exam 2

Question 1

1. What regulates our vitals?
2. What are the 2 parts of the ANS?
3. What do Alpha 1 receptors do when activated?
4. Where are Alpha 2 receptors located and their function?
5. Where are Beta 1 receptors located and what is their function?
6. Where are beta 2 receptors located and their function?
7. Where are muscarinic receptors found and what is their function?

Answer 1

1. the autonomic nervous system
2. Sympathetic (fight or flight) and Parasympathetic (rest and digest)
3. Vascular smooth muscle. vasoconstriction and activate sympathetic response
4. brain and periphery. Inhibit sympathetic response (decreased insulin)
5. cardiac tissue. speed HR, renin release, lipolysis for energy.
6. smooth muscle of lungs, blood vessels, and uterus. Cause brochodilation, vasodilation, and uterine relaxation
7. Sweat glands and vascular smooth muscle. Functions in cholinergic responses, actions of the parasympathetic nervous system.

Question 2

1. What does SLUG BAM stand for?

Answer 2

1. Acronym for the functions of the parasympathetic nervous system:

Salivation/secretions/sweating
Lacrimation
Urination
Gastrointestinal upset
Bradyardia/bronchoconstriction/bowel movement
Abdominal cramps/anorexia
Miosis

Question 3

1. What are cholinergic responses and which nervous system do they represent?
2. What is another name for cholinergic drugs?
3. What are anticholinergic responses and which nervous system do they represent?
4. What is another name for anticholinergic drugs?

Answer 3

1. parasympathetic responses (vessel dilation, decreased HR, bronchoconstriction, pupil constriction, digestion, lubrication, sex, bladder contraction for peeing (SLUG BAM).
2. parasympathomimetics.
3. sympathetic nervous system. Opposite from cholinergics. Blood gets sent to the heart/lungs for fight or flight. No seeing (dilated pupils), no peeing, no pooping.
4. sympathomimetics

Question 4

1. What are 3 types of sympathomimetic (aka adrenergic agonists) drugs, and what is their main job?
2. What are the 2 types of parasympathomimetics and their main job?
3. What are sympatholytics and their main job?
4. What drugs turn off the parasympathetic nervous system

Answer 4

1. All turn ON sympathetic nervous system for flight or fight.
   Adrenergics - stimulate adrenaline
   Beta agonist - turns on beta receptors to stimulate heart.
   Alpha agonist - turns on alpha receptors to vasoconstrict and increase BP
2. Stimulates the parasympathetic nervous system (BP down)
   Cholinergics
   Muscharinics
3. Inhibit the sympathetic nervous system.
   Adrenergic antagonist - blocks adrenergic receptors
   Alpha blockers - blocks alpha receptors causing vasodilation
   Beta blockers - blocks beta receptors slows HP and lowers BP
4. Anticholinergics and muscarinic blockers. These drugs block parasympathetic response (can’t see, can’t pee, and poo)

Question 5

1. What is another name for epinephrine? Norepinephrine?
2. What do epi, norepi and dopamine comprise?
3. What class of drugs are epi and norepi?

Answer 5

1. adrenaline, noradrenaline
2. the small hormone family called catecholamines
3. sympathomimetics, adrenergic agonists on alpha and beta receptors

Question 6

1. Name some common drugs in the alpha and beta agonist group (5):
2. What happens in the body with these meds?
3. What are some indications for these meds?
4. What are some adverse reactions?
5. What drugs interact with these?

Answer 6

1. Epinephrine (Adrenalin, Sus-Phrine), 
Norepinephrine (Levophed),
Dopamine (Inotropin),
Dobutamine (Dobutrex),
Ephedrine (Pretz-D)

2. heart rate increases, bronchi dilate, vasoconstriction, intraocular pressure decreases, glycogenolysis occurs throughout the body
3. hypotensive shock, bronchospasm, and some types of asthma
4. Arrhythmias, hypertension, palpitations, angina and dyspnea
   Nausea and vomiting
   Headache and sweating, tension and anxiety
5. Tricyclics and MAOI’s

Question 7

1. What are alpha specific adrenergic agonists, and name a few: Which is the prototype?
2. What are the indications for these drugs?
3. Being that these drugs stimulate alpha receptors, what do these drugs do to BP?
4. Why might you choose Neosynephrine (phenylephrine) instead of myosin for your unconscious patient?
5. What is the IV onset of of phenylephrine?

Answer 7

1. Drugs that bind primarily to alpha-receptors rather than to beta-receptors.
   Phenylephrine (Neo-Synephrine, Allerest, AK-Dilate, and others)
   Midodrine (ProAmantine)
   Clonidine (Catapres)
   Phenylepherine is the prototype alpha-agonist.
2. Orthostatic Hypotension, constriction of vessels in nose (for allergies and congestion), dilate pupils
3. increase
4. route. Neosynephrine can be given IV or IM
5. immediate

Question 8

1. what does non-selective mean when referring to adrenergic agonists?
2. How are direct acting agonists, such as epinephrine administered?
3. What is the treatment of choice for anaphylaxis? Why?

Answer 8

1. can act on alpha or beta
2. By injection (think epi pen)
3. Epinephrine because it is non-selective, meaning it can activate all adrenergic receptors. This means:
   alpha 1 - vasoconstriction and increased BP
   beta 1 - restores cardiac function in cardiac arrest
   beta 2 - opens up bronchioles

Question 9

1. Is norepinephrine a direct acting, non-selective agonist like epinephrine?
2. What are the only 2 indications for norepinephrine?

Answer 9

1. yes. Main difference is that it mostly stimulates alpha 1 leading to profound vasoconstriction. It doesn’t have much beta activity, hence its lesser use than epinephrine.
2. cardiac arrest and hypotensive shock

Question 10

1. Is Dopamine a direct-acting, non-selective agonist? What receptors does it stimulate? Is this a prototype?
2. In what order dose dopamine activate the various receptors?
3. By activating all these receptors, dopamine is very useful in treating what conditions? What do we need to watch out for?
4. What is the biggest adverse effect of dopamine?

Answer 10

1. Yes. alpha, beta, and dopamine receptors. Yes, prototype alpha-beta adrenergic agonist
2. low dose = dopamine receptors (low doses increase renal perfusion)
   higher dose = cardiac beta 1 receptors
   highest doses = alpha 1 receptors
3. acute, severe heart failure and hypertensive shock. Watch HR.
4. tachycardia

Question 11

1. Name the direct acting selective agonist that works on beta 1:
2. What is it indicated for and what does it do?
3. Name the direct acting selective agonists (4) that work on beta 2:
4. What are these indicated for and what do they do?
5. What is the 1 direct acting selective agonist of B3? What is the indication?

Answer 11

1. dobutamine
2. indicated for heart failure. Works on cardiac muscle.
3. albterol (short-acting), terbutaline (short-acting), salmeterol (long-acting), and formeterol (long-acting)
4. fast acting relief of breathing problems like asthma, long acting prevention.
5. Mirabegron for overactive bladder.

Question 12

1. What is the indication of Isoproterenol (Isuprel)? Is this drug a prototype?
2. What is the indication for Ritodrine (Yutopar)?
3. What receptors do these two meds stimulate?
4. What are the adverse effects of these two drugs (beta-specific adrenergic receptors [this also goes for albuterol and others in this class]).
5. Drug-to-Drug Interaction

Answer 12

1. Treatment of shock, cardiac standstill, and heart block in transplanted hearts; prevention of bronchospasm during anesthesia; inhaled to treat bronchospasm. Yes, its a protoype beta-specific adrenergic agonist
2. Management of preterm labor
3. Both stimulate Beta 2 receptors (remember these are in lungs and uterus)
4. Restlessness, anxiety, and fear
   Tachycardia, angina, MI, and palpitations
   Difficulty breathing, cough, and bronchospasm
   Nausea, vomiting, and anorexia
5. Increase with other sympathomimetic drugs
   Decrease with beta adrenergic blockers

Question 13

1. Give an example of 2 drugs (one is a street drug) that are indirect acting agonists: How do these work?
2. Since these drugs aren’t selective, they stimulate alpha 1 and beta 1 which causes what to happen?
3. Explain the mixed action of ephedrine and pseudoephedrine:

Answer 13

1. cocaine and amphetamine. Work by enhancing epi and norepi by preventing their degredation, thus making more of it in the synapses of the brain.
2. increased sympathetic response, increased BP and HR.
3. they cause relaxation of bronchial smooth muscle and vasoconstriction of nasal passageways. Ephedrine is rarely used anymore b/c of side effects, but pseudoephedrine is still very common.

Question 14

1. How do non-selective adrenergic antagonists (alpha blockers) work?
2. What is the action of these drugs and what effects are seen?
3. Name two alpha blockers (adrenergic agonists)
4. What are their side effects?
5. Name a few specific indications for phentolamine:
6. What are the onset, peak, and duration of phentolamine administered IM?

Answer 14

1. they bind to alpha receptors, but rather than stimulating them, they inhibit them.
2. Blocks the binding of norepi to smooth muscles causing vasodilation, lower BP and HR, lower adrenaline.
3. Phentalomine (Regitine) and Tamlusosin (Flomax)
4. tachycardia and arrhythmias.
5. prevention of cell death following extravasation of IV norepi or dopamine, management of HTN caused by pheochromocytoma.
6. onset: rapid, peak: 20min, Duration: 30-45min

Question 15

1. what type of agents need to be monitored closely for the possibility of IV extravasation?
2. What happens?
3. What drug can be injected around the area to vasodilate?

Answer 15

1. any vasoconstricting agents like norepi or dopamine
2. The agent will vasoconstrict the surrounding tissues causing cell death. High incidence of amputation.
3. Phentolamine

Question 16

1. Name a few selective adenergic antagonists (selective alpha 1 blockers) and what they treat:
2. What is the main adverse effect with alpha 1 blockers?
3. Do we use Alpha 2 blockers in clinical?

Answer 16

1. To treat HTN: Prazosin (minipress), Doxazosin (Cardura), Terazosin (generic).
   To treat benign prostatic hypertrophy: Tamulosin (Flomax)
2. Orthostatic hypotension (can also cause headaches and congestion).
3. No, alpha 2’s are mainly in research.

Question 17

1. How do beta blockers work?
2. What does Beta 1 effect? Beta 2?
3. Indication for beta blockers?

Answer 17

1. They counter epi and norepi leading to decrease in sympathetic effects (decreases HR and BP). They maily work on the cardiovascular system
2. beta 1 = heart, beta 2 = lungs (1 heart, 2 lungs)

3. Hypertension heart failure
Heart attack angina
Cardiac arrythmias
Glaucoma
Migraine prophylaxis
mainly for HTN though

Question 18

1. Name a few 1st gen beta blockers. Are these selective (meaning they bind b1 and b2 or not?)?
2. What are the adverse effects?
3. What are the interactions?
4. Who are these contraindicated for and why?

Answer 18

1. Propranalol - HTN
Pindolol
Nadolol - HTN
Satolol - ventricular arrhythmias
Timolol - specific for glaucoma
Non-selective

2. Adverse Reactions
   **Bradycardia, heart block, hypotension
   **Bronchospasm
   Nausea, vomiting, diarrhea
   Decrease libido
   Fatigue, dizziness, depression, sleep disturbances
3. Clonidine
   NSAIDs
   Insulin or anti-diabetic medications
4. COPD and asthmatics because they bind B1 AND B2 thus further inhibiting bronchodilation

Question 19

1. Name a 2nd gen beta blocker. Is it selective?
2. Can the selectivity be lost at high doses?
3. Can respiratory patients use this drug?
4. When do we hold this drug?

Answer 19

1. Metoprolol. Yes, selects only Beta 1 - for heart, doesn’t affect lungs.
2. yes.
3. yes
4. HR < 55

Question 20

1. Are 3rd gen beta blockers selective or not?
2. Name a few of each:
3. 2 questions before you can admin ANY beta blockers:

Answer 20

1. They are both
2. selective: Nebivolol and Betaxolol
   non-selective: carvedilol and labetolol (both drugs of choice for HTN because they have antioxidant properties)
3. HR must be >55 and BP >90 systolic

Question 21

1. What is amiodarone (Cordarone) indicated for?

Answer 21

1. Serious emergencies and used as an antiarrhythmic

Question 22

1. What does the drug, Pyridostigmine (Mestinon, Reginol) treat?
2. What kind of receptors does it stimulate?
3. What is another indication for this drug?
4. Descibe briefly Myasthenia Gravis:
5. What is the agent used to diagnose Myasthenia Gravis? What class of drug is this?
6. What is the Tensilon test?

Answer 22

1. myasthenia gravis (chronic autoimmune disorder)
2. muscarinic and nicatinic ACh receptors
3. stimulate bladder and GI to reverse anesthesia after surgery.
4. Neuromuscular disease caused by antibodies blocking ACH receptors which leads to muscle weakness. Characterized by progressive weakness and loss of voluntary muscle control.
5. Endrophonium (Tensilon). Its an ACh inhibitor
6. To diagnose, we inject Tensilon and see if it improves client’s muscle control. If so, they have myasthenia gravis.

Question 23

1. What type of drug is Atropine?
2. Mechanism of action?
3. Do we use atropine for eye surgery? Why?
4. Atropine blocks receptors in the GI tract causing what?
5. What does atropine do to the eart at higher doses?
6. What does atropine do to the mouth, skin, and body temp?

Answer 23

1. An anticholinergic
2. blocks muscarinic receptors/functions (mainly on the heart)
3. Yes because it causes mydriasis (causes pupil dilation), cycloplegia (inability to focus), and unresponsiveness to light.
4. Reduces GI motility
5. blocks the SA and AV node, speeding up the heart. Used in crash cart for bradycardia.
6. dry mouth, dry skin, elevates temp

Question 24

1. What do the following hormones have an effect on?
Adrenocorticotropic Hormone (ACTH) 
Follicle-Stimulating Hormone (FSH) 
Thyroid-Stimulating Hormone (TSH) 
Luteinizing Hormone (LH)
Growth Hormone (GH) aka somatotropin
Prolactin (PRL)

2. What inhibits growth hormone? Prolactin?
3. What is considered the master gland?

Answer 24

1. Adrenocorticotropic Hormone (ACTH) stress
Follicle-Stimulating Hormone (FSH) semen
Thyroid-Stimulating Hormone (TSH) 
Luteinizing Hormone (LH) ovulation
Growth Hormone (GH)
Prolactin (PRL) milk production

2. somatostatin, prolactin inhibiting factor
3. the pituitary

Question 25

1. Name 4 types of meds to treat hypothyroidism: 2. Is it ok to switch from levothyroxine to synthroid and vice versa? 3. Name 2 drugs that treat hyperthyroidism: 4. How do these drugs work?

Answer 25

1. Levothyroxine (T4) Liothyronine (T3) Liotrix (T4 & T3) Desiccated natural thyroid 2. no. it's a question of absorption 3. Prophylthioracil Methimazole 4. prevent thyroid hormone synthesis.

Question 26

1. What drug can be used to compensate for insufficient levels of growth hormone? 2. Indication: 3. Adverse effects: 4. Contraindications (main one is a test question): 5. how to administer:

Answer 26

1. synthetic somatropin 2. dwarfism (prior to epiphyseal plate closure), girls w/ Turner syndrome, and cachexia from HIV 3. Inflammation Swelling and joint pain Hypothyroidism and insulin resistance 4. Known allergy Presence of closed epiphyses - test quest. Underlying cranial lesions 5. IM or subq

Question 27

1. Name the drug that antagonizes growth hormone (somatostatin) 2. indication: 3. What is another purpose for Ocreotide (sandostatin)?

Answer 27

1. Octreotide acetate (Sandostatin), Bromocriptine (parlodel), Somatuline (Depot). These are synthetic somatostatins. 2. excessive growth hormone secretion. used to treat acromegaly and gigantism 3. acute hemorrhage from esophageal varices in liver cirrhosis and GI bleeds

Question 28

1. What happens in syndrome of inappropriate diuretic hormone? 2. What happens in Diabetes insipidus? 3. What drug treats DI? 4. What else does desmopressin (DDAVP) treat? 5. What are the actions of desmopression (DDAVP)?

Answer 28

1. body makes too much ADH causing fluid retention 2. huge amounts of urine 3. Desmopressin 4. Hemophilia A 5. pressor and antidiuretic effects. Also increases levels of clotting factor VIII

Question 29

1. What are the contraindications to desmopressin (DDAVP)? 2. Cautions: 3. Adverse: 4. Nursing considerations and why these might happen?

Answer 29

1. allergy or severe renal dysfunction 2. known vascular disease, epilepsy, asthma, pregnancy, lactation 3. Water intoxication Stimulation of GI tract Local nasal irritation Hypersensitivity ``` 4. Headache Confusion (monitor closely) Seizures Na levels happen because of shift in water retention ```

Question 30

1. What are the 3 types of cortocosteroids and short description of each. 2. What is the suffix for steroids? 3. What are the indications for adrenal agents?

Answer 30

1. Androgens Male and female sex hormones Glucocorticoids Stimulate an increase in glucose levels for energy Mineralocorticoids Affect electrolyte levels and homeostasis 2. "sone" like prednisone 3. Used for anti-inflammatory effects Widely used to suppress the immune system Short-term use to relieve inflammation during acute stages of illness Adrenal crisis

Question 31

1. What is adrenal crisis? 2. signs of adrenal crisis: 3. treatment of adrenal crisis?

Answer 31

1. a life threatening condition caused by lack of cortisol 2. Physiological exhaustion Hypotension Fluid shift Shock and even death 3. Massive infusion of replacement steroids (hydrocortisone) Constant monitoring and life support procedures

Question 32

1. Why do patients get adrenal insufficiency (5)? | 2. What are the actions of adrenocortical hormones?

Answer 32

1. not enough ACTH production from ant. pituitary, adrenal glands unable to respond to ACTH, Addison's disease damaging adrenal glands, surgical removal of adrenal gland, prolonged use of corticosteroid hormones. 2. Increase blood volume (aldosterone effect) Cause the release of glucose for energy, slow protein production (reserves energy), and most importantly, blocks inflammatory and immune responses (reserves lots of energy!)

Question 33

1. Give some examples of glucocorticoids with the most important first: 2. T or F, glucocorticoids treat covid? 3. Name 2 glucocorticoids that treat breathing issues. Also state the important nursing intervention here. 4. What drugs increase glucocorticoid effects when given together? 5. What drugs decrease glucocorticoid effects when given together?

Answer 33

1. **Prednisone (Rayos) (same thing as methylprednisolone. Just prednisone is PO and methyl is IV in hospital) Methylprednisolone (Medrol) Prednisolone (Omnipred, Pred Forte, and others) Triamcinolone (Kenalog, and others). 2. True 3. Beclomethasone (Beconase AQ) Budesonide (Rhinocort, Entocort EC) both are for breathing. Must rinse mouth to avoid thrush. 4. Erythromycin Ketoconazole (antifungal) Toleandomycin 5. Salicylates Barbiturates Phenytoin rifampin

Question 34

1. What are the adverse effects of glucocorticoids (what happens to blood sugars?)? 2. What do we give diabetics who are NPO and pre-surgical or under stress? 3. What is contraindicated with glucocorticoids? What about live vaccines? 4. What do we do when stopping glucocorticoid use? Why?

Answer 34

``` 1. Increase blood sugar Impaired wound healing Increased appetite Osteoporosis (decreased bone density) Mood changes, insomnia Water and sodium retention ``` 2. Short acting insulin because IVs and steroids increase blood sugar. 3. No use with pregnancy No use with Cushing’s syndrome No use with peptic ulcers No live vaccines 4. May cause adrenal glands to shut down, must taper dose

Question 35

1. Name the live vaccines 7:

Answer 35

``` 1. Measles Polio Rotovirus Smallpox TB Chickenpox Yellow fever ```

Question 36

``` 1. Name the onset, peak, duration, and a few names of the following insulins: Rapid: Short: Intermediate: Long: ```

Answer 36

Rapid: Onset = <15min, Peak = 30min, Duration 5 hours lispro = humalog, aspart = novolog, glulisine = apidra Short: Onset = 30-60m, Peak = 2h, Duration <8h Regular Interm: Onset = 1-1.5h, Peak = 6h, Duration up to 18h NPH = Humulin N Long: Detemir = Levemir: Onset 1-2h, peak 6-8h, duration 24h Glargine = Lantus: Onset 60-70m, Peak none, duration 24h