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Key Concepts Weeks 2-3
For Quiz #1
21
Nursing
Undergraduate 1
01/16/2012

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Term
What are the two categories of Cholinesterase (ChE) Inhibitors? How selective are they?
Definition
Reversible and irreversible. NOT SELECTIVE.
Term
NEOSTIGMINE -- class? What are it's two PHARMACOLOGIC effects? Main therapeutic indication?
Definition
Reversible cholinesterase inhibitor. Muscarinic and Neuromuscular effects. myasthenia gravis (respiratory support).
Term
What is a Myasthenic Crisis?
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)
Term
What is a Cholinergic Crisis?
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)
Term
How can you clinically distinguish btw a MYASTHENIC and CHOLINERGIC crisis if both cause muscle weakness?
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
Term
NEOSTIGMINE--method of administration? length of action? Contraindications?
Definition
Oral or IM, IV, SC. Not use is bowel/bladder obstruction (same as with cholinergic agonist!)
Term
For ADRENERGIC AGONISTS what are the endogenous transmitters and receptors involved?
Definition
Epinephrine, Norepinephrine, alpha and beta (1&2)
Term
Adrenergic Agonists: adregergic receptors can be activated in one of 4 ways:
Definition
1. Direct receptor binding, 2. Promote NE Release, 3. Decrease NE re-uptake 4. Inhibit NE Inactivation
Term
What are the two classes of Adrenergic Agonists?
Definition
Catecholamines and Noncatecholamines
Term
Which class of Adrenergic Agonists cannot be used orally and why?
Definition
Catecholamines, because the nz COMT and MAO act to quickly destroy them in the gut.
Term
What are the three catecholamines that must be administered by continuous infusion?
Definition
Norepinephrine, Dopamine and Epinephrine.
Term
Name one noncatecholamine:
Definition
EPHEDrine.
Term
Which class of Adrenergic Agonist can cross the BBB?
Definition
NONcatecholamines (ephedrine)
Term
What are the effects on specificity of beta drugs when giving large doses?
Definition
Beta 1 drugs if we give a large enough dose we lose specificity and go after both beta 1 and beta 2 receptors.
Term
What are the 6 therapeutic applications of Alpha 1 receptor activation?
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
Term
What are the 3 adverse effects of ALPHA 1 activation (with EPINEPHRINE for example)?
Definition
HTN, peripheral necrosis (toes falling off!), REFLEXIVE bradycardia because body tries to adjust for increasing BP by lowering heart rate.
Term
Therapeutic effects of Beta 1 agonists?
Definition
INCREASES HEART RATE: Treat cardiac arrest/heart failure, shock, atrioventricular block
Term
Adverse effects of Beta 1 agonists?
Definition
Tachycardia, dysrhythmias and angina pectoris
Term
Therapeutic effects of Beta 2 activation?
Definition
Asthma and delay pre term labor.
Term
Adverse effects of Beta 2 activation?
Definition
HYPERglycemia (glycogenolysis in liver and skeletal muscle), tremors (enhanced skeletal muscle contractions)--sometimes Beta 1 cross over gives you tachycardia as well.
Term
What is the MOA of Prazosin?
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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