pharmacology exam
Which of these drugs is considered specific alpha adrenergic agents? A) epinephrine B)phenylephrine C)isoproterenol
B
which of these would be useful in pulmonary function lab before and after bronchodialator therapy? A) bitolterol B)isoetharine C)albuterol
B
What neurotransmitter is used for both the sympathetic and parasympathetic nervous system?
acetylcholine (ACH)
ATP is broken down into cyclic-AMP by what enzyme?
adenyl cyclase
What is a type of saligenin bronchodialator?
albuterol
Give examples of beta agonists
albuterol, isoetharine, epinephrine
which of these is given by MDI? a. albuterol b. bitolterol c. terbutaline d.metaproterenol e. all of the above
all of the above
Which response in the sympathetic nervous system is responsible for decreasing airway edema?
alpha stimulation
which response in the sympathetic nervous system is responsible for elevating blood pressure through vasoconstriction?
alpha stimulation
What is the name of the xanthine used in the ER/ ICU through an IV?
aminophylline
What are two examples of xanthines and how are they administered?
aminophylline- IV in ER/ICU theophylline- orally preferred xanthine used as bronchodilator
ipratropium bromide and atropine are what type of drug?
anti-cholinergic
What is the prototype drug in the category anticholinergics?
atropine
bronchial smooth muscle are apart of which branch of the nervous system?
autonomic nervous system because we cannot control them
why do catecholamines cause side effects?
because they stimulate beta- one receptors which cause cardiac stimulation
What drugs increase sympathetic stimulation?
beta adrenergic drugs or beta agonists
What drugs result in a greater supply of cyclic- AMP, therefore causing bronchodilation?
beta adrenergic/ beta agonists -albuterol -metaproterenol -isoetharine
Which category of bronchodilators acts by stimulating adenyl cyclase to increase cyclic-AMP?
beta agonists
which receptors need to be stimulated to cause cardiac acceleration?
beta-one
which response in the sympathetic nervous system is responsible for accelerating both cardiac rate and contractility?
beta-one stimulation
which response in the sympathetic nervous system is responsible for promoting bronchodialation?
beta-two stimulation
what is an example of a Prodrug?
bitolterol
Whenever cyclic-AMP is greater than cyclic-GMP _____ occurs and if cyclic-GMP is greater ______ occurs.
bronchodiation brochospasm
An increase in the intra-cellular mediator cyclic-AMP correlates with?
bronchodilation
What effects do xanthines have?
bronchodilation pulmonary vasodilation cardiac stimulation diuresis cerebral stimulation skeletal muscle stimulation
how is bitolterol administered?
by MDI
what is another name for the sympathetic nervous system?
cholinergic
Where the parasympathetic uses acetylcholine at the synapse is referred to as?
cholinergic system
xanthines include compounds such as?
coffee (caffeine) cola (caffeine) tea (theophylline) cocoa (theobromine)
Cyclic-GMP correlates with ___ of bronchial smooth muscle
constriction
What are the effects of the parasympathetic nervous system?
decreased HR, digestion, increases peristalsis
What is the desired effect in using an alpha adrenergic agent in cases of upper airway edema?
decreased mucosal edema
epinephrine is most commonly used where? and for what?
during emergency treatments; for anaphylactic shock and allergic reactions
which two drugs have alpha, beta- one and beta- two activity?
epinephrine and racemic epinephrine
Where are alpha receptors found and what do they cause?
found in smooth muscles such as blood vessels and cause an increase in contractile activity resulting in vasoconstriction
An allergic reaction releases what into the airways?
histamine
Give an example of how cyclic-GMP can be increased and promote bronchospasm
histamine release because of allergies and vagus nerve stimulation because of suctioning
Substances that promote the increase of Cyclic-GMP are?
histamine release, parasympathetic stimulation such as irritation of vagus nerve which might occur when you suction a pt.
What effect would be expect if we administer a drug such as isoproterenol, with a potent beta-one activity?
increase in HR
which of these drugs is most likely to cause tachycardia as a serious side effect associated with its administration? a. albuterol b. isoproterenol c. isoetherine
isoproterenol
once in the body what is bitolterol converted to by enzymes?
its active form. colterol
wj=hat is norepinephrine mainly used for?
its affect of blood pressure (not used to treat airway edema)
Anti-cholingergic agents have more effect ____ airways and beta adrenergics have more effect on ____ airways
larger smaller
What are the two types of resorcinol bronchodialators?
metaproterenol and terbutaline
How do xanthines cause bronchodilation?
xanthines inhibit phosphodiesterase, therefore it cannot breakdown cyclic-AMP so there is more of it present causing bronchodilation
how long can saligenin last and it is good for what type of use?
-6 hrs. -maintenance on a long term basis and is potent enough to be used in acute cases as well
When your sympathetic nervous system is in action what increases?
-HR, blood pressure, increase in ventilation
What are the three categories of drugs that decrease bronchospasms? (bronchodilators)
-beta adrenergics -anti-cholinergics -xanthines
Where the sympathetic nervous system uses norepinepherine at the synapse is referred to as?
Adrenergic system
Where are beta receptors found and what do they cause?
-beta-one are found in the heart cause an increase in HR, contraction of heart muscle, conduction of impulses through heart -beta-two are found in bronchial smooth muscle, blood vessels, and skeletal muscles and cause relaxation of smooth muscle causing bronchodialation and vasodialation
What is an example of selective beta-one drug and what is it used for?
-dobutamine -used so we can get specific cardiac activity without extra effects on the body (cardiac arrest)
what effects are associated with atropine?
-increased HR -relaxation of smooth muscle -drying of airway secretions
How are resorcinols taken and how long do they last?
-orally -last up to 6 hrs. so they are useful for maintenance therapy on a long term basis
What are the 2 branches of the autonomic nervous system?
-sympathetic -parasympathetic
What do sympatholytics and parasympatholytics(anti-cholinergic agents) do?
-sympatholytics block norepinephrine -parasympatholytics block acetylcholine
What type of drugs mimic the affects of the sympathetic and parasympathetic nervous systems?
-sympathomimetics -parasympathomimetic
What is a normal adult dose of atropine?
1-2 mgm four times a day via hand held nebulizer
what are 3 types of catecholamine sympathomimetic bronchodilators?
1. isoproterenol 2. epinephrine 3. isoetharine
What is the therapeutic level of theophylline the serum?
10-20 mcg/mL
how long does bitolterol stay active?
8 hours
If we wished to increase nasal stuffiness we should administer a drug with which activity? A)alpha B)beta-one C)beta-two
A
Which of these is the longest lasting bronchodilator? A)bitolterol B)albuterol C)epinephrine
A
catecholamines are rapidly inactivated by what?
COMT ( catechol-o- methyltransferse)
What is the difference between the autonomic nervous system and the somatic nervous system?
We do not have control over the autonomic nervous system and we do have control over our somatic nervous system
What is a neurotransmitter?
a chemical mediator that transmits impulses from one nerve to another nerve or tissue
what is an example of an alpha stimulation form and how does it work?
nasal sprays; it constricts the blood vessels decreasing the amount of blood flow to the area and allows the excess edema to be absorbed by the body which eliminates the swelling
phenylephrine is a component of what? and is used for what?
nasal sprays; used for relieving nasal edema associated with allergies and common colds
Above 20 mcg/mL of theophylline an individual can develop toxic effects such as?
nausea, headaches, tachycardia followed by cardiac arrhythmias and seizures
can catecholamines be taken orally?
no. because of rapid degredation of the gut and they are inactivated by the light.
what are examples of alpha andrenergic agents?
norepinephrine and phynelephrine
how long do catecholamines work for?
one and a half to three hours at best
Give another name for the category of bronchodilators known as anti-cholinergics
parasympatholytics
What group of medications are used to prevent the breakdown of cyclic-GMP?
parasympatholytics/anti-cholinergics
What enzyme is inhibited by xanthines, causing an increase in cyclic-AMP?
phosphodiesterase
What could cause a bronchospasm?
pollen, dust, penicillin, cigarette smoke
which category of sympathomimetic bronchodilators is bitolterol? a. prodrug b. catecholamine c. resorcinol
prodrug
what is a milder form of epinephrine called and what kind of activity does it have?
racemic epinephrine; alpha activity
when are catecholamines used?
short term cases examples: emergency room management of bromchospasms or for pulmonary testing where rapid response is needed for follow up testing
bronchospasm of airways occurs due to constriction of?
smooth musvle
Norepinephrine (NE) is the neurotransmitter for which nervous system?
sympathetic
To decrease a bronchospasm you want to increase_____ stimulation?
sympathetic
Which nervous system is fight or flight?
sympathetic
If a patient has dilated pupils, hyperventilation, and tachycardia what type of drug did they take?
sympathomimetic such as epinephrine
How does the body increase ventilation during a stressful episode?
the bronchial smooth muscles relax
Smokers need greater amounts of theophylline to get the same effects as non-smokers? T/F
true
ipratropium bromide has fewer side effects than atropine? T/F
true
what is racemic epinephrine used for?
upper airway edemas examples: croup, edema from removing the ETT