(MSN) PHARM EXAM 1 QUESTIONS AND CORRECT ANSWERS WITH COMPLETE VERIFIED SOLUTION, UPDATED 2024.

PHARM EXAM 1 (MSN) PNS: cholinergic receptors 1. nicotinic (N): all ANS ganglia and medulla 2. nicotinic (M): neuromuscular junction 3. muscarinic: PNS organs site of action: PNS rx -synapse -rx alters synaptic transmission (AcH) SNS: Adrenergic receptors -alpha 1, alpha 2, beta 1, beta 2 -also effects epi/norepi, dopamine breakdown of AcH -via AChE or MAO 1. AcH=reuptake into nerve cell 2. degraded by MAO 3. diffusion of waste out of cell sites where Rx act/influence 1. receptor: rx binds to activate, enhance response, or block 2. synthesis of neurotransmitter: increases or decreases receptor activation/response 3. reuptake/termination cycle: blocking=prevents reuptake, inhibiting=prevents breakdown of trasmitter muscarinic receptors: M1 vs M2 vs M3 M1= CNS; salivary glands M2= HEART ONLY M3= bladder detrusor, eyes, salivary glands *most muscarinic agonists (cholinesterase inhibitors) are non-selective; more side effects!! agonist vs antagonist agonist=activate antagonist=block epinephrine: secreted and broken down where? secreted = medulla broken down = liver muscarinic agonists/cholinesterase inhibitors -MOA: prevents breakdown of AcH within SYNAPSE to make more available for receptor sites -Rx for: dementia + alzheimer's (both r/t excessive AcH breakdown), MG, neurogenic bladder, GERD, IBS, post-op -CI: hyperthyroidism -ex: rivastigmine, donepizil (aricept), galatamine Bethanechol (Urecholine) MOA: cholinesterase inhibitor; increases detrusor muscle tone to allow strong start to voiding for clients with postoperative urinary hesitancy. Precautions/interactions: PO ONLY ON EMPTY STOMACH; do not administer IV or IM CI: hypotension or decreased CO, hyperthyroidism SE: excessive saliva, increased urinary output Cevimeline (Evoxac) -MOA: muscarinic receptor agonist; admin PO only -CI: narrow eye glaucoma d/t increased pupillary constriction -also rx for sjorgen's Pilocarpine (Pilocar) -Direct-Acting Cholinergic Agonists; fewer SE, admin to eyes only; safe for kids/pregnant/breastfeeding -Use: constrict pupils (glaucoma; NOT NARROW ANGLE) cholinesterase inhibitors/agonists: common SE -bradycardia, hypotension -miosis/blurred vision -ABD cramping, diarrhea, increased gastric acid and salivation -bronchoconstriction (AVOID IN ASTHMASTICS IF ABLE) *most SE are reversible myasthenia gravis (MG): Rx -chronic disease characterized by muscle weakness and thought to be caused by a defect in the transmission of AcH -cholinesterase inhibitors used to increase AcH availability -assess for swallowing prior to giving PO; may need to be parenteral -can develop into MG crisis; treat w/ Neostigmine (AcH inhibitor) treating cholinesterase inhibitor overdose 1. atropine: muscarinic antagonist 2. benzo to decrease seizure risk 3. pralidoxime: reverse binding on enzyme cholinesterase **too much AcH=bradycardia, hypotension, flaccid muscles muscarinic antagonists/anticholinergics -MOA: block receptor to decrease availability of AcH or prevent reuptake -SE: dry eyes, tachy, decreased sweating/increased temp, constipation, confusion, dizziness -s/s of toxicity=hot temp/skin/dry mucous membranes, increased anx/agitation, decreased vision -CI: hx prolonged QT, hx MG (can cause crisis), hx myocardial ischemia, BPH/urinary retention, elderly (R/O dementia and alzheimer's), pregnancy (less blood flow to fetus). *safe for children tho! -Rx ex: bentyl, atropine (ANTIDOTE FOR CHOLINERGIC OD), scopolamine -antidote for OD: physostigmine enablex, vesicare, detrol (muscarinic antagonists): CI/considerations -can cause prolonged QT; avoid in elderly and those w/ pre-existing cardiac issues -decrease dose if used w/: ABX, azole anti-fungals, protease inhibitors (HIV) d/t interaction with CYP enzymes adrenergic receptors + locations A1= throughout body A2= CNS, not PNS B1= heart only B2= lungs/skeletal muscle/liver/uterus adrenergic agonists: 2 categories 1. catecholamines: epi/norepi/dopamine/dobutamine; usually given IV, no PO, brief duration, cannot cross BBB 2. non-catecholamines: ephedrine, albuterol, phenylephrine; can be given PO, longer duration, crosses BBB -ephedrine: nonselective; actives A1/2, B1/2 -phenylephrine: selective; A1 -albuterol: selective; B2 A1 receptors agonists -MOA: causes vasoconstriction; treats mydriasis, bleeding, hypotension, decongestant -AE: HTN, bradycardia, necrosis -ex: ephedrine, epi/norepi, phenylephrine, dopamine (high doses) B1 receptor agonists -MOA: increase contractility and conduction in AV node; treats HF, shock, AV block. B1=HEART ONLY, SELECTIVE -AE: tachy, dysrhythmias, angina -ex: epi/norepi, dopamine/dobutamine, ephedrine B2 receptor agonists -MOA: targets lungs, uterus, skeletal muscle; treat asthma, pre-term labor -AE: hypotension, tremor, hyperglycemia (effects liver/glucogenesis; avoid in diabetics if can) -ex: albuterol (selective B2), isoproterenol (non-selective), turbutaline dopamine receptor agonist -MOA: targets renal vessels; treat shock, renal vasodilation -dopamine=also A1 receptor agonist -same AE as A1 receptor agonists (HTN, necrosis, bradycardia) epi: Rx use -catecholamine; effects ALL receptors (norepi=A1/2, B1; less selective than epi) -use: anaphylaxis, local anesthetic/control bleeding, asthma, cardiac arrest, hypotension