NURS 5334 ADVANCED PHARMACOLOGY EXAM 2 Study Questions and Answers
• What are the basic mechanisms by which neuropharmocologic agents act?
o Can modify the disease process
o Act at the sites of actions which is the axons versus synapses and steps in synaptic transmission and effects of drugs o...
NURS 5334 ADVANCED PHARMACOLO GY EXAM 2 Study Questions and Answers
•What are the basic mechanisms by which neuropharmocologic agents act?
oCan modify the disease process
oAct at the sites of actions which is the axons versus synapses and steps in synaptic transmission and effects of drugs on the steps of synaptic transmission
•Transmittter synthesis is the first step in transmission. What are the other 4 steps?
oTransmitter storage, transmitter release, receptor binding, and termination of the transmission
•True or False: Neuropharmacologic drugs have high selectivity.
oTrue—the nervous system uses many different receptor types
•Information needed:
oType of receptors—through which the drug acts
▪Alpha and beta
oNormal responses to the activation of those receptors
▪Agonists vs. antagonists
oWhat the drug in questions does to the receptor function
•What are the 3 functions of ANS?
oRegulates the heart
oRegulates the secretory glands, saliva glands, gastric, sweat, and bronchial
oIt regulates smooth muscles: bronchi, blood vessels, urogenital system, and the GI tract
•What are the regulatory functions of the parasympathetic NS?
oSeven regulatory functions
▪Slowing the heart rate
▪Increasing the gastric secretions
▪Emptying the bladder
▪Emptying the bowel
▪Focusing the eye for near vision,
▪Constricting the pupil
▪Contracting the bronchial smooth muscle
oIt also regulates the digestion of food, excretion of waste, control of vision and conservation of energy
•What are the functions of the sympathetic NS?
oRegulation of the cardiovascular system
▪Maintaining blood flow to the brain
▪Redistributing blood and compensating for the loss of blood
oRegulation of body temperature
▪Regulates blood flow to the skin
▪Promotes the secretion of sweat
▪Induces piloerection (erection of the hair)
oImplementation of the fight or flight reaction
▪Increase HR and BP
▪Blood shuts away from the skin and visera
▪Bronchi dilate ▪Pupils dilate
▪Use energy that had been stored
•What is the baroreceptor reflex?
oThe receptors near the heart monitor BP changes and send the information to the brain
oThe brain then activates the Autonomic NS to restore blood pressure to normal
oWhen BP falls, this reflex causes vasoconstriction and increases cardiac output.
oWhen BP rises, it causes vasodilation and reduces cardiac output
•Where is acetylcholine employed?
oMost junctions at the peripheral nervous system
•Where is epinephrine and norepinephrine released?
oNorepinephrine—postganglionic neurons
oEpinephrine—adrenal medulla
•What are the cholinergic receptors mediated by? What are the subtypes?
oReceptors that mediate responses to acetylcholine
oSubtypes:
▪Nicotinic
▪Muscarinic
•Whare are adrenergic receptors mediated by? What are the subtypes?
oMediate responses to epinephrine and norepinephrine
oSubtypes:
▪Alphas
▪Betas
▪Dopamine
•What are the functions of each adrenergic subtype?
oAlpha 1—vasoconstriction, ejaculation and contraction of the bladder neck, and prostate
oAlpha 2—(located in presynaptic junction)—minimal clinical significance
oBeta 1—control the heart
▪Increase HR, increase force of contraction and velocity of conduction in the AV node; stimulate renin released in the kidney
oBeta 2—bronchial dilation, relaxation of the uterine muscle, vasodilation, glycogenolysis
oDopamine—dilates renal blood vessels
•Epinephrine can activate all alpha and beta receptors but not dopamine receptors
•Norepinephrine can activate alpha1, alpha2, and beta receptors but not beta2 or dopamine receptors
•Dopamine can activate alpha1, beta1 and dopamine receptors
•Muscarinic agonists mimic the effects of acetylcholine at muscarinic receptors
•Muscarinic antagonists selectively blood the effects of acetylcholine (and other muscarinic agonists) at muscarinic receptors
•What are therapeutic uses of Bethanechol?
oUrinary retention
oInvestigational GI uses—off label GI reflux
•What are actions on smooth muscle, exocrine glands, and eye?
oSmooth muscle— ▪lung by causing constriction of the bronchi
▪the GI system by increasing tone and motility
▪the bladder by contraction of the detrusor muscle
▪relaxation of the trigone and sphincter
oExocrine glands—increased sweating salivation, bronchial secretions and secretion of gastric acid
oEye—causes miosis and contraction of the ciliary muscle
•Adverse Effects?
oHypotension
oAbdominal cramps
oDiarrhea
oIncreased salivation
oExacerbate asthma
oCan cause dysrhythmias in patients with hyperthyroidism
•What are cevimeline, pilocarpine, and acetylcholine used for?
oCevimeline—treat dry mouth and Sjogren’s syndrome
oPilocarpine—topical treatment of glaucoma as well as dry mouth from Sjogren’s syndrome
oAcetylcholine—rapid myosis after delivery and cataract surgery
•Anticholinergics
oCompetitively block the actions of acetylcholine as muscarinic receptors
oMost muscarinic receptors are on structures innervated by parasympathetic nerves
oAlso known as parasympatholytic drugs, antimuscarinic drugs, muscarinic blockers, and anticholinergic drugs
oAnticholinergic drugs: produce selective blockade of the muscarinic receptors (not all cholinergic receptors)
oCan’t pee, see, spit or shit
•What are the pharmacologic effects of atropine?
oThe heart—increases in rate
oThe exocrine glands—decrease secretions
oSmooth muscle—relaxes the bronchi, decreases the tone of the urinary bladder detrusor and decreases the tone motility of the GI tract
oMydriasis and cycloplegia in the eyes
oMild excitation to hallucinations and delirium in the Central Nervous system
•Therapeutic Uses of Atropine?
oPre-anesthetic medication to help dry up secretions
oDisorders of the eye
oIn codes for bradycardia, intestinal hypertonicity and hypermotility
oMuscarinic agonist poisoning
oPeptic ulcer disease
oAsthma
oBiliary colic
•Side effects of Atropine oDry mouth
oBlurred vision
oPhotophobia
oElevation of interocular pressure
oUrinary retention
oConstipation anhidrosis
oTachycardia
oAsthma
•Overactive bladder
oOxybutyin—acts on M3 muscarinic receptors
▪Highly lipid soluble
▪Metabolized CYP3A4
▪Very short ½ life and must be dosed frequently
oDarifenacine—
▪Can reduce OAB symptoms while having no effect or M1 receptors in the brain or M2 receptors in the heart
▪Greatest degree of M3 selectivity
oSolifenacin—at high dose can prolong QT interval
oTolterodine—nonselective muscarinic antagonist
oFesoterodine—nonselective muscarinic antagonist
oTrospium-nonselective muscarinic antagonist
•Scopalamine
oUses?
▪Motion sickness
▪Production of a cytoplegia and mydriasis for ophthalmic procedures
▪Production of pre-anesthetic sedation and obstetric amnesia
oSide effects?
▪Xerostomia (dry mouth)
▪Blurred vision
▪Photophobia
▪Urinary retention
▪Constipation
▪Hyperthermia
▪Tachycardia
•Ipratropium Bromide
oUses?
▪Treat asthma, COPD and rhinitis caused by allergies or common cold
oSide effects?
▪Not associated with typical anti-muscarinic side effects
•What are mydriatic cycloplegics?
oAtropine, homatropine, scopolamine, cyclopentolate and tropicamide
oUsed to produce mydriasis and cyclopedia in ophthalmic procedures
•Muscarinic Poisoning
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