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Pharm 43-54

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mhewett's version from 2016-07-13 03:00

Chapter 43: Antinicotinic Drugs

Antinicotinic drugs affect the transmission of _____, acting as either antagonists or agonists. Acetylcholine
What is the primary use for antinicotinic drugs? Surgery
What are the two non-depolarizing antinicotinic drugs we discussed? (1) Tubocurarine (2) Pancuronium
What was the one depolarizing antinicotinic drug we discussed? Succinylcholine
Which of the antinicotinic agents is used for rapid endotracheal intubation and electroconvulsive therapy? What is the life-threatening disorder associated with use of this drug? Succinylcholine; Malignant hyperthermia
What is the treatment for malignant hyperthermia? Dantrolene
What are the three drugs that should be used with caution in combination with antinicotinic agents? (1) Halothane (2) Aminoglycosides (3) Calcium channel blockers
What antinicotinic is associated with an adverse effect of vagolysis? Pancuronium

Chapter 44: Adrenergic and Cholinergic Receptors

What are the two types of cholinergic (i.e. ACh-using) receptors? (1) Nicotinic (2) Muscarinic
Where would you expect to find type I nicotinic receptors? Type II? SNS and PNS; Skeletal muscle
Where would you expect to find M4 and M5 muscarinic receptors? CNS
Where would you expect for find M2 muscarinic receptors? Heart
What type of muscarinic receptor would you expect to find on most tissues? M3
What is the primary effect of M1, M3, and M5 muscarinic receptors? Stimulate phospholipase C (PLC), which results in increased intracellular calcium
What is the primary effect of M2 and M4 muscarinic receptors? Inhibit adenylate cyclase, which decreased cAMP and results in potassium efflux and sodium influx
What is the primary effect of beta receptors? Stimulate adenylate cyclase, which increased cAMP
What is the primary effect of alpha-1 receptors? Stimulate phospholipase C (PLC), which results in increased intracellular calcium
What is the primary effect of alpha-2 receptors? Inhibit adenylate cyclase, which decreased cAMP and results in potassium efflux and sodium influx

Chapter 45: Sex Hormones

What is the primary function of progesterones? What hormone do they inhbit? Maintain the endometrium; Inhibit gonadotropins (LH, FSH)
Progesterones are normally produced in response to _____. Luteinizing hormone
What are the two most common side effects of progesterones? (1) Weight gain (2) Depression
What are the two most common components of combination contraceptive pills? Ethinyl estradiol (an estrogen) (2) Progestin (such as levonorgestrel, norethidrone or norgestrol)
Why must you always give progesterone when prescribing estrogen to a pateint? Unopposed estrogen increases the risk of endometrial carcinoma
How do combination pills prevent pregnancy? Suppress follicular development and ovulation

Chapter 46: Hallucinogens

What hallucinogen promotes arousal, tachycardia, sweating, piloerection, as well as mydriasis? LSD (lysergic acid diethylamide)
What is the major alkaloid found in marijuana? What is the name of its pharmaceutical equivalent? THC (tetrahydrocannabinol); Dronabinol
What are the two clinical uses for dronabinol? (1) Severe emesis in chemotherapy (2) Appetite stimulation
What are the three major adverse effects of THC (tetrahydrocannabinol)? (1) Red conjunctiva (2) Increase heart rate (3) decreased blood pressure
What two hallucinogens cause dissociative anesthesia? (1) PCP (phencyclidine) (2) Ketamine
What hallucinogen is associated with biazrre and often aggressive behavior that may persist up to a week? What is the most common street name for this drug? PCP (phencyclidine); Angel dust
What hallucinogen promotes ulceration of the inner lining of the urinary bladder? Ketamine
What hallucinogen is the anesthetic of choice for trauma victims because of its ability to raise blood pressure? Ketamine

Chapter 47: Opioids

What are the two major opioid receptors in the CNS? (1) Mu receptor (2) Kappa receptor
Which of the two major opioid receptors causes stong analgesia and physical dependence? Mu receptors
Which of the two major opioid receptors causes decreased GI motility and respiratory depression? Mu receptors
What type of G protein do all opioids affect? Do opioids stimulate or inhibit adenylyl cyclase? Gi; Inhibit
What is the antidote for opioid toxicity? Naloxone
Besides pain control, what other pharmcologic use does codeine have? Antitussive
What stong opioid has a rapid onset, but short duration (15-30 mins)? Fentanyl
Methadone exerts its greatest effect on which of the two major opioid receptors? Mu receptors
Is heroine stonger, equal, or weaker than morphine? Codeine? Methadone? Fentanyl? Stronger (3x); Weaker; Equal; Stronger (80x)
Which of the two major opioid receptors causes the most sedation? Kappa receptors

Chapter 48: Antidepressants

What three neurotransmitters are potentiated, either directly or indirectly, by antidepressants? (1) Norepinephrine (2) Dopamine (3) Serotonin
What class of antidepressant do amitriptyline, clomipramine, desipramine, and imipramine belong to? Tricyclic amine antidepressants (TCAs)
What class of antidepressant is prefered by most non-specialists because they have fewer side effects? Selective serotonin reuptake inhibitors (SSRIs)
What class of antidepressant do citalopram, escitalopram, fluoxetine, proxetine, and sertraline belong to? Selective serotonin reuptake inhibitors (SSRIs)
In what trimester of pregnancy are SSRIs contraindicated? Which SSRI is contraindicated throughout pregnancy? 3rd trimester; Proxetine
What class of antidepressant do phenelzine, isocarboxazid, tranylcypromine belong to? MAO inhibitors (MAOIs)
What is monoamine oxidase (MAO)? Mitochondrial enzyme that inactivates excess neurotransmitter molecules (NE, DA, seotonin)
What class of antidepressant requires a 2 week washout period between its use and another class of antidepressant? MAO inhibitors (MAOIs)
What are the four major foods known to contain tyramine? What class of antidepressant requires a diet low/free from tyramine? (1) Cheese (2) Beer (3) Wine (4) Chicken liver; MAO inhibitors (MAOIs)
What class of antidepressant do duloxetine, venlafaxine, and desvenlafaxine belong to? Serotonin-Norepinephrine reuptake inhibitors (SNRIs)
What SNRI has a structure similar to amphetamine, accounting for its activating action on patients? Venlafaxine
What SNRI is contraindicated in patients with chronic renal disease, liver failure, and heavy alcohol use? Duloxetine
What antidepressant is also a nicotinic antagonist? Bupropion
What antidepressant is known to lower the seizure threshold more than other classes of antidepressants? Bupropion
What antidepressant is used for smoking cessation and for seasonal affective disorder? Bupropion

Chapter 49: Lithium and Other Mood Stabilizers

What is the drug of choice for bipolar disorder? Does it effect normal individuals? Lithium; No
Lithium has a very narrow therapeutic range, its side effects are mostly due to increased elimination of _____. Potassium (secondary to the drugs sodium ion effects)
What mood stabilizer inhibits voltage-gated sodium channels? What is another indication for this drug? Lamotrigine; Seizure disorders
What two mood stabilizers are associated with life-threatening rashes such as Steven-Johnson syndrome and toxic epidermal necrolysis? (1) Lamotrigine (2) Carbamazepine
What mood stabilizer has an FDA warning for the risk of development of temporary or permanent blindness? Topiramate
What mood stabilizer has the potential to cause aplastic anemia? Carbamazepine
Valporic acid is contraindicated in patients with _____. Liver disease
What mood stabilizer requires regular monitoring of serum CBC, thyroid function tests, and liver function tests? Carbamazepine
What is the drug of choice for the treatment of trigeminal neuralgia? Carbamazepine
What mood stabilizer is also used for seizure disorders and neuropathic pain? It is a structual analog of what neurotransmitter? Gabapentin; GABA
What are the three pregnancy class D mood stabilizers? What class do the other mood stabilizers belong to? (1) Lithium (2) Carbamazepine (3) Valporic acid; Class C
What mood stabilizer is associated with ebsteins anomally of the heart? Neural tube defects? Lithium; Carbamazepine and valporic acid
What mood stabilizer is known to cause renal stones? Topiramate
What mood stabilizer is known to diabetes inspidius and seizures? Lithium

Chapter 50: CNS Stimulants

What are the three primary psychotomimetic drugs? (1) LSD (2) PCP (phencyclidine) (3) THC
What are the three primary sources of methylxanthines? (1) Tea (2) Cocoa (3) Coffee/Coke
What is the number one consumed CNS stimulant in the world? Caffeine
Are methylxanthines smooth muscle stimulants or relaxants? Which of the methylxanthines has the greatest effect on the bronchioles? Relaxants; Theophyllines (found in tea)
What is the most abused drug in the world? Second most abused drug? Alcohol; Nicotine
What CNS stimulant is used pharmacologically to induce local anesthesia for the ear, eye, nose, and throat? Cocaine
What is the biggest risk in someone going through cocaine withdrawal? Suicide
What is the only local anesthetic known to cause vasoconstriction? Cocaine
What are the two primary mechanisms of action behind amphetamines? (1) Cause release of catecholamines (2) Block monoamine oxidase (MAO)
Where would you expect to find theobromine? Theophylline? Cocoa; Tea
How does nicotine effect blood pressure at low doses? High doses? Increase BP at low dose; Decreases BP at high dose
What CNS stimulant is known to cause perforation of the nasal septum with chronic inhalation? Why does this occur? Cocaine; Because it causes vasoconstriction that may lead to necorsis

Chapter 51: Anxiolytic Drugs

What is the mechanism of action of benzodiazepines? Enhance binding of GABA to GABA receptors
What are the four primary actions of benzodiazepines? (1) Decrease anxiety (2) Sedation (3) Anticonvulsants (4) Muscle relaxation
What is the drug of choice for status epilepticus? Diazepam (valium)
What non-benzodiazepine is used for the treatment of chonic, long-term anxiety? What is its mechanism of action? Buspirone; 5-HT1 agonist
What suffix do most benzodiazepines share? -pam or -lam
What is the most common adverse effect of benzodiazepines? Drowsiness
What benzodiazepine is more commonly used for anxiety disorders because it is long acting and less addicting? Diazepam (valium)
What benzodiazepine is used for the acute treatment of alcohol withdrawal? Chlordiazepoxide
What drug class is primarily used for the treatment of anxiety? Barbituates

Chapter 52: Hypnotic Drugs

What is the mechanism of action for barbituates? Interefere with Na/K transport system of cell membranes, increasing GABA action
In what patient population are barbituates contraindicated? Patients with acute intermittent prophyria
What is the drug of choice for children with recurrent febrile seizures? Phenobarbital
What non-barbituate hypnotic causes a very unpleasent taste? Chloral hydrate
What suffix do most barbituates share? -tal
Is phenobarbital long-acting or short-acting? How about thiopental? Long-acting (1-2 days); Short-acting (20 mins)
What is the primary use for thiopental? Anesthesia
What drug class is primarily used for the treatment of anxiety? Barbituates

Chapter 53: Antihistamines

What three cell types are known to release histamine? (1) Basophils (2) Mast cells (3) Platelets
What is the mechanism of action of antihistamines? Do they can an increase, decrease, or no change in the amount of histamine released? Block H1 receptors; No change in amount of histamine released
What type of histamine receptor stimulates gastric HCl secretion? Bronchoconstriction? Cardiac effects? H2; H1; H1 and H2
What are the three classic cutaneous signs of histamine release? (1) Wheal formation (2) Reddening (due to vasodilation) (3) Flare (diffuse reddening in the surrounding area)
What is the mechanism of action of diphenhydramine? What are its two primary indications? H1 blocker; (1) Allergy (2) Motion sickness
What suffix do most second generation antihistamines share? Are these more or less sedating then first generation antihistamines? -dine; Less
In what three patient populations are antihistamines contraindicated? (1) BPH (2) Bladder obstruction (3) Narrow (acute) angle glaucoma
What class of drug is strictly contraindicated in patients taking antihistamines? MAO inhibitors

Chapter 54: Anesthetics

What are the four major types of anesthesia? (1) General (2) Regional (3) Local (4) Monitored anesthesia care (MAC)
What general classification of anesthesia inhibits the entire CNS (spinal cord, brainstem, cerebral cortex)? General anesthesia
What general classification of anesthesia inhibits the spinal cord and peripheral nerve bundles? Regional anesthesia
What general classification of anesthesia inhibits the distal peripheral nerves in one isolated location? Local anesthesia
What suffix do most halogenated hydrocarbons share? What organ toxicity is common to all halogenated hydrocarbons? -ane; Hepatoxicity
_____ defines the potency of an inhaled drug. Minimal alverolar concentration (MAC);
Is a high minimal alverolar concentration (MAC) indicative of high or low potency? How about a low MAC? Low; High
What inhaled anesthetic carries the highest risk for malignant hypothermia? What is the antidote for malignant hypothermia? Halothane; Dantrolene
What is the mechanism of action for inhaled anesthetics? Enhance potassium ion leakage, causing neuronal depression
What are the two preferred inhaled anesthetics? Which is associated with renal toxicity? (1) Desflurane (2) Sevoflurane; Sevoflurane
What is the most potent of the inhaled anesthetics? Besides hepatoxicity, what other organ toxicity is it associated with? Methoxyflurane; Renal toxicity
What inhaled anesthetic is the least hepatoxic and has the least cardiovascular effects? Nitrous oxide (N20)
Is halothane hepatoxic in children, adults, or both? Adults
In what patient population is thipental (i.e. barbituates) contraindicated? Patients with acute intermittent prophyria
What is the drug of choice for induction of general anesthesia? What is its mechanism of action? Propofol; Stimulates GABA receptors
What hallucinogen is the anesthetic of choice for trauma victims because of its ability to raise blood pressure? What is its mechanism of action? Ketamine; Blocks N-methyl-D-aspartate (NMDA) receptors
What is the only IV anesthetic that causes direct cardiac stimulation? Ketamine
What are the three types of regional anesthesia? (1) Spinal (2) Epidural (3) Nerve block
What suffix do most local anesthetics share? -caine
What class of anesthetics are preferred for regional anesthesia? Local anesthetics