NU 518 EXAM 2 QUESTIONS AND ANSWERS STUDY GUIDE
ss ss ss ss ss ss ss ss
STUDY QUESTIONS AND ANSWERS EXAM 2 ss ss ss ss ss
• What are the basic mechanisms by which neuropharmocologic agents act?
ss ss ss ss ss ss ss ss ss
o Can modify the disease process ss ss ss ss
o Act at the sites of actions which is the axons versus synapses and steps in synaptic
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
transmission and effects of drugs on the steps of synaptic transmission
ss ss ss ss ss ss ss ss ss ss ss
• Transmittter synthesis is the first step in transmission. What are the other 4 steps?
ss ss ss ss ss ss ss ss ss ss ss ss ss
o Transmitter storage, transmitter release, receptor binding, and termination of the
ss ss ss ss ss ss ss ss ss
transmission
ss
• True or False: Neuropharmacologic drugs have high selectivity.
ss ss ss ss ss ss ss
o True—the nervous system uses many different receptor types ss ss ss ss ss ss ss
• Information needed: ss
o Type of receptors—through which the drug acts
ss ss ss ss ss ss
▪ Alpha and beta ss ss
o Normal responses to the activation of those receptors ss ss ss ss ss ss ss
▪ Agonists vs. antagonists ss ss
o What the drug in questions does to the receptor function
ss ss ss ss ss ss ss ss ss
• What are the 3 functions of ANS?
ss ss ss ss ss ss
o Regulates the heart ss ss
o Regulates the secretory glands, saliva glands, gastric, sweat, and bronchial
ss ss ss ss ss ss ss ss ss
o It regulates smooth muscles: bronchi, blood vessels, urogenital system, and the GI tract
ss ss ss ss ss ss ss ss ss ss ss ss
• What are the regulatory functions of the parasympathetic NS?
ss ss ss ss ss ss ss ss
o Seven regulatory functions ss ss
▪ Slowing the heart rate ss ss ss
▪ Increasing the gastric secretions ss ss ss
▪ Emptying the bladder ss ss
▪ Emptying the bowel ss ss
▪ Focusing the eye for near vision, ss ss ss ss ss
▪ Constricting the pupil ss ss
▪ Contracting the bronchial smooth muscle ss ss ss ss
o It also regulates the digestion of food, excretion of waste, control of vision and
ss ss ss ss ss ss ss ss ss ss ss ss ss
conservation of energy
ss ss ss
• What are the functions of the sympathetic NS?
ss ss ss ss ss ss ss
o Regulation of the cardiovascular system ss ss ss ss
▪ Maintaining blood flow to the brain ss ss ss ss ss
▪ Redistributing blood and compensating for the loss of blood ss ss ss ss ss ss ss ss
o Regulation of body temperature ss ss ss
▪ Regulates blood flow to the skin ss ss ss ss ss
▪ Promotes the secretion of sweat ss ss ss ss
▪ Induces piloerection (erection of the hair) ss ss ss ss ss
1
,o Implementation of the fight or flight reaction
ss ss ss ss ss ss
▪ Increase HR and BP
ss ss ss
▪ Blood shuts away from the skin and visera
ss ss ss ss ss ss ss
▪ Bronchi dilate
ss
2
, ▪ Pupils dilate ss
▪ Use energy that had been stored ss ss ss ss ss
• What is the baroreceptor reflex?
ss ss ss ss
o The receptors near the heart monitor BP changes and send the information to the brain
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
o The brain then activates the Autonomic NS to restore blood pressure to normal
ss ss ss ss ss ss ss ss ss ss ss ss
o When BP falls, this reflex causes vasoconstriction and increases cardiac output.
ss ss ss ss ss ss ss ss ss ss
o When BP rises, it causes vasodilation and reduces cardiac output
ss ss ss ss ss ss ss ss ss
• Where is acetylcholine employed?
ss ss ss
o Most junctions at the peripheral nervous system ss ss ss ss ss ss
• Where is epinephrine and norepinephrine released?
ss ss ss ss ss
o Norepinephrine—postganglionic neurons s s
o Epinephrine—adrenal medulla ss
• What are the cholinergic receptors mediated by? What are the subtypes?
ss ss ss ss ss ss ss ss ss ss
o Receptors that mediate responses to acetylcholine ss ss ss ss ss
o Subtypes:
▪ Nicotinic
▪ Muscarinic
• Whare are adrenergic receptors mediated by? What are the subtypes?
ss ss ss ss ss ss ss ss ss
o Mediate responses to epinephrine and norepinephrine ss ss ss ss ss
o Subtypes:
▪ Alphas
▪ Betas
▪ Dopamine
• What are the functions of each adrenergic subtype?
ss ss ss ss ss ss ss
o Alpha 1—vasoconstriction, ejaculation and contraction of the bladder neck, and prostate
ss ss ss ss ss ss ss ss ss ss
o Alpha 2—(located in presynaptic junction)—minimal clinical significance
ss ss ss ss ss ss
o Beta 1—control the heart ss ss ss
▪ Increase HR, increase force of contraction and velocity of conduction in the AV ss ss ss ss ss ss ss ss ss ss ss ss
node; stimulate renin released in the kidney ss ss ss ss ss ss ss
o Beta 2—bronchial dilation, relaxation of the uterine muscle, vasodilation, glycogenolysis
ss ss ss ss ss ss ss ss ss
o Dopamine—dilates renal blood vessels ss ss ss
• Epinephrine can activate all alpha and beta receptors but not dopamine receptors
ss ss ss ss ss ss ss ss ss ss ss
• Norepinephrine can activate alpha1, alpha2, and beta receptors but not beta2 or dopamine
ss ss ss ss ss ss ss ss ss ss ss ss
receptors
ss
• Dopamine can activate alpha1, beta1 and dopamine receptors
ss ss ss ss ss ss ss
• Muscarinic agonists mimic the effects of acetylcholine at muscarinic receptors
ss ss ss ss ss ss ss ss ss
• Muscarinic antagonists selectively blood the effects of acetylcholine (and other muscarinic
ss ss ss ss ss ss ss ss ss ss
agonists) at muscarinic receptors
ss ss ss ss
• What are therapeutic uses of Bethanechol?
ss ss ss ss ss
o Urinary retention ss
o Investigational GI uses—off label GI reflux ss ss ss ss ss
• What are actions on smooth muscle, exocrine glands, and eye?
ss ss ss ss ss ss ss ss ss
o Smooth muscle— ss
3
, ▪ lung by causing constriction of the bronchi ss ss ss ss ss ss
▪ the GI system by increasing tone and motility ss ss ss ss ss ss ss
▪ the bladder by contraction of the detrusor muscle ss ss ss ss ss ss ss
▪ relaxation of the trigone and sphincter ss ss ss ss ss
o Exocrine glands—increased sweating salivation, bronchial secretions and secretion of
ss ss ss ss ss ss ss ss
gastric acid
ss ss
o Eye—causes miosis and contraction of the ciliary muscle ss ss ss ss ss ss ss
• Adverse Effects?
ss
o Hypotension
o Abdominal cramps ss
o Diarrhea
o Increased salivation ss
o Exacerbate asthma ss
o Can cause dysrhythmias in patients with hyperthyroidism
ss ss ss ss ss ss
• What are cevimeline, pilocarpine, and acetylcholine used for?
ss ss ss ss ss ss ss
o Cevimeline—treat dry mouth and Sjogren’s syndrome ss ss ss ss ss
o Pilocarpine—topical treatment of glaucoma as well as dry mouth from Sjogren’s ss ss ss ss ss ss ss ss ss ss
syndrome
ss
o Acetylcholine—rapid myosis after delivery and cataract surgery ss ss ss ss ss ss
• Anticholinergics
o Competitively block the actions of acetylcholine as muscarinic receptors ss ss ss ss ss ss ss ss
o Most muscarinic receptors are on structures innervated by parasympathetic nerves
ss ss ss ss ss ss ss ss ss
o Also known as parasympatholytic drugs, antimuscarinic drugs, muscarinic blockers, and
ss ss ss ss ss ss ss ss ss
anticholinergic drugs
ss ss
o Anticholinergic drugs: produce selective blockade of the muscarinic receptors (not all ss ss ss ss ss ss ss ss ss ss
cholinergic receptors)
ss ss
o Can’t pee, see, spit or shit ss ss ss ss ss
• What are the pharmacologic effects of atropine?
ss ss ss ss ss ss
o The heart—increases in rate
ss ss ss
o The exocrine glands—decrease secretions
ss ss ss
o Smooth muscle—relaxes the bronchi, decreases the tone of the urinary bladder detrusor
ss ss ss ss ss ss ss ss ss ss ss
and decreases the tone motility of the GI tract
ss ss ss ss ss ss ss ss ss
o Mydriasis and cycloplegia in the eyes ss ss ss ss ss
o Mild excitation to hallucinations and delirium in the Central Nervous system
ss ss ss ss ss ss ss ss ss ss
• Therapeutic Uses of Atropine? ss ss ss
o Pre-anesthetic medication to help dry up secretions ss ss ss ss ss ss
o Disorders of the eye ss ss ss
o In codes for bradycardia, intestinal hypertonicity and hypermotility
ss ss ss ss ss ss ss
o Muscarinic agonist poisoning ss ss
o Peptic ulcer disease ss ss
o Asthma
o Biliary colic ss
• Side effects of Atropine
ss ss ss
4
ss ss ss ss ss ss ss ss
STUDY QUESTIONS AND ANSWERS EXAM 2 ss ss ss ss ss
• What are the basic mechanisms by which neuropharmocologic agents act?
ss ss ss ss ss ss ss ss ss
o Can modify the disease process ss ss ss ss
o Act at the sites of actions which is the axons versus synapses and steps in synaptic
ss ss ss ss ss ss ss ss ss ss ss ss ss ss ss
transmission and effects of drugs on the steps of synaptic transmission
ss ss ss ss ss ss ss ss ss ss ss
• Transmittter synthesis is the first step in transmission. What are the other 4 steps?
ss ss ss ss ss ss ss ss ss ss ss ss ss
o Transmitter storage, transmitter release, receptor binding, and termination of the
ss ss ss ss ss ss ss ss ss
transmission
ss
• True or False: Neuropharmacologic drugs have high selectivity.
ss ss ss ss ss ss ss
o True—the nervous system uses many different receptor types ss ss ss ss ss ss ss
• Information needed: ss
o Type of receptors—through which the drug acts
ss ss ss ss ss ss
▪ Alpha and beta ss ss
o Normal responses to the activation of those receptors ss ss ss ss ss ss ss
▪ Agonists vs. antagonists ss ss
o What the drug in questions does to the receptor function
ss ss ss ss ss ss ss ss ss
• What are the 3 functions of ANS?
ss ss ss ss ss ss
o Regulates the heart ss ss
o Regulates the secretory glands, saliva glands, gastric, sweat, and bronchial
ss ss ss ss ss ss ss ss ss
o It regulates smooth muscles: bronchi, blood vessels, urogenital system, and the GI tract
ss ss ss ss ss ss ss ss ss ss ss ss
• What are the regulatory functions of the parasympathetic NS?
ss ss ss ss ss ss ss ss
o Seven regulatory functions ss ss
▪ Slowing the heart rate ss ss ss
▪ Increasing the gastric secretions ss ss ss
▪ Emptying the bladder ss ss
▪ Emptying the bowel ss ss
▪ Focusing the eye for near vision, ss ss ss ss ss
▪ Constricting the pupil ss ss
▪ Contracting the bronchial smooth muscle ss ss ss ss
o It also regulates the digestion of food, excretion of waste, control of vision and
ss ss ss ss ss ss ss ss ss ss ss ss ss
conservation of energy
ss ss ss
• What are the functions of the sympathetic NS?
ss ss ss ss ss ss ss
o Regulation of the cardiovascular system ss ss ss ss
▪ Maintaining blood flow to the brain ss ss ss ss ss
▪ Redistributing blood and compensating for the loss of blood ss ss ss ss ss ss ss ss
o Regulation of body temperature ss ss ss
▪ Regulates blood flow to the skin ss ss ss ss ss
▪ Promotes the secretion of sweat ss ss ss ss
▪ Induces piloerection (erection of the hair) ss ss ss ss ss
1
,o Implementation of the fight or flight reaction
ss ss ss ss ss ss
▪ Increase HR and BP
ss ss ss
▪ Blood shuts away from the skin and visera
ss ss ss ss ss ss ss
▪ Bronchi dilate
ss
2
, ▪ Pupils dilate ss
▪ Use energy that had been stored ss ss ss ss ss
• What is the baroreceptor reflex?
ss ss ss ss
o The receptors near the heart monitor BP changes and send the information to the brain
ss ss ss ss ss ss ss ss ss ss ss ss ss ss
o The brain then activates the Autonomic NS to restore blood pressure to normal
ss ss ss ss ss ss ss ss ss ss ss ss
o When BP falls, this reflex causes vasoconstriction and increases cardiac output.
ss ss ss ss ss ss ss ss ss ss
o When BP rises, it causes vasodilation and reduces cardiac output
ss ss ss ss ss ss ss ss ss
• Where is acetylcholine employed?
ss ss ss
o Most junctions at the peripheral nervous system ss ss ss ss ss ss
• Where is epinephrine and norepinephrine released?
ss ss ss ss ss
o Norepinephrine—postganglionic neurons s s
o Epinephrine—adrenal medulla ss
• What are the cholinergic receptors mediated by? What are the subtypes?
ss ss ss ss ss ss ss ss ss ss
o Receptors that mediate responses to acetylcholine ss ss ss ss ss
o Subtypes:
▪ Nicotinic
▪ Muscarinic
• Whare are adrenergic receptors mediated by? What are the subtypes?
ss ss ss ss ss ss ss ss ss
o Mediate responses to epinephrine and norepinephrine ss ss ss ss ss
o Subtypes:
▪ Alphas
▪ Betas
▪ Dopamine
• What are the functions of each adrenergic subtype?
ss ss ss ss ss ss ss
o Alpha 1—vasoconstriction, ejaculation and contraction of the bladder neck, and prostate
ss ss ss ss ss ss ss ss ss ss
o Alpha 2—(located in presynaptic junction)—minimal clinical significance
ss ss ss ss ss ss
o Beta 1—control the heart ss ss ss
▪ Increase HR, increase force of contraction and velocity of conduction in the AV ss ss ss ss ss ss ss ss ss ss ss ss
node; stimulate renin released in the kidney ss ss ss ss ss ss ss
o Beta 2—bronchial dilation, relaxation of the uterine muscle, vasodilation, glycogenolysis
ss ss ss ss ss ss ss ss ss
o Dopamine—dilates renal blood vessels ss ss ss
• Epinephrine can activate all alpha and beta receptors but not dopamine receptors
ss ss ss ss ss ss ss ss ss ss ss
• Norepinephrine can activate alpha1, alpha2, and beta receptors but not beta2 or dopamine
ss ss ss ss ss ss ss ss ss ss ss ss
receptors
ss
• Dopamine can activate alpha1, beta1 and dopamine receptors
ss ss ss ss ss ss ss
• Muscarinic agonists mimic the effects of acetylcholine at muscarinic receptors
ss ss ss ss ss ss ss ss ss
• Muscarinic antagonists selectively blood the effects of acetylcholine (and other muscarinic
ss ss ss ss ss ss ss ss ss ss
agonists) at muscarinic receptors
ss ss ss ss
• What are therapeutic uses of Bethanechol?
ss ss ss ss ss
o Urinary retention ss
o Investigational GI uses—off label GI reflux ss ss ss ss ss
• What are actions on smooth muscle, exocrine glands, and eye?
ss ss ss ss ss ss ss ss ss
o Smooth muscle— ss
3
, ▪ lung by causing constriction of the bronchi ss ss ss ss ss ss
▪ the GI system by increasing tone and motility ss ss ss ss ss ss ss
▪ the bladder by contraction of the detrusor muscle ss ss ss ss ss ss ss
▪ relaxation of the trigone and sphincter ss ss ss ss ss
o Exocrine glands—increased sweating salivation, bronchial secretions and secretion of
ss ss ss ss ss ss ss ss
gastric acid
ss ss
o Eye—causes miosis and contraction of the ciliary muscle ss ss ss ss ss ss ss
• Adverse Effects?
ss
o Hypotension
o Abdominal cramps ss
o Diarrhea
o Increased salivation ss
o Exacerbate asthma ss
o Can cause dysrhythmias in patients with hyperthyroidism
ss ss ss ss ss ss
• What are cevimeline, pilocarpine, and acetylcholine used for?
ss ss ss ss ss ss ss
o Cevimeline—treat dry mouth and Sjogren’s syndrome ss ss ss ss ss
o Pilocarpine—topical treatment of glaucoma as well as dry mouth from Sjogren’s ss ss ss ss ss ss ss ss ss ss
syndrome
ss
o Acetylcholine—rapid myosis after delivery and cataract surgery ss ss ss ss ss ss
• Anticholinergics
o Competitively block the actions of acetylcholine as muscarinic receptors ss ss ss ss ss ss ss ss
o Most muscarinic receptors are on structures innervated by parasympathetic nerves
ss ss ss ss ss ss ss ss ss
o Also known as parasympatholytic drugs, antimuscarinic drugs, muscarinic blockers, and
ss ss ss ss ss ss ss ss ss
anticholinergic drugs
ss ss
o Anticholinergic drugs: produce selective blockade of the muscarinic receptors (not all ss ss ss ss ss ss ss ss ss ss
cholinergic receptors)
ss ss
o Can’t pee, see, spit or shit ss ss ss ss ss
• What are the pharmacologic effects of atropine?
ss ss ss ss ss ss
o The heart—increases in rate
ss ss ss
o The exocrine glands—decrease secretions
ss ss ss
o Smooth muscle—relaxes the bronchi, decreases the tone of the urinary bladder detrusor
ss ss ss ss ss ss ss ss ss ss ss
and decreases the tone motility of the GI tract
ss ss ss ss ss ss ss ss ss
o Mydriasis and cycloplegia in the eyes ss ss ss ss ss
o Mild excitation to hallucinations and delirium in the Central Nervous system
ss ss ss ss ss ss ss ss ss ss
• Therapeutic Uses of Atropine? ss ss ss
o Pre-anesthetic medication to help dry up secretions ss ss ss ss ss ss
o Disorders of the eye ss ss ss
o In codes for bradycardia, intestinal hypertonicity and hypermotility
ss ss ss ss ss ss ss
o Muscarinic agonist poisoning ss ss
o Peptic ulcer disease ss ss
o Asthma
o Biliary colic ss
• Side effects of Atropine
ss ss ss
4
