Muscarinic antagonists

Question 1

completely blocks the actions of acetylcholine at muscarinic receptors

Answer 1

muscarinic antagonists/anticholinergic agent

Question 2

potentially inappropriate for this population, can cause confusion, blurred vision, tachycardia, urinary retention, and constipation. It can also cause complications with pre-existing conditions

Answer 2

older adults with the use of muscarinic antagonists

Question 3

produces its effects through competitive blockade at muscarinic receptors, prevents receptor activation by endogenous acetylcholine

Answer 3

atropine mechanism of action

Question 4

Does atropine increase or decrease heart rate?

Answer 4

increases by blocking the receptors

Question 5

Does atropine increase or decrease secretion from glands?

Answer 5

decreases secretion from salivary glands, bronchial glands, sweat glands, and acid-secreting cells of the stomach

Question 6

What effect does atropine have on the smooth muscle?

Answer 6

relaxation of the bronchi, decreased tone of the urinary bladder detrusor, and decreased tone and motility of the GI tract

Question 7

dilation of the pupils and relaxation of the ciliary muscle

Answer 7

atropine effects on the eyes

Question 8

bradycardia, intestinal hypertonicity and hypermotility, asthma, biliary colic, muscarinic agonist poisioning, disorders of the eyes

Answer 8

therapeutic effects of atropine

Question 9

xerostomia

Answer 9

this is caused by the use of muscarinic receptors on salivary glands, causes dry mouth

Question 10

what can patients do to help with dry mouth?

Answer 10

chew sugar-free gum, sip fluids, and use salivary stimulants (citrus-flavored or tart sugarless candies, maltose lonzenges)

Question 11

constipation, xerostomia, blurred vision and photophobia, elevation of intraocular pressure, tachycardia, anhidrosis

Answer 11

adverse effects of atropine

Question 12

What is different about scopolamine vs atropine?

Answer 12

scopolamine produces sedation effects, suppresses emesis and motion sickness, whereas atropine produce mild CNS excitation

Question 13

What is Ipratroprium bromide used for?

Answer 13

Used to treat asthma, COPD, or rhinitis. This medication is an inhaler typically so adverse effects with typical anticholinergic drugs are not associated

Question 14

can be treated with behavioral or drug therapy

Answer 14

Overactive bladder

Question 15

behavioral therapy for OAB includes?

Answer 15

scheduled voiding, timing fluid intake, doing kegel exercises, and avoiding caffeine, and maybe a diuretic to help increase detrusor activity.

Question 16

How does anticholinergic agents work on the bladder transducer to assist with OAB?

Answer 16

These drugs block muscarinic receptors on the bladder detrusor and thereby inhibit bladder contractions and the urge to void

Question 17

M3 receptors

Answer 17

found in the salivary glands, the bladder detrusor, GI smooth muscle, and the eyes

Question 18

Why is Long acting Oxybutynin preferred over short acting?

Answer 18

With short acting you have to take several doses a day do to a short half life and the side effects are more intense for the IR formulations (short acting)

Question 19

What are some adverse effects of Oxybutynin?

Answer 19

dry mouth, constipation, tachycardia, urinary hesitancy, urinary retention, mydriasis, blurred vision, and dry eyes

Question 20

Which drug used for OAB displays the greatest degree of selectivity for M3 receptors?

Answer 20

Enablex (darifenacin)

Question 21

Which drugs have the greatest effect on the heart and blood vessels?

Answer 21

calcium channel blockers

Question 22

What is the site of action for the non-dihydropyridines of the CCBs?

Answer 22

act on arterioles and impact the heart rate, can decrease heart rate

Question 23

what is the site of action for dihydropyridines of the CCBs?

Answer 23

acts primarily on the arterioles, very little effect on HR or SA node conduction

Question 24

A patient comes in to the ER with A fib with a rapid ventricular rate. what med could you prescribe of the CCBs?

Answer 24

Diltiazem (cardizem) drip to decrease heart rate

Question 25

angina pectoris, HTN, and cardiac dysrhythmias are therapeutic indications for which drugs

Answer 25

verapamil and diltiazem

Question 26

What are the 6 other drugs besides nifedipine in its class of CCBs?

Answer 26

amlodipine, felodipine, isradipine, nicardipine, nimodipine, nisoldipine

Question 27

Can verapamil be used in infants to control dysrhythmias?

Answer 27

Yes

Question 28

What adverse effect can CCBs have on older adults?

Answer 28

chronic eczematous eruptions

Question 29

what can you combine with nifedipine to prevent reflex tachycardia?

Answer 29

beta-blocker

Question 30

Hydralazine is a drug from what class?

Answer 30

Vasodilator

Question 31

what are the 5 indications hydralazine can be used for?

Answer 31

HTN, hypertensive crisis, angina pectoris, heart failure, and MI

Question 32

if hydralazine is used to treat heart failure, what drug is best combined with it?

Answer 32

isosorbide dinitrate, this can be used short term to reduce afterload in patients with HF

Question 33

Drug that is reserved for patients with severe HTN, unresponsive to other drugs

Answer 33

Minoxidil

Question 34

Why do patients who develop hypertrichosis want to stop taking minoxidil?

Answer 34

hypertrichosis is excessive hair growth that begins on the face and later develops on the arms, legs, and back

Question 35

is made by ruling out probable specific causes of BP elevation

Answer 35

primary hypertension

Question 36

is defined as an elevation of BP brought on by an identifiable primary cause

Answer 36

secondary hypertension

Question 37

what is first line HTN therapy for a patient WITHOUT a compelling indication?

Answer 37

thiazide diuretic recommended for most patients, thiazides can reduce morbidity and mortality in HTN patients. ACEIs, ARBs, and CCBs can be first line but are not as effective at reducing morbidity and mortality

Question 38

when starting out with a blood pressure drug, what is important about the dosing?

Answer 38

dosage should be low initially and then gradually increased

Question 39

What drug class is not indicated for patients with advanced renal insufficiency?

Answer 39

thiazide diuretics

Question 40

in patients with diabetic nephropathy, ACEIs and ARBs can:

Answer 40

slow the progression of renal damage

Question 41

what is the first line choice for an African American?

Answer 41

diuretics, can decrease morbidity and mortality. CCBs and a/b blockers are also effective

Question 42

defined as the ratio of a drug's LD50 to its ED50

Answer 42

therapeutic index. If a drug is truly safe, the highest dose required to produce therapeutic effects must be substantially lower than the lowest dose required to produce death

Question 43

affinity

Answer 43

refers to the strength of the attraction between a drug and its receptor

Question 44

intrinsic activity

Answer 44

refers to the ability of a drug to activate a receptor upon binding

Question 45

drugs with high intrinsic activity have

Answer 45

high maximal efficacy, which causes intense responses

Question 46

potency

Answer 46

amount of a drug we must give to elicit an effect

Question 47

maximal efficacy

Answer 47

is defined as the largest effect that a drug can produce