Boards - Dit - Pharm

Front 1

Symptoms of excess parasymp. activity?

Back 1

DUMBBELSS:

Diarrhea, Urination, Miosis, Bronchospasm, Brady, Excitation of Skeletal m. and CNS, Lacrimation, Sweating, Salivation

Front 2

What drugs are used for Alzheimers?

Back 2

Donepezil, Galantamine, Rivastigmine

Front 3

Pathology of Myasthenia gravis? How treated?

Back 3

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

Front 4

What drug regenerates Ach after organophosphate poisoning?

Back 4

Pralidoxime = 2-PAM

Front 5

What is the antidote for organophosphate poisoning?

Back 5

Atropine

Front 6

Which anticholinesterases are used in the treatment of Alzheimer's disease?

Back 6

Donepezil, Galantamine, Rivastigmine

Front 7

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

Back 7

True

Front 8

List the Direct Ach Agonists (=Cholinergic Agonists) that mimic Ach

Back 8

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)

Front 9

What are the Indirect Agonists of Ach (=target Anti-cholinesterase which normally works to break down Ach)

Back 9

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)

Front 10

Organophosphates such as Parathion used by farmers and gardeners does what? Tx?

Back 10

Irreversibly inhibit AchE = we get Inc Ach = DUMBBELSS symptoms

Tx = Atropine and then Pralidoxine regenerates the AchE

Front 11

Most common Neuro-muscular junction disorder?

Back 11

Myasthenia Gravis

= Abs to post-synaptic Ach receptor causes ptosis, diplopia, general weakness

Front 12

What are the Muscarinic Blockers?

Back 12

Atropine, Homatropine, Tropicamide, Benztropine, Scopolamine, Ipratropium, Oxybutynin, Glycopyrrolate, Methscopolamine, Pirenzepine, Propantheline

Front 13

Use for Atropine?

Back 13

Mydriasis and Clycloplegia

Front 14

Use of Benztropine?

Back 14

Parkinsons

"Park my Benz"

Front 15

Use of Scopolamine

Back 15

Motion sickness

Front 16

What are the symptoms of inhibiting parasympathetic activity?

Back 16

"Dry Everywhere"

Ileus, urinary retention, hyper-pyrexia (=hot), dry mouth, Flushing of skin, blind tachy, dilation of eye, delirium

Front 17

Physostigmine, Echothiophate, Donepezil, Neostigmine, Edrophonium, Rivastigmine, Pyridostigmine

These are all are?

Back 17

Anti-AchE = anti-acetylcholinesterase = Inc. Ach b/c they inhibit the thing that breaks Ach down

Front 18

Pilocarpine, Bethanechol, Carbachol are all?

Back 18

Cholinergic Agonists = Inc Ach

Front 19

Oxybutynin, Atropine, Darifenacin, Ipratropium, Tropicamide, Benztropine, Scopolamine, Tolterodine, Trospium, Homatropine are all?

Back 19

M-Blockers = Block Ach binding

Front 20

Which of the M-Agonists are used to improve FEV1 in a pt with asthma?

Back 20

Ipratropium

Front 21

A 30 year old schizophrenic now has urinary retention due to his neuropleptic - what do you treat him with?

Back 21

Bethanechol

Front 22

What drugs can dilate pupils?

Back 22

Sympathetic Agonist OR Anti-cholinergic like an M-blocker

Front 23

What drugs can be used in treatment of urge incontinence?

Back 23

M Blockers:

Oxybutynin, Tolteradine, Darifenacin, Solfenacin, Trospium

Front 24

List the steps in Ach Synthesis and neurotransmission

Back 24

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

Front 25

What inhibits the making of Ach by disabling it from being packaged into vessicles?

Back 25

Vesamicol

Front 26

List the steps involved in NE synth and neurotransmission

Back 26

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

Front 27

What things promote NE release? Inhibit? Inhibit NE RE-UPTAKE?

Back 27

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

Front 28

What are two molecules that metabolize NE once it gets into the synapse (note, these are similar to Acetylcholiesterase which degrades Ach in synapse)

Back 28

COMT (methylates NE) and MAO (Monoamine Oxidase Oxidizes NE)

* Both make NE Unusable

Front 29

Vit B 6 and Vit C are needed in which steps of the making of NE from Tyrosine?

Back 29

Vit B6 needed in step from Dihydroxyphenylalanine to Dopamine

Vit C needed in step from Dopamine to NE

Front 30

What G proteins are coupled to the various receptors?

Back 30

Inhibitory G proteins = "MAD2"

Gi = M2, A2, D2

"qt's HAV 1 m&m"

Gq = H1, A1, V1, M1, M3

*Everything else is Gs

Front 31

Outline the path after a Gq receptor is stimulated

Back 31

Gq = Activates Phospholipase C --> Cleaves Lipids to PIP2 --> DAG or IP3... IP3 increases Ca2+ in cell while DAG leads to protein kinase C

Front 32

Outline the path after Gs or Gi stiulates or inhibits Aneylyl cyclase

Back 32

Gs or Gi stimulate (path preoceeds) or inhibit (path stops) Adenylyl cyclase --> ATP --> cAMP --> Protein kinase A

Front 33

What regulates prolactin secretion from pituitary?

Back 33

Dopamine from hypothalamus = INHIBITS prolactin secretion

Prolactin inhibits its own secretion by increasing Dopamine synthesis

Front 34

Effect of Epinephrine, NE, Isoproterenol, Dopamine, Dobutamine, Phenylephrine on alpha 1, 2, beta 1, 2, and D1 receptors?

Back 34

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)

Front 35

Albuterol, Metaproterenol, and Salmeterol are are all used for what?

Back 35

ASTHMA

Metaproterenol and Albuterol for Acute asthma

Salmeterol for long-term tx

(All work on Beta 2's)

Front 36

What do we use to reduce premature uterine contraction?

Back 36

Terbutaline or Ritodrine

(works on Beta 2's to dec. contractions)

Front 37

Most common first line agent for pts in septic shock? Cardiogenic shock?

Back 37

Septic chock = NE

Cardiogenic shock = Dobutamine

Front 38

What is Epi's affect on BP if administered after an alpha blocker is given?

Back 38

alpha blocker will block alphas so that Epi only works on the Beta 2's on blood vessels meaning we vasodilate

Front 39

Common side effects of beta blockers?

Back 39

Exacerbate asthma, raise blood glu, mask symptoms of hypoglycemia, bradycardia, AV Block, CHF, Impotence, Erectile Dysfunction,

Front 40

Be careful giving be blockers to pts with what conditions?

Back 40

Asthmatics, Diabetics, CHF

Front 41

What are the various clinical applications of Beta Blockers?

Back 41

HTN, Angina pectoralis, MI, SVT, CHF