Step 1: Pharm I

Front 1

phenobarbital, MTX, TCA, ASA...
tx OD with what? why?

Back 1

bicarb. These drugs are weak acids, and become trapped in basic environments.

Front 2

Tx OD of amphetamines w/ what? Why?

Back 2

Ammonium chloride. The amphetamines are weak bases, and become trapped (and excreted) in acidic environments.

Front 3

Phase I drug metabolism?

Phase II?

Which do geriatric pts lose first?

Back 3

P450, involveds reduction, oxidation, hydrolysis, etc. Metabolite often STILL ACTIVE.

Conjucation (-ation)... --> INACTIVE metabolite.

Type I.

Front 4

Follow a parasympathetic nerve from origin until the messages gets to the target.

Sympathetic?

Back 4

Comes down from CNS --> NICOTINIC synapse onto 2nd cell body --> MUSCARINIC synapse onto target.

I. NICOTINIC synapse DIRECTLY onto Adrenal medulla
II. NICOTINIC synapse in sympathetic chain -->
1. MUSCARINIC onto sweat glands
2. NE (a, B) onto cardiac/smooth/ gland, nerve terminals
3. D1 = Renal vascular smooth muscle

Front 5

What types of receptors are Nicotinic Ach receptors?
- two types and places they're found?

Back 5

ligand gated Na/K channels
- N(n) i/ autonomic ganglion
- N(m) i/ NMJ

Front 6

What is the mechanism of Muscarinic ACh receptors? Types?

Back 6

G-protein-coupled that act thru second messengers. M1-5.

Front 7

Three G protein types and their mechanisms.

Give the important types of each.

Back 7

Gi --> INHIBITS Adenyl cyclase --> \\cAMP --> \\PKA

Gs --> ^^AC --> ^^cAMP (from ATP) --> ^^PKA

Gq --> Phospholipase C --> (converts lipids to) PIP2 -->
1. IP3 --> ^^Ca
2. DAG --> ^^PKC


"HAVe 1 M&M" = G(q) (exiciting too)
- H1, a1, V1, M1, M3

"B.B.D.H.V. = Bring Back 'Dat Hum-Vee!"
- B1, B2, D1, H2, V2

"MAD 2's" = G(i)
- M2, a2, D2

Front 8

Where do the following drugs inhibit Cholinergic neurotransmission?
- Hemicholium
- Vesamicol
- Botulinum

Back 8

- inhibits choline reuptake into presynaptic terminal
- inhibits ACh repackaging into vesicles
- inhibits presynaptic ACh vesicle release

Front 9

Where do the following drugs modify Noradrenergic neurotransmission?
- Metyrosine
- Reserpine
- Guanethidine
- Amphetamine (2 ways!)
- Cocaine, TCAs

Back 9

- inhibits Tyrosine conversion into DOPA.
- inhibits Dopamine packaging/conversion into NE.
- Inhibits NE vesicle fusion/release
- INCREASES NE vesicle release, and INHIBITS NE reuptake.
- INHIBITS NE reuptake.

Front 10

Which receptors at the noradrenergic nerve terminal provide for inhibition of NE release caused by a signal?

Upregulates release?

What is the receptor for the local NE negative feedback mechanism?

Back 10

M2 (thru G(i))

Ang II

a2 (via G(i))

Front 11

Drug used for postoperative or neurogenic ileus, as well as urinary retention?
- mechanism?

Back 11

Bethanechol
- Cholinomimetic: activates bowel and bladder smooth muscle, and is resistant to AChEsterase.

Front 12

Carbachol class/mech.
- uses?

Back 12

Cholinomimetic agent used for glaucoma, pupillary contraction, and release of intraocular pressure.

Front 13

Pilocarpine class/mech.
- uses?

Back 13

Cholinomimetic: stimulates contraction of ciliary muscle of eye (open angle), pupillary sphincter (narrow angle) --> resistant to AChE.
- STIMULTATION of sweat, tears, and saliva.
"Pile on the Sweat and Tears!"

Front 14

Methacholine class/mech
- uses?

Back 14

Cholinomimetic: stim muscarinic receptors in airway when inhaled.
- challenge test for asthma dx.

Front 15

What is the mechanism of the -stigmine's?
- use of Neostigmine?
- use of Physostigmine?
- Pyridostigmine?

Back 15

Indirect choline agonists (inhibit AChE)
- postop and neurogenic ileu, urinary retention, myasthenia gravis, reversal of NMJ blockade after surgery. Does NOT penetrate BBB.
- Glaucoma (crosses BBB-->CNS) and atropine OD.
- longer acting form of Physostigmine. Does NOT penetrate CNS/BBB.

Front 16

Drug of choice for urinary retention?

Back 16

Bethanechol

Front 17

Edrophonium class and use.

Back 17

Indirect cholinergic agonist --> inhibits AChE.

- used to diagnose myasthenia gravis ...it's VERY short acting.

Front 18

Echothiophate class and use?

Back 18

AChE inhibitor.

Glaucoma.

Front 19

Sx of anti-AChE poisoning?
- antidote?

Back 19

Way to much autonomic stim for you:
- Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitiation of skeletal muscle and CNS, Lacrimation, Sweating, and Salivation.
- Atropine (blocks muscarinic receptors) + pralidoxime (chemical antagonist used to regenerate active cholinesterase)

Front 20

What is Pralidoxime?

Back 20

prompts regeneration of active AChE.

given with atropine for anti-AChE OD.

Front 21

Atropine class?
- organ system affects?
- application?

Back 21

muscarinic antag
eye
produce mydriasis and cycloplegia (paralysis of ciliary muscle ---> loss of accomodation)

Front 22

homatropine class?
- organ system affects?
- application?

Back 22

muscarinic antag
eye
produce mydriasis and cycloplegia (paralysis of ciliary muscle ---> loss of accomodation)

Front 23

tropicamide class?
- organ system affects?
- application?

Back 23

muscarinic antag
eye
produce mydriasis and cycloplegia (paralysis of ciliary muscle ---> loss of accomodation)

Front 24

Benztropine class?
- organ system affects?
- application?

Back 24

Muscarinic antagonist
- CNS
- Parkin' my Benz (Parkinson's dz)

Front 25

Scopolamine class?
- organ system affects?
- application?

Back 25

M antag
- CNS
- motion sickness

Front 26

Ipratroprium class?
- organ system affects?
- application?

Back 26

Muscarinic antag
- Respiratory
- Asthma, COPID ("[I pra]y I can breathe soon")

Front 27

Oxybutynin class?
- organ system affects?
- application?

Back 27

Muscarinic antag
- Genitourinary
- Reduces urgency in mild cystitis and reduces bladder spasms.

Front 28

Glycopyrrolate class?
- organ system affects?
- application?

Back 28

Muscarinic antag
- Genitourinary
- Reduces urgency in mild cystitis and reduces bladder spasms.

Front 29

Methscopolamine class?
- organ system affects?
- application?

Back 29

Muscarinic Antag
- GI
- PUD tx

Front 30

pirenzepine class?
- organ system affects?
- application?

Back 30

Muscarinic Antag
- GI
- PUD tx

Front 31

Propantheline class?
- organ system affects?
- application?

Back 31

Muscarinic antag
- GI
- PUD tx.

Front 32

Pt just took a drug that was supposed to decrease their urinary urgency. Now, they've got increased body temp, rapid pulse, dry mouth, dry flushed skin, cycloplegia, constipation, disorientation.

- drug?

Back 32

atropine.
"Hot as a hare
Dry as a bone
Red as a Beet
Blind as a Bat
Mad as a hatter"

Front 33

Atropine can cause what in the elderly?
- men w/ prostatic hyperplasia?
- infants?

Back 33

acute angle-closure glaucoma in the elderly.
- urinary retention
- hyperthermia.

Front 34

Hexamethonium class and uses?
- toxicities?

Back 34

Nicotinic antag
- blocks ganglion --> used to help prevent vagal reflex responses to changes in BP
- severe orthostatic hypotension, blurred vision, constipation, sexual dysfunction.