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module 5a Flashcards

1
Q

Stimulation of alpha andrenergic receptors on smooth muscles.

A

Vasoconstriction of blood vessels
Relaxation of GI smooth muscles( decreased mobility)
Constriction of bladder sphincter
Male ejaculation
Contraction of pupillary muscles of eye( dial action)

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2
Q

Stimulation of B1 andrenergic receptors on Myocardium, AV node, SA node results in cardiac stimulation.

A

Increase force of contractiin( pos. inoteopic effect)
Increase HR ( pos. chromite optic effect)
Increased conduction through the AV node ( pos. dromotropic effect)

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3
Q

Dopaminergic receptors

A 
Causes dilation of the following blood vessels, resulting in increased blood flow 
Renal
Mesenreric
Coronary
Cerebral
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4
Q 
Bronchodilation
Others:
Uterine relaxation
Glycogenolysis in the liver
Increase renin secretion in kidneys
Relaxation of GI smooth muscle
A

Stimulation of B2 andrenergic receptors on airways

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5
Q

Bronchodilators: drugs that stimulate B2 receptors of bronchial smooth muscle.

A

TX of asthma & bronchitis.

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6
Q

Reduction of intra ocular pressure & dilation of pupils: tx of open-angle glaucoma
Alpha- andrenergic receptors

A

Indications:

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7
Q

Temporary relief of conjunctival congestion.

Alpha andrenergic receptors

A

Indications:

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8
Q

TX of nasal congestion
Intra nasal (tropical) application causes constriction of dilated arteriolars & reduction of nasal blood flow, thus decreasing congestion
A1 receptor

A

Indications:

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9
Q

Used to support the heart during cardiac failure or shock, various alpha & beta receptor agonists

A

Vasoactive Sympathomimetics
(Pressors, Inotropes)
also called cardioselectiv sympathomimetics

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10
Q

dobutamine (Dobutrex)

synthetic catecholamines

A

(D) Beta 1 adrenergic; a pos. inotropy ( increase CO by increase contractability, increases SV) used esp. for HF. administered IV.

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11
Q

dopamine (Intropin)

A

(C) Beta 1 adrenergic; dosage related alpha 1 & beta1 receptors(low-dialation of blood vessels in brain, heart, kidneys & mesentery* high-pos inotropic* higher-alpha vasoconstriction) Contraindicated in pts with pheochromocytoma( tumor on adrenal gland that secretes catecholamine. administered IV

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12
Q

epinephrine (Adrenalin)

A

(C) alpha & beta adrenergic (nonselective) low dose B1& B2, ( cardiac, anaphylactic shock, asthma) high-alpha-vasoconstriction elevates BP administrated sub q & IV

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13
Q

fenoldopam (Corlopam)

A

(C) Dopamine 1 (D1)agonist(peripheral dopamine) produce vasodilation lower BP.Effective on sodium nitroprusside for short term tx of severe HTN. administered IV

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14
Q

midodrine ( ProAmatine)

A

(C) alpha1; prodrug converted by liver to desglymidodrine, causes constriction of blood vessels peripherally. TX orthostatic hypotension. administered PO 2-3X day

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15
Q

norepinephrine (Levophed)

A

(C) alpha & beta-mostly alpha-vasoconstriction also b1(only) It is directly metabolized to dopamine & primarily used tx of hypotension & shock. administered IV (PO)

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16
Q

phenylephrine (Neo-Synephrine)

A

(C) almost exculsive alpha. short term tx to raise BP in pt in shock, to control some dysrhythmias(supraventricular tachycardias) & produce vasoconstriction i regional anesthesia. Used topically as ophthalmic drug & nasal decongestant. administered sub q & IV

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17
Q

Vasoactive Sympathomimetics

Pressors, Inotopes

A

dobutamine dopamine
ephedrine epinephrine
fenoldopam phenylephrine
methoxamine noepinephrine

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18
Q

Alpha Adrenergic adverse Effects

A

CNS:
HA, restlessness, excitement, inswomnia, euphoria
Cardiovascular:
Palpitations(dysrhythmias), tachycardia, vasoconstriction, HTN
Other:
Anorexia, dry mouth, nausea, vomiting

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19
Q

Beta Adrenergic adverse Effects

A

CNS:
Mild tremors, HA, nervousness, dizziness
Cardiovascular:
Increased HR, palpitations(dysrhythmias),
Other:
Sweating, nausea, vomiting, muscle cramps

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20
Q

Adrenergic Blockers

A

bind to adrenergic ( alpha & beta) receptors but inhibit or block stimulation of the sympathetic nervous system
Have opposite effect of adrenergic drug

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21
Q

Drug effects & Indications:

Alpha-Blockers

A

Cause both arterial & venous dilation
reducing peripheral vascular resistance & BP
Used to tx HTN
Effect on receptors on prostate gland & bladder decreases resistance to urinary outflow, reducing urinary obstruction

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22
Q

A drug that quickly reverses the potent vasoconstritive effects of extravasted vaopressors such as norepinephrine or eprinephrine
Restores blood flow & prevents tissue necrossis

A

phentolamine (Regitine)

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23
Q

phenoxybenzamine HCL (Dibenzyline)
phentolamine (Regitine)
prazosin (Minipress)
tolazoline(Priscoline)

A

Common alpha blockers

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24
Q

Drug effects & Indications:

Beta-Blockers

A

Block stimulation of B receptors
Compete with norepinephrine & epinephrine
Selective & nonselective B blockers

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25
Alpha blocker adverse effects
CNS: dizziness, HA, drowsiness, anxiety, depression, vertigo, weakness, numbness, fatigue Cardiovascular: palpatations(dysrhythmias), orthostatic hypotension, tachycardia, edema,chest pain
26
Alpha blocker adverse effects
GI: nausea, vomiting, diarrhea, constipation, abdominal pain Other: incontinence, nosebleed, tinnitus, dry mouth pharyngitis, rhinitis
27
Indications for Beta blockers
Angina;decreases demand for myocardial O2 Cardioprotective:inhibits stimulation from circulating catecholamines Dyusrhythmias:Class II antidysrhythmic Migraine:lipophilicity allows entry into CNS Antihypertensive HF Glaucoma(topical use)
28
Beta blocker adverse effects
Blood: agranulocytosis, thrombocytopenia CNS: dizziness, depression, lethargy, hallucinations Cardiovascular: AVblock, bradycardia, HF, peripheral vascular insufficiency
29
Beta blocker adverse effects
GI: nausea, dry mouth, vomiting diarrhea, cramps, ischemic colitis Other: impotence, rash alopecia, bronchospasms
30
Beta Blockers
acebutolol(Sectral) atenolol(Tenomin) carvedilol(Coreg) esmolol(Brevibioc) labeltalol(Trandate) sotalol(Betapace) metoprolol(Lopressor) propranolol(Inderal) -note end in lol-
31
Cholinergic Drugs:
Mimic the effects of the PSNS neurotransmitter: acetylcholine
32
Cholinergic Receptors
``` Two types, determined by location action once stimulated Nicotinic receptors Muscarniic receptors ```
33
Niccotinic Receptors
Located in the ganglia of both the PSNS & SNS. | Named nicotinic because they can be stimulated by the alkaloid nicotine.
34
Muscarinic Receptors
Located postsynaptically in effector organs of PSNS Smooth muscle Cardiac muscle Glands Namediscarinic because they can be stimulated by the alkaloid muscadine
35
MOA of muscarinic receptor
Direct: bind to cholinergic receptors activating them Indirect:inhibit the enzyme acetylcholinesterase, which breaks down Ach Results in more Ach available
36
Indirect -acting (cholinesterase inhibitors
Reversible-bind to cholinesterase for a period of minutes to hrs Irreversible-bind to cholinesterase &form a permanent covalent bond Body must make new cholinesterase
37
Cholinergic Drug Effects
``` "SLUDGE" Salivation Lacrimation Urination Diarrhea/defection GI cramps Emesis ```
38
Drug effects
@ recommend doses the cholinergic s primarily affect the muscarinic receptors @ high doses, cholinergic s stimulate the nicotinic receptors MANY undesirable effects are due to stimulation of nicotinic receptors
39
Indications Direct-acting drug
``` Direct acting drugs Reduce intraocular pressure Useful for glauca& intraocular surgery Acetylcholine Carbachol Pilocarpine Topical appltn bcus of poor oral absorption ```
40
Indications Direct-acting drug
Direct-acting drug—bethanechol Increases tone and motility of bladder and GI tract Relaxes sphincters in bladder and GI tract allowing tract, them to empty Helpful for postsurgical atony of the bladder and GI tract
41
Indications Direct-acting drug
Direct-acting drug—cevimeline (Evoxac) | Used to treat xerostomia (dry mouth) resulting from Sjögren’s syndrome
42
Indications indirect acting anticholinesterase drug
Indirect-acting drugs Cause skeletal muscle contractions Used for diagnosis and treatment of myasthenia gravis Used to reverse neuromuscular blocking drugs Used to reverse anticholinergic poisoning (antidote)  Examples: physostigmine, pyridostigmine
43
Indications indirect acting anticholinesterase drug
``` Indirect-acting anticholinesterase drugs Used for treatment of mild to moderate Alzheimer’s disease • donepezil (Aricept) • tacrine (Cognex) • galantamine (Razadyne) • rivastigmine (Exelon) ```
44
Indications indirect acting anticholinesterase drug
memantine (Namenda) Not a cholinergic drug Also used in the treatment of Alzheimer’s disease
45
Adverse Effects
Adverse effects as a result of over stimulation of PSNS CNS: HA, dizziness, convulsions Cardio: Bradycardia, hypotension, conduction, abnormalities(AV block& cardiac arrest) GI: cramps, increased secretions, nausea, vomiting Respiratory: increased secretions, bronchospasms Other: lacrimation, sweating, salavation, miosis(constiction)
46
Cholinergic-Blocking Drugs
MOA Competitive antagonists Compete with Ach Block Ach at the muscarinic receptors in the PSNS As a result, Ach is unable to bind to the receptor site and cause a cholinergic effect Once these drugs bind to receptors, they inhibit nerve transmission at these receptors
47
Chemical Class
Natural Synthetic/Semisynthetic atropine benztropine clidinium belladonna dicyclomine glycopyrrolate hyoscyamine homatropine ipratropium scopolamine isopropamide methscopolamine oxybutynin propantheline tolterodine trihexyphenidyl
48
Drug Effects
``` Cardiovascular Small doses: decrease heart rate Large doses: increase heart rate CNS Small doses: decrease muscle rigidity and tremors Large doses: drowsiness, disorientation, hallucinations ```
49
Drug Effects
``` Eye Dilated pupils (mydriasis) Decreased accommodation due to paralysis of ciliary muscles (cycloplegia) Gastrointestinal Relax smooth muscle tone of GI tract Decrease intestinal and gastric secretions Decrease motility and peristalsis ```
50
Drug Effects
Genitourinary Relaxed detrusor muscle Increased constriction of internal sphincter Result: urinary retention Glandular Decreased bronchial secretions, salivation, sweating
51
Drug Effects
Respiratory Decreased bronchial secretions Dilated bronchial airways
52
Indications for CNS
Decreased muscle rigidity and muscle tremors Parkinson’s disease Drug-induced extrapyramidal reactions
53
Indications for Cardiovascular
``` Affect the heart’s conduction system Low doses: slow the heart rate High doses: block inhibitory vagal effects on the SA and AV node pacemaker cells Result: increased heart rate ```
54
Indications for Cardiovascular
``` Atropine Used primarily for cardiovascular disorders Diagnosis of sinus node dysfunction Symptomatic second-degree heart block Severe sinus bradycardia ```
55
Indications for Respiratory
``` Blocking the cholinergic stimulation of the PSNS allows unopposed action of the SNS Results Decreased secretions from nose, mouth, pharynx, bronchi Relaxed smooth muscles in bronchi and bronchioles Decreased airway resistance Bronchodilation ```
56
Indications for Respiratory
``` Respiratory drugs are used to treat: Exercise-induced bronchospasms Chronic bronchitis Asthma Chronic obstructive pulmonary disease ```
57
Indications for GI
``` PSNS controls gastric secretions and smooth muscles that produce gastric motility Blockade of PSNS results in: Decreased secretions Relaxation of smooth muscle Decreased GI motility and peristalsis ```
58
Indications for GI
Gastrointestinal drugs are used to treat: Irritable bowel disease GI hypersecretory states
59
Indications: Genitourinary
``` Reflex neurogenic bladder Incontinence Acute pancreatitis (reduces gastric and pancreatic secretions) Preoperatively: to reduce salivary secretions ```
60
Adverse Effects
CNS:restlessness, irritability, disorientation, hallucinations, delium Cardio: Increased HR, dysrhythmias Eye: dilated pupils, decreased visual accommodation, increasedx intraocular pressure
61
Adverse Effects
GI: decreased salivation decreased gastric secretions, decreased mobility Genitourinary: urinary retention Glandular: decreased sweating Respiratory: decreased bronchial secretions
62
Alzheimer's disease
Irreversible loss of neurons plaques & tangles in the cortex & hippocampus.
63
Parkinson's disease
Lack of neurotransmitter dopamine.
64
Glycogenolysis
Conversion of glycogen to glucose in the liver.
65
Albuterol
Bronchodilator
66
Ephedrine
Brinchodilator
67
Epinephrine
Bronchodilators
68
Formoterol
Bronchodilator
69
Levanuterol
Bronchodilators
70
Metaproterenol
Bronchodilator
71
Pirbuterol
Bronchodilators
72
Salmeterol
Bronchodilator
73
What is terbutaline normal used for and it's special use?
It is a bronchodilator & is used to stop premature labor( causes relaxation of uterine smooth muscle
74
Epinephrine
Used to treat open-angle glaucoma( reduces t pressure (dilation). Alpha andrenergic
75
Dipivefrin
Used to tx open-angle glaucoma( reduces intraocular pressure( dilation) Alpha adrenergic
76
Epinephrine
Temp relief of conjunctival contest ion. Alpha andrenergic
77
Naphazoline
Tmp relief of conjunctival congestion. Alpha andrenergic
78
Phenylephrine
Tmp relief of conjunctival congestion. Alpha adrenerg
79
Tetrahydrozoline
Tmp relief of conjunctival congestion. Alpha adrenergic

Pharmacology (7 decks)

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