NR 413 Exam #4 [Pharm] UPDATED ACTUAL Questions and
CORRECT Answers
Question: The acronym *SLUDGEM* is used to describe Parasympathetic (cholinergic) effects. What
does it stand for?
Correct Answer: *S*alivation *L*acrimation *U*rination *D*efecation *G*astroenteritis *E*mesis
*M*iosis
Question: Cholinergic Crisis
Correct Answer: -Crisis of too much acetylcholinesterase inhibitor medications -Bradycardia, pallor,
sweating, severe muscle weakness
Question: Myasthenic Crisis
Correct Answer: -Crisis of inadequate amounts of acetylcholinesterase inhibitor medications (not enough)
-Severe generalized muscle weakness, dysphagia, weakness, fatigue, ptosis
Question: Edrophonium Chloride (Tensilon)
Correct Answer: -Agent used to *diagnose* Myasthenia Gravis -Ultrashort acting AChE Inhibitor -If
ptosis improved, diagnosis is most likely Myasthenia gravis or Myasthenic Crisis
Question: Pyridostigmine Bromide (Mestinon)
Correct Answer: -Cholinesterase Inhibitor (AChE Inhibitor) -Intermediate action and helps with
maintenance treatment of myasthenia gravis -Side effects: increased salivation, miosis, bradycardia,
hypotension
Question: Antidote for cholinergic crisis?
Correct Answer: Atropine (anticholinergic)
Question: Beta-Interferon
Correct Answer: -Immunomodulator -Suppresses the inflammatory response and T-cell activation -Can
slow disease progression/prevent relapses of MS -Side effects include SOB, chest pain, edema, neutropenia
Question: Methylprednisolone (Solu-Medtrol)
Correct Answer: -Immunosuppressant Corticosteroid -Treats acute inflammation -Utilize for acute
exacerbations of MS
Question: Cyclobenzaprine HCl (Flexeril)
Correct Answer: -Centrally acting muscle relaxant -Not fully understood, but relieves muscle spasms by
acting in the *brain*. No action on neuromuscular junction or muscles involved -Side effects:
anticholinergic side effects, angioedema, MI, sedation
Question: Dantrolene
Correct Answer: -Peripherally acting muscle relaxant -Decreases muscle spasm and increases ROM
Question: Baclofen (Lioresal) Pumps
Correct Answer: -Central Acting Muscle Relaxant -For muscle spasms caused by MS and spinal cord
injury -OD may cause CNS depression
, Question: Contraindications of Centrally Acting Muscle Relaxants?
Correct Answer: -Renal or liver disease -Should not be taken concurrently with any other CNS
depressants -Don't stop abruptly! Rebound spasms can occur
Question: 2 Agents that treat Parkinson's Disease?
Correct Answer: -Dopaminergics -Anticholinergics
Question: Parkinson's disease
Correct Answer: -Loss of dopamine producing neurons in the Basal Ganglia -Extrapyramidal symptoms
Question: Levodopa
Correct Answer: -Dopaminergic -Levodopa is converted into dopamine via an enzyme called dopa
decarboxylase (will decrease symptoms of Parkinson's)
Question: Problem with Levodopa?
Correct Answer: -Only small amounts were able to cross the BBB and produce therapeutic effect
Question: What drug is combined with Levodopa to inhibit the dopa decarboxylase in the gut to increase %
of Levodopa to reach the brain?
Correct Answer: Carbidopa
Question: What is contraindicated with Carbidopa?
Correct Answer: Glaucoma! Drug increases intraocular pressire
Question: Concerns with Levodopa/Carbidopa?
Correct Answer: -Wearing off phenomenon (gradual loss of drug effects) -On-off phenomenon: causes
abrupt loss of drug effects (Tell pts to avoid high-protein diet)
Question: Bromocriptine
Correct Answer: -Stimulates dopamine receptors directly in the CNS, cardiovascular system and the GI
tract -Used to treat Parkinson's (Dopaminergic)
Question: Benztropine
Correct Answer: (anticholinergic) blocks cholinergic action to normalize dopamine and ACH imbalance
in CNS
Question: 2 Agents used to treat Alzheimer's Disease?
Correct Answer: -Acetylcholinesterase Inhibitors -NMDA Receptor Antagonists
Question: Alzheimer's
Correct Answer: Not fully understood, but associated with cerebral atrophy and degeneration of
cholinergic neurons
Question: Rivastigmine
Correct Answer: -Acetylcholinesterase Inhibitor -More ACH available for binding, enhancing cognition,
slowing disease progression
Question: Contraindications of Rivastigmine?
Correct Answer: Fainting, liver disease
CORRECT Answers
Question: The acronym *SLUDGEM* is used to describe Parasympathetic (cholinergic) effects. What
does it stand for?
Correct Answer: *S*alivation *L*acrimation *U*rination *D*efecation *G*astroenteritis *E*mesis
*M*iosis
Question: Cholinergic Crisis
Correct Answer: -Crisis of too much acetylcholinesterase inhibitor medications -Bradycardia, pallor,
sweating, severe muscle weakness
Question: Myasthenic Crisis
Correct Answer: -Crisis of inadequate amounts of acetylcholinesterase inhibitor medications (not enough)
-Severe generalized muscle weakness, dysphagia, weakness, fatigue, ptosis
Question: Edrophonium Chloride (Tensilon)
Correct Answer: -Agent used to *diagnose* Myasthenia Gravis -Ultrashort acting AChE Inhibitor -If
ptosis improved, diagnosis is most likely Myasthenia gravis or Myasthenic Crisis
Question: Pyridostigmine Bromide (Mestinon)
Correct Answer: -Cholinesterase Inhibitor (AChE Inhibitor) -Intermediate action and helps with
maintenance treatment of myasthenia gravis -Side effects: increased salivation, miosis, bradycardia,
hypotension
Question: Antidote for cholinergic crisis?
Correct Answer: Atropine (anticholinergic)
Question: Beta-Interferon
Correct Answer: -Immunomodulator -Suppresses the inflammatory response and T-cell activation -Can
slow disease progression/prevent relapses of MS -Side effects include SOB, chest pain, edema, neutropenia
Question: Methylprednisolone (Solu-Medtrol)
Correct Answer: -Immunosuppressant Corticosteroid -Treats acute inflammation -Utilize for acute
exacerbations of MS
Question: Cyclobenzaprine HCl (Flexeril)
Correct Answer: -Centrally acting muscle relaxant -Not fully understood, but relieves muscle spasms by
acting in the *brain*. No action on neuromuscular junction or muscles involved -Side effects:
anticholinergic side effects, angioedema, MI, sedation
Question: Dantrolene
Correct Answer: -Peripherally acting muscle relaxant -Decreases muscle spasm and increases ROM
Question: Baclofen (Lioresal) Pumps
Correct Answer: -Central Acting Muscle Relaxant -For muscle spasms caused by MS and spinal cord
injury -OD may cause CNS depression
, Question: Contraindications of Centrally Acting Muscle Relaxants?
Correct Answer: -Renal or liver disease -Should not be taken concurrently with any other CNS
depressants -Don't stop abruptly! Rebound spasms can occur
Question: 2 Agents that treat Parkinson's Disease?
Correct Answer: -Dopaminergics -Anticholinergics
Question: Parkinson's disease
Correct Answer: -Loss of dopamine producing neurons in the Basal Ganglia -Extrapyramidal symptoms
Question: Levodopa
Correct Answer: -Dopaminergic -Levodopa is converted into dopamine via an enzyme called dopa
decarboxylase (will decrease symptoms of Parkinson's)
Question: Problem with Levodopa?
Correct Answer: -Only small amounts were able to cross the BBB and produce therapeutic effect
Question: What drug is combined with Levodopa to inhibit the dopa decarboxylase in the gut to increase %
of Levodopa to reach the brain?
Correct Answer: Carbidopa
Question: What is contraindicated with Carbidopa?
Correct Answer: Glaucoma! Drug increases intraocular pressire
Question: Concerns with Levodopa/Carbidopa?
Correct Answer: -Wearing off phenomenon (gradual loss of drug effects) -On-off phenomenon: causes
abrupt loss of drug effects (Tell pts to avoid high-protein diet)
Question: Bromocriptine
Correct Answer: -Stimulates dopamine receptors directly in the CNS, cardiovascular system and the GI
tract -Used to treat Parkinson's (Dopaminergic)
Question: Benztropine
Correct Answer: (anticholinergic) blocks cholinergic action to normalize dopamine and ACH imbalance
in CNS
Question: 2 Agents used to treat Alzheimer's Disease?
Correct Answer: -Acetylcholinesterase Inhibitors -NMDA Receptor Antagonists
Question: Alzheimer's
Correct Answer: Not fully understood, but associated with cerebral atrophy and degeneration of
cholinergic neurons
Question: Rivastigmine
Correct Answer: -Acetylcholinesterase Inhibitor -More ACH available for binding, enhancing cognition,
slowing disease progression
Question: Contraindications of Rivastigmine?
Correct Answer: Fainting, liver disease
