Pharmacology - Adrenergic Antagonists and Cholinergic Agonists (Exam 2)

Question 1

Which system do adrenergic antagonists inhibit?

Answer 1

SNS (fight or flight)

Question 2

Most adrenergic antagonists are _________ antagonists for ____ or ____ receptors

Answer 2

competitive; a or B

Question 3

Some adrenergic antagonists are _______ acting ____ receptor agonists

Answer 3

centrally; a2

Question 4

What are adrenergic antagonists used to treat?

Answer 4

Cardiovascular and non-cardiovascular diseases

Question 5

What do a1 antagonists (blockers) INHIBIT?

Answer 5

Vasoconstriction
Bladder sphincter contraction

Question 6

Which drug is an a1 selective antagonist/blocker?

Answer 6

Prazosin (and other -osins)

Question 7

What does Prazosin (a1 selective antagonist) block?

Answer 7

a1 receptors in vascular smooth muscles

Question 8

What is the pharmacological effect of Prazosin (a1 selective antagonist)?

Answer 8

Vasodilation (decreases BP)

Question 9

Prazosin (a1 selective antagonist) is used for the treatment of what?

Answer 9

Hypertension
Congestive heart failure
Benign prostate hyperplasia

Question 10

What kind of drug is Tamsulosin (Flomax)?

Answer 10

a1 selective antagonist/blocker

Question 11

What does Tamsulosin (Flomax) (a1 selective antagonist/blocker) have an effect on?

Answer 11

Prostate - helps older men urinate

(little effect on BP)

Question 12

What are the adverse effects of a1 blockers?

Answer 12

Orthostatic and postural hypotension

Floppy iris syndrome during cataract surgery
(a1 agonist is given to dilate the pupil for surgery, but pt taking a1 blocker will have interaction that causes iris to be confused and “floppy”)

Question 13

Which drugs are non-selective a blockers?

Answer 13

Phentolamine
Phenoxybenzamine

Question 14

What do Phentolamine
and Phenoxybenzamine (non-selective a blockers) treat?

Answer 14

Epinephrine secreting tumors of adrenal gland

Question 15

What drugs are B blockers?

Answer 15

-lol drugs

Question 16

What are B blockers used to treat?

Answer 16

Cardiovascular effects due to B1 blockage

Question 17

What are the cardiovascular effects of B blockers?

Answer 17

Decreased HR (anti-arrhythmic)
Decreased force of contraction
Decreased BP

Question 18

What are the physiological effects of B blockers?

Answer 18

Decreased BP, O2 demand, and cardiac workload

Question 19

What are the adverse effects of B blockers?

Answer 19

Bronchoconstriction
Vasoconstriction

(since B blockers are non-selective, they can affect B2 receptors as well)

Question 20

Which drug is a 1st generation B blocker?

Answer 20

Propranolol

Question 21

Is Propranolol (B blocker) selective or non-selective?

Answer 21

Non-selective

Question 22

What are the side effects of Propranolol (B blocker)?

Answer 22

Bronchoconstriction
Vasoconstriction

(blocks B2 receptors since it is non-selective)

Question 23

What is a potential outcome of using lidocaine with epinephrine on patients taking Propranolol (B blocker)?

Answer 23

Cardiac arrest

(Patients taking Propranolol have blockage of B2 receptors which inhibits vasodilation. Too much epinephrine causes enhanced vasoconstriction in these patients)

Question 24

Epinephrine works on which receptors?

Answer 24

a1 (vasoconstriction)
B2 (vasodilation)

Question 25

What is a potential outcome of using Propranolol (B blocker) on patients with asthma or COPD?

Answer 25

Increased bronchoconstriction (since B2 receptors in lungs are blocked, thus blocking bronchodilation)

Question 26

What drug is a 2nd generation B blocker?

Answer 26

Metoprolol

Question 27

Is Metoprolol (B blocker) selective or non-selective

Answer 27

B1 selective

Question 28

Which drugs are a 3rd generation B blocker?

Answer 28

Labetalol Carvedilol

Question 29

Are Labetalol and Carvedilol (B blockers) selective or non-selective?

Answer 29

Non-selective

Question 30

What other receptor do Labetalol and Carvedilol (B blockers) block?

Answer 30

a1 (but effect on B is > than a1)

Question 31

What are the physiological effects of Labetalol and Carvedilol (B blockers)?

Answer 31

Decrease BP, HR, cardiac workload (blocks B1) Vasodilation (blocks a1)

Question 32

Which B blockers are 1st line drugs?

Answer 32

Labetalol and Carvedilol

Question 33

What is Carvedilol (B blocker) used to treat?

Answer 33

Hypertension Heart failure

Question 34

What specific cardiovascular diseases are B blockers generally used for?

Answer 34

Arrhythmia Heart failure Angina Hypertension

Question 35

Which drugs are a/B mixed antagonists (B non-specific, a1)

Answer 35

Labetalol Carvedilol

Question 36

What are the adverse reactions of B blockers?

Answer 36

Bradycardia Fatigue

Question 37

What happens to patients who chronically use B blockers?

Answer 37

B receptor becomes supersensitive (slow withdrawal of the drug is required)

Question 38

What do B blockers not mix with?

Answer 38

Ca2+ channel blockers

Question 39

What are the metabolic effects of B blockers?

Answer 39

Activation of B2 in liver (increases plasma glucose) Inhibition of B2 (hypoglycemia in type II diabetes)

Question 40

Muscarinic agonists activate _______ subtypes of the receptor (M1-M5)

Answer 40

most (if not all!) (this explains their variety of pharmacological actions)

Question 41

What are cholinergic drug receptors?

Answer 41

Muscarinic and nicotinic

Question 42

What are muscarinic and nicotinic receptors stimulated by?

Answer 42

ACh

Question 43

Which physiological systems do central cholinergic systems regulate and influence?

Answer 43

Regulate cardiovascular, respiratory, GI, etc Influence cognition and emotion

Question 44

Do cholinergic drugs produce effects on the CNS?

Answer 44

Depends on the lipophilicity of the drug

Question 45

Cholinergic/muscarinic agonists have ________ actions and have effects on _______ _______ (sympathetic)

Answer 45

parasympathomimetic; sweat glands

Question 46

Cholinergic agonists affect which system?

Answer 46

Both parasympathetic and sympathetic (there are cholinergic receptors for ACh in both)

Question 47

What do cholinergic agonists affect in the parasympathetic system?

Answer 47

Heart Lungs GI

Question 48

What do cholinergic agonists affect in the sympathetic system?

Answer 48

Sweat glands

Question 49

Muscarinic (parasympathomimetic) drugs have _________ parasympathetic responses

Answer 49

increased

Question 50

What pharmacologic effects do Muscarinic (parasympathomimetic) drugs have on the heart?

Answer 50

Decreased HR, BP, contractility, AV conduction, cardiac output

Question 51

What pharmacologic effects do Muscarinic (parasympathomimetic) drugs have on the lungs?

Answer 51

Bronchoconstriction (bad for asthma/COPD patients)

Question 52

What pharmacologic effects do Muscarinic (parasympathomimetic) drugs have on the eyes?

Answer 52

Miosis, decreased intraocular pressure

Question 53

What pharmacologic effects do Muscarinic (parasympathomimetic) drugs have on the blood vessels?

Answer 53

Vasodilation

Question 54

What pharmacologic effects do Muscarinic (parasympathomimetic) drugs have on the GI system?

Answer 54

Excite smooth muscle Increased GI activity, motility, secretion

Question 55

What pharmacologic effects do Muscarinic (parasympathomimetic) drugs have on the bladder?

Answer 55

Contract detrusor muscle Relax sphincter muscle Increased urination

Question 56

What pharmacologic effects do Muscarinic (parasympathomimetic) drugs have on the exocrine glands?

Answer 56

Increased lacrimation, GI secretions, sweating, salivation

Question 57

What pharmacologic effects do Muscarinic (parasympathomimetic) drugs have on the brain?

Answer 57

Inhibit ACh-esterase, leading to increased ACh

Question 58

Does every muscarinic drug produce all the physiological effects?

Answer 58

NO

Question 59

Peripheral nicotinic effects are ________, since they are selective towards _________ receptors

Answer 59

minimal; muscarinic

Question 60

T/F direct acting cholinergic agonists are clinically useful

Answer 60

FALSE, they are not clinically useful due to short duration of action

Question 61

What are the analogs of ACh?

Answer 61

Bethanechol Methacholine

Question 62

What is the naturally occurring alkaloid?

Answer 62

Pilocarpine (treats xerostomia)

Question 63

Analogs of ACh and naturally occurring alkaloids produce prominent _________ effects

Answer 63

muscarinic (aka parasympathomimetic)

Question 64

What are indirect acting cholinergic agonists called?

Answer 64

Anti-cholinesterases (ACh esterase inhibitors)

Question 65

T/F both direct acting cholinergic agonists and anti-cholinesterases produce cholinergic effects

Answer 65

True

Question 66

What drug is an anti-cholinesterase?

Answer 66

Neostigmine Physostigmine

Question 67

What are the 2 subclasses of anti-cholinesterases?

Answer 67

1. Reversible inhibitors (neostigmine, physostigmine) 2. Irreversible inhibitors (organophosphates - pesticides and nerve gas)

Question 68

What is the derivative of physostigmine (reversible anti-cholinesterase)?

Answer 68

Neostigmine

Question 69

Anti-cholinesterases require _______ to be present

Answer 69

ACh

Question 70

Anti-cholinesterases have pharmacological actions identical to those of ACh, producing _______ and _______ effects

Answer 70

Muscarinic and nicotinic

Question 71

What is Myasthenia Gravis?

Answer 71

Chronic autoimmune disease

Question 72

Myasthenia Gravis has auto-antibodies against ____ ________ receptors

Answer 72

ACh nicotinic

Question 73

What is used to treat Myasthenia Gravis by increasing ACh and thus neuromuscular transmission via nicotinic receptors?

Answer 73

Reversible anti-cholinesterase inhibitors (neostigmine)

Question 74

What neurochemical is affected early in the course of Alzheimer's?

Answer 74

ACh

Question 75

What is used to treat Glaucoma?

Answer 75

Pilocarpine

Question 76

What is used to treat paralytic ileus and bladder atony (after abdominal/pelvic surgery)?

Answer 76

Bethanechol Neostigmine

Question 77

What are the adverse effects of cholinergic drugs?

Answer 77

Colon "choline" SLUDGE Salivation, sweating Lacrimation Urination Defecation GI distress Emesis

Question 78

Do not take _______ drugs with GI or urinary tract obstruction

Answer 78

cholinergic