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Pharm Unit 2 Terms
Pharmacology: Unit 1 terms + drugs
| Question | Answer |
|---|---|
| Nervous system functions | to control, coordinate, and communicate among all systems within the body. |
| Structural divisions of the nervous system | central and peripheral |
| Central nervous system (CNS) | brain and spinal cord |
| Peripheral nervous system (PNS) | cranial nerves (12 pairs) and spinal nerves (31 pairs) |
| Peripheral nerve pathways | afferent and efferent pathways |
| Afferent pathway | pathway of peripheral nervous system; ascending pathways—carry sensory impulses toward the CNS |
| Efferent pathways | pathway of peripheral nervous system; descending pathways—innervate skeletal muscle or effector organs by carrying impulses away from the CNS |
| Functional divisions of peripheral nervous system | somatic and autonomic |
| Somatic nervous system | division of PNS; nerves are branches of cranial and spinal motor nerves that innervate skeletal muscle; under voluntary control of the cerebral cortex |
| Autonomic nervous system (visceral, vegetative, involuntary) | branches of the cranial and spinal motor nerves that innervate cardiac and smooth muscle and secretory glands; involuntary; regulated by hypothalamus and medulla oblongata |
| System that innervates smooth and cardiac muscle | autonomic nervous system |
| Automaticity/autorhythmicity | special property of smooth and cardiac muscle allowing them to initiate their own contractions |
| Autonomic nervous system function | regulates rate at which organs work, either increasing or decreasing activity in order to maintain homeostasis |
| Innervation of visceral organs | two different types of autonomic nerves—sympathetic and parasympathetic—innervate most internal organs; each organ/gland receives a nerve from each division; effect of division depends on stimulus |
| Sympathetic division | “fight or flight”; increases activity of some organs, decreases activity of others, in attempt to conserve energy. Activated during times of stress, anxiety, illness, even if “fight or flight” is not truly needed. All nerves activated at same time |
| Parasympathetic division | more active during periods of “rest and digest.” Nerves regulate body functions such as digestion and elimination. Only selected nerves can be stimulated, and stimulation can be confined to particular body system (i.e. bladder during urination) |
| Structural arrangements | preganglionic neuron and postganglionic neuron |
| Preganglionic neuron | neuronal fiber leaving brainstem and spinal cord synapse outside the CNS at ganglion |
| Postganglionic neuron | second neuron that impacts on effector organ |
| Sympathetic (thoracolumbar) division | fibers originate in the thoracic and lumbar regions of the spinal cord |
| Sympathetic division | ganglia are located near the spinal cord (distant from effector organ |
| Sympathetic division | preganglionic neurons innervate the adrenal medulla which is embryonically and anatomically analogous to other ganglia of the same division |
| Sympathetic division | One preganglionic neuron may act on many post ganglionic neurons |
| Sympathetic division | diffuse distribution pattern lead to widespread massive responses (desirable if organisms is confronted with a sudden emergency |
| Parasympathetic (craniosacral) division | fibers originate in the brain stem (oculomotor III, facial VII, glossopharyngeal IX, vagus X, and sacral segments of the spinal cord |
| Parasympathetic division | ganglia are located near the end effector organs (distant from spinal cord) |
| Parasympathetic division | generally 1 preganglionic to 1 postganglionic neuron ratio |
| Parasympathetic division | discrete distribution leads to fine and limited responses |
| Parasympathetic division | functionally important in protection, conservation, and restoration of bodily resources |
| Neurotransmission | communication b/t cells in nervous system accomplished by chemical mediators (transmitter, neurotransmitter, NT) released by nerve terminals; NT interacts w/specific receptor on second neuron (synapse) or on target tissue (neuroeffector junction) |
| Neurotransmitters of the ANS | acetylcholine (ACh), norepinephrine (NE); epinephrine (Epi) is released into circulation, so is a neurohormone |
| Cholinergic | neurons that release ACh |
| Adrenergic | neurons which release norepinephrine (NE) |
| Sympathetic division neurotransmitter release | preganglionic release ACh; postganglionic release NE (ACh—NE); ACh at sweat glands (ACh—ACh); adrenal medulla releases Epi, NE (ACh—Epi, NE) |
| Parasympathetic division neurotransmitter release | preganglionic neurons release ACh; postganglionic neurons release ACh (ACh—ACh) |
| Adrenergic (sympathetic) receptors | target organ receptors for norepinephrine and/or/ epinephrine; subdivided into Alpha and Beta receptors |
| Alpha adrenergic receptors | subdivided into Alpha-1 and Alpha-2 based on the action produced. |
| Alpha-1 receptors | adrenergic; assocd w/ excitation/stimulation; causes contraction of smooth muscle in blood vessels, glands, organs; smooth muscle contractions result in vasoconstricition/elevated blood pressure; most receptors on effector organs belong to this class |
| Alpha-2 receptors | adrenergic; associated w/ relaxation/inhibition; negative feedback stimulation of these receptors leads to decreased contraction of smooth musclelower blood pressure; stimulated by NE or Epi |
| Beta adrenergic receptors | adrenergic receptor subdivision according to location |
| Beta-1 receptors | adrenergic receptors; located in cardiac muscle; facilitate increased heart rate in cardiac muscle + increased HR and contractility + causes release of rennin from kidney; stimulated by NE or Epi |
| Beta-2 receptors | adrenergic receptor; located in lungs and cause bronchodilation as well as facilitating all remaining effects attributed to beta adrenergic receptors; stimulated by Epi or NE |
| Cholinergic (parasympathetic) receptors | target organ receptors for ACh; subdivided into muscarinic, nicotinic I, and nicotinic II |
| Muscarinic receptors | cholinergic; located on smooth muscle of internal organs, cardiac muscle, glands; w/ stimulation cause decreased heart rate, increased GI motility, increased salivary gland activity; stimulated by ACh |
| Nicotinic I receptors | cholinergic receptor; located in ganglia of post-synaptic nerve body in both sympathetic and parasympathetic systems; stimulated by ACh |
| Nicotinic II receptors | cholinergic receptors; located at the neuromuscular junction of skeletal muscles; when stimulated cause contraction of skeletal muscles; stimulated by ACh |
| Sympathetic nervous system function | innervates the heart, increasing heart rate & contraction; innervate all large and small arteries/veins, causing constriction of vessels except arterioles supplying skeletal muscles; innervate smooth muscle of gutdecreased motility |
| Sympathetic nervous system function | innervate smooth muscle of respiratory tract, causing bronchial relaxation/decreased bronchial secretions; stimulation affects liver, stimulates sweat glands, ejaculation |
| Parasympathetic nervous system functions | innervates heart, slowing heart rate; innervate the gut, increasing motility; innervate bronchial smooth muscle, causing airway constriction; innervates genitourinary tract, causing erection in males. |
| Somatic nervous system functions | efferent motor neurons synapse on skel. muscle cells & release ACh @ NMJ; binds w/ receptors on muscle cell; cell reaches threshold, causes action potential, opening of Ca channels in membrane; increase in IC Ca and contraction of skel. Muscle fiber |
| Autonomic nervous system regulates | regulates the physiological functions of the body—vegetative functions; respiration, perspiration, body temp, carbohydrate metabolism, digestion, bowel motility, pupil size, blood pressure, heart rate, glandular secretions. |
| Autonomic nervous system divisions | sympathetic and parasympathetic; normally in balance and maintain homeostasis |
| Sympathetic nervous system | fight or flight; also called adrenergic; closely associated with the quick regulation of the expenditure of energy during emergencies |
| Parasympathetic nervous system | vegetative; rest and digest; also called cholinergic; more involved with storage and conservation of energy |
| SNS neurotransmitters | norepinephrine (NE), epinephrine (Epi); dopamine; these are all considered catecholamines and are metabolized by monoamine oxidase (MAO) and catechol-Omethyl-transferase (COMT) |
| Monoamine oxidase (MAO) | enzyme that metabolizes NTs; works within the adrenergic nerve ending |
| Catechol-Omethyl-transferase (COMT) | enzyme that metabolizes NTs; works outside the nerve ending in the synapse |
| Norepinephrine (NE) | neurotransmitter of SNS; catecholamine; released at the postganglionic synapse |
| Epinephrine (Epi) | neurotransmitter of SNS; catecholamine; released by adrenal glands |
| Dopamine | neurotransmitter of SNS; catecholamine; present in the brain and also formed as a precursor in synthesis of NE in the postganglionic adrenergic nerve ending |
| PSNS neurotransmitter | acetylcholine (ACh) |
| Acetylcholine (ACh) | PNS neurotransmitter; inactivated by release of acetylcholinesterase in the synaptic cleft. |
| Autonomic drug categories | adrenergic (sympathomimetic); adrenergic blocking (sympatholytic); cholinergic (parasympathomimetic); cholinergic blocking (parasympatholytic, anti-cholinergic); ganglionic; serotonergic; skeletal muscle reactants, anti-Parkinson’s |
| Adrenergic (sympathomimetic) MOA | acts like NE;induces response 3 ways; direct-acting (receptor binding, causes physio response); indirect-acting (causes release of catecholamine from nerve ending); dual-acting (mixed acting, binds to receptor, stimulates release of NT from nerve ending |
| Adrenergic (sympathomimetic) Drug Therapeutic Uses | appetite suppression, bronchodilation, reduce intraocular pressure (glaucoma), nasal decongestant, temp. relief of conjunctiva congenstion (red eyes), support heart during cardiac failure (resuscitation) or shock (to increase BP) |
| Adrenergic (sympathomimetic) Drug side/adverse effects—Alpha | most frequent side/adverse effects—headache, restlessness, insomnia, euphoria; others inc. palpatations, dysrhythmias, vasoconstriction, hypertension, loss of appetite, dry mouth, nausea, vomiting |
| Adrenergic (sympathomimetic) drug side/adverse effects—Beta | mild tremors, headache, nervousness, dizziness |
| Adrenergic (sympathomimetic) toxicity/management of overdose | seizures (treat with diazepam); hypertension that can cause intracranial bleeding (treat with rapid acting alpha adrenergic blocker) |
| Adrenergic blocking (sympatholytic) MOA | alpha and beta blockers are antagonists—they bind to adrenergic receptors & inhibit/block stimulation of SNS via competitive or non-competitive inhibition; neuronal blockers inhibit the release from the nerve terminal |
| Adrenergic blocking (sympatholytic) Alpha blockers therapeutic use | treatment of hypertension, vascular headaches, pheochromomcytoma |
| Adrenergic blocking alpha blocker side/adverse effects | nausea, vomiting, diarrhea; orthostatic hypotension, reflex tachycardia, dizziness |
| Adrenergic blocking Beta blockers | cardioselective blockers work primarily in heart; nonspecific or nonselective blockers block both beta 1 & beta 2 receptors; nonselective blockers can cause bronchial constriction and vasoconstriction |
| Beta blocker therapeutic use | treatment of hypertension, protection of heart after MI, treatment of dysrhythmias, chronic open angle glaucoma, migraine headaches, mitral valve prolapse syndrome |
| Beta blocker side/adverse effects | NVD; possible bradycardia and cardiac arrest; agranulocytosis; thromcytopenia; give cautiously to patients w/ asthma or CAD |
| Cholinergic (parasympathomimetic) MOA | mimics PNS; mimics actions of ACh; can induce response in 2 ways—direct acting (binds to receptors) and indirect-acting (makes more ACh available at receptor site by blocking acetylcholinesterase in synaptic cleft. |
| Cholinergic therapeutic uses—direct acting | treatment of glaucoma—decreases intraocular pressure through inducing miosis |
| Cholinergic therapeutic uses—indirect-acting | diagnosis and treatment of myasthenia gravis; antidote to curare type muscle relaxants |
| Cholinergic drug side/adverse effects | these limit the use of cholinergic drugs; NVD; blurred visions, excessive sweating, flushing, excessive salivation, bradycardia, bronchoconstriction |
| Signs and symptoms of cholinergic poisoning | Salivation and sweating; Lacrimation, Urinary incontinence; Diarrhea; GI cramps; Emesis (vomiting)—SLUDGE; antidote is atropine (anti-cholinergic drug) |
| Cholinergic Blocking (parasympatholytic, anti-cholinergic) MOA | block or inhibit the actions of ACh; in large part these agents are competitive antagonists at muscarinic receptors of PSNS |
| Cholinergic Blocking Therapeutic Uses | drugs used to treat Parkinson’s disease; treatment of some dysrhythmias, pre-op med before general anesthesia |
| Cholinergic blocking side/adverse effects | cotton mouth, constipation, NV, tachycardia, palpitations, dizziness, drowsiness, blurred vision; oldest agents are atropine and scopolamine |
| Ganglionic blocking agent MOA | though to inhibit nerve transmission at nicotinic receptors |
| Ganglionic blocking agent therapeutic uses | potent antihypertensive but use limited because of extreme adverse effects (usually used in emergency situations) |
| Ganglionic blocking agent adverse effects | paralytic ileus, dry mouth, constipation, urinary retention, impotence |
| Serotonergic Drug MOA | believed to bind w/ one serotonin receptor subtype on cranial blood vessels; effect is vasoconstriction and perhaps cerebral blood vessel constriction resulting in reduction of pulsation associated w/ pain from vascular headaches |
| Serotonergic Drug therapeutic uses | vascular headaches, i.e. migraines |
| Serotonergic side/adverse effects | NV, dizziness, weakness, drowsiness, fatigue |
| Skeletal muscle relaxants—centrally acting MOA | unknown; possibly blocking of signal from spinal cord, but not sure |
| Skeletal muscle relaxants—centrally acting therapeutic uses | relaxation of spastic muslces caused by trauma, overexertion, or nervous tension. |
| Skeletal muscle relaxants—peripherally/direct acting MOA | inhibits skeletal muscle fiber; prevents actin and myosin contraction |
| Skeletal muscle relaxants—peripherally/direct acting therapeutic uses | treatment of spastic diseases (MS, cerebral palsy, spinal cord injury |
| Skeletal muscle relaxants—peripherally/direct acting side/adverse effects | dizziness, vomiting, fatigue, weakness, hepatotoxicity |
| Parkinson’s Disease | disease caused by excess cholinergic activity b/c of ACh & dopamine imbalance; decrease in dopamine & increase in ACh causes muscle rigidity, muscle tremor; treated w/ anti-cholinergic, dopaminergic, monoamine oxidase B inhibitor, antihistamine, antiviral |
| Anti-Parkinson’s anti-cholinergic agent MOA | inhibit/block effects of ACh; readily cross blood brain barrier and can produce some improvement in functional capacity |
| Dopaminergic MOA | 3 types—release dopamine, increase brain levels of dopamine, dopamine agonists; have major effect on akinesia (difficulty in or lack of ability to initiate muscle movement) |
| Dopaminergic therapeutic uses | treatment of Parkinson’s disease |
| Dopaminergic side/adverse effects | drowsiness, headache, nausea, sedation, confusion, hallucinations |
| Monoamine oxidase B inhibitor (dopamine conserver) MOA | irreversibly inhibits monoamine oxidase B, thereby preventing breakdown of dopamine |
| Monoamine oxidase B inhibitor therapeutic use | used in combo with levodopa or levodopa-carbidopa to treat Parkinson’s |
| Monoamine oxidase B inhibitor side/adverse effects | dry mouth, NV, insomnia, dizziness, mood alterations, dyskinesias |
| Myasthenia gravis | progressive, incurable autoimmune disease that results in skeletal muscle weakness and chronic fatigue; cause by lack of ACh; treated w/ anticholinesterase agents |
| Anticholinesterase MOA | inhibits/blocks acetylcholinesterase in synaptic cleft which in turn inhibits reuptake of ACh back into nerve terminal; results in increased levels of ACh in synaptic cleft |
| Anticholinesterase therapeutic use | treatment of myasthenia gravis |
| Action of histamine | found throughout body in mast cells and basophilic white blood cells; largest concentrations of mast cells are in the lungs, the GI tract, and skin. |
| Histamine receptors | 2 types—H1 receptors in blood vessels, bronchiolar smooth muscle, intestinal smooth muscle; H2 receptors—found in stomach, heart, blood vessels, uterine tissue |
| Anti-allergic agents—mast cell stabilizer | cromolyn sodium (Intal/Nasalcrom); must be given before histamine release has begun; used for prophylaxis |
| Mast cell stabilizers | allergic reactions can be blocked by preventing mast cells from releasing contents (histamine) or H1 receptors can be blocked from interacting w/ histamine. |
| Capsule (spinhaler); solution (nasalcrom); oral capsule (gastrocrom) | routes of administration for Cromolyn (anti-allergic agent) |
| Anti-allergic agent therapeutic use | used as prophylactic adjunct in mgmt of chronic bronchial asthma & allergic rhinitis to prevent bronchospasms; pulmonary function tests must show that patient has a bronchodilator reversible component to the airway obstruction for cromolyn to be benefit |
| Anti-allergic side/adverse effects | minimal, include wheezing, nasal itching, nasal burning, nausea, drowsiness, headache; rare bronchospasms; rash—discontinuation of drug |
| Antihistaminic | used to releave acute reaction in which histamine has already been released; all available specifically block histamine from interfacing w/ H1 receptors preventing H1 mediated allergic response. |
| Antihistaminic routes of administration | usually orally; few for parenteral administration; metabolized rapidly by liver, so repeat administration necessary to maintain therapeutic response |
| Antihistamine therapeutic use | used in acute allergic reactions including urticarial (hives), hay fever, insect bites, rhinitis, dermatitis; can induce sleep or relieve motion sickness; also anti-emetic. |
| Antihistamine adverse reactions | drowsiness, sedation and xerostomia/dry mouth; hypotension rapid heartbat, anorexia, apigastric distress, urinary retention |
| Antihistamine precautions/contraindications | s/b used with caution in patients w/ cardiovascular disease or hypertension/patients predisposed to developing increase in intraocular pressure or urinary retention. |
| Decongestant drugs | vasoconstrictor; reduce blood flow to edematous mucous membrane in nose, sinuses, pharynx; produce vasoconstriction by stimulating alpha receptors in smooth muscle around blood vessels; decrease swelling of mucous membranes, alleviate nasal stuffiness |
| Chronic obstructive pulmonary disease (COPD) | common respiratory condition caused by emphysema and chronic bronchitis. |
| Chronic bronchitis | caused by chronic irritation of respiratory tract by cigarette smoke or environmental pollutants |
| Emphysema | deases involving destruction of alveolar walls; difficulty expelling air from lungs; respiratory exchange is reduced and shortness of breath occurs. Irreversible lung damage. |
| Asthma | respiratory condition characterized by shortness of breath and wheezing; effects caused by bronchiolarChronic obstructive pulmonary disease (COPD) |
| Chronic bronchitis | caused by chronic irritation of respiratory tract by cigarette smoke or environmental pollutants |
| Emphysema | deases involving destruction of alveolar walls; difficulty expelling air from lungs; respiratory exchange is reduced and shortness of breath occurs. Irreversible lung damage. |
| Asthma | respiratory condition characterized by shortness of breath and wheezing; effects caused by bronchiolar constriction. Cause can be irritants, exercise, infections, aspirin, allergy. |
| Chemical mediators | formed during inflammatory reaction and released from injured tissue, mast cells, and leukocytes in the respiratory tract; responsible for most of the symptoms and complications of asthma |
| Histamines | produced by mast cells |
| Prostaglandins | produced by almost all body cells (ex. leukotrines) |
| Beta-adrenergic drugs (sympathomimetics) | bronchodilator drugs |
| Xanthine derivatives | xanthine compounds are found naturally in tea, cocoa, and coffee; theophylline is used in treatment of asthma |
| Corticosteroids | in treatment of asthma, inhibit inflammatory response that occurs in the respiratory airways; used in acute asthmatic conditions when bronchodilators have failed to provide relief or maintain control |
| Corticosteroid adverse effects | fluid retention, muscle wasting, metabolic disturbances, increased susceptibility to infection. |
| Cysteinyl leukotriene receptor antagonists | leukotrienes are prostaglandin derivatives and cause bronchoconstriction, mucus production, inflammation; these agents interfere w/ leukotriene formation |
| Mucolytics | chemical agents that liquefy bronchial mucus so can be removed by coughing or suctions |
| Expectorants | stimulate the production of respiratory secretions, which then decrease irritation and cough caused by excessive dryness of the airways; increase output of respiratory tract secretions which indirectly suppresses cough |
| Antitussives | depress the coughing center in the medulla; should be used only for non-productive cough |
| Inotropic | increases or decreases FORCE of myocardial contraction |
| chronotropic | increases or decreases HEART RATE |
| dromotropic | increases or decreases SPEED of electrical conduction |
Created by:
mbtrimm
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