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Pharmacology I > Test 2 part V > Flashcards

Test 2 part V Flashcards

(50 cards)

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1
Q

Indirect Acting Cholinomimetics cause _____ nerve activation and effects on the ________.

A

Vagal; Vasculature

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2
Q

What are the effects associated with Vagal Nerve Activation via Indirect Acting Cholinomimetics?

A
  1. Decreased CO due to bradycardia, dec atrial contraction, and some decreased ventricular contraction
  2. Prejunctional inhibition of NE release due to negative feedback on SNS ganglia (!!!!)
  3. Post-junctional inhibition of SNS effects
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3
Q

What are the effects associated with Vasculature effects from Indirect Acting Cholinomimetics?

A
  1. Most lack cholinergic innervation
  2. Increase in SNS tone due to Ach on sympathetic ganglia (increased NE in vasculature). (Remember: we have a dominant PNS System. Ach acts on both SNS and PNS. Inc Ach can have an effect of vasoconstriction due to Ach on sympathetic ganglia)
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4
Q

MR > NR in ______ (all MR Subtypes)
NR > MR in _______

A

Brain; Spinal Cord

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5
Q

A moderate dose of an Indirect Acting Cholinomimetic will cause what effects on the CV system?

A
  1. Bradycardia
  2. Decreased CO
  3. Increased PVR
  4. Increased BP
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6
Q

A high (toxic) dose of an Indirect Acting Cholinomimetic will have what effects on the CV system?

A
  1. Marked bradycardia
  2. Significantly decreased CO
  3. Severe hypotension
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7
Q

What is the prototype drug for antimuscarinics?

A

Atropine

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8
Q

Is Atropine tertiary or quaternary?

A

Tertiary

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9
Q

What is the mechanism of action for antimuscarinics?

A

Reversible blockade of the muscarinic receptor.
Prevents the release of IP3 and blocks the inhibition of adenylyl cyclase.

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10
Q

Muscarinic Blockers block ________ cholinoreceptor agonists more effectively than _______.

A

Exogenously administered; endogenously released Ach

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11
Q

Low doses of Atropine result in initial ______ as a result of the pre-junctional ____ on vagal postganglionic fibers that normally limit Ach release.

A

Bradycardia; M1

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12
Q

Which Drug?
1. A competitive antagonist at all MR
2. Prevents release of IP3 and inhibition of adenylyl cyclase.
3. Tertiary Amine

A

Atropine

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13
Q

Which Drug?
1. A competitive antagonist at muscarinic receptors.
2.Tertiary amine
3. Transdermal patch given for PONV and/or motion sickness (patch education needed)

A

Scopolamine

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14
Q

Which Drug?
1. A competitive, non-selective antagonist at M receptors
2. Reduces/prevents bronchospasm.

A

Ipratropium

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15
Q

Which Drug?
1. Blocks Ach at PNS sites in smooth muscle, secretory glands, and CNS, preventing salivation
2. Quaternary amine

A

Glycopyrrolate

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16
Q

Which Drug?
1. inhibits Ach-E, increases available Ach.
2. Tertiary amine - well absorbed throughout
3. Given for reversal of CNS anticholinergic syndrome

A

Physostigmine

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17
Q

Which Drug?
1. Forms covalent bond with Ach-E
2. Increases PNS activity, longer-acting.
3. Quaternary amine - does not enter CNS
4. Used in tx of Myasthenia Gravis

A

Neostigmine

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18
Q

What causes Cholinergic Poisoning?

A

Too much Acetylcholine

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19
Q

What are the S/Sx of Cholinergic Poisoning?

A

SLUDGE: Salivation, Lacrimation, Urination, Diarrhea, inc Gi motility, Emesis, pulm edema

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20
Q

A Medical emergency due to Insecticides, Wild mushrooms, or Nerve Gasses. Has a rapid onset of 30 min.

A

Cholinergic Poisoning

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21
Q

What is the treatment for Cholinergic Poisoning?

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A
  1. Tertiary Antimuscarinic (Atropine) for CNS and peripheral effects
  2. Benzos if seizures
  3. Cholinesterase Regenerators
22
Q

What are the S/Sx if too much Muscarine?

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A

N/V/D, urinary urgency, salivation, sweating, cutaneous vasodilation, bronchial constriction

23
Q

What is the treatment for too much Muscarine?

24
Q

What are the S/Sx of too much Nicotine?

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A

Seizure, coma, death, respiratory paralysis. Fatal dose = 40 mg

25
What is the treatment for too much Nicotine?
Symptom management (Nicotine is rapidly metabolized)
26
Which cholinergic drugs (agonists or antagonists) are Tertiary (Can cross the blood-brain barrier)
PAS: Physostigmine Atropine Scopolamine
27
T/F: if you give a muscarinic blocker, you will inhibit/slow digestion
false; gut motility still active d/t modulation of local hormones and NANC within the ENS
28
What clinical conditions are treated with Cholinomimetics?
1. closed angle glaucoma 2. accomodative esotropia 3. postop ileus 4. congenital megacolon 5. urinary retention 6. neurogenic bladder 7. reflux esophagitis 8. dry mouth 9. myasthenia gravis 10. alzheimers
29
What medication is used in the Tensilon Test to differentiate between a Myasthenia Crisis and a Cholinergic Crisis?
Edrophonium (an indirect acting cholinomimetic - simple alcohol)
30
What clinical conditions would you use a Muscarinic Blocker for?
1. mydriasis for eye exam 2. travelers diarrhea 3. urinary urgency and/or incontinence 4. urolithiasis 5. syncope 6. chagas dz 7. graves dz 8. copd/asthma recovery 9. parkinsons 10. motion sickness
31
What is the treatment for Atropine Intoxication?
Neostigmine
32
What are the S/Sx of Atropine Intoxication?
1. dry mouth 2. mydriasis 3. tachycardia 4. hot/flushed skin 5. agitation 6. delirium 7. fever 8. behavioral disturbances 9. lethal arrhythmias
33
There is no effective method for blocking the ______________ effect of cholinesterase inhibitors.
Nicotinic (remember: Nicotinic receptors are in SNS and PNS)
34
Which sympathetic receptor is most DOMINANT in the heart?
Beta 1
35
Adrenergic stimulation on the heart ___________ coronary blood flow
Increases
36
Direct Acting Cholinomimetics cause direct ______ of the SA and AV node.
Slowing
37
The slowing of the SA/AV node is opposed by what?
Reflex SNS discharge from the decrease in MAP
38
Indirect Acting cholinomimetics will cause prejunctional inhibition of _____ release, but secondarily will increase the _____ in the vasculature (as a response)
NE; NE
39
Which adrenergic receptor causes arterial and venous vasoconstriction = increased BP?
Alpha 1
40
What are the effects of Alpha 1 Stimulation?
1. Increased arterial tone/resistance 2. Decreased venous capacitance 3. Decreased HR due to baroreceptor reflex Ex: Phenylephrine
41
Stimulation of which Adrenergic receptor inhibits Renin secretion?
Alpha 2
42
Stimulation of Beta 1 receptors does what?
Increases CO by increasing contractility and direct stimulation of the SA node to increase HR.
43
Which adrenergic receptor stimulates Renin secretion?
Beta 1
44
Which adrenergic receptor decreases SVR through vasodilation of certain vascular beds?
Beta 2
45
What is the effect of Alpha 1 agonism on the eye?
Reduces outflow of aqueous humor and increases intraocular pressure.
46
What is the effect of Beta Blocker administration on the eye?
Reduces intraocular pressure through decreasing the aqueous humor.
47
Why do you want to avoid stopping a beta blocker rapidly in a patient with HTN?
To avoid rebound HTN
48
What is the effect of Alpha Blockers on the CV System?
Lowers BP and SVR
49
Which drug often causes orthostatic hypotension and reflex tachycardia?
Alpha Blockers
50
You should avoid which class of drugs in asthmatic patients?
Beta Blockers (bronchoconstriction)

Pharmacology I (16 decks)

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