Lecture 4 (Quiz 1)

Question 1

As a doctor, why should you use caution with a patient using Epinephrine involving: Beta-Blockers, Cardiovascular disease, taking Tricyclic Antidepressants, Pregnant, Diabetic, Hyperthyroid?

Answer 1

• Beta-Blockers: The cardiovascular (increase in HR, capillary dilation) and bronchodilating effects of EPI would be antagonized (canceled) by Beta-Blockers.
• Cardiovascular disease: Would exacerbate (worsen) the problem.
  Tricyclic Antidepressants: Can lead to excess Alpha/Beta stimulation.
  Pregnant: Decreases blood flow to the fetus.
  Diabetic: Insulin increases Beta-2, and decreases Alpha-2 which makes controlling blood sugar levels difficult to control.
  Hyperthyroid: Worsen palpitation and arrhythmias.

Question 2

What makes Epinephrine and Norepinephrine different? (receptors and effects)

Answer 2

Epinephrine:

• Effects A-1, A-2, B-1 and B2 the same.
• Increases HR, decrease TPR, little change to BP. (B-1)
• Constricts arterioles in the abdomen to get blood to more important areas. (A-1)
• Dilates capillaries. (B-2)

Norepinephrine:

• Effects A-1, A-2 the same, B-1 > B-2.
• Can increase or Decreases HR depending on amount, increases TPR, increase in BP. (B-1)

Question 3

What are the differences between Open-Angle Glaucoma and Angle-Closure Glaucoma (Closed-Angle)? What do you use to treat each of these?

Answer 3

Open-Angle Glaucoma:

• Most common, causes an imbalance in the production and drainage of aqueous humor due to an open/wide angle between the iris and cornea.
• Treat with EPI to decrease production of aqueous humor.

Close-Angle (Angle-Closure) Glaucoma:

• Caused by a narrow angle between the iris and cornea, causing blocked drainage, and resulting in a sudden rise in intraocular pressure.
• Treat with Pilocarpine to contract and pull the iris open.

Question 4

Amphetamine, Cocaine, Methylphenidate, and TCA’s (Tricyclic Acid) are all examples of what? What do each of these do?

Answer 4

• Indirect Adrenergic Agents
• Amphetamine: Causes the release of NE, DA, and 5HT.
• Cocaine: Blocks the re-uptake of NE, DA and 5HT. (Blocks the transporters of these)
• Methylphenidate: Blocks the re-uptake of DA.
• Tricyclic Acid: Block the re-uptake of NE, 5HT.

Question 5

________ is an Amino Acid that is degraded in the GI tract by Monoamine Oxidase (MAO). When MAO is blocked/inhibited, the amount of Tyramine in the blood increases and arrives at the brain where it is can be uptaken. What does this high amount of Tyramine do? **If you are taking an MAO Inhibitor you have to be careful of these foods.

Answer 5

• Tyramine (found in pickles, cheese and wine)

- Depletes the NE in the brain and causes a great burst in the amount of NE in the body??? (Increase in BP)

Question 6

There are 2 Non-Selective Alpha Antagonists. What are they and what effects do they have?

Answer 6

• Phenoxybenzamine, Phentolamine.

- Effects: Decreased TPR and BP. Increased HR and nasal stuffiness.

Question 7

There are 2 Antimuscarinic Agents to be aware of, what are they and what effects do they have?

Answer 7

• Atropine, Scopolamine
• Sedation for motion sickness, COPD and urinary urgency. Dry mouth, constipation, blurred vision, and urinary retention.