Term
|
Definition
| The __NS consists of the brain and spinal cord and is the center of integration and control. |
|
|
Term
| PNS, 31 spinal, 12 cranial |
|
Definition
| The __NS is outside the brain and spinal cord and consists of __ spinal nerves and __ cranial nerves. |
|
|
Term
| PNS --> sensory and motor divisions |
|
Definition
| The PNS is divided into ___ and ___ divisions. It functions to recognize changes to the environment and moves muscles or secretes chemicals. |
|
|
Term
| Sensory --> afferent (arrive at the brain) |
|
Definition
| The Sensory division is also called the ___ division. It conducts impulses from receptors to the CNS and informs the CNS of the body interior/exterior and contains sensory nerve fibers. |
|
|
Term
| somatic = skin, muscles, joints; visceral = organs |
|
Definition
| Sensory nerve fibers can be ___ from skin, skeletal muscles or joints or ___ from organs w/in the ventral body cavity. |
|
|
Term
| efferent division (exits brain) |
|
Definition
| The motor division of the PNS is also called the ___ division. It conducts impulses from the CNS to effectors (muscles/glands) and contain motor nerve fibers. |
|
|
Term
| Somatic nervous system, division of PNS |
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Definition
| ___ nervous system is voluntary and conducts impulses from the CNS to skeletal muscles. It provides voluntary control over skeletal muscles. |
|
|
Term
| Autonomic nervous system, division of PNS |
|
Definition
| ___ nervous system is involuntary and conducts impulses from the CNS to smooth muscle, cardiac muscle and glands. It regulates nerves to heart, digestive tract, reproductive tracts, salivary glands and some parts of the eye. |
|
|
Term
| sympathetic, parasympathetic |
|
Definition
| Autonomic nervous system can be divided into ___ (fight or flight) and ___ (rest and digest) nervous systems. |
|
|
Term
|
Definition
| ___ are the functional and structural unit of the nervous system. They are specialized to conduct information from one part of the body to the other. |
|
|
Term
| soma = cell body, dendrites = input, axon = conducting, axon terminal = output |
|
Definition
| ___ is a neuron cell body. ___ is the input region and the __ is the conducting component. The __ ___ is the secretory/output region. |
|
|
Term
| Acetylcholine, norepinephrine, epinephrine and dopamine |
|
Definition
| Name the four neurotransmitters. |
|
|
Term
|
Definition
| ___ is released from cholinergic fibers. |
|
|
Term
|
Definition
| ___ is the primary transmitter in all preganglionic efferent autonomic fibers and somatic motor fibers to skeletal muscle, all parasympathetic postganglionic and a few sympathetic postganglionic fibers. |
|
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Term
|
Definition
| ___ is released from adrenergic fibers. It is the primary transmitter in most postganglionic sympathetic fibers. |
|
|
Term
|
Definition
| ___ is released by some peripheral sympathetic fibers. ___ is released from adrenal medullary cells along with NE. |
|
|
Term
| Cholinergic = nicotinic or muscarinic, adrenergic = alpha or beta |
|
Definition
| Cholinergic receptors can be either ___ or ___. Adrenergic receptors can be either ___ (1 and 2) or ___ (1 and 2). |
|
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Term
|
Definition
| Somatic nervous system innervates/controls the (sensory/motor) function of the body. |
|
|
Term
|
Definition
| The ___ nervous system is regulated by the brain stem and has two parts - parasympathetic and sympathetic. |
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|
Term
| Parasympathetic: decrease HR, increase gastric emptying, bladder/bowel emptying, focusing eye, pupil constriction, bronchial smooth muscle constriction |
|
Definition
| Parasympathetic division of the autonomic nervous system results in the following: ___ in HR, ___ gastric secretion, emptying of bladder and bowel, focusing of eye for near vision, pupil (constriction/dilation) and bronchial smooth muscle (constriction/dilation). |
|
|
Term
| increase HR/CO/rate-force of contraction, vasoconstriction, blood flow to skin, sweat glands and making your hair stand up on end |
|
Definition
| Sympathetic division of the autonomic nervous system's main functions include: (increase/decrease) HR, CO, force/rate of contraction; vaso(dilation/constriction); blood flow to skin, sweat glands and piloerection. |
|
|
Term
| sympathetic (fight or flight) |
|
Definition
| ___ division of the autonomic nervous system's main functions are increased HR and BP, shunt blood to skeletal muscle, bronchodilation, pupil dilation, mobilize stored energy |
|
|
Term
| Albuterol/ventalin = bronchodilation; epinephrine = vasoconstriction |
|
Definition
| Albuterol and ventalin (dilate/constrict) bronchi. Epinephrine (dilates/constricts) blood vessels. |
|
|
Term
|
Definition
| T/F: All PREganglionic neurons release Ach. |
|
|
Term
|
Definition
| T/F: All PARASYMPATHETIC POSTganglionic neurons release ACh. |
|
|
Term
|
Definition
| T/F: Most SYMPATHETIC POSTganglionic release norepinephrine. |
|
|
Term
|
Definition
| T/F: Sympathetic POSTganglionic that innervates sweat glands release norepinephrine. |
|
|
Term
| False! It releases norepinephrine and epinephrine, epinephrine being the dominant one. |
|
Definition
| T/F: The adrenal medulla releases norepinephrine only. |
|
|
Term
|
Definition
| T/F: All motor neurons to skeletal muscles release ACh. |
|
|
Term
| 1. preganglionic neurons (autonomic); 2. postganglionic (parasympathetic) neurons; 3. Some postganglionic (sympathetic) neurons |
|
Definition
| Which three locations have ACh as the major neurotransmitter? |
|
|
Term
|
Definition
| ___ is released from preganglionic fibers of parasympathetic and sympathetic, postganglionic fibers of parasympathetic, somatic efferents innervating skeletal muscle. |
|
|
Term
| Acetyl-Co-A synthesized in mitochondria, combines with choline to create ACh via action of choline acetyltransferase (ChAT) |
|
Definition
| Acetyl-Co-A is synthesized in the ____. It then combines with ___ to create ACh via catalytic action of ___ ____ enzyme. |
|
|
Term
|
Definition
| An increase in ___ interacts with the vescicle membrane proteins causing ACh vescicles to fuse to nerve terminal membrane. |
|
|
Term
|
Definition
| ___ blocks acetylcholine release from nerve endings = no muscle contraction. |
|
|
Term
| metabolized by pseudocholinesterase, hydrolyzed by acetylcholinesterase (AChE) |
|
Definition
| ACh can diffuse away from the synapse and is metabolized by ____ or it can be hydrolyzed by ___ to choline and acetate. |
|
|
Term
| False! It is a very rapid process. |
|
Definition
| T/F: The half-life of ACh in the synapse is very long. |
|
|
Term
|
Definition
| ___ is found in blood plasma, liver and many other tissues and can metabolize ACh. |
|
|
Term
|
Definition
| What are the two subtypes of receptors for cholinergic receptors? |
|
|
Term
|
Definition
| ___ receptors are located on postsynaptic membrane of autonomic ganglia on postganglionic neurons and postjunctionally in adrenal medulla and at NMJ of skeletal muscles. |
|
|
Term
| Inhibitors, physostigmine is reversible; malathion is irreversible |
|
Definition
| Physostigmine and malathion are acetylcholinesterase (inhibitors/activators). |
|
|
Term
| Physo = reversible, malathion = irreversible |
|
Definition
| Physostigmine is a(n) (reversible/irreversible) AChE inhibitor. Malathion is a(n) (reversible/irreversible) AChE inhibitor. |
|
|
Term
| False!! Everything is true except that they are also called INdirect cholinergic agonists. |
|
Definition
| T/F: AChE inhibitors are also referred to as direct cholinergic agonists because they increase the [ACh] in the synaptic cleft resulting in activation of cholinergic receptors (both nicotinic and muscarinic) |
|
|
Term
| Muscarinic = g-protein linked, nicotinic = ion channel |
|
Definition
| (Muscarinic/Nicotinic) = g-protein linked; (Muscarinic/Nicotinic) = ion channel |
|
|
Term
|
Definition
| (Direct/indirect) acting cholinergic agonists bind and activate muscarinic or nicotinic receptors. Examples are choline esters such as carbachol or bethanechol and plant alkaloids such as pilocarpine and nicotine. |
|
|
Term
|
Definition
| (Direct/Indirect) acting cholinergic agonists inhibit AChE and increase [ACh] which stimulates cholinoreceptors. Examples are reversible ACHe inhibitors such as physostigmine and irreversible AChE inhibitors such as malathion and sarin. |
|
|
Term
| Choline esters... (all have "chol" in name) |
|
Definition
| Acetylcholine, carbachol and bethanechol are all ___ ___. |
|
|
Term
| True! (remember, all have "Chol" in name) |
|
Definition
| T/F: Choline esters are cholinomimetic and include Acetylcholine, carbachol and bethanechol. |
|
|
Term
| plant alkaloids (all have "ine" in name) |
|
Definition
| Muscarine, pilocarpine and nicotine are all ___ ___ that are direct-acting cholinergic agonists. |
|
|
Term
| Muscarine (MuscarINE - amINE) |
|
Definition
| ___ is a quaternary amine that is less completely absorbed from the GI tract that tertiary amines, but still toxic when ingested. It is excreted by the kidneys and its excretion is enhanced by acidification of the urine. |
|
|
Term
|
Definition
| Malathion and sarin are organophosphorus compounds that are (reversible/irreversible) indirect-acting cholinergic agonists. |
|
|
Term
|
Definition
| Donepezil and physostigmine are (reversible/irreversible) indirect-acting cholinergic agonists. |
|
|
Term
| reversible (all have "stigmine" in name) |
|
Definition
| Physostigmine, neostigmine and pyrisdostigmine are esters of carbamic acid and are (reversible/irreversible) indirect-acting cholinergic agonists. |
|
|
Term
|
Definition
| Donepezil and tacrine are centrally acting (reversible/irreversible) indirect-acting cholinergic agonists that can cross the BBB. They are used clinically for Alzheimer's disease. |
|
|
Term
|
Definition
| T/F: Pyrisdostigmine and Edrophonium do not cross the BBB. |
|
|
Term
|
Definition
| ___ is a reversible indirect acting cholinomimetic that can cross the BBB. It is used clinically as an eye ointment (miotic) and an antidote to atropine-like drugs. |
|
|
Term
|
Definition
| ___ is a reversible indirect-acting cholinergic agonist that cannot cross the BBB because it is more polar. It is used clinically post op to stimulate bladder and GI tract, as an antidote to tubocurarine and other competetive NM blockers and myasthenia gravis. |
|
|
Term
| False!! It stimulates cholinergic receptors therefore increases salivation, flushes skin and decreases BP. |
|
Definition
| T/F: Since neostigmine stimulates cholinergic receptors, some adverse effects include a decrease in salivation, pale skin and increase in BP. |
|
|
Term
|
Definition
| Organophosphorus compounds irreversibly bind with AChE how? |
|
|
Term
| Irreversible such as organophosphorus compounds. |
|
Definition
| (Reversible/Irreversible) indirect-acting cholinergic agonists cause salivation, lacrimation, miosis, bronchoconstriction, bradycardia, intestinal cramps, urinary incontinence, muscle paralysis, seizures, respiratory depression and coma. |
|
|
Term
|
Definition
| Atropine, scopolamine and hycoscyamine are all ____ ____ that dilate pupils |
|
|
Term
|
Definition
| ____-like drugs interact with antihistamines and CNS depressants by causing dry mouth. |
|
|
Term
| dilators (...tropium in both) |
|
Definition
| Ipratropium and tiotropium are anticholinergic broncho(dilators/constrictors). |
|
|
Term
|
Definition
| ___ is an antispasmodic for the urinary tract used with other anticholinergics and CNS antidepressants. |
|
|
Term
|
Definition
| SA and NA node is innervated by the ___ nerve. This nerve releases ACh and activates muscarinic receptors resulting in decrease in HR. |
|
|
Term
|
Definition
| Activation of muscarinic receptors brings about the release of ___ ___ from endothelial cells which causes vasodilation and decreases peripheral vascular resistance. |
|
|
Term
| ACh is released from cholinergic nerve endings causing ciliary muscle constriction which relaxes the lens for near vision. Also causes the pupil to contract. |
|
Definition
| How do cholinergic receptors effect the eye? |
|
|
Term
| glaucoma and in ocular surgery |
|
Definition
| Carbachol, pilocarpine and physostigmine are used to treat ___ and in ___ surgery. |
|
|
Term
|
Definition
| ___ is dilation of the pupil caused by blocking muscarinic receptors by drugs such as atropine, cyclopentolate and tropicamide. |
|
|
Term
| mydriasis by blocking muscarinic receptors. |
|
Definition
| Atropine, cyclopentolate and tropicamide all cause ____. |
|
|
Term
|
Definition
| ___ causes ciliary muscle spasm. |
|
|
Term
| True! Stimulating muscarinic = increase secretion. Blocking muscarinic = decrease secretion. |
|
Definition
| T/F: All glands are innervated by cholinergic nerves. |
|
|
Term
| atropine, gastric/sweat = atropine and scoplamine |
|
Definition
| ___ inhibits secretion and relaxes smooth muscles of the bronchi to assist in intubation. Gastric acid and sweat production is also decreased by this drug. |
|
|
Term
| sialogogue, antisialogogue |
|
Definition
| ___ increases saliva production by activating muscarinic receptors. Pilocarpine is an example. ___ decreases saliva production. Propantheline, atropine and scoplamine are examples. |
|
|
Term
|
Definition
| (Sympathetic/Parasympathetic) stimulation results in urination by contracting detrusor muscle, decreasing bladder capacity, relaxing trigone and urethra sphincter. |
|
|
Term
| Oxybutynin and tolterodine |
|
Definition
| ___ and ___ are muscarinic antagonists used to treat urinary incontinence. |
|
|
Term
|
Definition
| T/F: Salivary and gastric glands are strongly stimulated by parasympathetic. Pancreas and small intestinal glands are less affected. |
|
|
Term
| parasympathetic stimulation (muscarinic agonist) |
|
Definition
| ___ stimulation increases motor activity of the gut involving depolarization of the smooth muscle cell membrane and increased calcium influx. |
|
|
Term
| GI Atony (carbachol, bethanechol "nature "chols") |
|
Definition
| ___ ___ is when the gastrointestinal tract lacks muscular tone. Following surgery, you need to stimulate the parasympathetic nervous system to stimulate gastric and intestinal motility and increase lower esophaageal sphincter pressure. |
|
|
Term
| diphenoxylate and atropine |
|
Definition
| When you have diarrhea you need to decrease the motor activity of the gut using ___ and ____ to block muscarinic receptors. |
|
|
Term
| False!! Drugs like atropine relax GI muscles except sphincters and reduce intestinal motility, thereby increasing gastric emptying time and intestinal transit times |
|
Definition
| T/F: Drugs that act like atropine constrict the GI muscles except sphincters and increase intestinal motility. |
|
|
Term
|
Definition
| ACh released and activates ___ receptors causing bronchoconstriction. |
|
|
Term
|
Definition
| Atropine, ipratopium(atrovent), and tiotropium block ___ receptors causing bronchial relaxation. |
|
|
Term
|
Definition
| Combivent is made up of atrpine and ___. |
|
|
Term
|
Definition
| T/F: Atropine is more sedating than scopolamine. |
|
|
Term
|
Definition
| ___ causes mild stimulation followed by a slower and longer-lasting sedative effects, but at higher doses, patients experience delerium and hallucinations. |
|
|
Term
| >240/>100 hypertensive crisis |
|
Definition
| Hypertensive crisis = >___/>___ |
|
|
Term
| trimethaphan or mecamylamine |
|
Definition
| ___ and ___ selectively blocks nicotinic receptors at autonomic ganglia and rapidly decreases blood pressure. These drugs also cause xerostomia, blurred vision and urinary retention. |
|
|
Term
| neuromuscular blocking agents |
|
Definition
| ____ ___ ___ block nicotinic receptors and cause muscle weakness and paralysis. |
|
|
Term
|
Definition
| ___ (curariform drugs) include tubocurarine and pancuronium. Muscle relaxes without stimulation. |
|
|
Term
|
Definition
| ____ neuromuscular blocking agents include succinylcholine. They stimulate muscle before relaxation. |
|
|
Term
| neuromuscular junction blockers |
|
Definition
| ___ ___ blockers are adjuncts to surgical anesthesia to produce muscle relaxation and to facilitate intebation, adjunct to electroconvulsive therapy to prevent muscle tearing and diagnosis of myasthenia gravis. |
|
|
Term
|
Definition
| ___ ___ is an increase in body temp leading to protein denaturation @ about 40 degrees C/108 degrees F |
|
|
Term
|
Definition
| Succinylcholine is metabolized in blood by ____. |
|
|
Term
|
Definition
| ____ in high doses may cause CNS stimulation, orthostatic hypotension, parasympathetic overstimulation, increased saliva or sweating, nausea, vomiting, or seizures. |
|
|
Term
|
Definition
| ____ stimulates muscarinic receptors and is clinically used to increase salivary flow. Its adverse effects include sweating, nausea, urinary frequency, and dizziness. Patients with uncontrolled asthma should not take this. |
|
|
Term
|
Definition
| ___ is synthesized from pehylalanine, tyrosine, DOPA, and DA. |
|
|
Term
|
Definition
| ____ is transported into vesicles and is then converted to norepinephrine. |
|
|
Term
|
Definition
| In the ___ ___, norepinephrine is converted to epinephrine. |
|
|
Term
| Beta 1/2 post, alpha 1 post, alpa 2 pre |
|
Definition
| Beta 1/2 receptors are (pre/post) synaptic, alpha 1 is (pre/post) synaptic, alpha 2 is (pre/post) synaptic. |
|
|
Term
|
Definition
| Epinephrine is inactivated by ___ in the liver. |
|
|
Term
| epinephrine and isoproterenol |
|
Definition
| ___ and ___ are direct-acting adrenergic agonists. |
|
|
Term
|
Definition
| ___ promotes NE release and is an indirent-acting adrenergic agonist that lead to an increase in [NE]. |
|
|
Term
| phenelzine and tranylcypromine |
|
Definition
| ___ and ___ are indirect-acting adrenergic agonist and inhibit NE inactivation by inhibiting MAO. |
|
|
Term
| cocaine and tricyclic antidepressants |
|
Definition
| ___ and ___ antidepressants such as imipramine, amitryptyline and doxepin are indirect-acting adrenergive agonists that inhibit NE reuptake leading to an increase in [NE]. |
|
|
Term
| Epinephrine, norepinephrine |
|
Definition
| ___ works with alpha 1/2 and beta 1/2 while ___ only works with alpha 1/2 and beta 1. |
|
|
Term
|
Definition
| ___ works with alpha 1/2 and beta 1. ___ works with alpha 1, beta 1 and dopamine. |
|
|
Term
|
Definition
| Adrenergic agonists mimic the action of ____ and are called sympathomimetics. They stimulate adrenergic receptors. |
|
|
Term
| Both false! Catcholamines are short acting and noncatecholamines are long acting. |
|
Definition
| T/F: Catecholamines are long-acting direct-acting adrenergic agonists. Noncatecholamines are short-acting direct-acting adrenergic agonists. |
|
|
Term
|
Definition
| Norepinephrine, epinephrine and dopamine are _____ along with isoproterenol and dobutamine. |
|
|
Term
|
Definition
| Ephedrine and phenylephrine are ______. |
|
|
Term
| catecholamines such as norepinephrine, epinephrine, dopamine, isoproterenol and dobutamine |
|
Definition
| ____ have to be injected, have short duration of action, do not cross BBB, are rapidly inactivated by MAO/COMT enzymes and have a short shelf life. |
|
|
Term
|
Definition
| ___ ___ enzyme is present in the liver, intestinal wall and presynaptic nerve endings. |
|
|
Term
| catechol-o-methyltransferase (COMT) |
|
Definition
| ______ enzyme is present in the liver, intestinal wall and postsynaptic nerve endings. |
|
|
Term
|
Definition
| ___ administration is ineffective so NE, dopamine and dobutamine requires slow infusion, subcutaneous or intramuscular. |
|
|
Term
| noncatecholamines such as ephedrine, phenylephrine and terbutaline |
|
Definition
| ___ are metabolized slowly by MAO and not inactivated by COMT. They have longer half lives, can be given orally, and cross the BBB. |
|
|
Term
|
Definition
| Alpha __ agonist receptor activation results in vasoconstriction. |
|
|
Term
|
Definition
| ___ is used for hemostasis and an adjunct to local anesthesia. It is activates alpha 1 receptors. |
|
|
Term
|
Definition
| Adverse effects of ___ ___ agonist receptor activation include hypertension, necrosis and bradycardia. |
|
|
Term
|
Definition
| ___ ___ agonist receptors are activated by NE, epi, dopamine, isoproterenol, dobutamine and ephedrine. |
|
|
Term
|
Definition
| ___ ___ agonist receptors are activated to treat cardiac arrest, heart failure, shock, AV heart block, tachycardia, dysrhythmias and angina. |
|
|
Term
|
Definition
| ___ ___ agonist receptors affect the lungs and uterus. Epinephrine, isoproterenol, terbutaline, albuterol or ventalin are used to activate these receptors. |
|
|
Term
|
Definition
| ___ ___ agonist receptors are activated to treat asthma, hyperglycemia, tremors and to delay preterm labor. |
|
|
Term
|
Definition
| ___ is administered in the event of anaphylactic shock to activate agonists beta 1, alpha 1 and beta 2. |
|
|
Term
|
Definition
| ___ reacts with cocaine, tricyclic antidepressants, MAO inhibitors, general anesthetics and adrenergic blockers. |
|
|
Term
|
Definition
| ____ alpha adrenergic blocking agenst block both alpha 1 and 2. ____ block only alpha 1. |
|
|
Term
|
Definition
| ___ beta adrenergic blocking agents block beta 1 and 2. ___ block beta 1 only. |
|
|
Term
|
Definition
| T/F: Phentolamine and phenoxybenzamine are selective alpha blockers. Prazosin and terazosin are nonselective alpha blockers. |
|
|
Term
|
Definition
| ___ ___ adrenergic antagonist blocks on blood vessels as a local anesthesia reversal. It blocks in the eye and bladder also. |
|
|
Term
|
Definition
| ___ ___ adrenergic antagonist has no clinical application. |
|
|
Term
|
Definition
| T/F: Alpha adrenergic antagonists lower blood pressure via vasodilation. |
|
|
Term
|
Definition
| ___ is a catecholamine tumor in the adrenal medulla. |
|
|
Term
|
Definition
| ___ ___ is a peripheral vascular disorder with vasospasm in toes and fingers. |
|
|
Term
|
Definition
| ___ is a competitive selective alpha 1 antagonist indicative in hypertension. |
|
|
Term
|
Definition
| ___ adrenergic antagonists are competitive blockers. (1/2) blockage of cardiac tissue results in decrease HR, force of contraction, velocity of impulse conduction via VA node. (1/2) antagonists have minimal clinical use because it blocks the lungs. |
|
|
Term
|
Definition
| ___ ___ adrenergic antagonis is used to treat angina, hypertension, cardiac dysrhythmias and myocardial infarction. |
|
|
Term
|
Definition
| ___ depletes NE from nerve endings and has both peripheral and central effects. It is an indirect-acting antiadrenergic agent. |
|
|
Term
|
Definition
| ____ is a centrally acting alpha 2 agonist that is used to treat hypertension. It reduces the firing of sympathetic nerves to blood vessels and heart, causes vasodilation, slows HR and decreases in cardiac output. |
|
|
Term
|
Definition
| ___ is a both centrally and peripherally acting adrenergic neuron blocking agent. It depletes NE from nerve endings and stops neurotransmission. "Shut down/restart computer" |
|
|
Term
|
Definition
| ____ is a centrally acting alpha 2 agonist used in hypertension. It affects alpha 2 receptors on PREsynaptic nerve terminal in brain stem. |
|
|
Term
|
Definition
| ___ reacts with alpha 2 receptors on the presynaptic nerve terminal in the brain stem causing vasodilation (decrease HR, BP, CO) |
|
|
Term
|
Definition
| ___ is a centrally acting alpha2 agonist that causes drowsiness and xerostomia. |
|
|
Term
|
Definition
| T/F: It is ok to give a patient local anesthesia with epinephrine if you suspect that they have used cocaine in the last 24 hours. |
|
|
Term
|
Definition
| ___-like drugs are used to treat ADHD. |
|
|
Term
|
Definition
| (Acute/Chronic) pain deals with nociceptors when an excessive noxious stimulus gives rise to an intense and unpleasant sensation. |
|
|
Term
|
Definition
| ___ pain is an aberration of normal physiologic pathways. It deals with hyperalgesia, allodynia and spontaneous pain spasms. |
|
|
Term
|
Definition
| ___ is an increased amount of pain associated with a mild noxious stimulus. |
|
|
Term
|
Definition
| ___ is pain evoked by a non-noxious stimulus. |
|
|
Term
|
Definition
| ___ relieve pain by inhibiting specific pain pathways. ____ are the pharmacological agents that inhibit specific pain pathways. |
|
|
Term
|
Definition
| Primary afferent neurons consist mainly of ___ fibers and ___ fibers. |
|
|
Term
|
Definition
| ___ fibers conduct intense, sharp, stinging pain. They are lightly myelinated and fast-acting. |
|
|
Term
|
Definition
| ___ fibers conduct dull, burning, aching pain and are unmyelinated and slow-acting. |
|
|
Term
|
Definition
| ___ fibers deal with pain localization and withdrawal reflexes. ___ fibers deal with autonomic reflexes, pain memory and discomfort. |
|
|
Term
|
Definition
| Peripheral ___ sensory fibers inhibit A delta and C fibers via the release of enkaphalins. This principle is used in acupuncture, TENS and rubbing an injury site. |
|
|
Term
|
Definition
| ___ neurons include A delta and C fibers. |
|
|
Term
|
Definition
| ___ is the sensory detection, transduction and neural transmission of noxious/painful events. |
|
|
Term
|
Definition
| ___ are pain producing substances. |
|
|
Term
|
Definition
| ___ substances are generated at the injury site, stored in cells as precursors and are liberated during inflammatory response. Eg: Adenosine, adenosine triphosphate, serotonin, histamine, bradykinins, prostaglandins and neuroactive substances. |
|
|
Term
| 1. histamine and bradykinins 2. Presence of inflammatory cells (PGE, leukotrienes, PAFs) 3. lymphocyte involvement (interleukins, TNF-alpha and tissue repair occurs) |
|
Definition
| Explain the three steps in the time-related process of inflammation. |
|
|
Term
|
Definition
| T/F: Hydrocortisone and betamethason are NSAIDS. |
|
|
Term
| False! Acetaminophen is NOT an NSAID! |
|
Definition
| T/F: Acetaminophen is an NSAID along with ibuprofen and aspirin. |
|
|
Term
|
Definition
| Be able to understand the flow charts on the 3rd powerpoint of this exam. |
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Term
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Definition
| Products of what are used to induce/mimic biological effects and their biological effects are inhibited by NSAIDs? |
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Term
| PGE2alpha, PGF2alpha, PGD2alpha |
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Definition
| ___, ___, ___ are COX isoenzymes that we use to induce/mimic biological effects. |
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Term
| PGE2 (cervidil, prepidil, and prostin E2) |
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Definition
| ___ is used to induce abortion in the 12th-20th week of pregnancy. It acts directly on the myometrium, stimulates uterine contractions and induces labor. It also is used for cervical ripening during labor. |
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Term
| PGE1 analog (misoprostol) |
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Definition
| ___ is used to prevent gastric ulcers in susceptible patients taking NSAIDs. It enhances gastric mucosal defense mechanism and healing in acid-related disorders by increasing production of gastric mucus and increasing mucosal secretion of bicarbonate. |
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Term
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Definition
| ___ is a PGE1 analog that prevents gastric ulcers. |
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Term
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Definition
| Tissue injury induces ___ to be produced/released from the platelets, which then promotes platelet aggregation and causes vasoconstriction. |
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Term
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Definition
| ___ act on smooth muscle and platelet aggregation. TXA2 is an example and it stimulates platelet aggregation. |
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Term
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Definition
| If a patient is taking NSAIDs then ___ production is inhibited leading to prolonged bleeding time. |
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Term
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Definition
| ASA, APAP and naproxen are all NSAID COX___ inhibitors. |
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Term
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Definition
| Celecoxib/celebrex is an NSAID COX __ inhibitor. |
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Term
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Definition
| Acetaminophen (APAP) is a COX __ inhibitor. |
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Term
| False! APAP works on central COX only, not peripheral |
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Definition
| T/F: Acetaminophen has action on the peripheral COX as well as the brain. |
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Term
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Definition
| COX1 (constitutive/inducible) deals with platelets' production of TXA2, the kidney's regulation of renal blood flow, maintains gastric mucosa's integrity and regulates vasomotor tone. |
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Term
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Definition
| COX 2 (constitutive/inducible) deals with the brain, renal medulla and reproductive tract. |
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Term
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Definition
| COX 2 (constitutive/inducible) deals with inflammation and pain by a number of inflammatory mediators. |
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Term
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Definition
| COX3 (constitutive/inducible) deals with the CNS and is inhibited by APAP. |
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Term
| COX1 inhibitors are rapidly absorbed via the STOMACH and the upper GI. Liquid formulation is absorbed FASTER than tablets. Absorption is primarily via the GASTRIC MUCOSA and is delayed by food. It CAN cross the placenta and is metabolized in the liver and excreted via the kidneys. |
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Definition
| COX1 inhibitors are rapidly absorbed via the ___ and the upper GI. Liquid formulation is absorbed (faster/slower) than tablets. Absorption is primarily via the ___ ___ and is delayed by food. It (can/cannot) cross the placenta and is metabolized in the liver and excreted via the kidneys. |
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Term
| 1st false (it binds irreversibly), 2nd true |
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Definition
| T/F: ASA reversibly binds. This is called acetylation. |
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Term
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Definition
| ASA has selectivity for COX __ > COX __. It inhibits the production of cyclooxygenase products. |
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Term
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Definition
| T/F: Ibuprofen binds reversibly. |
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Term
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Definition
| ___ is a peripheral analgesic that inhibits the formation of eicosanoid mediators such as prostaglandins. |
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Term
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Definition
| ___ is effective in reducing mild to moderate pain and has antagonist actions of kinins. |
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Term
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Definition
| ____ ____ are products of arachidonic acid. |
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Term
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Definition
| ___ has anti-inflammatory, analgesic, antipyretic and antithrombotic effects. |
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Term
| salicylates and NSAIDs including methyl salicylate and tartrazine |
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Definition
| Aspirin has cross-sensitivity with all ____ and ____. |
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Term
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Definition
| ____ inhibits thromoxane A2 formation, leading to prolonged bleeding time. |
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Term
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Definition
| ___ decreases fetal PGE1 causing closure of the ductus resulting in decreased birth weight and increased mortality. It also increases the duration of labor and bleeding. |
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Term
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Definition
| ____ and ____s interact with antihypertensives such as ACE inhibitors, diuretics and non-selective beta blockers. |
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Term
| captopril, enalapril and lisonopril (...pril) |
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Definition
| ___, ___ and ___ are angiotensin converting enzymes (ACE) inhibitors that interact with ASA and NSAIDs. |
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Term
| furosemide and hydrochlorothiazide (...ide) |
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Definition
| ___ and ___ are diuretics that interact with ASA and NSAIDs. |
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Term
| propanolol and pindolol (...olol) |
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Definition
| ___ and ___ are non-selective beta blockers that interact with ASA and NSAIDs. |
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Term
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Definition
| ___ is an anticoagulant that interacts with ASA and NSAIDs by increasing gastric bleeding, gastric damage and platelet function inhibition. |
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Term
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Definition
| ____ along with ASA and NSAIDs damage gastric mucosal barrier and one should separate their ingestion by 12 hours. |
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Term
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Definition
| NSAIDs and ___ have shown to cause renal damage. |
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Term
| ...profen/oxen = propionic acid. ...acin/ac = acetic acid. |
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Definition
| Ibuprofen, naproxen and ketoprofen are all ___ acid derivitives. Indomethacin, ketorolac and diclofenac are ___ acid derivatives. |
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Term
| nasal polyps, asthma and chronic urticaria |
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Definition
| ___ ___, ___ and ___ ___ are allergic reactions to ASA. |
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Term
|
Definition
| ASA in children <6months may cause ___ ___. |
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Term
| Cox 1 (ASA and ibuprofen), Cox 2 (celecoxib) |
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Definition
| COX-__ inhibitors interact with NSAIDs by prolonging bleeding time. COX-__ inhibitors have no affect on platelet aggregation. |
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Term
|
Definition
| T/F: In regards to gastric bleeding, ibuprofen < naproxen < aspirin |
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Term
| leukopenia or thrombocytopenia |
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Definition
| ASA/NSAIDs chronic use may cause soreness, irritation or ulceration of oral mucosa, ____ or ___. |
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Term
| less GI effects, less bleeding effects |
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Definition
| COX2 inhibitors differ from aspirin in that they have (more/less) GI adverse effects and (more/less) effect on bleeding time. |
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Term
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Definition
| ____ is a COX2 inhibitor. |
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Term
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Definition
| COX__ inhibitors have less GI adverse effects, no effects on bleeding time, and no anti-inflammatory activity. |
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Term
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Definition
| ___ is an equianalgesic to ASA, no effect on platelets, non-ulcerogenic, safe for children (no Reye's syndrome), no effects on peripheral COX isoenzymes, acts in CNS on COX3 isoenzyme. |
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Term
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Definition
| ____'s oral pharmacokinetics are rapid and almost complete and is evenly distributed, crosses placenta and milk. |
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Term
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Definition
| ___ is hepatotoxin and nephrotoxic as intermediate metabolites in phase I. Then goes through conjugation with glucuronic acid in phase II metabolism. |
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Term
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Definition
| Max dose for APAP = ___grams. Max dose for ASA = ___ grams. max dose for ibuprofen = ___ grams. |
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Term
| 5% by CPY2E1 --> NAPQ1, inactivated by glutathione. 95% metabolized by conjugation |
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Definition
| ___% of APAP is metabolized by CYP2E1 to MAPQ1 which causes hepatic cell death, it is then inactivated by ___. ___% is metabolized by conjugation to inactive metabolites. |
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Term
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Definition
| ___ is also metabolized by CYP2E1 along with APAP, which induces CYP2E1 levels and also inhibits CYP2E1. |
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Term
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Definition
| Codeine, oxycodone, hydrocodone, morphine, methadone and heroin all activate to give ___ ___. |
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Term
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Definition
| ___ pushes morphine off receptor to reverse its effects. |
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Term
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Definition
| ___ are small peptides (5 amino acids). Have met- and leu- types which are endorphines found in spinal tap of 2nd trimester pregnancy. |
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Term
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Definition
| ___ peptides are also produced by many non-neuronal cells including endocrine and exocrine glands and cells of immune system. Also found in distinct areas in brain associated with nociception and play regulatory roles in many different systems. |
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Term
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Definition
| Opioid receptors on the __synaptic nerve inhibit the opening of calcium channels resulting in inhibition of neurotransmitter release. |
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Term
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Definition
| Opioid receptors on the ___synaptic nerve open the potassium channels resulting in hyperpolarization of the postsynaptic membrane, inhibiting firing. |
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Term
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Definition
| ____ receptor activation produces analgesia, sedation, pupillary constriction and cradycardia. |
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Term
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Definition
| Most analgesic opioids are __-receptor agonists. |
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Term
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Definition
| __ opioid receptors are mainly responsible for alagesic effects as well as respiratory depression, euphoria, sedation and dependence. |
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Term
| activate (agonist to) both |
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Definition
| Morphine, codeine and meperidine (activate/block) mu and (activate/block) kappa. |
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Term
| blocks mu, activates kappa |
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Definition
| Pentazocine (activate/block) mu and (activate/block) kappa. |
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Term
|
Definition
| naloxone and neltrexone (activate/block) mu and (activate/block) kappa. |
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Term
|
Definition
| Morphine, meperidine (demerol), codeine, oxycodone, and hydrocodone are (agonists/antagonists). |
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Term
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Definition
| ___ is a partial opioid agonist. |
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Term
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Definition
| ___ and ____ are pure opioid antagonists. |
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Term
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Definition
| (Pure/Partial) opioid (agonist/antagonist) are morphine like drugs that have a high affinity for mu receptors and lower affinity for delta and kappa receptors. |
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Term
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Definition
| Morphine and meperidine are (strong/weak) opioid agonists. |
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Term
| pentazocine... antagonist at mu, agonist at kappa... it should not be used with morphine |
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Definition
| ___ is a mixed opioid agonist. |
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Term
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Definition
| Codeine, oxycodone and hydrocodone are (weak/strong) opioid (agonists/antagonists). |
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Term
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Definition
| ____ is administered to reverse effects of opioids by blocking mu receptors. |
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Term
|
Definition
| __mg codeine in tylenol 3. __mg codeine in tylenol 2. __mg in tylenol 1. __mg in tylenol 4. |
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Term
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Definition
| ___ increase tone of GI smooth muscle leading to constipation. |
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Term
|
Definition
| emesis is ____. This is a side effect of opioids. |
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Term
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Definition
| ___ is well absorbed orally with extensive 1st pass effect (90%). It does not cross the BBB easily. It is a strong opioid. |
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Term
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Definition
| ___ is a prodrug metabolized to morphine by CYP___. |
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Term
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Definition
| ___ is excreted in the urine and bile via the enteroheptaic cycling. It is subjected to 1st pass effect and metabolized to morphine. |
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Term
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Definition
| ___ ___ is a centrally acting analgesic that is not chemically related to opioids but acts on mu receptors. Its brand name is Ultram or Ultracet (w/APAP). |
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Term
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Definition
| ___ ___ lowers seizure threshold of patients and may cause syncope. |
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Term
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Definition
| ___ is 12x more potent than codeine. |
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Term
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Definition
| Ibuprofen + (weak/strong) opioid is best mix for ibuprofen-narcotic combo. |
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Term
|
Definition
| ___ is an tricyclic antidepressant analgesic adjuvant. |
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Term
|
Definition
| ___ is an antiepileptic/anticonvulsant analgesic adjuvant. |
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Term
| capsaicin... used as a topical analgesic in TMD |
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Definition
| ___ is an active substance in chili peppers responsible for their burning taste. It is a highly potent pain-producing substance which selectively stimulates nociceptive and temperature-sensitive nerve endings in tissues. |
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Term
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Definition
| ___ causes the release/depletion of substance P from afferent neurons and spinal interneurons. It takes days to weeks to recover from effects. |
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Term
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Definition
| Bupivacaine and etidocaine are (strong/weak) vasodilating local anesthetics. |
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Term
|
Definition
| mepivacaine and prilocaine are (strong/weak) vasodilating local anesthetics. |
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Term
| alpha-1 acid glycoprotein |
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Definition
| Once in blood, local anesthetics are reversibly bound to plasma proteins, principally _________ and to a lesser extent albumin and RBCs. |
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Term
|
Definition
| (Esters/Amides) such as benzocaine are absorbed in blood by pseudocholinersterase. |
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Term
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Definition
| (Esters/Amides) such as lidocaine are metabolized primarily in the liver. When excreted by kidney they may have active metabolites. |
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Term
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Definition
| ____ is metabolized outside the liver (extrahepatic). ___ is inactivated/metabolized in the liver and plasma by hydrolysis. |
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Term
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Definition
| Pseudocholinesterases metabolize ___ in the blood often to para-aminobenzoic acid (PABA). |
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Term
| amides such as prilocaine and articaine |
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Definition
| ___ local anesthetics cause methemoglobinemia where patient turns blue = medical emergency. The ability of hemoglobin to pick up/drop off O2 decreases. |
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Term
| 1. beta blockers, 2. H2-antihistamine |
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Definition
| What are 2 drugs that lower hepatic blood flow? |
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Term
|
Definition
| T/F: Allergic reactions are extremely common and they exhibit cross-sensitivity between ALL esters. |
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Term
| True! You can still be allergic to one amide, but it does not mean you are allergic to all like you would be with easters. |
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Definition
| T/F: Amide allergic reactions are rare and there is no cross-sensitivity between them. |
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Term
|
Definition
| What is the treatment of choice in methemoglobinemia? |
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Term
|
Definition
| ____ stimulates alpha 1/2 receptors causing vasoconstriction. It is a sympathomimetic. |
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Term
| Blood --> liver (MAO and COMT) |
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Definition
| Where and how is epinephrine metabolized? |
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Term
|
Definition
| When used with non-selective beta blockers such as propanolol, epinephrine should not exceed ___mg. |
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Term
|
Definition
| When used with tricyclic antidepressants such as amitripytline or doxepine, epinephrine should not exceed ___mg. |
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Term
| 0mg!! Treatment should be deferred! |
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Definition
| When used with cocaine (w/in 24 hrs), epinephrine should not exceed ___mg. |
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Term
| False! Only use with caution in corticosteroid-dependent asthmatics and contraindicated in patients with documented sulfite allergy. |
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Definition
| T/F: Local anesthetics with epinephrine is contraindicated for all asthmatic patients. |
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Term
|
Definition
| T/F: Metabisulfite is a preservative found in local anesthetics without epinephrine. |
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