Pharm Exam 2

Front 1

2 basic categories of receptors of periph. nervous system

Back 1

cholinergic and adrenergic

Front 2

subtypes of adrenergic receptors (5)

Back 2

Alpha 1, Alpha 2, Beta 1, Beta 2, Dopamine

Front 3

4 actions of Alpha 1

Back 3

vasoconstriction, contraction of bladder, neck and prostate

Front 4

location of Alpha 2

Back 4

located in presynaptic junction...

Front 5

2 organs Beta 1 acts on

Back 5

heart; increase force and velocity of conduction in AV node. kidney; renin release

Front 6

4 actions of Beta 2

Back 6

bronchial dilation, relax uterine muscle, selective vasodilation, glycogenolysis

Front 7

action of Dopaminergic receptor

Back 7

Dilates renal blood vessels

Front 8

what induces liver to release glucose from glycogen stores?

Back 8

epinephrine

Front 9

muscarinic AKA...

Back 9

cholinergic agonists or parasympathetomimetics

Front 10

prototype muscarinic agonist

Back 10

Bethanechol; use for urinary retention & GI function

Front 11

muscarinic antagonists AKA...

Back 11

anticholinergic or parasympatholytics

Front 12

prototype muscarinic antagonist

Back 12

Atropine; use for symptomatic bradycardia... any negative effects of parasympathetic; allows sympathetic to take over

Front 13

what receptors does norepinephrine activate

Back 13

Alpha and Beta 1; not Beta 2 -> does not help anaphylaxis

Front 14

significance of dopamine dosage

Back 14

low dose: beneficial to kidney b/c of increased perfusion
high dose: more stimulation of Alpha 1 -> vasoconstriction; negative for kidney.

Front 15

scopolamine

Back 15

patch for motion sickness; slows GI tract

Front 16

signs & symptoms of toxic effects of atropine

Back 16

blurred vision, hot, dry, CNS effects

Front 17

treatment of myasthenia gravis

Back 17

reversible cholinesterase inhibitor

Front 18

signs of overmedication of cholinesterase inhibitor

Back 18

increased urinary frequency

Front 19

reversible v. irreversible cholinesterase inhibitors

Back 19

reversible: beneficial in myasthenia gravis
irreversible: used as nerve gas and insecticide; only clinical use is glaucoma

Front 20

main reversible cholinesterase inhibitor

Back 20

Neostigmine

Front 21

NMBA

Back 21

neuromuscular blockers; prevent acetylcholine from activating nicotinic receptors; causes paralysis/muscle weakness.

Front 22

main adrenergic agonists

Back 22

catecholemines; can't be taken orally; brief duration of action; can't cross BBB

Front 23

main use for alpha 1 agonists

Back 23

vasoconstriction; decongestant

Front 24

alpha 2 agonists

Back 24

act on brain, not on blood vessels; cause reduction of sympathetic action on heart and vessels; relief of severe pain

Front 25

beta 1 activation

Back 25

increase cardiac output; danger: dysrythmia, increased demand on heart; heart attack.

Front 26

isoproterenol/isuprel

Back 26

beta 1&2 agonist; not used much anymore; speeds up heart at a risk

Front 27

dopamine

Back 27

low dose for renal failure; high dose causes vasoconstriction; therapeutic uses in shock for increasing c.o., heart failure

Front 28

dobutamine (dobutrex)

Back 28

beta 1 agonist; increase CO, mild vasodilation, causing decreased afterload

Front 29

phylephrine/neosynephrine

Back 29

alpha 1 decongestant; constrict vessels in mucous membrane; not good for patients w/ heart disease b/c of generalized vasoconstriction

Front 30

terbutaline (bricanyl)

Back 30

beta 2 agonist; delay preterm labor & halt asthma attack

Front 31

ephedrine

Back 31

sudafed; controlled b/c meth can be made; therapeutic use: nasal congestion, adverse effects: crosses bbb -> insomnia, hyperglycemia, dysrhythmia

Front 32

effect of alpha antagonist

Back 32

no more vasoconstriction

Front 33

important adverse effects of alpha1 blocker

Back 33

less signif: orthostatic hypotension
more signif: reflex tachycardia (as bp drops)
Na and water retension -> dependent edema

Front 34

conidine

Back 34

antihypertensive (potent) acts on CNS; can have CNS side effects-drowsiness; also used for pain; rebound hypertension ->ween off

Front 35

Parkinson's disease characterized by...

Back 35

dyskinesias and akinesia (difficulty w/ moving); imbalance of dopamine and acetylcholine (Ach)

Front 36

therapeutic goals of treating parkinson's

Back 36

improve patient's ability to carry out activities of daily living

Front 37

2 major categories of parkinson's treatment & main drug

Back 37

1. dopaminergic agents; Levodopa (Dopar)
2. Anticholinergic agents; Benztropine (Cogentin)

Front 38

Levodopa

Back 38

stimulates amount of Dopamine; more effective than dopamine agonists, but long-term use carries higher risk of disabling dyskinesias; cardiac effects, GI effects, sweat and urine discoloration

Front 39

on/off effect

Back 39

L-Dopa alternating from working to not working; may be due to decreased effectiveness after 2-5 years, or from food effect

Front 40

foods that effect L-Dopa

Back 40

high protein foods

Front 41

Carbidopa

Back 41

increases amount of L-dopa available, allowing for 75% decrease in L-dopa dosage, reducing CV and GI effects of L-dopa

Front 42

Sinemet

Back 42

Levodopa/Carbidopa combination

Front 43

2 types of dopamine agonists

Back 43

derivatives of ergot
nonergot derivatives

Front 44

nonergot dopamine agonists

Back 44

mirapex; maximum effects take several weeks
nausea, diziness, insomnia, constipation, weakness, hallucinations, nontypical behavior of person (eg: selfishness)

Front 45

COMT inhibitors

Back 45

entacapone; block metabolism or breakdown of levodopa in the periphery (Ldopa/Carbidopa/Entacapone exists)

Front 46

4th leading cause of death in U.S.

Back 46

Alzheimers

Front 47

diagnostic of alzheimers

Back 47

beta-amyloid plaques; only upon autopsy

Front 48

homocysteine

Back 48

elevated plasma levels are associated w/ increase risk for Alzheimers

Front 49

major risk factors for alzheimers

Back 49

age and family history

Front 50

other slight risk factors for alzheimers

Back 50

head injury, smoking

Front 51

life expectancy following symptom onset of alzheimers

Back 51

4-8 years, but may be 20 years or longer

Front 52

goal of drug therapy for alzheimers

Back 52

improve symptoms and slow process of cognitive decline

Front 53

2 treatments for alzheimers

Back 53

neuronal receptor blocker: Namenda
cholinesterase inhibitor: Aricept

Front 54

adverse effects of aricept

Back 54

cholinergic side effects; GI, dizziness, headache, bronchoconstriction, liver injury

Front 55

what links estrogen to alzheimers

Back 55

hormone replacement therapy: slight increased risk in older women who have received estrogen replacement

Front 56

other treatment for alzheimers

Back 56

SSRIs for depression (not for AD symptoms)

Front 57

multiple sclerosis

Back 57

demyelination -> motor problems and poor sensory transmission

Front 58

signs and symptoms of m.s.

Back 58

visual impairment
muscle motor problems
bowel/bladder problems

Front 59

drug therapy for m.s.

Back 59

slow disease progression; frequency and intensity of relapsed decreased; all patients should be receive immunomodulators (interferon) & glucocorticoids

Front 60

main causes of epilepsy

Back 60

congenital
injury
tumor

Front 61

2 general types of seizures

Back 61

partial and generalized

Front 62

goal of epilepsy drugs

Back 62

control the seizure activity as much as possible

Front 63

phenytoin

Back 63

main drug to treat epilepsy; (Dilantin) good, old, effective drug, but narrow therapeutic range; should Not be mixed w/ anything other than Saline. Precipitates easily. Give it as close to injection site as possible. Give slowly--can cause bradycardia and severe hypotension if given too quickly. Unpredicatble half life; small increase may cause huge jump in drug levels

Front 64

phenytoin: Therapeutic range
rate of administration
half-life

Back 64

Therapeutic range: 10-20 mcg/mL
Rate of admin: 50 mg/min
Half life: 8-60 hr

Front 65

drug interactions of phenytoin

Back 65

decreased effectiveness of contraceptives and warfarin
counteracts steroids
increased effects of diazipam and benzodiazapines (anxiety relief/depressants), alcohol, cimetidine (reduces gastric acid); and these increase toxicity of phenytoin (Dilantin)

Front 66

adverse effects of phenytoin

Back 66

drowsiness; bradycardia; rashes; hyperplasia of gums over long-term use.

Front 67

tegretol and valproic acid

Back 67

used for both epilepsy and bipolar disorder; valproic occasionally used for migranes-- it is toxic to liver, pancreas, and is teratogenic

Front 68

phenobarbital

Back 68

barbituate used for epilepsy; similar drugs are used for helping sleep

Front 69

status epilepticus; goals of treatment

Back 69

maintain ventilation
correct hypoglycemia
terminate seizure (IV benzodiazapines to stop muscle activity, which is causing metabolic demand) (simultaneously slowly admin. dilantin)

Front 70

prototype opioid

Back 70

morphine

Front 71

what do opioids do?

Back 71

depress CNS, CV, respirations

Front 72

analgesics v. opioids

Back 72

analgesics don't cause loss of consciousness
opioids are most effective pain relief

Front 73

route of admin. for morphine

Back 73

any route; oral: highly subject to 1st pass effect

Front 74

actions of morphine

Back 74

vasodilation -> decreased afterload; useful in pulmonary edema/ congestive heart failure, depression of head, heart, and breathing, limit pain and anxiety, pinpoint pupils

Front 75

adverse effects of morphine

Back 75

slowing GI tract-> constipation, decreased respiration and CV

Front 76

tolerance, physical dependence

Back 76

tolerance: increased dosage necessary to get the same effect. narcotics are subject to both; physical dependence -> abstinence syndrome

Front 77

problem w/ tolerance to morphine

Back 77

no tolerance to constipation; higher dosage->more constipation

Front 78

withdrawal from narcotics

Back 78

not fatal, but painful/very uncomfortable. can last up to 10 days.

Front 79

precautions for morphine

Back 79

CNS injury, hypoxia of baby

Front 80

drug interactions of morphine

Back 80

other bp lowering drugs, opioid antagonist (to counteract effects of opioids)

Front 81

antagonists of opioid

Back 81

Narcan/Naloxone

Front 82

triad of opioid toxicity:

Back 82

coma
respiratory depression
pinpoint pupils

Front 83

2 important tasks when admin. opioid

Back 83

1. monitor vitals (baseline and throughout admin.)
2. give on schedule so that pain doesn't get out of control

Front 84

Demerol

Back 84

pain relieving effects are result of conversion of drug to morphine; some people can't convert it, and it doesn't work for them; not used much anymore--shorter duration of action,and toxic metabolite. used more for shivering; to treat reaction to anasthesia...

Front 85

opioid agonists

Back 85

eg: hydromorphone, oxymorphone, codeine; treat them the same as morphine, pretty much. Narcan is useable as treatment for toxicity.

Front 86

"oxy" as in oxycodone

Back 86

time release; oxycodone = another opioid agonist

Front 87

propoxyphene

Back 87

No longer used in the U.S. b/c of toxic metabolite; minimal relief, but addictive

Front 88

agonist-antagonist opioids

Back 88

less addictive than agonists.

Front 89

what is important to document when administering opioid

Back 89

pain level before admin. and during effects of opioid

Front 90

addiction v. physical dependence

Back 90

addiction is behavioral
physical dependence is characterized by phase of w/drawal

Front 91

what to give to relieve headaches

Back 91

depends on underlying cause; common cause is vasodilation -> vasoconstrictor may help.

Front 92

common drug for relieving migrane

Back 92

Imitrex/Sumatriptan/seratonin 1b/1d receptor agonists; vasoconstriction; careful in patients w/ hypertension

Front 93

antipsychotics treat...

Back 93

schizophrenia, dilusional disorders, bipolar, depressive psychoses, drug-induced psychoses
also... emesis, tourrettes and hunnington's

Front 94

divisions of antipsychotic agents

Back 94

1. FGAs (First generation antipsychotics); generally dopamine blockers
2. SGAs (second generation antipsychotics; aka atypical)

Front 95

adverse effect of FGA's

Back 95

dopamine blockers -> parkinsonian effects; EPS: extrapyramidal symptoms

Front 96

adverse effects of SGA's

Back 96

less EPS's; but more metabolic problems; increased blood glucose and cholesterol; weight gain; agranulocytosis

Front 97

acute dystonia

Back 97

spasms of upper back, neck, face and tongue (EPS)

Front 98

akasthisia

Back 98

pacing, squirming (EPS)

Front 99

Tardive dyskinesia

Back 99

fly-catching; involuntary mouth movements (EPS)

Front 100

NMS

Back 100

Adverse effect of antipsychotics; Neuroleptic malignant syndrome; sweating, rigidity, febrile, autonomic instability (digestive, respiratory become unstable) Can be fatal.

Front 101

other adverse effects of antipsychotics

Back 101

drowsiness, seizure activity, sexual disfunction-- either direction, rashes, agranulocytosis, potential for dysrythmia

Front 102

most common drug for schizophrenics

Back 102

SGA; Clozaril (Clozapine); most effective; anticholinergic effects: blurred vision, urinary retention, GI, tachycardia; decrease granulocytes, incidence of seizures

Front 103

2 examples of FGA's

Back 103

Thorazine and Haldol

Front 104

Risperidone/Risperdal

Back 104

schizophrenia & bipolar SGA; metabolic effects of SGA, agranulocytosis

Front 105

Zyprexa

Back 105

SGA; less EPS, more metabolic effects

Front 106

Abilify

Back 106

less metabolic effects; treats schizophrenia, depression and bipolar