Nagelhout Pharmacology 2 Exam 2 (Graded A+ actual test)

Nagelhout Pharmacology 2 Exam 2

How is the spread of epidural and spinal anesthesia different in pregnant women? -
ANSWER-the spread and depth is greater; the fetus is pushing back so you have
decreased epidural space

How does pregnancy change the dosage of LA given? - ANSWER-give decreased
dose; they are more sensitive to LA d/t increased hormone (progesterone) levels

Lidocaine for tumescent anesthesia - ANSWER-they use large amounts of diluted LA
for liposuction; doses from 35-55mg/kg (if not lipo 28mg/kg)

What is Hyaluronidase - ANSWER-an enzyme that helps break down tissue matrix;
breaks down hyaluronic acid so fluids can go further;
*helps spread LA*
this also increases the risk of toxicity

Synthesis of catecholamines - ANSWER-phenylalanine--> tyrosine (tyrosine
hydroxylase)--> dopa--> dopamine--> NE--> Epi
increased NE will inhibit the change from tyrosine to dopa (tyrosine hydroxylase)


What does mixing LAs do to your toxic doses? - ANSWER-decreases them; the toxicity
is additive so if you have used 50% of your lidocaine dose and watch to switch to bu
pivacaine- you can only give 50% of your toxic bupivacaine dose

increased catecholamines - ANSWER-sympathomimetic

decreased catecholamines - ANSWER-sympatholytic

2 enzymes that break down catecholamines - ANSWER-MOA- stored in nerves
COMT- stored in synapse

PNS preganglionic and postganglionic NTs - ANSWER-pre: nACh
post mACh

SNS preganglionic and postganglionic NTs - ANSWER-pre: nACh
post: NE (adrenergic)

pre-synaptic alpha 2 agonists: sympathomimetic/sympatholytic? - ANSWER-
sympatholytic; activates the negative feedback so nerve does not release any more
catecholamine

, post-synaptic alpha2 agonists: sympathomimetic/sympatholytic? - ANSWER-
sympathomimetic; it reached its destination so it will cause the effects

MOA: interference with synthesis of neurotransmitter: sympathomimetic/sympatholytic?
- ANSWER-sympatholytic

MOA: metabolic transformation by same pathway as precursor of transmitter:
sympathomimetic/sympatholytic? - ANSWER-sympatholytic

MOA: blockade of transport system at nerve terminal membrane:
sympathomimetic/sympatholytic? - ANSWER-sympathomimetic;
block reuptake

MOA: blockade of transport system of storage vesicles - ANSWER-sympatholytic; not
safely in vesicle so more will be broken down my MAO or COMP

MOA: promotion of exocytosis or displacement of transmitter from axonal terminal:
sympathomimetic/sympatholytic? - ANSWER-sympathomimetic

MOA: prevention of release of transmitter: sympathomimetic/sympatholytic? -
ANSWER-sympatholytic

MOA: mimicry of transmitter at post junctional sites: sympathomimetic/sympatholytic? -
ANSWER-sympathomimetic; aka: direct agonist

MOA: blockade of postsynaptic receptor: sympathomimetic/sympatholytic? - ANSWER-
sympatholytic; aka direct antagonist

MOA: inhibition of enzymatic breakdown of transmitter:
sympathomimetic/sympatholytic? - ANSWER-parasympathomimetic

MOA: interference with second messenger system: sympathomimetic/sympatholytic? -
ANSWER-sympathomimetic; prevents breakdown of second messenger--> increased
catecholamines

MOA: interference with synthesis of transmitter: cholinergic and adrenergic agents -
ANSWER-sympatholytic
cholinergic: choline acetyl transferase inhibitors
adrenergic: a-methyl tyrosine

MOA: metabolic transformation by same pathway as precursor: adrenergic agents -
ANSWER-sympatholytic
adrenergic: methyldopa