1A: Dt 1 - 2

Front 1

Hexamethonium:
Effects
Drug Class

Back 1

Nicotinic antagonist (blocks transmission of PSymp and Symp--this is at the level of the autonomic--first--ganglion)

Dominant tone of tissue will prevail. So drug can look either symp or psymp antagonist.

Front 2

Hexamethonium effects:
BP
HR
Q
Urine Output
GI Motility
Pupil of Eye

Back 2

Dominant tone at arteries/veins = symp, so will appear anti-symp. BP will decrease

At other tissues, dom tone is psymp. So will appear anti-parasymp.

HR: Up
Q: Down
Urine Output: Down
GI Motility: Down
Pupil of Eye: Mydriasis (dilation)

Front 3

Muscarinic vs Nicotinic Receptors:
Biochemical receptor tyoe

Back 3

Musc: G-protein coupled receptors

Nicotinic: Sodium/K+ channels

Front 4

Production of ACh.

List enzymes and drugs that block each step.

What causes vesicle release?

Back 4

Choline enters via Na+-Co-transporter (uses Na+ gradient)-RATE LIMITING STEP; blocked by HEMICHOLINIUM

Acetyl CoA added to Choline; via Choline Acetyltransferase; blocked by VESAMICOL

Vesicles released by Ca2+
Inhibited by BOTULINUM

Front 5

Botulinum toxin:
MOA
Symptom

Back 5

Prevents release of ACh vesicles

Symptom: Flaccid paralysis

Front 6

Black Widow Spider Toxin:
MOA

Back 6

Stimulates release of Ach into synapse

Front 7

Production of NE.

List enzymes and drugs that block each step.

What causes vesicle release?

What inhibits reuptake?

Back 7

Tyrosine transported into cell with Na+ co-transporter

Tyrosine-->DOPA via TYROSINE HYDROXYLASE; inhibited by METYROSINE

L-DOPA-->DA-->NE

Packaged into vesicles. This step blocked by RESERPINE.
-->Epi

Ca2+ causes release; release inhibited by GUANETHIDINE, BRETYLIUM

NE can undergo re-uptake--inhibited by Cocaine, Amphetamines, TCA (tricyclic anti-depressants)

Front 8

Pre-cursor of Tyrosine.

Back 8

Phenylalanine

Front 9

Pre-cursor of Thyroxine.

Back 9

Tyrosine

Front 10

What drus stimulate the release of NE?

Back 10

Amphetamine
Ephedrine
Tyramine

Front 11

Pre-Synaptic Auto-Receptors:
Effect
Example for NE

Back 11

Regulate release of NT

alpha-2 receptor inhibits release of NE when NE binds to it.

Front 12

Enzymes that metabolize NE

Back 12

COMT (Catechol-O-methyltransferase)--methylates NE

MAO (monoamine oxidase)--oxidate NE

Front 13

MAO-inhibitors:
Effect

Back 13

Inhibit MAO (enzyme that metabolizes NE) so that NE sticks around longer.

Used in anti-depressants

Front 14

What substance is contraindicated with MAO-inhibitors?

Back 14

Tyramine--can result in hypertensive crisis. Stimulates release of NE.

Would have too much NE if took both!

Front 15

Byproducts of breakdown of NE.

Back 15

VMA
Metanephrines
Normetanephrines

Front 16

alpha-1 receptor effects

Back 16

vascular SM contraction (raise BP)
mydriasis

Front 17

alpha-2 receptor effects

Back 17

vasodilation (decrease

Front 18

beta-1 receptor effects

Back 18

act at heart, increase heart rate

Front 19

beta-2 receptor effects

Back 19

vasodilation, bronchodilation***

also compensatory HR increase due to drop in BP

Front 20

GQ Receptor effects
Example receptor

Back 20

GQ receptor: QC
activates phospholipase C
Cleaves lipids into PIP2
PIP2 broken down to IP3 (inositol triphosphate) and DAG (diacylglycerol)

IP3-->increases intracell Ca2+
DAG-->activates Protein Kinase C

Front 21

GS Receptor effects

Back 21

GS stimulates adenylyl cyclase
Cleaves ATP-->cAMP-->activates Protein Kinase A

Front 22

Gi Receptor effects

Back 22

INhibits adenylyl cyclase
Decrease cAMP-->dec Protein Kinase A

Front 23

Tyrosine kinase receptor effects

Back 23

GF's bind tyrosine kinase receptors
Use PLC to make IP3 and DAG

OR

bind adaptor prots-->activate Ras-->activates Protein Kinase I-->activates Protein Kinase II-->activates Protein Kinase III

Front 24

Specific G protein receptors for:
alpha-1
alpha-2
beta-1
beta-2
D1
D2
H1

Back 24

alpha-1 GQ
alpha-2 Gi
beta-1/2 GS
D1: GS
D2: Gi
H1: GQ
(QIS SIQ)--kiss sick

Front 25

D1 receptor effects

Back 25

relaxes renal vessels

Front 26

D2 receptor effects

Back 26

Modulates NT release, esp in brain

Front 27

M1 receptor effects

Back 27

CNS, enteric NS

Front 28

M2 receptor effects

Back 28

dec heart rate, contractility of atria

Front 29

M3 receptor effects

Back 29

inc exocrine gland secretions (sweat, stomach acid)
inc gut persitalsis
inc bladder contraction
bronchoconstriction
inc miosis
ciliary muscle contraction (accommodation)

Front 30

G-protein class for muscarinic receptors.

Back 30

M1 Q
M2 I
M3 Q

Front 31

Epinephrine:
receptors it acts at
uses

Back 31

alpha 1, beta 1, alpha 2, beta 2

anaphylactic shock, asthma

Front 32

NE:
receptors it acts at
uses

Back 32

alpha 1, alpha 2>>beta 1
not very strong heart effects

septic shock (bc there's vasodilation of BVs)--will tighten BVs without inc'd heart rate (like Epi would)

Front 33

Isoprotenelol
receptors it acts at

Back 33

beta 1, beta 2

Front 34

Dopamine:
receptors it acts at
uses

Back 34

beta 1, beta 2 >>alpha 1, alpha2

shock (renal perfusion)
heart failure
D1>beta>alpha

Front 35

Dobutamine:
receptors it acts at
uses

Back 35

beta-1

ionotropic and chronotropic

used in cardiogenic shock, cardiac stress testing

Front 36

Phenylephrine:
receptors it acts at
uses

Back 36

alpha 1, alpha2

pupillary dilaiton, vasoconstriciotn, nasal decongestion

Front 37

Metaproterenol:
receptors it acts at
uses

Back 37

beta 2 > beta 1
asthma

Front 38

Albuterol:
receptors it acts at
uses

Back 38

beta 2 > beta 1
asthma

Front 39

Salmeterol:
receptors it acts at
uses

Back 39

beta 2>beta1
Long-Term asthma tx

Front 40

Terbutaline:
receptors it acts at
uses

Back 40

beta 2>beta 1
Reduces premature uterine contractions

Front 41

Amphetamine:
MOA
Use

Back 41

Releases stored catechols

Uses: narco, obesity, ADD

Front 42

Ephedrine:
MOA
Use

Back 42

releases stored catechols

nasal decongest, urinary incont, hypotn

Front 43

Cocaine:
MOA
Use

Back 43

Symp uptake inhibitor

Vasoconstriction, local anesthesia

Front 44

Effect of NE on:
BP
HR

Back 44

NE: alpha1 > beta1

Results in Inc BP (due to vasoconstriction)

and a REFLEX BRADYCARDIA

Front 45

Effect of isoproterenol on:
BP
HR

Back 45

beta 1 = beta 2 activity


BP: drops

HR: increases (beta1), reflexive tach

Front 46

Clonidine:
Receptors act on
Uses

Back 46

Centrally acting alpha-2 agonist

Use in HTN, esp with renal dz (no blood flow to kidney)

Front 47

alpha-methyldopa:
Receptors act on
Uses

Back 47

Centrally acting alpha-2 agonist

Use in HTN, esp with renal dz (no blood flow to kidney)

SAFE IN PREGNANCY

Front 48

beta-blocker:
Effects
AEs

Back 48

dec'd cardiac output
dec'd renin secretion

AE's:
ED
Asthma exacerbation
Bradycardia, AV block
Sedation, fatigue
Use in caution w/DM (blocks syx of hypoglycemia--tachycardia, diaphoresis)

Front 49

beta-blockers that decrease AV conduction velocity.

When would this be necessary?

Back 49

Use in SVT:
propranolol
Esmolol

Front 50

This beta-blocker is used in glaucoma. Why?

Back 50

Timolol

dec'd secretion of aqueous humor

Front 51

Which beta-blockers aren't selective?

Back 51

N-->Z non-zelective

Front 52

Which beta-blockers are selective? Which receptor do they select for?

Back 52

beta-1>beta-2
A-->M

Advantageous in pts with pulm dz.

Front 53

Which beta-blockers are also partial beta-agonists?

Back 53

PAPA
Partial Agonist: Pindolol, Acebutolol

Front 54

What are the effects of cocaine on arterial pressure?

Is this an indication for beta-blockers?

Back 54

Cocaine increases arterial pressure

But BP will increase even more if you treat with beta-blocker!

Front 55

Glaucoma:
Aqueous humor pathway
Pathophys

Back 55

Aq humor formed in ciliary body
-->posterior chamber
-->anterior chamber via lens/iris angle
-->reabsorbed via canal of schlemm

Glaucoma: impaired flow of aq humor-->inc'd intraocular pressure-->optic disc atrophy with cupping

Front 56

Open angle glaucoma:
Pathophys
Syx
Visual Changes

Back 56

Obstructed outflow--problem with canal of schlemm; can't get rid of aqueous humor

This is common and insidious (comes on slowly); silent glaucoma

Almost always bilateral

Risk factors:
Myopia
Age >40
DM

Visual changes: reduced/absent vision, contraction of visual field (peripheral-->central)

Front 57

Acute angle glaucoma:
Pathophys
Syx
Visual Changes

Back 57

Obstruction of flow between iris and lens (between posterior and anterior chamber), pressure builds up behind iris.

Very painful! abrupt onset of syx. abrupt decrease in vision.frontal headache.

EMERGENCY!

Colored halos, rainbows around light

Front 58

Epi exacerbates which glaucoma?

Back 58

close angle

epi causes mydriasis, makes situation worse (pressure buildup behind iris)

Front 59

Fixed, mid-dilated pupil not reactive to light =

Back 59

acute angle-closure glaucoma

also is firm to palpation

Front 60

Cup:Disc ratio > _____ = glaucoma

Back 60

Greater than 1:2

Front 61

60 year-old male has hard time driving at night because of worsening vision, appearance of halos around oncoming headlights.

Dx?

Back 61

Cataracts

Not an abrupt change, not painful.

Front 62

beta-blockers in glaucoma treatment:
Examples

Back 62

beta-blockers: timolol, betaxolol

Lower intraocular pressure

Front 63

Alpha agonists in glaucoma treatment:
MOA
Examples

Back 63

alpha-agonists: epi, brominidine--vasoconstriction-->dec aq humor synthesis due to vasoconstriction (OPEN ANGLE ONLY)

Front 64

Diuretics in glaucoma treatment:
MOA
Examples

Back 64

Diuretics: mannitol, azetazolamide; dec'd humor secretion due to dec'd HCO3-

Front 65

PGs in glaucoma treatment:
MOA
Examples
AEs

Back 65

LatanoPROST; inc outflow of aqueous humor

AE: darkens color of iris

Front 66

Cholinomimetics in glaucoma treatment:
MOA
Examples

Back 66

Inc outflow of aq humor; contract ciliary muscle, open trabecular meshwork

Pilocarpine (direct cholinomimetic)

Physostigmine--indirect cholinomimetic

Front 67

Phenoxybenzamine:
Drug Class
Use

Back 67

IRREVERSIBLE (NONCOMP)

nonselective alpha blocker: alpha1, alpha2 both blocked

use in pheochromocytoma--must give phenoxybenzamine first! or you'll get rid of beta-2 effect and will inc BP.

Front 68

Phentolamine:
Drug Class

Back 68

REVERSIBLE (COMP)

nonselective alpha blocker: alpha1, alpha2 both blocked

Front 69

Prazosin:
Drug Class
Use
AE

Back 69

alpha-1 blocker (selective)

Use in HTN, urinary retention in BPH

AE: first dose orthostatic hypotension--start with a low dose at night

Front 70

Terazosin:
Drug Class
Use

Back 70

alpha-1 blocker (selective)

Use in HTN, urinary retention in BPH

AE: first dose orthostatic hypotension--start with a low dose at night

Front 71

Mirtazapine:
Drug Class
Use

Back 71

alpha-2 selective

Use in depression

May cause sedation, inc'd appetite

AE: first dose orthostatic hypotension--start with a low dose at night

Front 72

Tamsulosin:
Drug Class
Use

Back 72

alpha-1 antag; selective for alpha-1 A receptors-->relaxes prostatic urethra

DOESN'T LOWER BP

Use in urinary retention due to BPH

Front 73

Epi:
Low vs High Doses
Effect of large dose after alpha-blocker administration

Back 73

Low doses: vasodilation, lower BPs (Beta 2 vasodilation predominates)

High doses: alpha-1 constriction predominates

Need high doses of Epi for constrictive effects (raise BP)

Large dose after alpha-blockade results in decreased BP because there are no alpha-receptors to act on (acts on beta receptors)

Front 74

Phenylephrine:
Low vs High Doses
Effect of large dose after alpha-blocker administration

Back 74

No beta effect, all alpha effect.

If alpha blockade and then administer phenylephrine-->no effect.

Front 75

Sildenafil:
Suffix
Drug Category

Back 75

-denafil

PDE5 Inhibitor (inc'd cGMP)-->Vasodilate; ED

Front 76

Halothane:
Suffix
Drug Class

Back 76

-ane

Inhalational anesthetics

Front 77

Diazepam:
Suffix
Drug Class

Back 77

-azepam

Benzodiazepine

Front 78

Chlorpromazine:
Suffix
Drug Class

Back 78

-azine

Phenothiazine (neuroleptic, antiemetic)

Front 79

Ketoconazole:
Suffix
Drug Class

Back 79

-azole

Anti-fungal

Front 80

Metronidazole:
Drug Class

Back 80

Anti-biotic, NOT antifungal

Front 81

Phenobarbital:
Suffix
Drug Class

Back 81

-barbital

Barbiturate

Front 82

Lidocaine:
Suffix
Drug Class

Back 82

-caine

Local anesthetic

Front 83

Tetracycline:
Suffix
Drug Class

Back 83

-cycline

Abx: protein synthesis inhibitor

Front 84

Paroxetine:
Suffix
Drug Class

Back 84

-etine

SSRI

Front 85

Imipramine:
Suffix
Drug Class

Back 85

-ipramine

TCA

Front 86

Saquinavir:
Suffix
Drug Class

Back 86

-avir

Preotase inhibitor (for HIV)

Front 87

Haloperidol:
Suffix
Drug Class

Back 87

-operidol

Butrophenone (neuroleptic)

Front 88

Digoxin:
Suffix
Drug Class

Back 88

-oxin

Cardiac glycoside (inotropic)

Front 89

Captopril:
Suffix
Drug Class

Back 89

-pril
ACE inhibitor

Front 90

Albuterol:
Suffix
Drug Class

Back 90

-terol

beta-2 agonists

Front 91

Cimetidine:
Suffix
Drug Class

Back 91

-tidine

H2 antagonist

Front 92

Sumatriptan:
Suffix
Drug Class

Back 92

-triptan

5-HT agonists (migraine)

Front 93

Amitryptyline:
Suffix
Drug Class

Back 93

-triptyline

TCA

Front 94

Somatotropin:
Suffix
Drug Class

Back 94

-tropin

Pituitary hormone

Front 95

Alprazolam:
Suffix
Drug Class

Back 95

-zolam

Benzodiazepine

Front 96

Alendronate:
Suffix
Drug Class

Back 96

-dronate

Bisphosphonate

Front 97

Losartan:
Suffix
Drug Class

Back 97

AgII receptor antagonist

Front 98

Bethanechol:
Suffix
Drug Class

Back 98

-chol

Musc agonist

Front 99

Neostigmine:
Suffix
Drug Class

Back 99

-stigmine

Anti-AChE

Front 100

Lomustine:
Suffix
Drug Class

Back 100

-mustine

Put Nitro on a Mustang

Nitrosureas (brain ca; cross BBB)

Front 101

Atracurium:
Suffix
Drug Class

Back 101

-curium

Paralytic; non-depolarizing NM blockage

Reversed with neostigmine (AntiAChE)

Front 102

Vecuronium:
Suffix
Drug Class

Back 102

-curonium

Paralytic drug; non-depolarizing NM blockage

Reversed with neostigmine (Anti-AChE)

Front 103

Atorvastatin:
Suffix
Drug Class

Back 103

-statins

HMG CoA reductase inhibitors

Front 104

Rosiglitazone:
Suffix
Drug Class

Back 104

-glitazones

Inc target cell response to insulin

Front 105

Albendazole:
Suffix
Drug Class

Back 105

-bendazole

Antiparasite/antihelmintic

Front 106

Nifedipine:
Suffix
Drug Class

Back 106

-dipine

Dihydropyridine Calcium Channel Blocker

Front 107

Travoprost:
Suffix
Drug Class

Back 107

-prost

Prostaglandin analog (tx glaucoma)