerin nitric oxide causes vasodilation via opening K channels
Beta 1 mechanism Gs increases cAMP
alpha 2 mechanism Gi decreases cAMP
alpha 1 mechanism GQ increases Ca
Insulin receptor mechanism tyrosine kinase recruits glucose transporters to cell membrane from intracellular reserves
Aspirin irreversible inhibition of COX (cyclooxygenase)
Acetaminophen competitive inhibitor of COX (cyclooxygenase)
Reversible COX inhibitors ibuprofen, acetaminophen
Caffeine non specific inhibitor of PDEs, stimulant, increases HR
Theophylline specific to cAMP PDE in lungs, bronchodilation
PDE inhibitors caffeine, theophylline, sildenafil
sildenafil cGMP PDE5 inhibitor on corpus cavernosum
enalapril -april ACE inhibitor
ciproflaxacin fluoroquinolone, inhibits DNA gyrase & topoisomerase
fluoxetine SSRI, antidepressant
chloroquine antimalarial
Advantages of gene therapy replace a dysfunctional gene, create continuous production of deficient protein, target specific cells, maximize compliance
Gene therapy vectors Plasmids: does not integrate into host DNA Virus- based vectors: Retrovirus: RNA virus integrates into host DNA Adenovirus: double strand DNA that can transfer to non-dividing cells, largest segments, but not integrative
Adenovirus adv & disadvantages -capable of integrating in both dividing and nondividing cells -can insert a large piece of DNA -Not integrative, so effect is transient
Full vs partial agonist Full agonist only binds to active receptors
Noncompetitive or uncompetitive antagonist Prevents receptor activation, reduces max response
Inverse agonist vs antagonist Antagonist has no effect without agonist Inverse agonist has effect without agonist
Therapeutic index LD50/ ED50 Bigger is better
Low therapeutic index drugs "The Queen Likes Digging Low" Low therapeutic index Theophylin (asthma), Quinine (anti-arrhythmic), Lithium (bipolar), Digoxin (cardiac)
succinylcholine only depolarizing NMJ blocker, "flaccid paralysis" by inhibiting stimulation by Ach at NMJ, half life of one minute, used in surgery
curare non-depolarizing NMJ blocker, half life 1 hours, patients come off by achetylcoline esterase inhibitor and muscarinic antagonist
gallamine non-depolarizing NMJ blocker, half life 1 hours, patients come off by achetylcoline esterase inhibitor and muscarinic antagonist
Atropine competitive inhibitor of ach at muscarinic receptors, blocks M2 muscarinic receptors; increase HR by blocking vagal affect on SA node (dec HR at low levels), decrease secretion, decrease mictutition, decrease accomodation; can enter CNS; can treat nerve
Cholinergic antagonists/ antimuscarinics inc HR, inc CV, mydriasis, cycloplegia (inability to focus), dec GI motility, dec secretions, urinary retention; include atropine, scopolamine, glycopyrollate, scopolamine; ipratroprium for bronchiodilation in COPD
Depolarizing NMJ antagonist succinylcholine, binds Nm receptor, opens channel in end plate, depolarizes endplate, blocks receptor so desensitized to effect of ach, transient fasciculations then flaccid paralysis
Non-depolarizing NMJ antagonist competitive antagonist, bind Nm receptor, do not open ion channel, produce skeletal muscle relaxation, include -"cur"- drugs, *d-tubocurarine* and *gallamine*; toxicity causes respiratory paralysis so mechanical ventilation required,
bring patient off *d-tubocurarine* and *gallamine* half life 1 to 2 hours, bring patient off with cholinesterase inhibitors & muscarinic antagonist (to prevent overstimulation at muscarinic receptors)
Malignant hyperthermia autosomal dominant disorders with rapid increase temp and serum potassium in response to inhalation anesthesics or muscle relaxants (succinylholine) increase in Ca, muscle contraction; treat with ice & dantrolene to block Ca from SR
PAM regenerates Ach Esterase, does not enter CNS, treat nerve gas
Sarin nerve gas, inhibits cholinesterase, stopping Ach degradation, build up of Ach at synapses
Cholinergic agonist/ cholinomimetics dec HR, dec CV, miosis, accomodation, increase GI motility, bronchoconstriction, increaase secretions, promote urination
Cholinergic antagonists/ antimuscarinics inc HR, inc CV, mydriasis, cycloplegia (inability to focus), decrease GI motility, dec secretions, urinary retention; include atropine, scopolamine, glycopyrollate to dec secretions; scopolamine for motion sickness; ipratropprium for bronchiodilation in C
Cholinergic antagonist for asthma block constriction (dilation) via blocking muscarinic receptor on central airways, muscarinic receptor constant rate through aging, e.g. ipratropium
Adrenergic agonist for asthma bronchodilation via activating beta 2 receptors in small peripheral airways, incrases adenyl cyclase, incraeses cAMP to promote relaxation, beta 2 receptors in airways reduce with age, e.g. albuterol
Xanthines inhibit PDE, which breaks down cAMP to increase cAMP and promote smooth muscle relaxation, includes caffeine, theophylline, , and theobromine
Albuterol adrenergic agonist on beta 2 receptors, bronchodilation for asthma and COPD with side effect of chest pain
Ipratroprium cholinergic antagonist on M3 receptors for bronchodilation for asthma & COPD, side efects of dry mouth and sedation
Theophylline methyl xanthine, acts on adenosine receptors for bronchodilation, treats asthma & COPD, side effects inc heart rate, inc force of contraction, increase gut secretions
Scopolamine patches, treats motion sickness
How do you treat an atropine overdose 1) treat symptoms 2) provide cholinesterase inhibitor eg psysotigmine, in small doses 3) blankets for cold and diazepam for seizure control
Ganglionic blockers interfere with post synaptic action of Ach at Nicotinic Nn receptors of all autonomic ganglia, treat hypertension in ER or during surgery, side effects include Nm blockade, hypotension, impotence; include nicotine, mecamylamine, trimethaphan
NMJ blockers drugs that bind competitively to nicotinic receptor, classified as de-polarizing or non-depolarizing
Depolarizing NMJ antagonist binds Nm receptor, opens channel in end plate, depolarizes endplate, and blocks receptor so desensitized to effect of ach, produces skeletal muscle transient fasciculations followed by flaccid paralysis; eg succinylcholine
Non-depolarizing NMJ antagonist competitive antagonist, bind Nm receptor, do not open ion channel, produce skeletal muscle relaxation, include -"cur"- drugs, *d-tubocurarine* and *gallamine*; toxicity causes respiratory paralysis so mechanical ventilation required,
Malignant hyperthermia autosomal dominant disorders with rapid increase in temp and serum potassium in response to inhalation anesthesics or muscle relaxants (succinylholine) caausing increase in Ca, muscle contraction, heat cycles; treated with ice packs & dantrolene to block
Dantrolene treats malignant hypothermia
Botulinum toxin prevents release of acetylcholine in synaptic terminal by cleaving SNAP 25 to
Atropine competitive inhibitor of ach at M2 muscarinic receptors; increase HR by blocking vagal affect on SA node (dec HR at low levels), dec secretion, decrease mictutition, decrease accomodation; can enter CNS; treat nerve gas (excess Ach)
ANS on SA node, b1 (b2) Increased heart rate & M2 Decreased heart rate
ANS on Atria b1 (b2) Increased contractility & M2 Decreased contractility
ANS on AV node b1 (b2) Increased Conduction Velocity & M2 Decreased Conduction Velocity
ANS on His-Purkinje b1 (b2) Increased Conduction Velocity & M2 Decreased Conduction Velocity
ANS on Ventricles b1 (b2) Increased Contractility & little effect on contractility
Sympathetic stimulation of Arterioles blood supply increases, decreases, or same due to a1/b2 receptor rato & local demand)
ANS on Arterioles a1 Constriction, b2 dilation* ; No PS innervation
ANS on Veins a1 Constriction*, b2 dilation ; No PS innervation
ANS effects on Eye pupil dilation mydriasis via sympathetic for far vision; Constriction & accommodation via parasympathetic for near vision, reading
ANS on Radial muscle-iris a1 Contraction (mydriasis) ; no PS innervation
ANS on Sphincter muscle-iris no sympathetic innervation, PS stimulation causes Contraction / miosis M3
ANS on Ciliary muscle b2 relaxation (far vision), Contraction (reading) M3
ANS on Lung Smooth muscle b2 relaxes – bronchodilation, M3 bronchoconstriction
ANS on GI Motility & tone decreases –a2 inhibition, b2 relaxation, PS increases motility, increases secretions
ANS on GI Sphincters a1 contraction of sphincter, PS relaxation of sphinters
ANS on GI Secretions a2 decrease, PS Stimulation M3 on M3 increases secretions
ANS effect on Bladder sympathetic – difficult to urinate; parasympathetic – facilitates urination
ANS on bladder Detrusor muscle symp b2 relaxation; PS M3 Contraction
sympathetic effect on Pancreas keep glucose levels up; less insulin, more glucagon
ANS effect on b-cells producing insulin in pancraes a2 inhibits release, PS Stimulates release
ANS effect on a-cells producing glucagon in pancreas b2 stimulates release, PS inhibits release
ANS effect on Liver sympathetic - increased glycogen breakdown & gluconeogenesis
ANS effect on Gluconeogenesis sympathetic on b2 increases gluconeogenesis to increase glucose, PS increase Glycolysis
ANS effect on Glycogen breakdown sympathetic on b2 – increase glycogenolysis, PS increase glycogen synthesis
ANS effect on Insulin receptors sympathetic a1 inactivation of insulin receptors by dephosphorylation to increase blood glucose, PS insulin receptors activated
ANS effect on Adipose sympathetic stimuation causes breakdown of triglycerides, supply fatty acids to rest of the body
ANS effect on Adipocytes symp on b1, b3 lipolysis, PS stimulates fat synthesis, storage
ANS effect on Kidney b1 – rennin secretion goes up
ANS effect on Pituitary b1 – ADH secretion goes up
Where are MOST of the beta 1 receptors located in our body Heart
Adrenergic nervous system is generally mediated by Norepinephrine and Epinephrine. Name an EXCEPTION to this general rule Temperature control & Sweat glands by acetylcholine
What is the effect of an alpha 2 agonist on blood glucose levels Increase, alpha 2 lowers insulin levels, lower insulin increases glucose levels
You prescribe Terazosin (Hytrin), an alpha-1 blocker to an elderly male for an enlarged prostate. What is the effect of an alpha-1 blocker on blood pressure decrease
What is effect of prednisone on a. Blood pressure, b. Blood glucose levels, c. Blood lipid levels, d. Weight e. Blood CRH levels f. Blood Cortisol levels g. Blood ACTH levels h. Ability to fight infections i. Fluid retention a. Blood pressure (incr), b. Blood glucose levels (incr), c. Blood lipid levels (incr)d. Weight (incr) e. Blood CRH levels (decr)f. Blood Cortisol levels (decr)g. Blood ACTH levels (decr)h. Ability to fight infections (decr)i. Fluid retention (incr)
The autonomic nervous system is responsible for ____ homeostasis
Within the autonomic nervous system, there are always how many neurons needed to reach the target organ _two
All preganglionic neurons release _______, which binds to ____ receptors on the postganglionic neurons acetylcholine, nicotinic
The sympathetic nervous system is (catabolic/anabolic) and is often called the (craniosacral/thoracolumbar) system. The preganglionic fibers connect with (few/many) postganglionic fibers catabolic, thoarcolumbar, many
The parasympathetic nervous system is (catabolic/anabolic) and is often called the (craniosacral/thoracolumbar) system. The preganglionic fibers connect with (few/many) postganglionic fibers anabolic, craniosacral, few
Within the parasympathetic system, the postganglionic fibers release __, which interacts with ____ receptors acetycholine, muscarinic
Within the sympathetic system, most of the postganglionic fibers release __, which interacts with __ _ receptors norepinephrine, α or β
Noradrenaline is also called _norepinephrine___
Adrenaline is also called _epinephrine__
Acetylcholine is synthesized from ___ and ____. It's action is terminated by _____ (enzyme name) acetylCoA, choline, cholinesterase
What is the rate-limiting step in the synthesis of epinephrine tyrosine hydroxylase
How is the effect of norepinephrine terminated reuptake
In the resting state, most dually innervated organs are controlled by the what system parasympathetic
Which important organs/cells are not dually innervated blood vessels (symp only, alpha 1 constrict and beta 2 relaxation), skin (symp only, beta 1?), radial/ dilator muscle (symp only, alpha 1 mydriasis or dilation), and sphincter/ constrictor muscle (PS only, M3 miosis or pupil constriction)
In the eye, the sympathetic nervous system innervates the __________ muscle, which causes _____________, or ___________. The parasympathetic nervous system innervates the ____________ muscle, which causes ________________, or __________ sympathetic radial for mydriasis, parasympathetic sphincter for miosis
ß1 receptors are found predominantly in the _______ heart
Activation of α1 receptors causes ______________________ constriction of blood vessels, constriction of GI sphincters, constriction of urinary sphincter, inactivation of insulin receptor in liver causing blood glucose increase,
Activation of ß2 receptors causes _____________ of smooth muscle relaxation
To stimulate dilation of the bronchioles in an asthmatic patient without causing stimulation of the heart, it would be best to give a selective ____ stimulant beta 2 selective stimulant
Why do drugs that increase acetylcholine transmission, such as anticholinesterases, promote sympathetic as well as parasympathetic responses both PS and sym use Ach at first synapse
A drug that can dilate the pupil and simultaneously block accommodation of the lens is a drug that (stimulates/blocks) (adrenergic/cholinergic) receptors blocks cholinergic
Adrenomimmetics drugs that produce response by interacting with alpha or beta adrenoreceptors on sympathetic effector cells, direct, indirect, reuptake inhibition or COMT & MAO inhibitors
Direct adrenomimmectis eg epinephrine, norepinephrine, dopamine at high conc, isoproterenol
Indirect adrenomimetics cause release of NE, eg tyramine, ephedrine, amphetamin
Cathecolamine reuptake inhibitors cocaine, imiprisine, amirtryptyline, SSRIs
COMT & MAO inhibitors increase catecholamine levels by inhibiting breakdown
Adrenergic receptors G protein coupled receptors, alpha1, alpha2, beta1, beta2, beta3
Norepinephrine acts on alpha 1&2, beta 1, but not beta 2; most same effects as epinephrine but with beta2, it does not dilate bronchial smooth muscle to dilate airways and does not dilate blood vessels to skeletal muscles,
Epinephrine all adrenergic receptors, beta1 to incr HR,CO,contract&lusitropy, alpha1 dilates pupil, beta2 dilates bronchial sm muscle, alpha1 constricts vessels to skin, beta2 dilates vessels to sk muscle, beta2 relax GI, alpha1 contracts sphincters, inc glucose
Sympathetic innervation blood vessels to skeletal muscle primarily beta2 to dilate, at high levels of epinephrine, alpha1 to constrict blood vessels
Why do local anesthetic contain epinephrine to achieve vasoconstriction through alpha1 receptors to keep anesthetic local
Isoproterenol acts on adrenergic beta but not alpha, large group on amine nitrogen increases affinity for beta receptor, same effects as epinephrine except not dilate pupils, not constrict blood vessels to skin, not contract GI & bladder sphincters
Catecholamines on glucose level epinephrine has strongest effect on glucose level because it acts on alpha1&2, beta 2 of pancreas to decrease insulin and increase glucagon, while norepinephrine doesnt act on beta2 and isoproterenol doesn't acts on alpha
Dopamine acts on dopamine receptors, and with increasing concentrations Beta1 then alpha 1 then alpha2
Sympathetic innervation of veins alpha1 predominates on veins, so epinephrine and norepinephrine constrict veins to increase BP, alpha1 & beta2 together in capillaries
Epinephrine effect on vessels to skeletal muscle dose dependent; at low dose, activates beta2 for dilation, and high dose, activates alpha1 for constriction
Sympathetic stimulation effect on blood supply to different organs increase to heart, lungs and skeletal muscles, brain stays same, decrease to skin, GI, and genitals
Norepinephrine effect on heart sudden increase in peripheral resistance due to contriction of blood vessels with stimulation of alpha1 & not beta2, increase in systolic, diastolic, & MAP, induces reflex bradycardia
Epinephrine effect on heart peripheral resistance decreases through beta2 stimulation, systolic pressure increases, diastolic pressure decreases, MAP stays same, pulse increases with rate of contraction through beta1
isoproterenol effect on heart peripheral resistance decreases through vasodiation through beta2 receptors, significant decrease in diastolic and slight increase insystolic, slight overall decrease in MAP, increased pulse rate due to increase contraction rate through beta1
presynaptic autoreceptors alpha2 for NE on presynaptic terminal to monitor amount of NE being released to downregulate NE release when NE excess
Created by: rcconrad
 

 



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