Pharmacology Exam 2- Wcc

Front 1

Norepinephrine's action on the CNS

Back 1

Effects learning, memory, sleep/wake cycle, mood & anxiety

Affective disorders/ADD

Front 2

Explain the effects of drug effects/side effects on the CNS (think about anti-depressants)

Back 2

Over time there is an increase in the therapeutic effects

Over time the side effects tend to resolve

Front 3

What is tolerance?

Back 3

When taking a drug that effects the CNS over a period of time the body needs more to produce the same therapeutic effects.

Front 4

What is physical dependence?

Back 4

When stopping a drug suddenly causes a withdrawal syndrome.

Front 5

What are some changes in drug absorption in the elderly?

Back 5

Increased gastric pH
Decreased absorptive surface area
Deceased splanchnic (organ/intestinal) blood flow.
Decreased GI motility
Delayed gastric emptying

Front 6

What are some PO absorption considerations in infants?

Back 6

1. Prolonged/irregular gastric emptying (absorption is unpredictable, can be increased or delayed)
2. Infants have lower gastric pH, so more acid drugs are more readily absorbed and basic drug absorption can possibly be delayed

Front 7

Pregnancy class A?

Back 7

Remote risk of fetal harm

controlled studies show no harm in the first trimester, 2nd/3rd not tested.

Front 8

Pregnancy class B?

Back 8

Slightly more risk than A

Animal studies show NO risk & no studies have been done in women.

OR

Animal studies show risk but studies in women (1st tri) show NO risk. (2nd/3rd tri.not tested)

Front 9

Pregnancy class C?

Back 9

More risk than B

Animal studies may show risk & there have been no studies in women

OR

NO studies done in either animals or women

(this is the class most drugs are in because the classification system was put in place AFTER many of the drugs were put on the market)

Front 10

Pregnancy class D

Back 10

Proven fetal risk, but the benefits outweigh the risks. (asthma medications)

Front 11

Pregnancy class X?

Back 11

Proven fetal risk, benefits do not outweigh the risks (think accutane)

Front 12

Changes in drug distribution in the elderly?

Back 12

Increased body fat --> lipid soluble drugs are not distributed as efficiently because they are diffusing into the fat.

Decreased lean body mass + decreased H2O --> H2O soluble drugs have no where to diffuse so there is more free drug in the blood

Low albumin

Decreased CO

Front 13

Consideration for drug distribution in neonates/infants?

Back 13

Low albumin

BBB not fully developed

Front 14

Changes in drug metabolism in the elderly?

Back 14

Decreased metabolism --> increased half-life

Decreased first pass effects c PO medications

Front 15

Ach life cycle?

Back 15

1. Released in response to action potential

2. Binds to nicotinic/muscarinic receptors

3. Disassociates from receptor

4. Degradation almost immediately by ach-esterase

5. By product of degradation choline reabsorbed to make Ach again

Front 16

Norepi. life cycle?

Back 16

1. Released in response to action potiential

2. Binds to A1, A2, B1

3. disassociates

4. Re-uptake @ terminal

5. Stored in vesicles or degradation by monoaminoxidase (sp?)

Front 17

Epi life cycle?

Back 17

1. Synthesis in the adrenal medulla

2. Norepi is released and converts to epi

3. TRAVELS IN THE BLOOD to target organs

4. Disassociates

5. METABOLIZED by liver

Front 18

B1 location & activation?

Back 18

heart & kidneys

In the heart: Increases HR, increases contractility, and increased velocity @ the AV node.

In the kidneys: Renin--agiotensin-aldosterone cascade

BOTTOM LINE= INCREASED BP

Front 19

What is the MAIN reason for geriatric non-compliance?

Back 19

The belief that the drug is not needed and/or causes side effects

Front 20

Other reasons for geriatric non-compliance?

Back 20

Forgetfulness
Failure to understand instruction
$$
Complexity

Multiple: chronic disorders, Rx, prescribers

regimen changes
living alone
low literacy
hospital discharge

Front 21

1. Selectivity of drugs that alter axonal conduction?
2. Why?
3. What type of drugs use axonal conduction?

Back 21

1. LOW selectivity

2. Drugs that alter axonal conduction will affect ALL nerves it has access to

3. Local anesthetics

Front 22

3 ways transmitters are removed from the synaptic gap?

Back 22

1. Re-uptake by transport pump
2. Enzymatic degradation
3. Diffusion

Front 23

7 main CNS neurotransmitters?

Back 23

Ach
Epi
Norepi
Dopamine
Seritonin
Histamine
GABA

Front 24

3 basic patterns of autonomic regulation?

Back 24

1. balance/opposition (as seen in the heart)

2. complementary (erection-pns/ejaculation-sns)

3. innervation and regulation of only ONE of the autonomic systems (blood vessels)

Front 25

5 step of synaptic transmission?

Back 25

1. Transmitter synthesis
2 . " " storage
3. " " release
4. Receptor binding
5. Termination of transmission

Front 26

3 main function of SNS?

Back 26

1. Regulation of CVS
2. Thermoregulation
3. Fight-Flight

Front 27

Ach action on the CNS?

Back 27

excitatory
Ach is decreased with Alzheimer's

Has influence on: attention/memory/mood/aggression/sleep/muscle tone/thirst/deference

Front 28

Epi action on the CNS?

Back 28

low concentrations unlikely to play a role

Front 29

Dopamine receptor function in SNS?

Back 29

Dilate renal flood vessels

Increase cardiac contraction

Front 30

Dopamine receptor function in CNS?

Back 30

The most important receptor in the CNS

Generally INHIBITORY

hypothalamus, retina, limbic system, olfactory bulb, pituitary, cerebrum

D1 & D2 subtypes

Effects thoughts, emotions, movement, cognition/motivation

Front 31

B2 receptor function?

Back 31

Broncho-dilation
Relaxing of uterine muscle (you want that Baby 2 stay in there)

Increase Blood glucose

vasodilation, in the heart/lungs/skeletal muscle

VASODILATION...VASODILATION

Front 32

A1 Receptor function?

Back 32

"I'M CONSTRICTING"

Ejaculation (Alpha male, is #1 and spreads his seeds)

Contraction of bladder neck and prostate

Constriction of skin mucous membranes

Pupil dilation

VASOCONSTRICTION

Front 33

A2 receptor function/location?

Back 33

"STOP CONSTRICTING"

This receptor is located on the terminal end of the nerve itself NOT a target organ

INHIBITS A1

Helps reduce transmitter release where there is too much in the synaptic gap

VASODILATION

Front 34

Epi acts on what receptors?

Back 34

A1, A2, B1, B2

Front 35

Norepi act on what receptors?

Back 35

A1, A2, B1

Front 36

Dopamine acts on what receptors?

Back 36

A1. B1, & dopamine receptors

Front 37

Primary peripheral nervous system receptors and their sub-types?

Back 37

Cholinergic: nicotinic(n&m), muscarinic

Adrenergic: A1, A2, B1, B2, dopamine

Front 38

What neurotransmitters do cholinergic receptors respond to?

Back 38

Ach

Front 39

What neurotransmitters do adrenergic receptors respond to?

Back 39

Epi, norepi, dopamine

Front 40

At what junctions is Ach the transmitter?

Back 40

All preganglionic neurons

Postgang. neurons of the parasympathetic nervous system

Sweat glands (only place Ach is postgang in the SNS)

All skeletal muscle

Front 41

Nicotinic N receptor function?

Back 41

Release of epi from adrenal medulla

Front 42

Nicotinic M receptor function?

Back 42

muscle contraction

Front 43

How selective is synaptic transmission? how?

Back 43

HIGHLY SELECTIVE, synapses at different sites employ different transmitters

Front 44

Finish the sentence:

The impact of a drug on a neuronally regulated process is dependent on...

Back 44

the ability of the drug to influence receptor activity at the target cells

Front 45

Three principal functions of the autonomic nervous system?

Back 45

1. Regulation of the heart

2. Regulation of secretory glands

3. Regulation of smooth muscles

Front 46

Serotonin functions in CNS?

Back 46

Most is in the brain stem

regulation of sleep/pain/depression/mood/sex/aggression/appetite/pain control/temp regulation

Front 47

Muscarinic 1-2-3 receptor function?

Back 47

1. increased oral secretions, gastric acid and cognition

2. Decreased HR

3. Increased gladular secretions, pupil constriction, lens focus,
bronchoconstriction, increased GI motility, erection

Front 48

Histamine's function in CNS?

Back 48

Regulation of food/fluid intake, temperature, hormone release, sleep, allergic response mediation

Front 49

Finish the sentence

Most nueropharmacologic agents act by___

Back 49

altering synaptic transmission

Front 50

Changes in drug excretion in the elderly?

Back 50

Renal impairment/degeneration

Front 51

What is the risk to a presomite when exposed to a teratogen?

Back 51

If the dose is high enough (over lethal dose for presomite) = death

Usually if the dose is ANYTHING UNDER the lethal dose = generally no effects will be noticed

Front 52

What is the risk to an embryo when exposed to a teratogen?

Back 52

Gross malformations, because the limbs are forming

Front 53

What is the risk to a fetus when exposed to a teratogen?

Back 53

The brain is affected. Learning and behavioral problems may be noted

Front 54

Neonate (1) and infant (2) absorption of IM medications?

Back 54

1. Neonate: slow, erratic
2. Infants: faster than adults

Front 55

Infant and neonate absorption of percutaneous medications?

Back 55

Babies have thin skin, increased absorption

Front 56

Drug metabolism in neonates/infants/children?

Back 56

Neonates: metabolize SLOWER than adults

Infants: MUCH FASTER than adults

age 2: sharp decline

Puberty: gradual decline until another sharp decline at puberty when adult levels are reached.

Front 57

Division of the peripheral nervous system

Back 57

A. Somatic motor
B Autonomic...PNS & SNS

Front 58

Renal excretion considerations in neonates/infants?

Back 58

Slow excretion

Front 59

At what age does drug absorption, distribution, and excretion reach adult levels?

Back 59

ONE YEAR

Front 60

At around what age does drug metabolism reach adult levels?

Back 60

PUBERTY

Front 61

Main ways drugs can effect receptor function and synaptic transmission

Back 61

CAUSE receptor activation

BLOCK receptor activation

Enhance receptor activation by the natural transmitter at the site

Front 62

Finish the sentence

The impact of a drug on a neuronally regulated process is _____

Back 62

DEPENDENT on the ability of that drug to directly or indirectly influence receptor activity on target cells.

Front 63

Lehne's definition of activation?

Back 63

an effect on receptor function equivalent to that produced by the natural neurotransmitter at a particular synapse.

Front 64

3 different effects drugs can have on transmitter synthesis?

Back 64

1. Increased transmitter synthesis

2. Decreased transmitter synthesis

3. Cause the synthesis of transmitter molecules that are more effective than natural transmitters

Front 65

drugs that interfere with transmitter storage will cause?

Back 65

Receptor activation to decrease. Because there is less neurotransmitter available.

Front 66

How can drugs effect transmitter release?

Back 66

Either promote or inhibit transmitter release

Front 67

3 ways drugs can effect receptor binding?

Back 67

1. Bind to receptor and cause activation (agonist)

2. Bind to receptor and block activation (antagonist)

3. Enhance the natural transmitter activation

Front 68

2 ways drugs can interfere termination of transmitter action?

Back 68

1. Block reuptake (SSRI)

2.Inhibit transmitter degradation