Pharmacology Flashcards

(77 cards)

1
Q

Are pre- and/or post-gangionic neurons myelinated?

A

Pre-ganglionic are myelinated, post ganglionic are not

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2
Q

In general, where is the gangion and synapse located for the parasympathetic vs. sympathetic nervous systems

A

Parasympathetic: near the effector tissue Sympathetic: in the sympathetic chain, near the spinal cord

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3
Q

What are the 3 tissue types controlled by the autonomic nervous system?

A
  1. Cardiac tissue (muscle, nodes, and conduction system) 2. smooth muscle 3. glands
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4
Q

Contrast miosis and mydriasis. What autonomic nervous system causes each?

A

Miosis: pupil constriction due to contraction of the sphincter muscle, caused by parasymathetic innervation Mydriasis: pupil dialation due to contraction of the radial muscle, caused by sympathetic innervation

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5
Q

What are the neurotransmitters associated with the pre- and post-ganglionic synapses of the parasympathetic vs. sympathetic nervous systems?

A

Pre-ganglionic: ACh for both para and symp Post-ganglionic: ACh for para, Epinephrine and Norepinephrine for symp

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6
Q

Contrast the parasympathetic and sympathetic effects on blood vessel dilation/constriction.

A

Parasympathetic: weak (not significant) dilation Sympathetic: strong constriction to unnecessary tissues (skin and GI), dialation to liver and skeletal muscle

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7
Q

Name the peptides that sometimes coexist with ACh and NE in their respective post-ganglionic nerves.

A

Vasoactive intestinal peptide with ACh in parasympathetic Neuropeptide Y with NE in sympathetic

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8
Q

Where is ACh synthesized?

A

in the pre-synaptic terminal (Extra detail: after ACh is broken down in the synapse by AChE, the choline is transported back into the pre-synaptic neuron so it can be used to make more ACh.)

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9
Q

Where in a cholinergic synapse are nicotinic and muscarinic receptors found (if present)?

A

On the post-synaptic neuron

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10
Q

Identify the excitatory and inhibitory muscarinic receptors and contrast their effects.

A

M1, M3, M5: excitatory; stimulate IP3 and eventually increase intracellular Ca++ M2, M4: inhibitory; decrease cAMP, open K+ channels (hyperpolarizes the cell)

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11
Q

Name the 5 important molecules in the catecholamine synthesis pathway.

A
  1. tyrosine 2. L-dopa 3. dopamine 4. norepinephrine 5. epinephrine (last step only happens in adrenal medulla)
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12
Q

Identify the two types of nicotinic receptors, where they are found, and their general effects.

A

nAChRn (autonomic gangia - N for nerve) nAChRm (skeletal muscle - M for muscle) They cause stimulation and then blockade of their end tissue

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13
Q

What is the most important mechanism for termination of the action of NE?

A

Reuptake from the junctional space into the pre-synaptic nerve and storage vessels (requires ATP and Mg^2+) - Drugs like cocaine, tricyclic antidepressants, & methylphenidate inhibit this. (Impt exception: in blood vessels, excess NE is broken down by enzymes and/or diffused away.)

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14
Q

Describe the mechanism of reuptake blockers, and give examples (3).

A

They block reuptake of NE from the synpase (keeps stimulating the post-synaptic neuron) e.g.: cocaine, tricyclic antidepressants, methylphenidate

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15
Q

What class of drugs includes cocaine and methylphenidate?

A

Indirect acting sympathomimetic amines

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16
Q

What is the function of enzymes such as monoamine oxidase (in mitochondria) and catechol-O-methyl transferase (in cytoplasm)

A

Breaks down catecholamines (like NE) in synapse to terminate the effects.

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17
Q

what heart rate represents tachycardia? bradycardia?

A

tachy: 100
brady: 60

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18
Q

what effect do catecholamines have on action potential velocity?

A

increases action potential velocity. catecholamines include epinephrine and norepinephrine.

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19
Q

what arrhythmia is depicted here?

A

premature atrial contraction: the wave are normal but there is less distance between waves two and three

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20
Q

what arrhythmia is seen here?

A

supraventricular tachycardia the waves are regular but close together, really fast

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21
Q

what arrhythmia is seen here?

A

Accessory Pathway tachycardia: the delta wave is seen here which indicates that the signal has found another route to excite the ventricles before the normal path (example: WPW)

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22
Q

what arrhythmia is seen here?

A

Atrial tachycardia: there is a decreased PR interval

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23
Q

what arrhythmia is seen here?

A

atrial fibrillation: the QRS complex looks normal but there is no distinct P wave because there are too many atrial impulses

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24
Q

what arrhythmia is seen here?

A

atrial flutter: re-entry circuit that circulates in the atrium shows rapid, back-to-back atrial depolarization waves (ex. “saw-tooth” appearance)

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25
what arrhythmia is seen here?
ventricular tachycardia: the ventricles are contracting too often so they can't fill up all the way. therefore this lowers cardiac output.
26
what arrhythmia is seen here?
ventricular fibrillation with big **coarse** waves and small, frequent **fine** waves: the QRS is rapid and indistinguishable.
27
what is happening during ventricular fibrillation? what is the immediate treatment?
the ventricles are quivering and can't pump enough blood to the body CPR and defibrillate
28
what part of the cardiac cycle does long QT sydrome delay? what dangerous ECG pathology can this lead to?
delays repolarization. this can lead to Torsades de Pointes which can lead to ventricular tachycardia and death
29
whatare the three requirements for re-entry?
1. unidirectioncal conduction block 2. conduction time slows so the refractory tissue can recover (while other tissue is still depolarizing) 3. adjacent cardiac tissue with many parallel pathways and different refractory periods
30
what arrhythmia is seen here?
bradycardia: distance between R peaks is extended (Hr approx 50)
31
what arrhythmia is seen here?
First degree heart block: fixed long PR interval
32
where does a heart block occur? what does it cause (in terms of heart beat)?
as the signal travels from the AV node/His-Purkinje system to the ventricles. causes a slow and irregular heart beat
33
what arrhythmia is seen here?
second degree heart block type 1 (Wenckenbach): PR interval continues to get larger and larger and then the QRS is dropped
34
what arrhythmia is seen here?
2:1 Mobitz type 2: the PR interval is stable and the P wave arrives regularly. For every two normal beats, 1 QRS complex is dropped.
35
what arrhythmia is seen here?
third degree heart block: the P, QRS and T are all out of synchronization
36
what are the class 1a antiarrhythmics?
Quinidine Procainamide Disopyramide "The **Q**ueen **P**roclaims **D**iso's pyramid."
37
name two class 1B antiarrhythmics
lidocaine mexiletine tocainide phenytoin (also a seizure med)
38
name the two class IC antiarrhythmics
flecainamide propafenone (also a beta blocker) "Can I have **F**ries **P**lease?"
39
what are class II antiarrhythmics? name three (there are 6 in FA)
beta blockers **metoprolol, propanolol, ****carvedilol** atenolol, timolol, esmolol
40
what do class 3 antiarrhythmics block?
they block potassium channels (ie prolong depolarization)
41
name 3 potassium channel blockers
amiodarone, ibutilide, dofetalide, sotalol
42
what do class 1 antiarrhythmics block?
sodium channels
43
what do class 2 antiarrhythmics block?
selective: only beta 1 receptors non-selective: beta 1 and 2 receptors
44
what do class 4 antiarrhythmics block?
calcium channels
45
name the two calcium channel blockers
verapamil diltiazam
46
what does adenosine mainly treat?
paroxysmal supraventricular tachycardia
47
what is used to treat bradyarrhythmias?
pacemaker
48
what is used to treat atrial fibrillation?
ablation, beta blockers (propanolol), calcium channel blockers (verapamil), digoxin
49
what are the primary indications for amiodarone?
ventricular tachycardia (with MI) ventricular fibrillation ventricular premature beats Atrial fibrillation Atrial flutter
50
what are the primary indications for digoxin?
PSVT, atrial fibrillation, congestive heart failure
51
what are the primary indications for procainamide?
WPW, PSVT, VT with MI, VF
52
what is the primary indication for verapamil?
PSVT | (AV reentry, Afib)
53
what is metoprolol used for?
hypertension mainly also angina and CHF
54
what are the primary indications for propanolol?
HTN, angina, a fib, a flutter, post-MI
55
what are the primary indications for lidocaine?
VT with MI, VF
56
Which class of antiarrhythmics is best for hypertension?
II- beta blockers
57
Name four drugs that treat PSVT:
Adenosine, Digoxin, Procainamide, Verapamil
58
Name three drugs that treat atrial fibrillation:
amiodarone, digoxin, propanolol
59
alpha 1 receptor with G protein class?
vasoconstriction, mydriasis, intestinal and bladder sphincter muscle contraction Gq
60
alpha 2 receptor with G protein class?
decreasesd sympathetic outflow (autoregulation), decreased insulin release, decreased lipolysis, increased platelet aggregation Gi (inhibitory)
61
beta 1 receptors and G protein class?
incrased heart rate, increaseed contractility, increased renin release, increased lipolysis Gs (stimulatory)
62
beta 2 receptor and G protein class?
vasodilation, bronchodilation, increases heart rate, increases contractility, increased lipolysis, insulin release, decreased uterine tone (tocolysis), ciliary muscle relaxation, increased aqueous humor production Gs
63
M1 and G protein class?
CNS, enteric nervous system Gq
64
M2 and G protein class?
decrease heart rate and contractility of the atria Gi
65
M3 and G protein class?
increase exocrine gland secretions, increase gut peristalsis, increase bladder contraction, bronchoconstrition, increase pupillary sphincter muscle contracion (miosis), ciliary muscle relaxation (accomodation) Gq
66
D1 and G protein class?
relaxes renal vascular smooth muscle Gs
67
D2 and G protein class?
modulates transmitter release, especially in brain Gi
68
V1 and G protein class?
increased vascular smooth muscle contraction Gq
69
V2 and G protein class?
increased water permeability and reabsorption in the collecting tubules of kidney (V**2** is found in the **2** kidneys) Gs
70
Which antiarrhythmic is best for "atrial fibrillation with atrioventricular conduction via accessory pathway" hint: WPW
procainamide slow conduction in accessory pathway connecting atrium and ventricle
71
Which antiarrhythmic is best for patients with heart failure? why?
digoxin- (+) ionotroph slows conduction, but increases contractility
72
how to treat Vfib (ventricular fibrillation)
life threatening! 1. cardioversion 2. Epi + defibrillation 3. lidocaine, amiodarone, procainamide, magnesium 4. treat hyperkalemia
73
how to treat torsades de pointes (long-QT syndrome)
pacing magnesium isoproterenol (B1 and B2 agonist, effects like epi)
74
how to treat digitalis toxicity
stop digitalis tx: digibind magnesium
75
What drug can you not give to WPW or SA/AV node dysfunction
digitalis, verapamil, diltiazem, amiodarone
76
what drug do you not want to give to a pt with a history of MI or structural deformity
flecainide can induce AV block slows conduction of the electrical impulse within the heart, decreased contractility of the muscle,
77
what drug can you not give to a pt with long QT interval
amiodarone, quinidine, procainamide, sotalol, ibutilide lengthens QT interval