Pharmexam2.txt

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scawrse1
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41489
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Pharmexam2.txt
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2010-10-11 20:00:42
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Pharm exam adrenergic cholinergic musculoskeletal receptors
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Pharm Exam 2, part 1
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  1. The involuntary nervous system is also known as what?
    Autonomic nervous system
  2. The autonomic nervous system consists of what two parts?
    • Sympathetic nervous system
    • Parasympathetic nervous system
  3. The voluntary nervous system is also known as what?
    The somatic nervous system.
  4. The sympathetic and parasypathetic systems control what?
    • Cardiac output
    • Blood flow to organs
    • Digestion
  5. The somatic nervous system controls what?
    • movement
    • respiration
    • posture
  6. Adrenergic receptors are stimulated by what?
    norepinephrine
  7. Cholinergic receptors are stimulated by what?
    Acetylcholine
  8. What are the two types of cholinergic receptors?
    • muscarinic (parasympathetic and sympathetic)
    • nicotinic (parasympathetic, sympathetic, and somatic)
  9. What types of receptors are found in the sympathetic nervous system (fight or flight)?
    • muscarinic (cholinergic)
    • nicotinic (cholinergic)
    • adrenergic
  10. What are the four types of adrenergic receptors?
    • alpha 1
    • alpha 2
    • beta 1
    • beta 2
  11. How is the activity of acetylcholine controled in cholinergic synapses?
    Acetylcholine-esterase is in the synapse and it breaks down acetylcholine, returning the pieces to the pre-ganglionic fiber. The activity level is therefore controled by the amount of acetylcholine and acetylcholinesterase in the synapse.
  12. How is the activity of norepinephrine controled in adrenergic synapses?
    Norepinephrine is controled by a negative feedback loop. NE stimulates alpha 2 receptors on the pre-ganglionic fibers which sends a message to slow or stop the release of NE into the synapes. This, in turn, limits the stimulation of alpha 1, beta 1, and beta 2 receptors on the post-ganglionic fiber.
  13. Alpha 1 stimulation results in:
    • arteriolar constriction, resulting in increased peripheral resistance and increased blood pressure
    • pupillary dilation (midriasis)
    • sphincter contration in the bladder
    • increased tension of smooth muscle around prostate
  14. Alpha 2 stimulation results in:
    decreased sympathetic activity, therefore peripheral vasoliation
  15. Beta 1 stimulation results in:
    • increased heart rate (chronotropic)
    • increased force of contraction (inotropic)
    • increased speed of conduction (dromotropic)
  16. Beta 2 stimulation results in:
    • dilation of bronchioles
    • dilation of arterioles and therefore decreased PR
    • release of glucose from liver
    • potassium shift into cells
    • relaxation of detrusor muscle around bladder
    • slowing of GI peristalsis
  17. How to alpha 1 and beta 2 stimulation affect PR?
    Alpha 1 increases PR and Beta 2 decreases PR. The net effect is an increase in PR.
  18. What happens to the heart when muscarinic cholinergic receptors are stimulated?
    • HR decreases
    • speed of conduction decreases
    • force of contraction decreases
    • (similar to blocking of beta 1 receptors; also known as vagal nerve stimulation)
  19. What systems are effected and what happens when muscarinic cholinergic receptors are stimulated?
    • heart rate slows, force of contraction decreases
    • pupil constrics and intraocular pressure decreases
    • GI system speeds up digestion
    • tone of smooth muscle increases in bronchiol tree (can result in bronchospasms)
  20. What happens with excessive blockade of the muscarinic cholinergic receptors?
    • Mad as a hatter (psychosis and seizures)
    • Dry as a bone (decreased secretions)
    • Blind as a bat (pupil can't constict or accomodate)
    • Red as a beet (vasodilation)
    • Hot as a hare (warm to touch)
  21. What happens when nicotinic receptors are blocked in the musculoskeletal system?
    muscle paralysis
  22. Stimulation of which receptors causes increased conduction and contractility in the heart?
    Beta 1 (and Beta 2)
  23. Stimulation of which receptors causes decreased condution and contractility in the heart?
    muscarinic receptors
  24. Stimulation of which receptor causes blood vessels to contract?
    Beta 2
  25. Stimulation of which receptors causes blood vessels to relax?
    Beta 2 and muscarinic
  26. Stimulation of which receptor causes smooth muscle in lungs to relax?
    Beta 2
  27. Stimulation of which receptor causes smooth muscle in the lungs to contract?
    muscarinic
  28. Stimulation of which receptors decrease digestion in the GI tract?
    Beta 2 and Alpha 1
  29. Stimulation of which recpetors causes increases digestion in the GI tract?
    muscarinic
  30. Stimulation of which receptors causes urinary retention?
    Beta 2 (relaxing bladder wall) and Alpha 1 (contraction of sphincters)
  31. Stimulation of which receptors causes urinary release?
    muscarinic (contract bladder wall and relax sphincters)
  32. Stimulation of which receptors cause release and production of glucose?
    Beta 2 (gluconeogenesis) and Alpha 1 (glucogenolysis)
  33. Stimulation of which receptors cause mydriasis?
    Alpha 1 causes pupil dilation
  34. What drugs are muscarinic agonists?
    • bethanechol
    • pilocarpine
  35. Bethanechol
    • muscarinic agonist
    • selective for GI tract and bladder
    • used to help pt's gain control of bladder function, allows them to pee
    • patient related variables include: asthma, peptic ulcers, heart conduction defects
  36. pilocarpine
    • muscarinic agonist
    • topical treatment for glaucoma
    • causes pupil constriction and decreases intraocular pressure
    • patient related variables include: asthma, peptic ulcers, heart conduction defects
  37. Common patient related variables for muscarinic agonists include:
    • asthma (may precipitate bronchospasms)
    • peptic ulcers (increases acid secretion)
    • heart conduction defects (slows conduction)
  38. Muscarinic antagonists include:
    • atropine/scopolamine/belladonna
    • ipratropium quarternary amine
    • dicyclomine
    • oxybutynin
  39. atropine/scopolamine/belladonna
    • competatively blocks muscarinic receptors
    • used pre-operatively to decrease salivation, blocks vagal effects on heart, dilates pupils, treats bradycardia, reverses toxicity of too much muscarinic stimulation, prevents motion sickness (scopolamine patch)
    • patient related variables include: BPH, high temperatures, reflux esophagitis
    • too LITTLE can result in paradoxical bradycardia
  40. ipratropium quarternary amine
    • blocks muscarinic receptors
    • used in asthma/COPD to cause bronchodilation
  41. dicyclomine
    • blocks muscarinic receptors
    • decreases digestion, used for IBS
    • patient related variables include: tachycardia, confusion, urinary retention, increased intraocular pressure
  42. oxybutynin
    • blocks muscarinic receptors
    • used to treat urinary incontinence r/t muscle spasms
    • patient related variables include: tachycardia, confusion, increased intraocular pressure
  43. Nicotinic antagonist (neuromuscular blockers) include:
    • atracurium (non-depolarizing)
    • pancuronium (non-depolarizing)
    • succinylcholine (depolarizing)
  44. atracurium or pancuronium
    • non-depolarizing neuromuscular blocking agents (nicotinic antagonists)
    • competatively blocks ACh
    • used as adjunct to general anesthesia
    • toxicity: respiratory paralysis (reversed by AChase inhibitors)
  45. succinylcholine
    • depolarizing neuromuscular blocking agent (nicotinic antagonist)
    • produces a persistent depolarization, preventing further stimulation
    • CANNOT be revered by AChase inhibitors
    • used for anesthesia, tracheal intubation
    • avoid in patients with major burns, multiple traumas, h/o skeletal muscle myopathy, h/o malignant hyperthermia, as these can cause hyperkalemia and exacerbate toxicity
    • toxicity: hyperkalemia
  46. Nicotinic and muscarinic agonists (AChase inhibitors)
    • neostigmine
    • organophosphate insecticides
  47. neostigmine
    • AChase inhibitor (nicotinic, muscarinic agonist)
    • reversibly blocks action of AChase
    • used to reverse action of non-depolarizing neuromuscular blocking agents (atracurium/pancuronium), and to treat antocholinergic effects (mad as hatter, etc)
    • toxicity (from excessive stimulation): nausea, vomiting, diarrhea, increased salivation, increased bronchial secretions, bronchoconstriction, bradycardia, muscle cramps, muscle fasciculation
  48. organophosphate insecticides
    • irreversibly blocks action of AChase
    • nicotinic/muscarinic agonist
    • toxicity antidote: pralidoxime and atropine
  49. Adrenergic alpha agonists
    • phenylephrine (Alpha 1)
    • clonidine (Alpha 2)
  50. Mixed alpha/beta adrenergic agonists
    • norepinephrine (alpha 1, alpha 2, beta 1)
    • epinephrine (alpha 1, alpha 1, beta 1, beta 2)
  51. Beta adrenergic agonists
    • dobutamine (beta 1)
    • isoproterenol (beta 1, beta 2)
    • albuterol, terbutaline, metraporterenol (beta 2)
  52. dopamine adrenergic agonists
    • dopamine (dopa 1, dopa 2, beta 1, alpha 1)
    • fenoldopam (dopa 1)
  53. isoproterenol
    • stimulates beta 1 and beta 2
    • used for testing purposes only (stress tests)
  54. metaproterenol
    • stimulates beta 2
    • used as a bronchodilator in asthmatics
    • doesn't affect the heart
  55. dobutamine
    • beta 1 agonists
    • used to support cardiac function by increaseing rate and force of contraction
  56. dopamine
    • at medium dose stimulates beta 1
    • at high doses stimulates beta 1 and alpha 1
  57. norepinephrine
    • stimulates alpha 1, alpha 2, and beta 1
    • used to support cardiac function, is a potent vasoconstrictor
  58. epinephrine
    • stimulates alpha 1, aplha 2, beta 1, and beta 2
    • primary drug used in cardiac arrest, used to treat anaphylaxix, produce local vasoconstriction
  59. phenylephrine
    • alpha 1 agonists
    • topical decongestant
    • given IV to support blood pressure
  60. ritodrine, terbutiline
    • beta 2 stimulator
    • inhibits uterine contractions
  61. clonidine
    • alpha 2 similator
    • decreases sympathetic outflow, may cause analgesia
  62. Toxicity from beta 1 stimulation:
    tachycardia, cardiac ischemia, cardiac arrhythmias
  63. Toxicity from beta 2 stimulation:
    hypotension, tremor
  64. Toxicity from alpha 1 stimulation:
    hypertension, decreased organ perfusion
  65. Toxicity from alpha 2 stimulation:
    orthostatic hypotension
  66. Patient related variables for beta 1 stimulation:
    ischemic heart disease, heart conditions
  67. Patient related variables for alpha 2 stimulation:
    hypertension, hypovolemia
  68. Adrenergic alpha blockers
    • phentolamine
    • prazosin, terzosin, doxazosin
    • tamsulosin
  69. adrenergic beta blockers
    propanolol
  70. phentolamine
    • blocks alpha 1 and alpha 2
    • used to reverse local vasoconstricting effect of extravasated alpha agonist
  71. prazosin/terzosin/doxazosin
    • blocks alpha 1 receptor
    • used for hypertension, BPH
    • toxicities: orthostatic hypotension, nasal stuffiness, peripheral edema
  72. tamsulosin
    • blocks alpha 1 receptors
    • used to treat BPH
    • toxicities: orthostatic hypotension
  73. propanolol
    • blocks beta 1 and beta 2
    • used to treat hypertension, angina, antiarrythmic
    • toxicities: heart failure, bradycardia, bronchospasms (do not give SR as first dose)
    • patient related variables: heart failure, asthma (better to give beta 1 selective agonist)

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