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true or false. Acetylcholine is available as a drug and used in pharmacotherapy
What are 2 examples of choinomimetic drugs used in dentistry to treat xerostomia?
- pilocarpine (salagen)
- cevimeline (evoxac)
Why aren't the cholinergic agonists pilocarpine (salagen) and cevimeline (evoxac) inactivated by acetylcholinesterase?
because they are not choline esters
What else is pilocarpine used for besides dentistry?
as eyedrops for glaucoma
drugs that do not act on cholinergic receptors, but instead inhibit the enzyme that degrades acetylcholine
What is an example of an antichlinesterase drug that is useful in the treatment of myasthenia gravis?
group of drugs that includes agents that affect muscarinic receptor activity and drugs that affect nicotinic receptor activity
cholinergic blocking agents
What is the prototype antimuscarinic drug that blocks muscarinic receptors only and has no effect on nicotinic receptors?
What is the name of the plant that atropine comes from?
a nightshade plant called atropa belladonna
What is the action of atropine?
a competitive antagonism
true or false. Atropine has a higher affinity for the muscarinic receptor than that of acetylcholine
What is the action of atropine?
it binds to the receptor, preventing acetylcholine from binding, which allows tissue cholinesterase to degrade acetylcholine before it can bind to muscarinic receptors
What is an example of when atropine has been used in dentistry?
prior to making a dental impression when a dry field is needed
What is the mnemonic that describes the effects of toxic doses of atropine?
- dry as a bone (decreased sweating)
- hot as a hare (increased body temp)
- blind as a bat (mydriasis, cycloplegia)
- mad as a hatter (CNS stimulation)
What type of drugs are ganglionic blocking agents and skeletal muscle relaxants?
nicotinic-receptor blocking agents
What do nicotinic-receptor blocking agents do?
they inhibit ach affects at the synapse between preganglionic and postganglionic fibers in the ANS, at the adrenal medulla, and at the skeletal myoneural junction
What are nicotinic-receptor blocking agents used in dentistry for?
therapeutically as skeletal muscle relaxants
What are the 2 types of nicotinic-receptor blocking agents?
- competitive nondepolarizing agents
- noncompetetive depolarizing agents
this occurs when an antagonist competes with an agonist for the same receptor site; and may be overcome by administration of higher concentrations of ach
this occurs when an agonist binds to the receptor site, causes muscle contraction, and then dissociates slowly from the receptor; during the time that the agonist remains bound to the receptor, other agonists are excluded from binding to the same receptor site
atropine, scopolamine, methantheline, propantheline are all what type of drug?
muscarinic cholinergic blocking agents
tubocurarine, metocurine, alcuronium, doxacurium, and pancuronium are all what type of drug?
competitive nondepolarizing nicotinic cholinergic blocking agents
succinylcholine is what type of drug?
noncompetitive depolarizing nicotinic cholinergic blocking agent
What is the drug scopolamine used for?
- it is used for surgical premedication to gain a dual benefit of CNS depression and reduced airway secretions (amnesia to surgery)
- it is also used as motion sickness drug
What type of drugs are used to reduce tremors associated with parkinson's disease?
What are some contraindications for the used of antimuscarinic drugs?
- cardiovascular disease
- benign prostate hypertrophy
- prepuberty age group
When are sympahtomimetic drugs (adrenergic) used in dentistry?
- local vasoconstriction (EPI, levonordefrin) in local anesthetic agents
- gingival retraction cord
What are 6 uses of adrenergic drugs?
- vosoconstriction to control bleeding
- local vasoconstriction to prolong duration of local anesthesia
- relief of nasal congestion via constriction of vessels in the upper respiratory tract
- increased blood pressure in treatment of shock
- bronchodilation in asthma and allergic bronchoconstriction
- anaphylactic shock
sympathomimetics act by dirct activation of ________ or indirctly by actions at the _________. And some drugs act both directly and indirectly
how do indirectly acting sympathomimetics act?
they block the reuptake of Nor into the ANT, or they may displace Nor from the mobile pool within the nerve terminal
What is the prototype of indirectly acting sympathomimetics that block the active uptake of nor and other catecholamines into the ANT?
What is the prototype for indirectly acting drugs that cause a rapid release of Nor from the mobile pool of the ANT
What can occur if the dose of amphetamine is too high?
What are amphetamines used therapeutically for?
When used therapeutically, what are 6 effects of amphetamines?
- stimulate the medullary respiratory center in the brain
- reverse drug induced CNS depression
- increase wakefulness and alertness
- decrease the apetite
- decrease fatigue
- elevate the mood leading to euphoria
What is artificial prolongation of amphetamine followed by?
- prolonged sleep
What is an example of a sympathomimetic with a mixed action (both direct and indirect affects)
Why were ephedrine products removed from the market?
due to reports of cardiovascular stimulation, in some cases leading to death
The effects of ephedrine are similar to EPI but last up to ________ times longer.
What are the two groups included in drugs that block SNS activity?
- inhibitors of catecholamine storage
- adrenergic-receptor blocking drugs