Term
| What are the two categories of Cholinesterase (ChE) Inhibitors? How selective are they? |
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Definition
| Reversible and irreversible. NOT SELECTIVE. |
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Term
| NEOSTIGMINE -- class? What are it's two PHARMACOLOGIC effects? Main therapeutic indication? |
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Definition
| Reversible cholinesterase inhibitor. Muscarinic and Neuromuscular effects. myasthenia gravis (respiratory support). |
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Term
| What is a Myasthenic Crisis? |
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Definition
| It is when untreated MG results in dangerously low concentrations of ACh at the NMJ causing muscle weakness. (treat with AcE Inhibitor like Neostigmine) |
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Term
| What is a Cholinergic Crisis? |
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Definition
| It is when there is a dangerously high concentration of ACh at the NMJ also resulting in muscle weakness PLUS Muscarinic Symptoms (excessive salivation, cramps, sweating, etc) |
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Term
| How can you clinically distinguish btw a MYASTHENIC and CHOLINERGIC crisis if both cause muscle weakness? |
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Definition
| Look for signs of muscarinic activation OR test with a short acting ChE Inhibitor to see if that improves symptoms of muscle weakness--if so then MYASTHENIC, if not then CHOLINERGIC |
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Term
| NEOSTIGMINE--method of administration? length of action? Contraindications? |
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Definition
| Oral or IM, IV, SC. Not use is bowel/bladder obstruction (same as with cholinergic agonist!) |
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Term
| For ADRENERGIC AGONISTS what are the endogenous transmitters and receptors involved? |
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Definition
| Epinephrine, Norepinephrine, alpha and beta (1&2) |
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Term
| Adrenergic Agonists: adregergic receptors can be activated in one of 4 ways: |
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Definition
| 1. Direct receptor binding, 2. Promote NE Release, 3. Decrease NE re-uptake 4. Inhibit NE Inactivation |
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Term
| What are the two classes of Adrenergic Agonists? |
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Definition
| Catecholamines and Noncatecholamines |
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Term
| Which class of Adrenergic Agonists cannot be used orally and why? |
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Definition
| Catecholamines, because the nz COMT and MAO act to quickly destroy them in the gut. |
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Term
| What are the three catecholamines that must be administered by continuous infusion? |
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Definition
| Norepinephrine, Dopamine and Epinephrine. |
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Term
| Name one noncatecholamine: |
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Definition
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Term
| Which class of Adrenergic Agonist can cross the BBB? |
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Definition
| NONcatecholamines (ephedrine) |
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Term
| What are the effects on specificity of beta drugs when giving large doses? |
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Definition
| Beta 1 drugs if we give a large enough dose we lose specificity and go after both beta 1 and beta 2 receptors. |
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Term
| What are the 6 therapeutic applications of Alpha 1 receptor activation? |
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Definition
| 1. peripheral vasoconstriction stops bleeding, 2. increases BP, 3. mydriasis, 4. stops nasal decongestion, 5. prolongs anesthesia and 6. decreases systemic effects of anesthesia |
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Term
| What are the 3 adverse effects of ALPHA 1 activation (with EPINEPHRINE for example)? |
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Definition
| HTN, peripheral necrosis (toes falling off!), REFLEXIVE bradycardia because body tries to adjust for increasing BP by lowering heart rate. |
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Term
| Therapeutic effects of Beta 1 agonists? |
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Definition
| INCREASES HEART RATE: Treat cardiac arrest/heart failure, shock, atrioventricular block |
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Term
| Adverse effects of Beta 1 agonists? |
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Definition
| Tachycardia, dysrhythmias and angina pectoris |
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Term
| Therapeutic effects of Beta 2 activation? |
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Definition
| Asthma and delay pre term labor. |
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Term
| Adverse effects of Beta 2 activation? |
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Definition
| HYPERglycemia (glycogenolysis in liver and skeletal muscle), tremors (enhanced skeletal muscle contractions)--sometimes Beta 1 cross over gives you tachycardia as well. |
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Term
| What is the MOA of Prazosin? |
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Definition
| Prazosin is an adrenergic alpha 1 antagonist. It is approved ONLY for treating HTN and it causes relaxation of the bladder neck. |
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