CRNA Pharm Sympathomimetic Short Review

1. Remember when I talked in broad generalities about cAMP and cGMP and in general which one might be considered an up regulator and which one might be considered a down regulator. cAMP = up-regulator, cGMP down-regulator?This is my best guess. cAMP generally increases contractility and cGMP causes smooth muscle relaxation/vasodilation.

True

False

The explanation for the given correct answer is that cAMP is generally considered an up-regulator because it increases contractility, while cGMP is considered a down-regulator because it causes smooth muscle relaxation and vasodilation. Therefore, the statement that cAMP is an up-regulator and cGMP is a down-regulator is true.

Explanation

The explanation for the given correct answer is that cAMP is generally considered an up-regulator because it increases contractility, while cGMP is considered a down-regulator because it causes smooth muscle relaxation and vasodilation. Therefore, the statement that cAMP is an up-regulator and cGMP is a down-regulator is true.

2. Ephedrine's direct action occurs by stimulating adrenergic receptors similar to epinephrine, indirect actions may be due to central stimulation, peripheral postsynaptic norepinephrine release, or inhibition of norepinephrine reuptake

True

False

Ephedrine's direct action occurs by stimulating adrenergic receptors similar to epinephrine. This means that ephedrine activates specific receptors in the body that are typically activated by epinephrine, a hormone involved in the "fight or flight" response. Indirect actions of ephedrine may be due to central stimulation, peripheral postsynaptic norepinephrine release, or inhibition of norepinephrine reuptake. In other words, ephedrine can also affect the release and reuptake of norepinephrine, another hormone involved in regulating various bodily functions.

Explanation

Ephedrine's direct action occurs by stimulating adrenergic receptors similar to epinephrine. This means that ephedrine activates specific receptors in the body that are typically activated by epinephrine, a hormone involved in the "fight or flight" response. Indirect actions of ephedrine may be due to central stimulation, peripheral postsynaptic norepinephrine release, or inhibition of norepinephrine reuptake. In other words, ephedrine can also affect the release and reuptake of norepinephrine, another hormone involved in regulating various bodily functions.

3. Which of the following is decreased during a fight or flight reaction?

Plasma glucose levels

Cardiovascular function

Metabolic function

Gastrointestinal and genitourinary function

All others are increased.

Explanation

All others are increased.

4. Ephedrine is commonly given as a continuous infusion.

True

False

Incremental doses

Explanation

Incremental doses

5. Dosing for ephedrine is 2.5-10 mg for adults and 0.1 mg/kg for children.

True

False

According to ppt, don't know what N/P says

Explanation

According to ppt, don't know what N/P says

6. Regarding increased acetylcholine, the muscarinic effect on the heart is bradycardia, on the pulmonary system is bronchospasm and increased secretions, and can also cause diffuse EEG activity neurologically.

True

False

Bradycardia can progress to sinus arrest.

When reversing nondepolarizers---- goal is to maximize nicotinic transmission and minimize muscarinic side effects

Explanation

Bradycardia can progress to sinus arrest.

When reversing nondepolarizers---- goal is to maximize nicotinic transmission and minimize muscarinic side effects

7. Phenylephrine is associated with tachyphylaxis and reflex bradycardia.

True

False

Phenylephrine also causes a significant decrease in renal blood flow.

Dose:
IV bolus of 50-100 mcg (0.5-1 mcg/kg)
Continuous: 0.25-1 mcg/kg/min

Explanation

Phenylephrine also causes a significant decrease in renal blood flow.

Dose:
IV bolus of 50-100 mcg (0.5-1 mcg/kg)
Continuous: 0.25-1 mcg/kg/min

8. According to Greg's ppt, the continuous infusion dose of epinephrine is 2-20 mcg/min.

True

False

According to N/P
Beta stimulation @ 0.01-0.03 mcg/kg/min
Beta/A1 @ 0.03-0.15 mcg/kg/min
A1 @ 0.15-0.3 mcg/kg/min

Explanation

According to N/P
Beta stimulation @ 0.01-0.03 mcg/kg/min
Beta/A1 @ 0.03-0.15 mcg/kg/min
A1 @ 0.15-0.3 mcg/kg/min

9. Albuterol is commonly used for treatment of ________.

Albuterol is commonly used for the treatment of asthma. Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to symptoms such as wheezing, shortness of breath, and coughing. Albuterol is a bronchodilator medication that works by relaxing the muscles in the airways, allowing for easier breathing. It is often prescribed as a quick-relief medication to provide immediate relief during asthma attacks or as a preventive measure before physical activities that may trigger symptoms.

Explanation

Albuterol is commonly used for the treatment of asthma. Asthma is a chronic respiratory condition characterized by inflammation and narrowing of the airways, leading to symptoms such as wheezing, shortness of breath, and coughing. Albuterol is a bronchodilator medication that works by relaxing the muscles in the airways, allowing for easier breathing. It is often prescribed as a quick-relief medication to provide immediate relief during asthma attacks or as a preventive measure before physical activities that may trigger symptoms.

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10. Beta1 stimulation via epinephrine increases cardiac output, contractility, and heart rate; it therefore _________ myocardial oxygen demand

Stimulation of Beta1 receptors by epinephrine leads to an increase in cardiac output, contractility, and heart rate. These effects result in an increased demand for oxygen by the myocardium, as the heart needs more oxygen to meet the increased workload. Therefore, the correct answer is "increases."

Explanation

Stimulation of Beta1 receptors by epinephrine leads to an increase in cardiac output, contractility, and heart rate. These effects result in an increased demand for oxygen by the myocardium, as the heart needs more oxygen to meet the increased workload. Therefore, the correct answer is "increases."

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11. Match the following

G-protein coupled receptors

Ligand-gated ion channels

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12. Which of the following are NOT naturally occurring catecholamines?

Epinephrine

Norepinephrine

Dopamine

Isoproterenol

Dobutamine

Isoproterenol and dobutamine are synthetic catecholamines

Explanation

Isoproterenol and dobutamine are synthetic catecholamines

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13. The activation of beta-2 receptors causes glycogenolysis, lipolysis, gluconeogenesis and ______ secretion from the pancreas.

Activation of beta-2 receptors stimulates the release of insulin from the pancreas. Insulin is a hormone that plays a crucial role in regulating blood sugar levels. It promotes the uptake of glucose by cells, inhibits glycogenolysis (breakdown of glycogen into glucose), and enhances the storage of glucose as glycogen in the liver and muscles. Therefore, the activation of beta-2 receptors leads to an increase in insulin secretion, which helps to lower blood sugar levels and maintain glucose homeostasis in the body.

Explanation

Activation of beta-2 receptors stimulates the release of insulin from the pancreas. Insulin is a hormone that plays a crucial role in regulating blood sugar levels. It promotes the uptake of glucose by cells, inhibits glycogenolysis (breakdown of glycogen into glucose), and enhances the storage of glucose as glycogen in the liver and muscles. Therefore, the activation of beta-2 receptors leads to an increase in insulin secretion, which helps to lower blood sugar levels and maintain glucose homeostasis in the body.

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14. Ephedrine is a catecholamine.

True

False

Ephedrine is not a catecholamine. It is a sympathomimetic amine that acts as a decongestant and bronchodilator. Catecholamines, on the other hand, are a class of neurotransmitters that include dopamine, norepinephrine, and epinephrine.

Explanation

Ephedrine is not a catecholamine. It is a sympathomimetic amine that acts as a decongestant and bronchodilator. Catecholamines, on the other hand, are a class of neurotransmitters that include dopamine, norepinephrine, and epinephrine.

15. Match the following

Arterial vasodilator

Venous vasodilator

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16. Match the following dosages of dopamine with their effects.

Activate dopaminergic receptors

Beta-1 stimulation

Alpha-1 stimulation

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17. Both of the following drugs can be used for treatment of pheochromocytoma.

Phenoxybenzamine

Phentolamine

When using phentolamine - reflex tachycardia and postural hypotension limit the usefulness to the treatment of hypertension caused by excessive alpha stimulation (such as with pheochromocytoma)

Explanation

When using phentolamine - reflex tachycardia and postural hypotension limit the usefulness to the treatment of hypertension caused by excessive alpha stimulation (such as with pheochromocytoma)

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18. Match the following

0.2-0.7 mg/kg/hr

0.01-0.2 mg/kg/hr or 2-20 mcg/min

0.15-1 mcg/kg/min or 50-200 mcg/min

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19. All of the following describe phosphodiasterase inhibitors except:

Positive inotrope

Vasoconstrictor

Increase cAMP by preventing breakdown

Decrease SVR

Phosphodiesterase inhibitors have vasodilatory properties.

Explanation

Phosphodiesterase inhibitors have vasodilatory properties.

20. Match the following

CNS

Heart

Smooth muscle, glands

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21. _______ is to beta-blockade overdose as narcan is to opioid overdose. The likely mechanism of action is the increase of cAMP in the myocardium, in effect bypassing the beta-adrenergic second messenger system.

According to wikipedia ;)

Explanation

According to wikipedia ;)

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22. What is the preferred vasopressor for obstetric cases?

Ephedrine

Epinephrine

Norepinephrine

Phenylephrine

Does not decrease uterine blood flow.

Explanation

Does not decrease uterine blood flow.

23. The indirect affects of dopamine are due to the release of __________.

The indirect effects of dopamine are caused by the release of norepinephrine. Norepinephrine is a neurotransmitter that is released in response to dopamine. It plays a role in various physiological processes such as regulating blood pressure, heart rate, and mood. The release of norepinephrine can have an impact on the body and brain, leading to changes in arousal, attention, and overall functioning. Therefore, the release of norepinephrine is responsible for the indirect effects of dopamine.

Explanation

The indirect effects of dopamine are caused by the release of norepinephrine. Norepinephrine is a neurotransmitter that is released in response to dopamine. It plays a role in various physiological processes such as regulating blood pressure, heart rate, and mood. The release of norepinephrine can have an impact on the body and brain, leading to changes in arousal, attention, and overall functioning. Therefore, the release of norepinephrine is responsible for the indirect effects of dopamine.

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24. With patients on monoamine oxidase inhibitors, they should not receive ________ as norepinephrine is in abundance in the nerve cleft and administration can cause a hypertensive crisis

Patients on monoamine oxidase inhibitors should not receive ephedrine because it can cause a hypertensive crisis. This is because ephedrine increases the levels of norepinephrine in the nerve cleft, and since norepinephrine is already in abundance in patients on monoamine oxidase inhibitors, administering ephedrine can lead to a dangerous increase in blood pressure.

Explanation

Patients on monoamine oxidase inhibitors should not receive ephedrine because it can cause a hypertensive crisis. This is because ephedrine increases the levels of norepinephrine in the nerve cleft, and since norepinephrine is already in abundance in patients on monoamine oxidase inhibitors, administering ephedrine can lead to a dangerous increase in blood pressure.

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25. When using epinephrine, the B2 stimulation causes vasodilation of skeletal muscle and causes _________ diastolic blood pressure.

Epinephrine is a hormone that stimulates B2 receptors, leading to vasodilation of skeletal muscles. Vasodilation refers to the widening of blood vessels, which results in decreased resistance to blood flow. As a result, the diastolic blood pressure, which is the pressure in the arteries when the heart is at rest, is decreased. Therefore, when using epinephrine, the B2 stimulation causes a decrease in diastolic blood pressure.

Explanation

Epinephrine is a hormone that stimulates B2 receptors, leading to vasodilation of skeletal muscles. Vasodilation refers to the widening of blood vessels, which results in decreased resistance to blood flow. As a result, the diastolic blood pressure, which is the pressure in the arteries when the heart is at rest, is decreased. Therefore, when using epinephrine, the B2 stimulation causes a decrease in diastolic blood pressure.

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