Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
41 Cards in this Set
- Front
- Back
Symptoms of excess parasymp. activity?
|
DUMBBELSS:
Diarrhea, Urination, Miosis, Bronchospasm, Brady, Excitation of Skeletal m. and CNS, Lacrimation, Sweating, Salivation |
|
What drugs are used for Alzheimers?
|
Donepezil, Galantamine, Rivastigmine
|
|
Pathology of Myasthenia gravis? How treated?
|
Myasthenia gravis = Ab's to Acetylcholine receptor = pt presents with Diplopia and Ptosis = drooping eye that worsens throughout day, can also have Thymic Hyperplasia, Atrophy or tumor --> can lead to Myasthenic Crisis = progressing weakness in respiratory muscles
Dx = Tensilon test Tx = Acetylcholinesterases (Pyridostigmine, Neostigmine), Corticosteroids, Thymectomy = remove thymus, Plasmapharesis = will remove the Abs to the Ach receptor |
|
What drug regenerates Ach after organophosphate poisoning?
|
Pralidoxime = 2-PAM
|
|
What is the antidote for organophosphate poisoning?
|
Atropine
|
|
Which anticholinesterases are used in the treatment of Alzheimer's disease?
|
Donepezil, Galantamine, Rivastigmine
|
|
T/F: Nicotinic Ach receptors are ligand gated Na+/K+ channels and Muscarinic Ach receptors are G-protein-coupled receptors that act through second messenger subtypes M1, M2, M3, M4, M5
|
True
|
|
List the Direct Ach Agonists (=Cholinergic Agonists) that mimic Ach
|
Bethanechol (post-op and neurogenic ileus and urinary retention), Carbachol (galucoma, pupillary contraction, releif of intraocular pressure), Pilocarpine (stimulator of sweat, tears, salica), Methacholine (challenge test to Dx asthma)
|
|
What are the Indirect Agonists of Ach (=target Anti-cholinesterase which normally works to break down Ach)
|
Neostigmine (post-op and neurogenic ileus and urinary retention, myasthenia gravis, reverses neuromuscular junction blockade), Pyridostigmine (Myasthenia gravis doesn't penetrate CNS, Edrophonium (Dx Myasthenia gravis), Physostigmine (Glaucoma and atropne over-dose), Ecothiophate (glaucoma), Donepazil (Alzheimer's)
|
|
Organophosphates such as Parathion used by farmers and gardeners does what? Tx?
|
Irreversibly inhibit AchE = we get Inc Ach = DUMBBELSS symptoms
Tx = Atropine and then Pralidoxine regenerates the AchE |
|
Most common Neuro-muscular junction disorder?
|
Myasthenia Gravis
= Abs to post-synaptic Ach receptor causes ptosis, diplopia, general weakness |
|
What are the Muscarinic Blockers?
|
Atropine, Homatropine, Tropicamide, Benztropine, Scopolamine, Ipratropium, Oxybutynin, Glycopyrrolate, Methscopolamine, Pirenzepine, Propantheline
|
|
Use for Atropine?
|
Mydriasis and Clycloplegia
|
|
Use of Benztropine?
|
Parkinsons
"Park my Benz" |
|
Use of Scopolamine
|
Motion sickness
|
|
What are the symptoms of inhibiting parasympathetic activity?
|
"Dry Everywhere"
Ileus, urinary retention, hyper-pyrexia (=hot), dry mouth, Flushing of skin, blind tachy, dilation of eye, delirium |
|
Physostigmine, Echothiophate, Donepezil, Neostigmine, Edrophonium, Rivastigmine, Pyridostigmine
These are all are? |
Anti-AchE = anti-acetylcholinesterase = Inc. Ach b/c they inhibit the thing that breaks Ach down
|
|
Pilocarpine, Bethanechol, Carbachol are all?
|
Cholinergic Agonists = Inc Ach
|
|
Oxybutynin, Atropine, Darifenacin, Ipratropium, Tropicamide, Benztropine, Scopolamine, Tolterodine, Trospium, Homatropine are all?
|
M-Blockers = Block Ach binding
|
|
Which of the M-Agonists are used to improve FEV1 in a pt with asthma?
|
Ipratropium
|
|
A 30 year old schizophrenic now has urinary retention due to his neuropleptic - what do you treat him with?
|
Bethanechol
|
|
What drugs can dilate pupils?
|
Sympathetic Agonist OR Anti-cholinergic like an M-blocker
|
|
What drugs can be used in treatment of urge incontinence?
|
M Blockers:
Oxybutynin, Tolteradine, Darifenacin, Solfenacin, Trospium |
|
List the steps in Ach Synthesis and neurotransmission
|
Choline enters with the help of Na+ --> (Hemicholnium inhibits this process) --> Acetyl CoA and choline acetyltransferase are made into Ach, then packaged into vessicles --> Ca2+ needed for release
Black widow spider toxin causes release, while Botulinum toxin inhibits release and causes flaccid paralysis |
|
What inhibits the making of Ach by disabling it from being packaged into vessicles?
|
Vesamicol
|
|
List the steps involved in NE synth and neurotransmission
|
Tyrosine enters cell with the help of Na+ --> Tyrosine turned into DOPA by Tyrosine Hydroxylase (inhibited by Metyrosine) --> DOPA turned into Dopamine by Dopadecarboxylase --> Dopamine pachaged into vessicle (inhibited by Reserpine) --> Ca2+ needed to release vessicle into synapse
|
|
What things promote NE release? Inhibit? Inhibit NE RE-UPTAKE?
|
Promote NE release: Amphetamines, Ephedrine, Tyrosine, Angiotensin II
Inhibit NE release: Guanethidine, Bretylium, Alpha 2 and M2 ie if parasympathetic activity is going on, we don't want NE to be released = we want to inhibit Symps Inhibit re-uptake: Coccaine, TCA's |
|
What are two molecules that metabolize NE once it gets into the synapse (note, these are similar to Acetylcholiesterase which degrades Ach in synapse)
|
COMT (methylates NE) and MAO (Monoamine Oxidase Oxidizes NE)
* Both make NE Unusable |
|
Vit B 6 and Vit C are needed in which steps of the making of NE from Tyrosine?
|
Vit B6 needed in step from Dihydroxyphenylalanine to Dopamine
Vit C needed in step from Dopamine to NE |
|
What G proteins are coupled to the various receptors?
|
Inhibitory G proteins = "MAD2"
Gi = M2, A2, D2 "qt's HAV 1 m&m" Gq = H1, A1, V1, M1, M3 *Everything else is Gs |
|
Outline the path after a Gq receptor is stimulated
|
Gq = Activates Phospholipase C --> Cleaves Lipids to PIP2 --> DAG or IP3... IP3 increases Ca2+ in cell while DAG leads to protein kinase C
|
|
Outline the path after Gs or Gi stiulates or inhibits Aneylyl cyclase
|
Gs or Gi stimulate (path preoceeds) or inhibit (path stops) Adenylyl cyclase --> ATP --> cAMP --> Protein kinase A
|
|
What regulates prolactin secretion from pituitary?
|
Dopamine from hypothalamus = INHIBITS prolactin secretion
Prolactin inhibits its own secretion by increasing Dopamine synthesis |
|
Effect of Epinephrine, NE, Isoproterenol, Dopamine, Dobutamine, Phenylephrine on alpha 1, 2, beta 1, 2, and D1 receptors?
|
Epinephrine does alpha 1, alpha 2, and beta 1 >> Beta 2 (Anaphylaxis, glaucoma, asthma, hypotension)
NE does alpha 1 and alpha 2 >> beta 1 (Hypotension but dec renal perfusion, inc BP, dec. HR due to reflex brady) Isoproterenol does beta 1 and beta 2 (AV Block, vasodilation causes reflex tachy) Dopamine does alpha 1, alpha 2, beta 1 >> beta 2 and Dopamine receptors at low doses (High dose = vasoconstriction, low dose = augments renal blood flow...uses = chock, heart failure) Dubutamine does Beta 1 (heart failure, cardiac stress testing, Phenylephrine does alpha 1 (pupillary dilation, vasoconstriction, nasal decongestion) |
|
Albuterol, Metaproterenol, and Salmeterol are are all used for what?
|
ASTHMA
Metaproterenol and Albuterol for Acute asthma Salmeterol for long-term tx (All work on Beta 2's) |
|
What do we use to reduce premature uterine contraction?
|
Terbutaline or Ritodrine
(works on Beta 2's to dec. contractions) |
|
Most common first line agent for pts in septic shock? Cardiogenic shock?
|
Septic chock = NE
Cardiogenic shock = Dobutamine |
|
What is Epi's affect on BP if administered after an alpha blocker is given?
|
alpha blocker will block alphas so that Epi only works on the Beta 2's on blood vessels meaning we vasodilate
|
|
Common side effects of beta blockers?
|
Exacerbate asthma, raise blood glu, mask symptoms of hypoglycemia, bradycardia, AV Block, CHF, Impotence, Erectile Dysfunction,
|
|
Be careful giving be blockers to pts with what conditions?
|
Asthmatics, Diabetics, CHF
|
|
What are the various clinical applications of Beta Blockers?
|
HTN, Angina pectoralis, MI, SVT, CHF
|