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Pharmacology > EX 3 Cholinergic > Flashcards

EX 3 Cholinergic Flashcards

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1
Q

What is the baroreceptor reflex?

A

feedback loop between the spinal cord and brain

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2
Q

what does the baroreceptor reflex do?

A

regulates BP and maintaines homeostasis
- watch for BP changes and sends a message to the brain

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3
Q

what is an agonist

A

molecules that activate reptor

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4
Q

what is an antagonist

A

prevents or blocks receptoractivation

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5
Q

these mediate responses to epinephrine and norepinephrine

A

adrenergic drugs

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6
Q

what are the Alpha1 adrenergic agonists/ which drugs act directly on the Alpha 1 receptor

A

Phenylephrine
epinephrine
norepinephrine

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7
Q

Where does the Alpha 1 receptor work on and what happens when activated

A

(BEVAPP)
Bladder - contraction (stops voiding0
Eye - contraction of iris
Veins - constriction
Areterioles - vasocnstrictions
Penis - ejacultation
Prostate capsule - contraction

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8
Q

what is phenylephrine used for and what receptor does it act on

A

nasal decongestion, Alpha 1

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9
Q

what is epinephrine used for and what receptor does it act on,

A

homeostasis
adjunct to local anaesthesia
Alpha 1,2 and Beta 1,2

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10
Q

what is mydriasis

A

contraction of iris muscle + pupil dilation

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11
Q

what is norepinephrine used for and what receptor does it act on

A

(rarely) BP elevation, Alpha 1, Alpha2, and Beta 1

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12
Q

Adv Effects of Alpha1 agonists

A

HTN (can be severe with IV admin)
Bradycardia
Tissue necrosis (if an IV extravasates)

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13
Q

Where does the alpha 2 receptor work on and what happens when activated

A

Presynaptic nerve terminals - inhibits transmitter release

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14
Q

Where does the Beta 1 receptor work on and what happens when activated

A

Heart - increased rate, contraction strength, conduction velocity over AV node
Kidney - release of renin

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15
Q

Where does the Beta 2 receptor work on and what happens when activated

A

(SKLUBA)
Skeletal muscle - enhanced contraction
Kidney - dilation of kidney blood vessels
Liver - glycogenolysis
Uterus - relaxation
Bronchi - dilation
Arterioles - Dilation

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16
Q

Where does the Dopamine receptor work on and what happens when activated

A

Kidney - dilation of kidney blood vessels

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17
Q

Alpha 1 therapeutic uses?

A

mostly based on vasoconstriction

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18
Q

Beta 1 therapeutic uses?

A

on the heart
- heart failure (dopamine, isoproterenol)
- shock (dopamine, isoproterenol)
- Av heart blocks (epinephrine)
- restarting after cardiac arrest (epinephrine)

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19
Q

Adverse effects of Beta 1 activation

A

tachycardia, dyshythmias, angina pectoris

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20
Q

Beta 2 therapeutic uses?

A

Lungs (and uterus)
asthma - albuterol
- prefer meds that are selective for B2 receptors only
- delays of preterm labor

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21
Q

Adverse effects of beta 2 activation

A
  • hyperglycemia (typically in pt w/DM
  • muscle tremors
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22
Q

Dopamine receptor activation

A

dopamine is the receptor and the drug

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23
Q

considerations for dopamine receptor activation

A

Given IV, weight based, very short T1/2

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24
Q

Dopamine receptor activation in low doses

A
  • dilation of renal blood vessels
  • improves GFR and urine output, maintains kidney function
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25
Dopamine receptor activation in high doses
- Beta 1 and Alpha 1 effects; vasoconstriction, increased BP & HR, improved cardiac output - used for hemodynamic support: shock, advanced heart failure
26
Adverse effects of dopamine receptor activation seen in high doses
Dysrhythmias/tachycardia (activation of B1) Angina pectoris (activation of B1) Tissue Necrosis if IV infusion extravasates (vasoconstriction)
27
Epinephrine receptor activation
activates all alpha and beta receptors= broad range of effects and clinical uses
28
Epinephrine A1 receptor activation
- delay absorption of local anesthetic, control bleeding, raise blood pressure, induce mydriasis during ophthalmologic procedure
29
Epinephrine B1 receptor activation
reverse AV heart blokc, restore rhythm during cardia arrest
30
Epinephrine B2 receptor activation
Bronchodilation (not preferred drug) - treatment of anaphylaxis/shock
31
Pharmokinetics of epinephrine
absorption: topically or by injection metabolism: in liver and intestine very short T1/2
32
Adverse effects of epinephrine
HTN crisis, Dysrhythmias/tachycardia angina pectoris necrosis if IV infusion extravasates hyperglycemia interacts with A1 and beta blockers
33
A1 Blocker protype
prazosin (selective)
34
Therapeutic uses of prazosin (A1 blocker)
- essential HTN - renal stones - Raynaud's Disease - Reversal of overdose/toxicity of A1 agonists
35
adverse effects of prazosin (A1 blocker)
Orthostatic Hypotension Reflex tachycardia nasal congestion inhibition of ejaculation Na retention and increased blood volume
36
Non- selective Alpha blocker
phentolamine
37
Therapeutic use of phentolamine
- pheochromocytoma - treatment of tissue necrosis after extravasation of A1 agoinst
38
adverse effects of phentolamine (Alpha blokcer)
- same as A1 antagonists - significant relfex tachycardia (may need to give a B-blocker
39
Beta blocker adrenergic antagonists therapeutic uses
HTN stable angina tachycardia POst-Mi Heart failure hyperthyroidism Migrains Stage fright/anxiety glaucoma
40
adverse side effects of beta1 blockers
- bradycardia - reduced cardiac output - precipitation of heart failure - AV heart block - rebound excitation -fatigure, often depression reported - can mask hypoglycemia
41
Beta2 blokcer therapuetic uses
none
42
adverse effects of beta 2 blockers
bronchoconstriction inhibition of glycogenolysis
43
1st generation beta blocker
propranolol
44
propranolol (1st gen B-blocker) MOA:
nonselective blockade, blocks B1 and B2 receptors
45
propranolol (1st gen B-blocker) uses:
HTN, Angina pectoris, Tachycardic dysrhythmias MI stage fright highly lipid soluble --> crosses membranes to CNS
46
propranolol (1st gen B-blocker) adv side effects:
Beta 1 and Beta 2 effects
47
2nd generation beta blocker
metoprolol
48
metoprolol (2nd gen B-blocker) MOA:
Cardio selective, blocks B1 receptors
49
metoprolol (2nd gen B-blocker) uses:
mostly HTN angina pectoris tachycardic dysthrythmias MI HF
50
metoprolol (2nd gen B-blocker) adv side effects:
Beta 1 effects only
51
3rd gen beta blocker
carvedilol
52
carvedilol (3rd gen B-blocker) MOA:
non-selective blockade + a1 blockade (casues vasodilation)
53
carvedilol (3rd gen B-blocker) uses:
HTN angina pectoris Tachycardic dysrthymias MI HF
54
carvedilol (3rd gen B-blocker) adv side effects:
Beta 1,2 effects Alpha 1 effects
55
What are all the locations for muscarinic receptors
Eye, Heart, Lung, Bladder, GI tract, Sweat glands, Sex organs, Blood vessels
56
What happens when the muscarinic receptor in the eye gets activated
contraction of lene and iris to focus
57
What happens when the muscarinic receptor in the heart gets activated
decrease rate
58
What happens when the muscarinic receptor in the lungs gets activated
constriction of bronchi and promotion of secretions
59
What happens when the muscarinic receptor in the bladder gets activated
contraction of detrusor muscle, relax sphincter and coordinate these actions
60
What happens when the muscarinic receptor in the GI tract gets activated
salivation, increase in Gastric secretions, increase in intestinal tine and motility, and defecation
61
What happens when the muscarinic receptor in the sweat glands gets activated
generalized sweating
62
What happens when the muscarinic receptor in the sex organs gets activated
erection
63
What happens when the muscarinic receptor in the blood vessel gets activated
vasodilation
64
muscarinic agonists
bethanechol
65
bethanechol (muscarinic agonist) MOA:
activate muscarinic receptors
66
bethanechol (muscarinic agonist) Pharmacokinetics:
absorption: rapidly PO - give on an empty stomach Metabolism: metabolized by cholinesterase at the cholinergic receptor sites, in the plasma and in the liver short T1/2
67
bethanechol (muscarinic agonist) adv side effects:
cardiovascular: bradycardia, hypotension respiratory: SOB GI/GU - increased salivation and motility
68
muscarinic agonist contraindications
- can OD on too much - pt with gastric ulcers, asthma, HF
69
muscarinic agonisti nursing considerations
- advise to take 1 hr before or 2 hrs after meals monitor HR and BP educate of toxicity: SLUDGE
70
Cholinergic side effects: SLUDGE
Salivation Lacrimation Urination Defecation Gastric upset Emesis (vomiting)
71
Overactive Bladder d/t?
involuntary contractions of detrusor muslce of bladder more common with increasing age and multiple pregancies
72
treatment of OAB
- treat with non pharm therapy first, scheduled voiding timing fluid intake kegel exercise avoid caffeine muscarinic antagonists
73
muscarinic antagonist MOA
blocks acetylcholine at muscarinic receptors
74
muscarinic antagonists used to treat
OAB bradycardia eye disorders motion sickness athams
75
poem for remembering what muscarinic antagonists used to treat
Cant think (confusion) Cant blink (dry eyes) Cant see (blurred vision) Can't pee (urine retention) Cant spit (dry mouth) Cant poop (constipation)
76
muscarinic antagonist for OAB
oxybutynin
77
muscarinic antagonist for OAB MOA
block muscarinic receptors on the bladder detrusor muscle --> inhibits bladder contractions --> decreases urge to void
78
muscarinic antagonist for OAB uses
OAB treatment but only moderately effective
79
muscarinic antagonist for OAB pharmacokinetics
PO, patch, gel crosses BBB metabolism by CYP enzymes Short T1/2
80
muscarinic antagonist for OAB adverse effects
causes typical anticholinergic effects dont give with other anticholinergic drugs
81
Atropine
muscarinic antagonist
82
muscarinic antagonist atropine MOA
prevents recpetor activation by acetylcholine
83
muscarinic antagonist atropine uses
bradycardia, ACLS drugs, eye exams, cholinergic overdose
84
muscarinic antagonist atropine pharmacokinetics:
absorption: may be given PO, eye drops, or IM, IV metabolism liver excretion kidneys
85
muscarinic antagonist atropine adverse effects:
CNS: mild excitation Eyes: blurred vision Cardiovascular: Tachycardia GI- Decreased secretions/constipation GU- urinary retention Misc - decreased sweating
86
Ipratropium bromide (Atrovent)
common muscarinic antagonist
87
Ipratropium bromide (Atrovent) does what
inhaler - treats asthma, copd, prevents bronchoconstriction nasal spray - treat allergic rhinitis

Pharmacology (8 decks)

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