Unit 3, Pharmacology (Chapters 13-17)

Neuromuscular Junction
the space between the motor neuron end plate and the muscle sole plate that neurotransmitters must cross

Endotracheal Intubation
the process of inserting a tube down into the trachea, or windpipe, to facilitate mechanical ventilation

a condition that causes eyelid muscles to droop

Nondepolarizing competitive blockers
drugs that compete with acetylcholine for binding sites

Diaphoresis (hyperhidrosis)
medical term for excessive sweating

a projection extending off the end of a motor neuron and is where the neurotransmitter acetylcholine is released

Peripheral-acting Muscle Relaxants
block nerve transmission between the motor end plate and skeletal muscle receptors

the portion of the membrane of muscle cells that receives messages transmitted by motor neurons

a fatal condition, characterized by continuous muscle spasm and is also known as “lockjaw”

Central-acting Muscle Relaxants
drugs that produce relaxation of muscles by central nervous system depression, blocking nerve transmission between the spinal cord and muscles

Botulinum Toxin
a poison produced by the bacterium Clostridium Botulinum, caused muscle paralysis

Anaphylactic Shock
an acute, life-threatening allergic reaction

Depolarizing Neuromuscular Blockers
produce sustained depolarization by causing acetylcholine receptor sites to convert to an inactive state

an enzyme that degrades acetylcholine and reverses acetylcholine-induced depolarization

Depolarizing neuromuscular blockers produce sustained depolarization by causing __________ receptor sites to convert to an inactive state.

Is NOT a symptom associated with anaphylactic shock.
***The following are associated with anaphylactic shock:
*Peripheral Vasodilation
*Laryngeal Edema
*Airway Obstruction

Botox injections are made from a substance derived from botulinum toxin that works by preventing nerve impulses from reaching the muscle.

High Alert
Neuromuscular blocking drugs are classified as ___________, by the Interdisciplinary Safe Medication Use Expert Committee of the United States Pharmacopeia.

A drug that reverses the effects of neuromuscular blocking agents.

Inadequate patient monitoring
Problem associated with neuromuscular blocking drugs is NOT attributed to the dispensing pharmacy.

Should always be placed on dispensed neuromuscular blocking drugs.

Short (10-90 minutes)
The onset of action of neuromuscular blocking drugs is rapid (1-4 minutes), and the duration of action __________?

Botox injections can cause all the flowing adverse reactions, droopy eyelid muscles, headache, muscle weakness, flulike syndrome, EXCEPT?

A drug that does NOT decrease acetylcholine release.

Acetylcholinesterase is an enzyme that reverses acetylcholine-induced depolarization by degrading acetylcholine?

(should bind to nicotinic)
Acetylcholine that is released from the nerve end plate binds to adrenergic receptor sites located in the muscle sole plate?

(should be hyperhidrosis)
Another name for diaphoresis is hypohidrosis?

The endings -curonium and -curium are commonly used for nondepolarizing neuromuscular blockers?

Look-alike packaging is a problem that can be attributed to drug manufacturers as well as to pharmacies dispensing drugs.

The neuromuscular junction is the space between the neuron endplate and receptor sites in the muscle cell.

ACh binding to nicotinic receptors opens sodium, calcium, and potassium channels, increasing the endplate potential.

Neuromuscular blocking drugs cause skeletal muscle relaxation by increasing the percent of ACh receptor sites that are inactivated.

Drugs that decrease ACh release or deplete the neuron of ACh also cause relaxation of muscles.

Botulinum toxins, magnesium, and high dose of ethanol
Examples of drugs or substances that decrease ACh release are?

Depolarizing neuromuscular drugs are agonists and nicotinic receptors

Neuromuscular blocking drugs are most commonly used in general anesthesia for endotracheal intubation to facilitate mechanical ventilation.

Drugs that reverse the effects of neuromuscular blockade must always be readily available anytime neuromuscular blocking drugs are administered.

Administration of neuromuscular __________ drugs leads to an increase in the percent of acetylcholine receptor sites that are inactivated and results in relaxation of skeletal muscles.

Most neuromuscular blocking drugs are poorly absorbed from the gastrointestinal tract so they are administered _________?

Neuromuscular drugs should be stored apart from other drugs.

persons who have ___________ are unable to metabolize the amino acid phenylalanine to tyrosine

a motor disorder that causes increased muscle tone, exaggerated tendon jerks, and hyperexictable muscles

Negative Symptoms
spasticity symptoms that can produce muscle weakness, decreased endurance, and reduction in the ability to make voluntary muscle movements.

Lower Motor Neurons
branch out from the spinal cord to the muscles and tissues of the body

Cerebral Palsy
is neurological disorder that affects the muscle movement and coordination

Positive Symptoms
spasticity symptoms that cause muscle spasms and hyperexictable reflexes

Upper Motor Neurons
neurons that carry messages from the brain down to the spinal cord

Multiple Sclerosis
an autoimmune disease that causes progressive damage to nerves resulting in spasticity, pain, mood changes, and other physical symptoms

involuntary rhythmic muscle contraction that causes the feet and wrists to involuntarily flex and relax

Amyotrophic Lateral Sclerosis (ALS)
also known as Lou Gehrig’s disease

the contracting unit of muscle fibers

ALS is a degenerative disease that causes muscle wasting and weakness?

Botulinum toxins type A and B are used for the treatment of _________ and cervical dystonia.

Hot Packs (thermal therapy)
Nonpharmacological management of spasticity includes all the following: transcutaneous electrical stimulations (TENS), cold packs (cryotherapy), biofeedback, physical therapy EXCEPT?

Drug used for the treatment of muscle strain.

Medical condition NOT associated with spasticity.
**The following conditions ARE associated with spasticity
*Spinal cord injury
*Cerebral palsy
*Head Injury

After a spinal cord injury, spasticity develops because the body grows new synapses, resulting in a stronger reflex response

Peripherally acting skeletal muscle relaxants act at the neuromuscular junction.

Dantrolene is a peripherally acting skeletal muscle relaxant.

(acts as a electrical insulator and increases the velocity of impulse transmission)
The myelin sheath around neurons acts as an electrical conductor and slows the velocity of impulse transmissions?

Skeletal muscle relaxants should be used along with nonpharmaceutical therapies such as rest, exercise, cryotherapy, and physical therapy?

(4 phases)
There are five phases in the development of spasticity?

Drugs used in the treatment of spasticity are classified as centrally acting and peripherally acting drugs.

(Acts like GABA)
Baclofen is a centrally acting drug that looks and acts like 5-hydroxytryptamine (5-HT), a naturally occurring neurotransmitter

Four phases to development of spasticity:
1. decreased muscle contractility
2. excessive muscle tone and increased reflex activity lasting from days to years
3. decreased reflex excitability
4. stiff, contracted muscles

Spasticity impairs effective muscle movement in some people and helps maintain posture, making walking easier in other people.

Drugs used in the treatment of spasticity are grouped according to the site of action and are classified as central acting and peripheral acting.

Central-acting drugs primarily act on GABA receptors in the CNS or act at a2-adrenergic receptor sites.

The ability of baclofen to cross the blood-brain barrier is limited. Its effectiveness is augmented by direct administration into CSF via surgically implanted pump (intrathecally)

Skeletal muscle relaxants are used to treat muscle stiffness, pain, and spasms associated with muscle tension, strain, sprains, or injury.

People who have amyotrophic lateral sclerosis exhibit predominantly __________ symptoms?

GABAb, receptors
The mechanisms of action for drugs used to treat spasticity is to directly bind to or enhance the binding of?

12 weeks
The effect of botulinum toxins in reducing spasticity lasts up to ?

the most commonly used benzodiazepine for the treatment of spasticity and it is effective in treating hyperactive reflexes and painful muscle spasms

Orange, reddish purple
Chlorzoxazone (Paraforon forte) discolors urine to what colors?

The brand name for cyclobenzaprine ?

**Interferons are a group of signaling proteins made and released by host cells in response to the presence of several pathogens, such as viruses, bacteria, parasites, and also tumor cells
enhance T-cell recognition of antigens and produce immune system suppression

the fatty covering insulating nerve cells in the brain and spinal cord

an autoimmune disease that causes chronic inflammation of the muscles

damage caused by recurrent inflammation of myelin and results in nervous system scars that interrupt communication between the nerves and the rest of the body.

Rheumatoid Arthritis
chronic disease characterized by inflammation of the joints

Autoimmune disease
disease that occurs when the immune system turn against the parts of the body it is designed to protect

Tumor Necrosis Factor
( cell signaling protein (cytokine) involved in systemic inflammation)
found in the synovial fluid of people with rheumatoid arthritis

Myelin Basic Protein
can be detected in the cerebrospinal fluid of people with multiple sclerosis

Antinuclear Antibody
an abnormal antibody that attacks the nucleus of normal cells in the body

Systemic Lupus Erythematosus
an autoimmune disease that affects nearly all body systems

Myasthenia Gravis
an autoimmune disease in which muscle cells are attacked at the neuromuscular junction, causing muscle weakness

an autoimmune disease in which muscle cells are attacked at the neuromuscular junction, causing muscle weakness

are patch areas of inflammation and demyelination that disrupt nerve signals between the brain and the rest of the body

Multiple Sclerosis
an autoimmune disease that causes progressive damage to nerves, resulting in spasticity, pain, and other physical symptoms and mood changes

used to describe an abnormal antibody that attacks heathy cells and tissues

refers to a condition in which the muscles fail to function in a coordinated manner

a form of myositis that affects multiple muscles, mainly muscles closest to the trunk

Warning label that should NOT be applied to prescriptions for cyclosporine oral solution

12 hours
Cyclosporine parenteral solution is stable for __________ in normal saline glass bottles

Mitoxantrone must be disposed of in the cytotoxic waste containers (including intravenous bags, sets, and tubing and gloves)

Grave’s Disease is an autoimmune disorder that does NOT affect the muscles.

Suppressing inflammation, suppressing pain, suppressing the immune system response
Treatment goals of current drug therapy for autoimmune diseases affecting the musculoskeletal system.

Biological response modifiers interfere with the activity of cytokines, leukocytes, B cells, and T cells

Rheumatoid Arthritis
Gold compounds are used in the treatment of?

(reduces flare ups)
Drugs used for the treatment of multiple sclerosis.

Drugs used for the treatment of Rheumatoid Arthritis.

Dermatomyositis affects the muscles of the trunk?

Polymyositis is a form of myositis that affects multiple muscles, particularly the muscles closest to the trunk.

(gently swirling, not shaking)
The reconstituted solution of azathioprine must be shaken well?

Cycloporine oral solution should be dispensed in a glass container.

RH is far more common in men then women

Celecoxib (Celebrex) is the only selective COX-2 inhibitor still available for use in the United States and Canada
**NSAID used to treat pain or inflammation

Drug therapy for autoimmune diseases affecting the musculoskeletal system is aimed at suppressing inflammation, pain, and immune system response. Treatment goals are also aimed at minimizing further nerve or joint destruction, preservation of body functions and prevention of disability.

Glucocorticosteroids are prescribed to suppress inflammation, reduce flare-ups, and treat pain.

Glucocorticosteroids have immunosuppressive actions and they inhibit the synthesis of antibodies that are responsible for attacking the body’s healthy cells.

NSAID’s and aspirin are widely used in the treatment of pain and inflammation

Tumor Necrosis Factor (TNF) inhibitors are genetically engineered drugs that block the inflammatory process triggered by high concentrations of TFN

In myasthenia gravis, the body attacks and destroys receptor sites in the neuromuscular junction that bind_________?

(chemicals that promote inflammation, pain, and fever)
Aspirin and NSAIDs inhibit the release and block the activity of__________?

Drug indicated for the treatment of active RA, ankylosing spondylitis, and chronic plaque psoriasis.

is a chronic, progressive disease of bone characterized by loss of bone density and increased risk for fractures

Bone Mineral Density
measures the degree of bone loss

used to describe the dissolution or degradation of bone

used to describe the process of continual turnover of bone

decreased bone mineral density and is a precursor of osteoporosis

Bone resorption
process by which bone is broken down to mineral ions (calcium)

are cells responsible for bone formation, deposition, and mineralization of the collagen

cells responsible for bone resorption (breaking down the tissue in bones and release the minerals)

1 in 2
The lifetime risk for fractures in women over 50 years of age is?

Coughs, sneezes
In a person with osteoporosis, a fragility fracture may occur when the person?

A drug that may cause osteoporosis is?

The percentage of total body calcium located in the skeleton is?

Which hormone is NOT involved in the regulation of serum calcium levels?
***The following drugs are:
*Parathyroid hormone
*Vitamin D

Vitamin A
A program for the prevention and treatment of osteoporosis includes all of the following except?

Which drug must be taken on an empty stomach at least 30 minutes before the first meal or beverage of the day?

Patients taking Didronel and Aredia must sit upright or stand for at least __________ minutes after dosing to avoid possible esophageal ulceration?

Calcium Carbonate
Calcium supplement that contains the highest percentage of elemental calcium per tablet?

The use of teriparatide, a genetically engineered form of human parathyroid hormone and the only drug currently available in this category, is limited because of risks for?

The rate of bone loss for men and women is equal after age 65 to 70 years?

Hormones linked to the regulation of bone formation and bone loss are estrogen, progesterone, and luteinizing hormone?

Paget’s disease is characterized by insufficient bone resorption?

Paget’s disease is most common in women older then 55 years?

Secondary osteoporosis may be caused by disease of drugs?

Glucocorticoids use can cause osteoporosis?

Pharmacological agents used in the treatment of osteoporosis or Paget’s disease are categorized as antiresorptive (inhibit bone resorption or bone remodeling) or anabolic (promote bone formation)
**Antiresorptive drugs can reduce further bone loss and slow down disease progression
**Most drug treatments for osteoporosis work by slowing down the activity of the cells that break down old bone (osteoclasts). These are known as ‘antiresorptive’ drugs. Some treatments stimulate the cells that build new bone (osteoblasts). These are known as ‘anabolic’ drugs

Bisphosphonates, calcitonin, SERMs, and estrogen are antiresorptive agents

Increase, Reduce
The goals of osteoporosis treatment is to ___________ bone density and to ___________ risks for future fractures.

The majority of drugs used to treat osteoporosis and Paget’s disease are __________ agents

a selective estrogen receptor modulator (SERM) indicated for the treatment and prevention of osteoporosis in postmenopausal women and prevents further destruction of bone architecture?

hormone replacement therapy is the first-line therapy for the prevention of osteoporosis because of the increased risk for coronary heart disease, stroke, thromboembolism, and breast and uterine cancer?

a product of purine metabolism that produces inflammation

a drug that increases the renal clearance of urates

a disease associated with deposits of urate crystals in the joints

a condition in which urate levels build up in the blood serum

one of the two nitrogen-containing bases found in DNA and RNA

Deposits of uric acid are called?

Drug that would NOT be prescribed for the treatment of gout.

Drug that blocks the final enzymatic step in the production of uric acid.

Nausea and vomiting
Common side effect of colchicine?

Analgesics, anti-inflammatories, uricosuric and inhibitors of uric acid syntheses
Drugs prescribed for the treatment of gout include?

Shellfish and bacon are high in purines?

(cetirizine hydrochloride)
The brand name of allopurinol is Zyrtec

Probenecid and allopurinol should be taken on an empty stomach?

a uricosuric is a drug that decreases the renal clearance of urates?

The principal anti-inflammatory used in the treatment of gout is colchicine?

A uricosuric is a drug that increases the renal clearance of urate crystals

NSAIDS and glucocorticosteriods are used to reduce pain and inflammation in gout

Most commonly prescribed NSAID for gout is ?

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Acetylcholine (ACh) A neurotransmitter that binds to ACh receptors on the membranes of muscle cells, beginning a process that ultimately results in muscle contraction. Cyclooxygenase-2 (COX-2) An enzyme that is present in the synovial fluid of arthritis patients and is …

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