Pharmacology Exam Number 2-part one

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Catecholamines:

Fight-or-flight hormones released by the adrenal glands in response to stress; they are part of the sympathetic nervous system

Sympathetic NS activates:

Pupil dilation, increased sweating, increased heart rate and increased blood pressure.

Fight or Flight:

The sympathetic Nervous System

Adrenergic Agents:

Drugs that stimulate the Sympathetic Nervouse System

Adrenergic Drugs:

Mimic the effects of SNS neurotransmitters norepinephrine, epinephrine & dopamine.

Alpha One adrenergic receptors:

Are located on smooth muscles, such as blood vessels and result in vasoconstriction and CNS stimulation.

Beta one adrenergic receptors:

Primarily located in the heart, and increase the heart rate and force of contraction, as well as increasing the conduction of nerve impulses.

Beta two adrenergic receptors:

Known as Bonchi & Babies.
Located in smooth muscle fibers fo the bronchioles, arterioles and visceral organs.
Relaxation: Bronchodilation and uterus contractions

Nasal decongestants:

Vasoconstrict nasal mucosa, decreasing blood flow, thereby decreasing congestion.

Ophthalmic decongestants:

Arteriolar vasoconstriction, reducing conjunctival compression, redness.

Some A1 adrenergic drugs:

naphazoline, phenylephrine, tetrahydrozoline, pseudoephedrine.

Naphazoline:

Clear eyes

Phenylephrine:

Neo-Synephrine

Tetrahydrozoline:

Murine, or visine

Pseudoephedrine:

Sudafed

A1 adrenergic receptor rescue drug:

Norepinephrine (lovophed)
Used for shock & hypotension, causing systemic vasoconstriciton.

Cardiovascular Alpha 1 receptors:

Blood vessels-vasoconstriction

Beta one receptors:

Rescue Drugs; used to support the heart during cardiac failure or shock.

Albuterol:

Asthma Rescue medicine

Epinephrine:

Asthma 911 med; mixture of alpha one and beta two

Levalbuterol (Xopenex):

Inhalation bronchodilator

Salmeterol (Advair)

Asthma maintenance

Terbutaline (brethine):

Uterine relaxation-stops labor

Vasoconstriction:

Activation of A1 receptor

Vasodilation:

Blocking of A1 receptor
*exception-brain & uterus vasocontricts

Alpha Blockers:

Treat hypertension by causing both arterial and venous dilation, reducing peripheral vascular resistance and bp.

Benign Prostatic Hypertrophy:

Alpha blockers effect receptors on prostrate gland, decreasing bladder resistance to urinary outflow.

Phentolamine (regitine):

Vasodilation; controls and prevents hypertension.

Pheochromocytoma:

Tumor on adrenal gland that secrets norepinephrine.

(regitine) Phentolamine:

Also quickly reverses vasoconstrictive effects of extravasated vasopressors: norepinephrine or epinephrine.

Prazosin (minipress):

____ ( ___ ) is an Alpha blocker that causes vasodilation to decrease blood pressure & urinary obstruction w/BPH.

Tamsulosin (Flomax):

Alpha blocker ; vasodilation to decrease blood pressure & urinary obstruction w/BPH

BPH:

Benign prostatic hypertrophy-enlargement of prostrate gland

Inotrope:

An agent that alters the force or energy of muscular contractions. Negatively inotropic agents weaken the force of muscular contractions. Positively inotropic agents increase the strength of muscular contraction.

Increases:

Activations of B1 receptor ____ heart rate and force of contraction.

Blocking; decreases:

____ of B1 receptors ____ the heart rate and foce of contraction.

Heart; cardioselective:

Beta 1 receptors are located primarily on the _____; Beta-blockers selective for these receptors are called ______ beta-blockers.

Smooth muscles; blood vessels:

Beta 2 receptors are located primarily on ____ ____ of bronchioles and ____ ____.

Nonspecific:

_____ beta-blockers block both B1 and B2 receptors.

Metoprolol:

_____ (lopressor) is a cardioselective Beta blocker, given post MI.

Acebutolol:

____ (sectral) treats angina, hypertension, & dysrhthmias.

Catecholamines:

Cardioselective B-Blockers, such as metoprolol & acebutolol, block the action of ____ on the B1 receptor; cardiac effects w/out constriction of bronchi.

Activation; relaxation:

____ of B2 adrenergic receptors causes ____.

Blocking; constriction:

_____ of B2 Adrenergic receptors causes ____.

B1; B2:

Nonspecific B-blockers block both ____ and ____ receptors.

Blocking Agents:

Adrenergic ____ _____: Assess for COPD, hypotnesion, cardiac dysrhythmias, bradycardia, and heart failure.

Beta blockers:

Patients taking ____ ____ need to check apical pulse for one minute and blood pressure.

Rest; digest:

The Parasympathetic NS is where ___ and ____ occurs.

Direct Acting; cholinergic:

____ ____ cholinergic agonists bind to ____ recpetors, activating them.

Indirect acting; enzyme:

___ ___ cholinergic agonists inhibit the ____ cholinesterase which breaks down acetylcholine.

Stimulate; increased:

Cholinergic drugs ____ the intestine and bladder, resulting in ____ gastric secretions, gastrointestinal motility & urinary frequency.

Cholinergic:

_____ drugs stimulate the pupils and increase salivation and sweating.

Miosis:

Pupil constriction.

Cholinergic; decrease:

___ drugs ___ the heart rate.

Cholinergic; bronchial:

____ drugs cause ___ constriction.

Acetylcholine, carbachol, pilocarpine:

___, ___, & ____ are used in glaucoma and intraocular surgery to reduce pressure.

Bethanechol:

____ (urecholine) treats atony and neurogenic bladder, by increasing the tone and motility of bladder and GI tract.

Pyridostigmine; physostigmine:

____ & ____ are indirect acting cholinergic agents that cause skeletal muscle contractions, such as those associated with myasthenia gravis.

Myasthenia Gravis:

____ ____ is a neuromuscular disorder that causes weakness of the voluntary (skeletal) muscles.

Physostigmine:

____ is an antidote for anticholinergice poisoning .

Donepezil; indirect:

____ (aricept) is an ____-acting agent helps maintain or increase memory

Overstimulation:

Side effects of donepezil (aricept) are caused by ____ of the PSNS.

Circulatory collapse; shock:

Cholinergic toxicity causes ___ ___ , hypotension, bloddy diarrhea, ____, & cardiac arrest.

Atropine:

Cholinergic toxicity is reversed by _____.

SLUDGE:

Salivation, lacrimation, urinary incontinence, diarrhea, gastrointestinal cramps, emesis.

Acetylcholine; cholinergic:

Drugs that block/inhibit the actions of ____ in the PSNS are called ____ blocking agents.

Atropine; scopolamine:

Natural cholinergic-blocking drugs are ____ and ____.

Benztropine; blocking:

____ (cogentin) is a synthetic cholinergic ____ drug that treats parkinsonins.

Dicycolmine; cholinergic:

____ (Bentyl) is a synthetic ____ blocking drug.

Tolterdine; synthetic:

____ ( Detrol ) is a ____cholinergic blocking drug.

Glycopyrrolate; blocking:

____ (Robinul) is a synthetic cholinergice ____ drug.

Oxybutynin; cholinergic blocking:

____ (Ditropan) is a synthetic ____ ____ drug.

Tartive dyskinesia:

____ ___ is involuntary, irregular muscle movements, usually in the face.

Akathisia:

Restlessness

Dystonia:

____ is a neurological movement disorder, in which sustained muscle contractions cause twisting and repetitive movements or abnormal postures.

Torticollis:

____ is a twisted neck in which the head is tipped to one side, while the chin is turned to the other.

Atropine:

____ is used primarily for cardiovascular disorders.

Physostigmine:

The antidote for atropine overdose is ____.

Decreased:

Atropine causes ____ secretions from the nose, mouth, pharynx and bronchi.

Airway resistance:

Atropine decreases ____ ____.

PSNS; decreased; relaxation:

Blockage of the ____ results in ____secretions, ____ of smooth muscle, and decreased GI motility.

Dicyclomine; IBS:

____ (Bentyl) treats Peptic ulcer disease, ____, and GI hypersecretory states.

Glycopyrrolate:

____ (Robinul) is used to control secretions during surgery.

Scopolamine:

____ prevents motion sickness, as well as correcting imbalances of acetylcholine and norepinephrine in high centers of the brain.

Tolterodine:

____ (Detrol) treats incontenence due to overactive bladder.

Overactive bladder; bladder:

____ _____ results from relaxed detrusor muscles of the ____.

Oxybutynin:

____ (Ditropan) treats incontenence due to over active bladder, as well as reflex neurogenic bladder (spinal cord injury).

Heat stroke:

Anticholinergics taken by geriatric patients may lead to high risk for ____ ____.

Chronotropic:

Rate of the heartbeat

Dromotropic:

The conduction of electrical impulses.

Inotropic:

Force or energy of muscular contractions.

Digitoxin:

____ is no longer available in US.

Digoxin:

___ in as cardiac glycoside that increases myocardial contractility

Cardiac Glycosides:

____ ____ reduce heart rate and improve cardiac efficiency.

Electrical conduction:

Cardiac glycosides change the ____ ____ properties of the heart.

Positive inotropic:

Some cardiac glycosides have a ___ ___ effect, in that they increase the force and velocity of myocardial contractions, without an increase in oxygen consumption.

Negative chronotropic; reduce:

Some cardiac glycosides have a ___ ___ effect in that they ___ the heart rate.

Negative dromotropic:

Some cardiac glycosides have a ____ ____ effect in that they decrease automaticity at SA node as well as decreasing nodal conduction.

Increased; decrease; increase:

Side effects of cardiac glycosides include ____ stroke volume, ____ in BP and ____ in coronary circulation.

Digoxin; electrolyte:

____(lanoxin) levels must be monitored, as well as ___ levels; also has a very narrow therapeutic window.

0.5; 2.0:

The normal therapeutic drug level of digoxin should be between ___ and ___ mg/mL

Colored halos:

____ ____ are a side effect of Digoxin:

Phosphodiesterase:

____ inhibitors work by inhibiting the enzyme_____, which results in a positive inotropic response (vasodilation).

Amrinone; milrinone :

___ and ___ are phosphodiesterase inhibitors with positive inotropic effects useful for the treatment of ventricular dysfunction after cardiac surgery.

Phosphodiesterase inhibitors:

____ ____ are used in the short term management of heart failure, when pt hasn't responded to digoxin, diuretics or vasodilators.

6 hour infusions:

Phosphodiesterase inhibitors are often given as WEEKLY __ __ ___.

<60 or >120:

When giving positive inotropic agents, hold does and notify prescriber is apical pulse is between _____.

Green; yellow:

Signs and symptoms of Inotropic toxicity is blurred vision or seeing ___ or ___ halos around objects.

Cardiac Dysrythmias:

____ ____ involve changes to the automaticity or conductivity of the heart cells.

Electrolyte imbalances; acidosis:

Cardiac Dystythmias can be caused by ____ ____, decreased O2 delivery, structural damage, ____ or adverse effects of drugs.

Vaughan Williams:

___ ____ classification system is used to classify antidysrhythmic drugs.

Class 1:

____ ____ blocks sodium channels.

Class 2:

____ ____ are beta adrenergic blockers.

Class 3:

____ ____blocks potassium channels.

Classe 4:

____ _____ blocks calcium channels.

Digoxin; adenosine:

___ and ____ fall into the "other" VW classification system.

Quinidine, procainamide:

Class 1a includes ____, ____ and disopyramide.

Lidocaine:

____ is the drug of choice for treating acute ventricular dysrhythmias associated w/MI.

Lidocaine, tocainide, mexiletine, phenytoin

Class 1b antidysrhythmic drugs include ___, ___, ___, & ____.

Flecainide (Tambocar); Propafenone (Rythmol):

____ (___) and ____ (____) are Class 1c antidysrhythmic drugs, which are used for severe ventricular dysrhythmias.

Atenolol, esmolol, petaprolol, propranolol:

___, ___, ___, & ____ are all class II beta blockers, which reduce or block sympathetic NS stimulation

Amiodarone, bretyliu, sotalol, ibutilide:

____, ___, ___, & ___ are all Class III are potassium channel blocking antidysrhythmic drugs.

Verapamil, diltiazem:

____ & ____ are class 4 calcium channel blocker antidysrhythmic drugs.

Adenosine (adenocard):

____ (___) is an unclassified antidysrhythmic drug that slows conduction through the AV node.

Paroxysmal supraventricular tachycardia:

Adenosine (adenocard) is a rescue drug used to convert ____ ____ _____ to sinus rhythm. Short half life-10 sec; iv push.

Digoxin:

____ is used to treat dysrhymias, by slowing the calcium from leaving the cell, which slows conduction and heart rate.

Atropine:

___ is the ONLY antidysrhythmic drug used to increase heart rate.

Enhances:

Atropine ____ SV nodal automaticity and AV nodal conduction.

Antidysrhythmics:

All _____ can cause dysrhythmias.

Chronic stable angina:

___ ___ ____ is also called classic or effort angina.

Unstable angina:

___ ___ is also called preinfarction or crescendo angina.

Vasospastic angina:

___ ___ is also called Prinzmetal's or variant angina.

Athersoclerosis:

____ is the primary cause of Chronic stable angina, which is triggered by exertion or stress.

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