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108 Cards in this Set
- Front
- Back
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: A 12yo patient was treated for a reaction to a bee sting, what drug provides the best coverage of sympathomimetic receptors?
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Epinephirine(Alpha1,2 and Beta 1,2)
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A 57 yo heart failure pt develops cardiac decompensation, what drug will give you adequate perfusion of his kidneys as well as tx for his Hypotension
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Dopamine
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A fellow passenger on a Carnival cruise ship looks pale and diaphoretic, what antimuscarinic agent would you give them?
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scopolamine
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A group of pts are rushed into the ER complaining of excessive sweating, tearing, salivation, HA, N and V, muscle twitching, difficulty breathing and diarrhea. What drug would be the most effective immediate tx
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Atropine pts are suffering from Cholinestrase inhibitor poisining(Nerve gas/Organophosphate poisining)
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As an Anes you want to use a depolarizing neuromuscular blocking drug on your pt, what do you use
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Succinylcholine
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By what mechanism does this drug help(Succinylcholine)
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Prevents the release of Ca from SR of skeletal muscle
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Clonidine is the preferred sym pathomimetic tx of HTN in pts with renal disease, why?
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Centrally acting alpha agonist, thus causing a decrease in central adrenergic outflow, spairing renal blood flow
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Cocaine casues vasoconstriction and local anesthesia by what mechanism?
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Indirect agonist, uptake inhibitor
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Cocaine shares is mechanism of action with what antidepressant
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TCA
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Dobutamine used for the tx of shock acts on which receptors?
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Beta1 more than B2
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Guanethidine enhances the release of Norepi?
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No, it inhibits the release of Nor Epi
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How does angiotensin II affect NE release?
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It acts presynaptically to increase NE release.
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How does botulinum toxin result in respiratory arrest?
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Prevents the release of ACh, which results in muscle paralysis.
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How does dantrolene work?
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Prevents the release of calcium from the sarcoplasmic reticulum of skeletal muscle.
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How does NE modulate its own release? What other neurotransmitter has this same effect?
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A: NE acts presynaptically on alpha-2 receptors to inhibit its own release.
A: ACh also acts presynaptically through M1 receptors to inhibit NE release. |
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How would hemicholinium treatment affect cholinergic neurons?
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Hemicholinium inhibits the transport of choline into the nerve, thus inhibiting formation of ACh.
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How would you reverse the effect of a neuromuscular blocking agent?
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Give an anti-chloinesterase - neostigmine, edrophonium, etc
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If a patient is given hexamethonium, what would happen to his/her heart rate?
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It would increase to ~ 100 beats/min. Both sympathetic and vagal stimulation would be knocked out, but the SA node has an intrinsic pace of 100 beats/min, which is normally checked by vagal stimulation.
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Q: Isopoterenol was given to a patient with a developing AV block, why?
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A: Stimulates beta adrenergic receptors
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Q: Norepi feedbacks and inhibits the presynaptic receptor by what mechanism
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A: Binding to the presynaptic alpha 2 release modulating receptors
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Q: Reserpine will block the syntheis of this drug and but not its precursor.
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A: Blocks Norepi, but not Dopamine
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Q: These drugs acts indirectly by releasing strored catecholamines in the presynaptic terminal
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A: Amphetamine and Ephedrine
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What anticholinesterase crosses the blood-brain-barrier?
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physostigmine
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Q: What antimuscarinic agent is used in asthma and COPD?
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A: Ipratropium
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What antimuscarinic drug is useful for the tx of asthma
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Ipratropium
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What are the classic symptoms of cholinesterase inhibitor poisoning (parathion or other organophosphates)?
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Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, and Salivation = DUMBBELS; also abdominal cramping
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Q: What are the clinical indications for bethanechol?
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A: Activates cholinergic receptors on bladder and bowel smooth muscle, alleviating post-op and neurogenic ileus and urinary retention.
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What are the clinical indications for neostigmine?
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Post-op and neurogenic ileus and urinary retention, myasthenia gravis, and reversal of neuromuscular junction blockade (post-op) through anticholinesterase activity.
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Q: What are the indications for using amphetamine?
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A: narcolepsy, obesity, and attention deficit disorder (I wouldn't recommend this)
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What are the nondepolarizing neuromuscular blocking drugs?
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Tubocurarine, atracurium, mivacurium, pancuronium, vecuronium, rapacuronium
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Q: What are the phases of succinylcholine neuromuscular blockade?
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A: Phase 1 = prolonged depolarization, no antidote, effect potentiated by anticholinesterase; Phase 2 = repolarized but blocked, an anticholinesterase is the antidote for this phase
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Q: What are two indirect acting adrenergic agonists?
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A: amphetamine and ephedrine
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Q: What beta 2 agonist will help your 21yo Astma pt?
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A: Albuterol, tertbutaline
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What cholinergic inhibitor acts by directly inhibiting Ach release at the presynaptic terminal
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Botulinum
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Q: What cholinomimetic is useful in the diagnosis of Myasthenia Gravis
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A: Edrophonium
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What cholinomimetics might your pt be taking for his glaucoma
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Carbachol, pilocarpine, physostigmine, echothiophate
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Q: What class of drug is echothiophate? What is its indication?
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A: anticholinesterase
A: glaucoma |
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Q: What conditions would you use dantrolene?
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A: In treatment of malignant hyperthermia, due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome, a toxicity of antipsychotic drugs.
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Q: What drug is used to diagnose myasthenia gravis?
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A: edrophonium (extremely short acting anticholinesterase)
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Q: What cholinomimetics might your pt be taking for his glaucoma
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A: Carbachol, pilocarpine, physostigmine, echothiophate
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Q: What class of drug is echothiophate? What is its indication?
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A: anticholinesterase
A: glaucoma |
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Q: What conditions would you use dantrolene?
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A: In treatment of malignant hyperthermia, due to concomitant use of halothane and succinylcholine. Also in neuroleptic malignant syndrome, a toxicity of antipsychotic drugs.
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Q: What drugs target this enzyme (cholinesterase)
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A: Neostigmine, pyridostigmine edrophonium physostigmine echothiophate
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Q: What effect would atropine have on a patient with peptic ulcer disease?
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A: Theoretically it could be used to block the cephalic phase of acid secretion (vagal stimulation).
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Q: What effect would atropine have on the preganglionic sympathetic activation of sweat glands? Would this person sweat?
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A: None. No, because atropine would block the postganglionic muscarinic receptors involved in sweat gland stimulation.
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Q: What enzyme is responsible for the breakdown of ACh in the synaptic cleft?
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A: Acetylcholinesterase; ACh is broken down into choline and acetate.
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Q: What enzyme is responsible for the degredation of Ach
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A: Acetylcholine esterase
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Q: What enzyme is responsible for the production of Ach from Acetyl CoA and Choline
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A: Choline acetyltransferase
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Q: What is the clinical utility of clonidine?
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A: Treatment of hypertension, especially with renal disease (lowers bp centrally, so flow is maintained to kidney).
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Q: What is the clinical utility of cocaine?
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A: The only local anesthetic with vasoconstrictive properties.
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Q: What is the difference between the affinity for beta receptors between albuterol/terbutaline and dantroline?
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A: Dobutamine has more of an affintiy for beta-1 than beta-2, and is used for treating heart failure and shock. Albuterol and terbutaline is the reverse, and is used in treatment of acute asthma.
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Q: What is the difference in receptor affinity of epinephrine at low doses? High doses?
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A: Prefers beta's at low doses, but at higher doses alpha agonist effects are predominantly seen.
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Q: What is the effect of epinephrine infusion on bp and pulse pressure?
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A: Increased systolic and pulse pressure, decreased diastolic pressure, and little change in mean pressure.
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Q: What is the effect of guanethidine on adrenergic NE release?
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A: It inhibits release of NE.
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Q: What is the effect of norepinephrine on bp and pulse pressure?
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A: Increases mean, systolic, and diastolic bp, while there is little change in pulse pressure.
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Q: What is the effect of TCA's on the adrenergic nerve?
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A: They inhibit reuptake of NE at the nerve terminal (as does cocaine).
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Q: What is the only depolarizing neuromuscular blocking agent?
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A: Succinylcholine
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Q: What is the receptor affinity and clinical use of isoproterenol?
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A: It affects beta receptors equally and is used in AV heart block (rare).
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Q: What makes this drug effective (isoproterenol)
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A: It antagonizes Ach M receptors and decreases parasym (GI) rxn
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Q: What nondepolorizing agents could you have used
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A: Tubocurarine, atra-, miv-, pan-,ve-, rapacuronium
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Q: What other substances regulate the Norepi nerve ending
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A: Ach, AngiotensinII
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Q: What other syndrome can this drug tx
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A: Neuroleptic malignant syndrome
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Q: What physiological effects was the Anes using Atropine to tx
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A: SLUD (salivation, Lacrimation, urination, Defecation)as well as airway secretion, GI motility, acid secretions
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Q: What reversal agent could a Anes give to reverse the effects of Atropine
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A: Bethanechol, Neostigmine, physostigmine
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Q: What side effect of using atropine to induce pupillary dilation would you expect?
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A: Atropine would also block the receptors in the ciliary muscle, causing an impairment in accommodation (cycloplegia).
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What sympathomimetic would you not prescribe for hypotension in a pt with renal artery sclerosis.
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Norepinephrine (Alpha1,2 and beta 1)
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Q: What type of neurological blockade would hexamethonium create?
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A: Hexamethonium is a nicotinic antagonist, and thus is a ganglionic blocker.
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Q: What would be the effect on blood pressure with infusion of the alpha -2 agonist clonidine?
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A: Initially vasoconstriction would increase bp, but then it acts on central alpha-2 receptors to decrease adrenergic outflow resulting in decreased bp.
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Q: What would be the next drug that you would give and why
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A: Pralidoxime, regenerates active cholinestrase
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Q: Which antimuscarinic agents are used in producing mydriasis and cycloplegia?
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A: atropine, homatropine, tropicamide
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Q: Which drug increases Sys BP w/o affecting Pulse Pressure
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A: Epinephrine
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Q: Which of epi, norepi, or isoproterenol results in bradycardia?
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A: Norepinephrine
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Q: Which of the following would atropine admi
nistration cause? Hypothermia, bradycardia, excess salivation, dry flushed skin, or diarrhea |
A: Dry flushed skin, due to inhibition of sympathetic post-ganglionic blockade on muscarinic receptors of sweat glands. All others are opposite of what would be expected.
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Q: Which of these three drugs will cause a reflex bradycardia in your pt (Norepi, Epi, or Isoporterenol)
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A: Norepinephrine
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Q: Which receptors does phenylephrine act upon?
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A: alpha-1 > alpha-2; used as a pupil dilator, vasoconstrictor, and for nasal decongestion
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Q: While at a tail gait party, you bite into a sandwich that a yellow jacket is also enjoying. Knowing your allergy to this creature, what should you do?
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A: Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma, asthma, or hypotension.
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Q: Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
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A: These B-2 agonists cause respiratory smooth muscle to relax.
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Q: Why does atropine dilate the pupil?
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A: Blocking muscarinic receptors in the circular fibers of the eye, results in unopposed action of radial muscles to dilate.
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Q: Why does NE result in bradycardia?
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A: NE increases bp, which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
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Q: Why is carbachol and pilocarpine useful in treatment of glaucoma?
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A: They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
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Q: Why is pyridostigmine effective in the treatment of myasthenia gravis?
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A: As an anticholinesterase it increases endogenous ACh and thus increases strength
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Q: Why is reserpine effective in treating HTN?
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A: Reserpine inhibits dopamine transport into vesicles, attenuating its conversion to NE by dopamine beta-hydroxylase.
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Q: Why is there a drop in systolic, mean, and diastolic bp with infusion of isoproterenol?
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A: Stimulating beta receptors stimulates heart rate, but beta receptor induced vasodilation reduces peripheral resistance.
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Q: Why would a patient with cog-wheel rigidity and a shuffling gait be given benztropine?
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A: Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
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Q: Why would dopamine be useful in treating shock?
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A: Receptors = D1=D2>beta>alpha, thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
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Q: Why would you give a drug like pancuronium or succinylcholine?
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A: Useful in muscle paralysis during surgery or mechanical ventilation.
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Q: Why would you use pralidoxime after exposure to an organophosphate?
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A: Pralidoxime regenerates active cholinesterase.
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Q: Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
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A: No, hemicholinum block the uptake of Choline and thus Ach synthesis
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Q: Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
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A: No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention
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Q: Would Hexamethonium be an effective substitute
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A: No, hexamethonium targets Nicotinc receptors and will block Parasym, Sym, as well as Somatic systems
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Q: While at a tail gait party, you bite into a sandwich that a yellow jacket is also enjoying. Knowing your allergy to this creature, what should you do?
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A: Epinephrine to treat anaphylaxis. Also useful if you have open angle glaucoma, asthma, or hypotension.
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Q: Why are albuterol and terbutaline effective in tx of acute asthmatic attacks?
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A: These B-2 agonists cause respiratory smooth muscle to relax.
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Q: Why does atropine dilate the pupil?
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A: Blocking muscarinic receptors in the circular fibers of the eye, results in unopposed action of radial muscles to dilate.
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Q: Why does NE result in bradycardia?
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A: NE increases bp, which stimulates baroreceptors in the carotid sinus and the aorta. The CNS signals through vagal stimulation to decrease heart rate.
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Q: Why is carbachol and pilocarpine useful in treatment of glaucoma?
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A: They activate the ciliary muscle of the eye (open angle) and pupillary sphincter (narrow angle).
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Q: Why is pyridostigmine effective in the treatment of myasthenia gravis?
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A: As an anticholinesterase it increases endogenous ACh and thus increases strength
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Q: Why is reserpine effective in treating HTN?
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A: Reserpine inhibits dopamine transport into vesicles, attenuating its conversion to NE by dopamine beta-hydroxylase.
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Q: Why is there a drop in systolic, mean, and diastolic bp with infusion of isoproterenol?
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A: Stimulating beta receptors stimulates heart rate, but beta receptor induced vasodilation reduces peripheral resistance.
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Q: Why would a patient with cog-wheel rigidity and a shuffling gait be given benztropine?
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A: Parkinson patients benefit from antimuscarinic agents through its inhibitory action within the indirect pathway.
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Q: Why would dopamine be useful in treating shock?
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A: Receptors = D1=D2>beta>alpha, thus increasing heart rate (beta) and blood pressure (alpha vasoconstriction) while maintaining kidney perfusion (dopamine receptors)
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Q: Why would you give a drug like pancuronium or succinylcholine?
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A: Useful in muscle paralysis during surgery or mechanical ventilation.
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Q: Why would you use pralidoxime after exposure to an organophosphate?
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A: Pralidoxime regenerates active cholinesterase.
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Q: Will Hemicholinum affect the release of stored Ach during Cholinergic Stimulation
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A: No, hemicholinum block the uptake of Choline and thus Ach synthesis
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Q: Would blockade of muscarininc receptors in the bladder be useful in treating urinary retention?
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A: No. Atropine is used to reduce urgency in mild cystitis. So it would aggravate the urinary retention
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Q: Would Hexamethonium be an effective substitute
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A: No, hexamethonium targets Nicotinc receptors and will block Parasym, Sym, as well as Somatic systems
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Q: You tx your pt with halothane as well and he has also developed malignant hypothermia, what drug can you give
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A: Dantrolene
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Q: Your patient develops a marked arrythmia due to a prolonged depolarization, can you tx this w/ Neostigmine
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A: No cholinesterase inhibitors will potentiate the stimulating action of Succinlycholine
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Q: Your patient has acute angle glaucoma, does this affect your tx
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A: Yes, Scopolamine would antagonize his glaucoma
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