Okay folks are welcome back good to have you back in class
Of course no surprises on my end or going to pick up right where we left off on Saturday night so if you're following along with me
848 let me just go back and kind of recap where we were so as we finished up the night on Saturday night we were talking about
Patient and I told you to start tonight with it so let me just remind you that your step 1 exam gloves acetylcholinesterase
Right I love these drugs are multiple multiple choice questions so what we finished up the other night with was this we finished
Drug Emporium neostigmine and I really hope we have a role in myasthenia gravis and I've shown you a clinical vignette related to
As an antidote Atropine overdose in the distinguishing characteristic of this drug is the fact of being a tertiary mean it's very
Can you get into the Central and the peripheral effects of atropine so that's pretty much as far as we have gotten a whole weekend
Talking about the next drug is the drug test 4848 both of these are very lipid soluble drugs can be used in Alzheimer
Both computers WGRZ this table that really describes Alzheimer's disease for you and I would say that you guys are fairly familiar with all timers disease
Entangles is part of the characteristics of this disease I don't remember this when it comes to our Primary Therapy for treating
Alzheimer's the primary therapy is this we want to raise the levels of the:
Individuals of all timers disease are losing cholinergic neurons so these folks have low levels of a single Primary Therapy used to give drugs
Level
Restrooms also mentioned can be used as well as an nmda receptor blocker and nmda receptor for glutamate that's true that isn't
Absolutely
Now we go to the last part of this table the very last part of his table involves organophosphate so here it is always a question
We love to ask questions about organophosphate to let me tell you one of the reasons why these these drugs are irreversible
The only drugs and irreversible so every other drugs from him down to real estate need all of these drugs are reversible inhibitors
Once again use your hands to creative visual imagine that this is the enzyme acetylcholinesterase is there to break down a single
Virginia Legal organophosphate will do this they will bind to the enzyme but it's reversible so then I let go and the enzyme can
Put the mail in the enzyme continues to work that's an organophosphate going to do as an irreversible and it's going to be
Informal very strong covalent bond that bond is very very difficult to break clearly that means the organophosphate two or more
There are more dangerous group because of this irreversibility it also means we're going to have to use an additional antidote
Focus on here are like malathion and purify on and also nerve gas is an example of that would be sarin nerve gas
A question on the board about
Neostigmine overdose take me to 411 Highway Alias or urine retention the reason I didn't highlight those two things is because I would
Mechanical Woodwork and have fewer side effects than me or Pirates evening so the two main things that I would use those drugs
Are indicated here by my highlights on my underwear
3047 Hibert I put on there always are
Not too serious think about two scenarios obviously with insecticides it could be the farmer right are you ready for the farmer Quest
Christianbook.com
37 year old working in the crop duster flies over and dumps out a bunch of insecticide so if you get insecticide poisoning think about that
Phosphate poisoning very very dangerous the other scenario because of the gas situation would be the soldier in the field
The soldier in the field who might get exposed to their guests so certain you got to be where either of those types of things
The question how are you going to know how are you going to know what does patient is going to look like how did they prevent that
So how is this patient going to proceed with this organophosphate poisoning if you look in the margin on page 48 looking to bottom
Mnemonic called dumbbells
Dumbbell first of all it's a mnemonic that you absolutely have to practice spelling you have to practice spelling if you read through
Dr.
What happens to assets which is about like trying to spell the word bills and doubling everything that you're not supposed to double
So two days to East 100 and then to SS to go through this together to go through everything except what you're supposed to
Which means don't ee ee ee
Double Dash certainly
So you should be able to do this for 9 a.m. to 7
Be able to name the receptor okay so first of all what are the symptoms of diarrhea
You want receptor that is diarrhea is from excessive stimulation of what receptor that would be in three urination urination
Urination is M3 very good meiosis What receptor is that
Meiosis is going to be pupils are going to constrict M3 now if you're saying anyone let me clear that up right now if you're saying
Does she think about him wanting to bring remember the autonomic nervous system so if its innervated by autonomic it's almost
The rest of the CNS is most commonly going to
Bronchoconstriction what receptor is going to be the 8th bronchoconstriction
That's going to affect you starting to figure out if you're not sure so um 3 you're probably going to be right but be careful
What is bradycardia what receptor is that Bacardi is the cardia is a very good now it's the fact that these guys have an effect
Look up the GI system to see if we have in one receptors that could contribute it might be a mixture of M1 and M3 might be a little bit of
Okay now I'm going to skip a citation just for a minute we'll come back to that how about lacrimation lacrimation what receptor
Lacrimation is M3 lacrimation is m 3 salvation
Salvation is M3
Sweating sweating is
Also M3 also M3
Also went through so a couple of things that you can do you can certainly go back to page 40 and look at that wonderful diagram
We go back to page 46 and look at the table with the receptors there now the only thing that is sympathetic on this diagram
What is sympathetic in this list is sweating sweating is a sympathetic pathway but it's mediated by muscarinic receptors
What is part of an increased level of the ceiling
Let's go back to a citation for a moment excitation is really really special
Excitation of muscle of skeletal muscle
Excitation of skeletal muscle what receptor is that
You increase acetylcholine at the neuromuscular Junction you're going to activate and Sub in receptors your neck to make that a new room
Wreck in Savannah
You're also going to get some excitation of the CNS can you tell me to receptors that that might involve
Excitation of the CNS might be to work that would be in one what's the other one the other would-be nicotinic
Remember we're raising the level it's got to be a cholinergic receptor
How many senses do you notice do you notice an excitation is very special excitation involves both muscarinic and nicotinic
Air Force Base or somewhere nice for you down towards the bottom of the page in the top of the next page
I will tell you this I will tell you that you don't need to worry so much about this particular diagram what it does show you as
Show me why these insecticides are a little bit more active are certainly a lot more active in insects compared to humans so the fact that
456 activate these drugs it happens very fast and very slow and humans
And of course to break these things down as also be 450 pathway that happens very fast enough but very slow and insects showing you that there
Toxic for insects that's true however if you get the farmer in the field he's out there working and he gets exposed to a large
Insecticide if you a large quantity he's going to get done doesn't matter how fast is p450 enzymes are
Bottom of 48 Tahoe 49
You'll notice there's 2 different muscarinic effects and there's the nicotinic effects
But those are things we just went over the world want to go to next it how do you treat these people some of you are too kind of
How do you treat these folks have been exposed to an organophosphate of course after painting can be very important after pain is gone
It isn't going to block most of the symptoms of dumbbells okay here's a question for you tell me which letter tell me which letter
This is not going to be blocked by atropine atropine doesn't stop everything tell me something it doesn't stop about done
Well if it's a message that's mediated by muscarinic receptors it'll stop at if it's sweating that's muscarinic I'll be stopped by
Nicotinic nothing like an extension of skeletal muscle or even a citation neither of those are going to be stopped by a
Atropine won't stop everything else because it's a block of M1 M2 and M3
So importantly it won't stop the skeletal muscle excitation because the question is really this what part of dumbbells will kill you
What part of dumbbells is fatal well you might look at some parts of it and go to some parts of it scared me a little bit
Really scares me bronchoconstriction scares me but how about skeletal muscle paralysis check out my note down here at the bottom
Insecticide gases permanently
I have an important muscle called the diaphragm you keep stimulating that diaphragm diagram
Diaphragm becomes paralyzed that stops breathing
And that causes death here's the important note as you're getting that down here is the important of the cause of death is near
Is most often paralysis of the diaphragm which is skeletal muscle in Savannah
So doesn't it make sense that actually being all by itself atropine all by itself is not going to stop that
How to stop a lot of the symptoms but not the effect on skeletal muscle so we need a second antidote we need a second hand
Go to call Pradaxa
Wii Pro Boxing phone number a scam or is this truck going to do okay guys watch the screen
So here's my enzyme remover restoration breaking down acetylcholine which one of these nerve gases are insecticides going to do
Irreversibly bind to it right covalent bond
What is the special talent that production has one
Free waxing can break that Bond reduction can break the bond between the nerve gas in the inside and guess what happens to the end
Now it works again you see that it works once again and that's why we call Prima nocta
That's the time that we use we call it a regenerator
So hopefully what it's going to do is remove the drug from the inside and then it's going to work
It is not going to happen
The nerve gas for insecticide know what's going to happen and all of your symptoms go away
So you have to be able to give these notes quickly and there's also
It's changed
So watch out for that watch out for that it's got to be given before aging takes place so the question of how quickly does age
Depends on the gas the meaning of these things take hours and hours and hours maybe 6 to 8 hours
Maybe even longer but some of the nerve gases that are used today minutes in a matter of minutes so aging is very very significant
You got one more time when are you going back up
Where are you going to use one of those what are you going to use atropine and pralidoxime
The answer is irreversible organophosphate if you've been exposed to one of these organophosphate insecticides or nerve gases
Are you as you're headed up once again you need trailer boxing
Especially
Does insulin receptors
But you have to give this and of those combination
If possible or else aging Wilton Place
That's why folks if you're a soldier you're a soldier in the field and you think that you get exposed to a nerve gas you want to use you
Very quickly as possible because maybe you're pretty far away from a care facility and will you want to use your antidote just
Great that's exactly right was posted on the board is exactly right for irreversible nerve gases are insecticides and before that
Absolutely right that was ever seen the movie called The Rock The Rock has Nicolas Cage and Sean Connery in it if you've never seen
I need to find that movie you need to watch it if you watch that movie you're actually studying pharmacology right and it hurts
How do I add Harris was in that as well and he was kind of on the other side right now the whole premise behind that movie
The whole premise behind the movie The Rock was this that bad
Nerve gases and they have these little containers right let me just tell you my favorite thing in the whole movie
Kay Jewelers one of our heroes Nicolas Cage picks up one of these containers and it puts it into bad guys mouth pop him in the mouth and
Explode all over this guy's face
So funny about that I was experiencing dumbbells right they showed me her phone when at the mouth and everything but I got to say it
Well it didn't show that though but you know if you seen the movie you know that are here I was about this far away in the movie
Nicolas Cage's only about this far away from this guy he was getting those as well but they didn't show that they don't show
The pants because that doesn't make for a very good hero right but what they did show was this nation Nicolas Cage pulling out his
What did Nicholas Cage do with his surroundings when he did go straight to the heart
The hard way you gotta have good aim if you're going to go straight to the heart right now that's what I call a Hollywood movie
That's what Hollywood does with there and go straight to the heart let me show you guys a different movie already watch this right here
It works you don't have to worry about any quite as much you could try to call Hollywood which one of those you want to try
Locate Nicolas Cage got these loans and things right
Pretty impressive
Absolutely
Atropine and pralidoxime atropine and pralidoxime
Supposed to be you want to stop any kind of absorption of that drug so if it's on your clothes absolutely that's just good standard
The clock tower the mall
That way if it's irreversible there's a risk of death
The bottom of page 49 talk about must have lockers
Walker's very important group of drugs atropine is the Prototype intravenous the Prototype is a tertiary amine you guys know what that
As a cashier you mean it's going to enter the CNS is going to go everywhere
You might also know that a scorpion is a plant derived compound
BaByliss mini people by the way who who buy into the whole natural is better natural is safe you guys heard this right people are going to
Natural medicines are safe okay so let me remind you that atropine is natural atropine comes from belladonna plant
And we called a Belladonna alkaloid
Belladonna means beautiful centuries ago we thought if we let women eat plants that contain atropine look at these big dilated pupils
Man she looks beautiful she looks beautiful that is a beautiful woman and she couldn't read anything she can't read a thing
She looks good I'm going to tell you right now she look good
Kids eating
Logos that some Crazy Mocha
Wonderful wonderful
You don't need to memorize this list
You are going to do
And also
Somebody
30 minutes
Pages just think about it with me okay let's just think about it for a second so don't worry about the cover art are drugs that
Blocking properties muscarinic blockers but there are other types of drugs for antipsychotics
Any of these drugs because they have autonomic side effects
Their favourites for the test so this was right here in the middle of the page
Antihistamines antihistamines were talking about first generation antihistamines
We're talking about pretty much most of those over-the-counter antihistamines MO
Restoration you tell the difference likely to make you drowsy and sleepy first generation drugs also block muscarinic receptor
Next right that's right I can hire me
Mexican tca's tricyclic
Hey you guys remember to see a really really safe drugs anybody really a safe group of drugs no that's really one of the most day
Side effects cardiotoxicity
What are the side effects of a TCA
Cardiotoxicity what's one of the ways they can be cardiotoxic block muscarinic receptors if you block muscarinic receptors
You can increase the heart rate by the way there are four ways that they can be cardiotoxic come back for that and we'll talk about
He was one of the ways they're cardiotoxic
Not going to increase your risk for arrhythmias
Next antipsychotics mean
Many of these antipsychotics
Block muscarinic receptors many of them can block muscarinic receptors
What about what a wonderful drug this is quinidine an antiarrhythmic
What causes arrhythmias you gotta love that
One of the ways
Quinidine causes arrhythmias is it by blocking muscarinic receptors you're going to increase the heart rate once again not a good thing
The way we get the corner game tomorrow night we get the corner they were going to do an exercise called why I never want to use Quinn
We're going to that why I never want to use quantity what a wonderful thing to talk about come back tomorrow night we're going to do
The corsairs amantadine amantadine is sometimes used in Parkinson's disease
What are the reasons that you say is that block
Finally
Parody
A parody is an Open Door parody is it okay if you know what I call it I call it the oddballs I hope you it's the one that's different
Especially when it comes to what the drugs do to smooth muscle appear then does the opposite the smooth muscle you know what does the
Review it because it was going to cause pinpoint pupils but not the parody of blocks muscarinic receptors so when you see a note
The smooth muscle that is not here and it's the one that's different
How would your patient present
How's your patient presented let you know that they have muscarinic walking side effects well they might experience mydriasis
Tachycardia
Hey some of your mouth that's nothing no that's something that's probably the answer to the test question
People complain of dry mouth people complain of dry mouth they have difficulty with saliva production and dry mouth decreased
Dry mouth really problems but you can certainly get more problems with your teeth more prone to cavities and it is a common complaint
Next to you really important who cares you care cuz it's on the test
We're going tomorrow
The patterns
So
Ganglion blockers to talk about make sure you understand we're going to talk about the clinical significance of meconium
Megamind and is rarely used in severe hypertension the reason why we talk about them if they show up in test questions
You're asked to identify the drug your ass what is this truck in the ganglion block her could help you because that's right ganglion
So if I put one on the test is the higher chance it is going to be making my love me
Maybe they just simply say William Walker
Atracurium is not a ganglion block or atracurium UNC
Saudi
Take a look at this table follow my advice this table not important to sit down and try to memorize it you don't even have to try to
You know because you follow couple of basic rules you already know this table if I ask you this question look at all of the Oregon
Google Domino's to me
Because you know the rules parasympathetics dominate
Blood vessels and sweat glands don't you already know that blood vessels and sweat glands are only interviewed by sympathetic half
How do you know what a ganglion water is going to do this
Ganglion blocker will do.
Of the dominant parasympathetics dominate the heart
Parasympathetic cause bradycardia ganglion blockers do the opposite they cause tachycardia
Parasympathetic dominance causing pupil constriction ganglion blockers do the opposite ganglion blockers block the dominant sis
What's going to happen to your blood vessels sympathetic dominate blue
Alpha 1 receptors having sympathetics one of vasoconstriction
What's a ganglion blocker going to do this or dilate
Once again you don't need to memorize this table in fact you don't even probably need to use this table not the most important thing
Despite the most important thing but I went over it just so you can see exactly what I would do just don't think that's the basis for the test
I think this thing can be very very helpful for you
This cartoon can be very helpful because you can use this cartoon to actually solve some of these cardiovascular Trace problems
Just got the part and it's got your autonomic nervous system here
So you give somebody a drug test today so constrictor when you Vaso constrict CPR and blood pressure go up when keep your blood pressure go
The receptors are going to their going to tell the parasympathetic nervous system to Fire and you get a reflex bradycardia
Cardio if you give somebody a vasoconstrictor
Now what if you use a ganglion blocker ganglion blockers are going to block you and hear you. Your reflexes
And then I give them the best constrict blood pressure go up but I get no reflex Brady you see that I'm blocked right here so much
And that kills me this was an unknown and not directly on the heart
Okay now I want to give you a problem to solve this thing okay so here's what happened the blood pressure went down
And the heart rate went up so when I gave the drug the blood pressure went down and the heart rate went up
Experiment number to experiment number two
We pre-treated
Preaching with a ganglion blocker
And then we observe when we gave you I guess the blood pressure went down
And the heart rate didn't change
The blood pressure went down in the heart rate didn't change what receptor or receptors do you think that drug works on and let's drink
Think about Agatha Falon what receptor do you think that drug works on
So the blood pressure went down so that's vasodilation vasodilation is beta 2 that's beta 2
Now in the first experiment we saw that the heart rate went up
But we gave the ganglia blocker is a pre-treatment
Change was permit was no change in the heart rate so the ganglia blocker blocker reflex the heart rate change because of a reef
Guardian
Get my Droid X work directly on the heart and did not my Droid not work correctly on the heart so it doesn't it doesn't stay
Directly only stimulate beta 2
Once again we're going to do more problems but I wanted to show you these types of problems on the hard ones on the heart and the JJ
Are some receptors in the CNS
Okay thanks looks to me like we finish the chapter I think this is a good place to ask for us to do a few practice questions to finish
What's your practice questions to get there get your pot
And let you go and I got three questions for you he was number one
Okay few more seconds on this question if you haven't voted yet
Okay so let's discuss now looking at drug based questions
Want to give you a strategy that you should use every time you read a question that deals with the drug you can watch what I'm going to do here
Read the question that's why I typically effective dose of atropine stop classified that drug stop and classify that drunk
Walker atropine is a muscarinic blocker muscarinic receptor antagonist
Is given to a patient poisoned by malathion okay stop what type of drug is malathion you might say acetylcholinesterase inhibitor
Can you tell me more about it it's an organophosphate and specifically it's an irreversible acetylcholinesterase
Reversible correct
Questions to know
Over activated even after you give atropine the key is to remember acetylcholinesterase Inhibitors blocking your going to rain
Activate cholinergic receptors in all nicotinic receptors correct almost there anything on nicotinic
Atropine only stops the muscarinic part it does not stop the nicotinic side isn't this question really asking this which of the
Is nicotinic which of these is the one that is nicotinic
Skeletal muscle skeletal muscle
77% pretty strong response for the first question tonight remember that it's Mom's heart salivary glands are all
Is malathion by the way is malathion going to do anything to your vascular smooth muscle
Rco cholinesterase Inhibitors going to affect those to him threes on blood vessels
They are not they are not those in threes on blood vessels are not innervated malathion does nothing there
Okay thanks good job on that one question number 2
Okay
Okay last chance if you haven't voted
So once again patients overdose with atropine muscarinic blocker and Pyrrha no Stigma of reversible acetylcholinesterase
This wasn't so much about what type of drug is remembering a specific property of this drug because I really did mean for folks Maybe
Pyretos to meet her maybe you call a pyro stick mean by roasting meat is a quaternary amine it only stays down below it's the fire in your bed
The fire somewhere else on a bad day but certainly it doesn't get into that it doesn't get into that is the correct answer
Quaternary Amine
Hydrolock Imodium
Positive charge an extra dose take me to neostigmine are always positively charged or always on so that's why they're very very
So quickly and I understand because you keep clams have to be the answer to some question sweat glands are so special they have to be there
Just thinking about the right answer but you know about those guys for sure
One more question for you
Challenge
Okay
Okay everyone welcome back so now we're going to be over on page 55 so I'm going to work after all adrenergic pharmacology
The first thing we talk about is how do you synthesize norepinephrine and then once it's released what are all the things
When it finally we're all the drugs that can work on this diagram
Look at this picture in quite some time there are a lot of drugs that work on this diagram so this is definitely worth your time
What start with the synthesis of norepinephrine and epinephrine of course you know that I receive the conversion of tyrosine
Nova aliens on tyrosine hydroxylase that is the rate-limiting step
And I believe that if you study by doing a compare and contrast that is a fantastic way to study so let's do a comparison
The conversion of tyrosine to Dover is the rate-limiting step
Tell me what the rate-limiting step is
What happens to people when they study all the time I think you study this diagram and you go okay so the rate-limiting step for me
What is the conversion of tyrosine dopa okay good and then you go and remember what the rate-limiting step for a suit
I don't I know I should go back and look but I'm not going to do that so that's terrible that's terrible you should go back and look
Remember
Decarboxylase convert Stone into dopamine
Inside your storage baskets with this big box is trying to show you
Converted into
Sundance toward norepinephrine and epinephrine is going to stay
We're going to talk about the things that happened to the Post
I didn't say that was the critical reason why
You should be able to predict
Different drugs
First
There's a. of
What is free in the cytoplasm
It's what we call the mobile pool it's on its way back to the vesicle but as part of its Journey Back to the vesicle here's Ma
Capitalize
So what's the job of a monoamine oxidase inhibitor monoamine oxidase inhibitor by blocking those are you going to say more
Mason end of the vesicle if more norepinephrine mortgage relief
Mechanism number two would be for amphetamines
No amphetamines if you look at your metabolism is part of the movie released from the
Cocaine TCS
Cocaine
Shutdown
Surfing destroys the vesicle when you destroy the vessel you deplete the neurotransmitter
And finally number for going after the blocks exocytosis exocytosis so I can spit it out and therefore norepinephrine vesicles don't
Remember
What does the comment there about 1
Water intake was going to block the release of those two mechanisms what kind of the photos each other they would actually work again
So there are mechanisms there's the ones that are going to increase more if he and the synapse and certainly those that are going to be
Look at all the different drugs hey folks I noticed this every single one of these drugs and one way or another it's actually work
Adrenergic nerves a lot of drugs that work directly on receptors look at how many drugs are actually working on the nerve cell
Miguel driving can act like a really nice as well
Alright so we got $55 57
Next to ask Max about the Androgen receptors what we're going to start with the alpha receptors now let me tell you lots of information
Of course the more you know the better you can do let me help you focus on something specifically that show up on your test
Isn't that the way that you got to be looking at this material what am I most likely going to see and you have to be prepared for that
And second what are some other things that can show up on the test so you weren't trying to prioritize here okay so what do I know
Alpha 1 receptors three things
First ones are in the eye
Alpha ones are found on the radio muscle stimulator for once I'm going to contracted muscle but that causes people die
Dresses
Now to help is not to be such a pure memorization exercise we don't want to do that we want to think about it we were thinking about
Do with that information so we love you and we remember that alpha 1 receptors are found on the radio muscle and then cause my dryer
Think about it
If you use an alpha 1 Agonist if you use an alpha 1 Agonist you could use those types of drugs for a dilated eye exam
Absolutely right
At this point you should be able to say this you should be able to talk about the two types of drugs that you're going to use for
Name the two types of drugs you're going to use for a dilated eye exam so there's going to be a muscarinic blocker
And there's also going to be alpha 1 Agonist
Dr. Walker Alpha
If you got a little something to talk about if you're a visual learner you should call yourself a picture of an eye drawn
Factors of 3/1
You want to block the M3 you want to stimulate the off of 1 if your goal is pupil dilation exam
Organ number 2
Blood vessels blood vessels arterioles and veins have alpha 1 receptors in both cases you're going to be so constrict both cases are going
Going to cut out a few months ago Alpha ones are GQ couple
They're GQ so you expect me to muscle to constrict exactly right the radio muscle contraction smooth muscle constrictor
So what would an alpha 1 Agonist
Low blood pressure and Alpha One to
Going to rain this is going to raise your blood pressure
Hypertension hypertension what type of way about what you can do with that information on the blood do with that information
Are you ready number 3
You must know the ones are also found in the prostatic urethra
They're found on the prostatic urethra now why would I emphasize that specifically well what condition might you be thinking of
And that's right is BPH that's why I want you to think about this particular location so if I stimulate out for once I'm going to come
So get your attention
What do I want to do with BPH treatment
I want to use an alpha-1 antagonist
What are going to relax the smooth muscle increased urination but hey if you see that it is tell me what type of drug would be really bad
With BPH
Tell me what type of drug is bad for somebody with BPH
Absolutely right when I get it bad for somebody with BPH what is the preferred drug in the condition you could study the office
Indication of high blood vessels in prostate and in just blindly wearing those things think about the clinical utility and the side effects
Male sex organs liver
For the test for the first three are the most likely
When it comes to Alpha two places I'm going to focus on is really really important we already talked about it it's the fact that healthy
Alpha 2 is the negative feedback receptor found on presynaptic nerve they're going to decrease the release of norepinephrine
Accommodation
Call later on tonight so hang on and we'll discuss that in more detail
Negative feedback receptor decreasing transmitter release second place on the pancreas Alpha choose on the pancreas to found on the beach
Insulin secretion
Let me emphasize the Alpha 2 receptor is the major adrenergic receptor found on beta cells
By far and away it's the one that has is the most numerous so lots of altitude on beta cells of the pancreas
Okay so two places presynaptic nerves and pancreas for altitude
The same table I'm just going to move it up a little bit so we can look at the bed is a little bit better
What's going on
The ones on the heart you would say I know that I think one of the first things you learn in medical school and you might wear the phrase
8201 heart to God it beta 1 beta 2
Where in the heart feels better ones are found a really highly concentrated in a very concentrated in the SI system
Positive inotropic effect as well so it's going to
Don't forget I also found on the ga
Question example
What drug can specifically inhibit sympathetic induced
So don't forget
Pretty predictable what is going to happen it's going to happen
Skeletal muscles have lots of
Think about this situation
Fireflight you want to dilate the vessels to the organs that need that blood like skeletal muscle so what do your skeletal muscle
Lots of lots and lots of beta choose the heart need a lot of water what about most of the internet do you want to do today
What does constrict the blood going to your GI tract during fight or flight
You think about yourself I'm just curious
Fight on a daily basis the traffic is that your biggest fight in the day is it with traffic I don't I don't know what to study and every day
Did you wash nice okay so you find all kinds of things that that's nice you got all kinds of things that you fight 3 Doors Down from me
Black bear come up again
Black bears in Eastern Kentucky to say we have like a herd of black bears out in the yard or anything like that but every now and then
Black Bear shows up in our neighborhood black bear came up and got in mind
He went inside and got two pots seriously he got two pots he walked out on his front porch he banged pots together the bear ran off
Okay that's good to know so I own a shotgun I'm just saying I understand that I wasn't going to shoot the bear that's not what I said
Driving schools are there in the bear would run off I've got a backup plan
But when you're in fight or flight you start to think about where is the blood going to go was going to go to Oregon flight
Now I tell you that story to tell you the other part
Blood have lots of bathing suits
But the skeletal muscle itself the skeletal muscle itself actually has beta-2 receptors
The skeletal muscle that somatic motor nerves that is correct correct
However
Skeletal muscle itself also has two receptors are not just all the blood
Which means what an asthma patient
Who you put on an albuterol inhaler and you tell them take one puff 1 - 2 + 7
Would you get an asthma patient who says I don't know I think it was the two pups are good campus is going to be fantastic
Images keep using their inhaler
Now what's going to happen now that beta 2 Agonist goes right so what happens to their blood pressure what happens to their blood pressure drops
Your heart rate heart rate is going to go up tachycardia right
What happens to their skeletal muscle
I get a tremor
They did a Tremor skeletal muscle Tremors if you get a beta 2 Agonist systemic
That shouldn't happen right it shouldn't happen if you're delivering the drug straight to the loss but you use it excessively
Can get a skeletal muscle tremor
I think it happens because people watched too many of those old movies with the asthma kid in it have you ever seen the old movie called
The Goonies movie by the way also studying pharmacology if you seen The Goonies The Goonies start little Sean Astin
Going back down to be Samwise gamgee in Lord of the Rings anybody know what I'm talking about movie Buffs out there
Who is Rudy and then you became Samwise gamgee in Lord of the Rings okay he was the ass my kid in The Goonies if you watch that
Like every 5 minutes and
Every five minutes in that movie he was puffing on that and I remember every time you got to go
So much terrible terrible technique you're supposed to fully exhale
Slowly inhale
Who has time for that when you're running from the fratellis right so what are you doing the movie and he's off and running that's wise
What was the shaky as my kid in The Goonies right that was little Sean Astin back in skeletal muscle Tremor is a possible side
You'll notice also that you get certain metabolic effects from stimulating baby juice
Now you got increased glycogenolysis in skeletal muscle and liver
Increase glycogen Allison in skeletal muscle and liver that means stimulating beta-2
Getting baby to increases blood glucose
Now don't focus on the Patriots right now I'm going to tell you wanted to come over but don't do it don't focus on the pancreas
What happens to blood glucose
What do you think about what is due to blood glucose think about the skeletal muscle and skeletal muscle are you going to see
Detroit possible hyperglycemia therefore if you use a drug that blocks pain tattoos if you block their tattoos what do you expect
YouTube
Hypoglycemia make sure you understand walking baby tooth hypoglycemia the two organs that are responsible for that skeletal muscle
Uber
Now I know that you won't just not look at something just cuz I said hey don't look at this so you going to look at the pancreas
You going to the pancreas pancreas is going to increase insulin secretion
Increase insulin secretion but if you only focus on the pancreas and you say if you increase insulin secretion that should go
Low glucose if you only focus here though you're going to miss the point if you increase insulin to lower blood glucose and you would say
Stimulating beta-2 score
Hypoglycemia and therefore blocking baby tooth would cause hyperglycemia and you just got it backwards so think about the paint
Assembly part of a regulation
But the skeletal muscle in the liver and the primary things to think about
You're definitely going to need those pills during fight or flight that's exactly the way I would say it you're definitely going to think
But don't Focus too much on the pancreas remember this we go back once I remember the Alpha 2 is the predominant receptor on the pain
What is the predominant receptor on the pancreas and its job is to decrease insulin secretion
Notice the beta 2 is not a major increase is going to increase insulin secretion but certainly if you've got organs your daughter
Just cause you're going to need some insulin help utilize those tools and some point so this is consistent with the response
Those babies are doing it so this is more of a regulatory effect
Moreover regulatory
There's also something else that somebody is going to pay attention to somebody got into all the details example
We talked about this release that's a significant fact you need to know that you also noticed around the kidney
Alpha ones are on the kidney and a decrease in her really well we talked about one of those things related to read it and it was made
That's the important ones doing there probably some type of Regulation because if you're in fight or flight you want your blood pressure
Does consist
Apple one is only a type of Regulation but it's not the major effect
At the very bottom of this table you see dopamine D1 you don't think about too much dopamine is a transmitter in the sea
Great transmitter in the CNS
Photo receptors which are mostly found on renal blood vessels dopamine stimulate renal blood vessels to cause vasodilation
And that's going to help to maintain the normal function of dopamine receptors
Think about D1 and renal blood vessels think about D2D to his being the major dopamine receptor in the CNS
There's a couple of notes in the margin let's take a look at the first one at the top go to the top of the page there is a man
Basically here's what it says it says that generally speaking we can to see better responses at lower Doses and Alpha responses
Closest drug like epinephrine so happy to give you a beta effects before alphabet
So remember before Alpha Beta or Alpha is what happens with that the nephron so there is a dose dependent effect of epinephrine to lower
Beta 1 beta 2 doses Alpha responses
The bottom part of the page in the margin dose dependent effect for dog with me to check this out low doses of dopamine
Medium doses stimulate beta 1
High doses
So it's still before Alpha do you say that it's beta before Alpha just like it was for epinephrine
Except what does the drug is dope for me because it's so, what is the first
Don't mean it's going to be late it's only one first
Speed of sound
Low dose dopamine the renal dose why would you call those
What would you call me medium going to be more active and then Alpha One alpha one is going to be more of the peripheral blood
More of your blood vessels which really do blood vessels of the kidney first then start and then it's the remainder of the Pooh
Blood vessels that are affected
Espinoza Paz
What is a D1 Agnes it's a pretty powerful vasodilator and it can be used for severe hypertension a pretty powerful drugs or do you want me to
Your blood pressure
Okay so you want to for sure
So the question that don't mean causing renal basal dilation have better ones went through better ones on the JG sales
Which would actually tend to cause more of a basil constricting effect so it's really when you're giving dopamine for the cardiac
Things for the shower
Altitude
LDS
Do you want is us as well
Now that's one that you need to add to your list so we already said all babies are GF so is the dopamine D1 receptor
I have to think about this though
Appleton recycling
What do demons do to renal blood vessels D1 vasodilator
Vasodilator and they're doing that to a g-protein It's gotta be GS
It's gotta be a couple increasing psychic AMV
Store next to the address to Alpha 1 Agonist quotes I have great news for you
When it comes to the number of alpha 1 Agonist that you have to know for the test are you ready there is
1
1001 Agnes and you have to know it it's the drug phenylephrine have no boyfriend alpha 1 Agonist
Have you ever noticed this if you've been doing practice questions you know that there are just certain Concepts or maybe if it comes
Call Me Maybe there are certain drugs the haunt you to follow you around it is like you a question you have to learn that drugs
Every time I see you again shows back up in a practice question sometimes it's the drug phenylephrine never have any trouble with this
Over the counter High
Go to your favorite store and you can buy something different but I didn't take it for your sink in your bathroom next to your tooth
Everytime You Look At That Dragon you go
I don't have enough time to think about how you're going to pile up on your second review as you're brushing your teeth each day
Right I have a 9 foot wall and sink in my bathroom right after that has A9 foot long thing I guess I could line up a whole bunch of drugs
Okay
Another word for classic alpha 1 Agonist
Hey could you recognize this drug in a diagram like this if this is normal blood pressure if this is normal blood pressure
This is normal heart rate what do you expect phenylephrine
Blood pressure that's what the pressure if the pressure goes up with a reflex
To the right
Reflex bradycardia heart rate
What drug would you put the reflex
Heart rate
Heart rate in the heart rate and blood pressure
Okay thanks I'll talk about alpha 1 Agonist talking about
The farther down the page on page 58 the specific uses for this drug is used as a nasal decongestant used for eye exams in Hazleton
You might remember several years ago and many of the over-the-counter
What is phenylephrine start replacing pseudoephedrine in a lot of those products
Because wonderful people were taking pseudoephedrine and making a mess out of it that's making methamphetamine so we started
Many of those products switched over to the left one of the ways that you can identify those products is that products for a long time
Yamaha abbreviation for phenylephrine how about this how about a variation off of that if you think about PE as an alpha 1 Agonist
You can also tell your two organs have Alpha receptors of the prostate in the eyes so a couple of organs right there that have
Alpha 1 Agonist for somebody with BPH
Not a good idea is it not a good idea to use a lot of finding somebody who's already probably the BPH you can see the challenge is there
Exactly
Clonidine and methyldopa I will tell you that we're going to cover these drugs in more detail and the hypertension chapter so that's
Okay so not tonight but first here's my way to remember the two outfits of what I believe is the most famous equation of all time
We disagree but I think the most famous equation of all time is equals mc squared is the most famous equation of all time
We're going to make it in the college equation are you ready we're going to say equals mc squared equation 1 equals mc squared 2 drugs
Methyldopa clonidine way to remember the two outfits
But like I said we will cover those drugs and hypertension not going to do anything else with them for right now
If you like most people I get somebody's number to be quite as good as many as I can you get to filter out which ones you like which
You come up with something better for everybody if you come up with something better you send me an email and I'll give you credit for
Go to the beta drugs right let's go onto the Babies R Us so we start thinking about this we start thinking about the beta Agnes
Certainly if you look at beta-1 and beta-2
YouTube beta 1 and beta
Both of those beta receptors by stimuli
Pressure indicator
Actually is the difference between systolic and diastolic pressure
Equal
Classic
What are some other drugs that cause flushing well you might remember niacin
Not to cause Flushing
Okay who remembers before you give somebody a niacin what do you pre treat them with to prevent the Flushing
What are you pre treat them with you give them a drug like ask for it you give him aspirin which means what is causing the flush
What's causing the flushing it must be
Prostaglandins right it must be prostaglandins for nice and it's a prostaglandin mediated plush
But you know for the next three drugs the reason they cause flushing is because of histamine hey it's a different reason
Drugs that cause histamine release the first one I think of my son
Vancomycin causes histamine release
The side effect of Vancomycin that you see is called red man syndrome it's a flushing reaction do this to me correct
What about morphine
Morphine causes the release of histamine
Tell me this tell me why you don't use morphine in head trauma
Funny avoid morphine and head trauma what's the problem there
Morphine can do what you're thinking increased intracranial pressure headache causes histamine release which is amazing
Try increasing interest cerebral pressure avoiding Hedgehog things that you know but we just got reminded you of us and what about amputee
Application for the wonderful drug dishes right some people call them feel terrible right
What You Preach to me because it causes
Recover remind you of this once again
It's going to be really not
What is this
What happened over here reflex bradycardia
I'm trying to
Reflex
What's a good place for a test question it's a perfect place for you to do some pretreatment it's a perfect place for preaching
Before I gave norepinephrine what if I treated with atropine
Retreat with atropine
What's going to happen to the blood pressure what's going to happen to the heart rate
So you're saying no reflex that is correct
So is the blood pressure still going to go up if I pre treat with atropine up blood pressure goes up does the heart rate go up
Yes it does do I get a reflex bradycardia
No I don't know this part is the part that's going to change if I pretreat with atropine the Heart Radio
Basically it'll still look like this
Would I get the same thing if I pre-treated with a ganglion blocker first what if I gave a ganglion block her and then gave
Never would it work the same way yes
Gateway Walker would you say that
Direct on the blood vessel Direct on the heart rate so you do a ganglion blocker or a muscarinic blocker
This part of the graph
And it would just look like this long trip and that's correct you're happy never lower the blood pressure
Now some of you are wondering why I haven't said anything about the Alpha 2 receptor thinking about that right now focused on Alpha One
Altitude for small in a graph like this you never ever see an alpha to affect never see it out for to affect
The reason his forties are found on presynaptic curse how to choose a real autoreceptor there your negative feedback binds to an ounce of
That's okay that's okay
What is a drug directly stimulates an effect on the heart here's the bottom line in an experiment like this I don't see any Alpha
I don't see any Alpha two properties because it is a drug works on nerves and organs what is it that we can really easily mesh
What's happening at the corner so we're going to observe the organ effects
Check the comment about water
What is when a blood vessel receptor the blood vessel receptor that Griffin is going to work on it just doesn't do anything
Pressure
Different pretty interesting don't you think
Well if you thought norepinephrine was interesting
Just what you haven't seen anything yet because their friend is way more interesting if he is way more interesting
Take a look at this you have to have 3 different graphs to explain epinephrine because if he's going to come in low medium or high dose of that
First things first you stimulate alpha 1 Alpha 2 beta 1 and beta 2
So you've got all four receptors been affected
Got all 4 receptors being effect
Notes that includes the beta 2
That includes tomato juice
I wish I can control my blood vessel alpha 1 beta to Alpha one wants to raise the pressure beta 2 wants to lower the pressure
MotoGP what's the rules on the board before our first date is before Alpha solo dose epinephrine is going to be beta 1 beta 2
Is beta 1 beta 2 come out like isoproterenol
Hey if you want to do something but back one page in your book you got an e-book it's not as fun to flip but go back one page
1-page you actually see the graph for isoproterenol and it looks exactly like this isoproterenol and low dose
I'm going to strongly encourage you to try to practice questions that are in your pharmacology book strongly encouraged by the way I had
Did you try those practice questions in your phonebook so after we finish your topic try those questions right triangles questions in it
How do you do if you do those questions like I'm suggesting this is probably going to happen to you you're going to get you a question
You're going to stop in USA
The answer is no answer is isoproterenol and then you look at your list of answer choices right there
And there's no isoproterenol you like
Why would you do that to me talk to her
But you know if it's not it could be most happy you could be Moto's happy so keep that in mind if you're thinking is over here at all
Bethany Mota happy
Questionnaire about the tachycardia you know the director is a reflex really hard to tell the difference but clearly the
Tachycardia even if you use the game with a blockage and still get the card so you really need to think about the fact
Think about it that way
You know nobody likes medium does that nobody likes
Nobody likes me it's not exciting doesn't make for a good test course many of those that is the transition
Medium those areas where you start to see some of the bait at 2 a.m.
Vista Cruiser
MotoGP not supported on being in the same answer choice that will be evil to the core never going to happen to pick between the two
Camping between the two so they wouldn't both be there by one of the other
Beta to Alpha One they're canceling each other out okay so no real change here and your blood pressure don't worry about mediums
Is it going to start to see that one of them could be the major effect
But look at here
Doesn't this crap for high-dose epi
Look just like norepinephrine
High-dose epi
Just like you're happy
On your test you probably will have to pick between these two though you're going to have to pick between these two
Do one more thing first and then we'll talk about how you can pick between these two
If you go to the bottom if there's a specific specific
Is well
Would like to use it as an adjunct to local anesthetics
Hypotension blood pressure
What are the benefits of guitar question remember was mediated by histamine
Is going to be
What type of antagonism
Absolutely
The number one
Remember the last time we covered
Think about this
Hypertensive crisis
Think about the food and beverage side quest
Don't know if you know for sure if you're having a really good day here's how you tell if you're taking your step 1 exam another one
You get a question about tyranny and that is followed by a question about a 37 year old
Two questions back to back I don't even think
Out of control right now
This exam because you're going to have to show the house right now you two options to options for showing how happy you are when you get the square
One option is to do this you can start banging all the sides you can't do that out of the question question is what you do
Eukaryotic
Move back up you keep on going on your test the person sitting next to you is going to go do it so good and you're over there doing that
One of the roads that start with the first one to get to it
Your choice you can bang on the cubicle or you can let him know that you're just grooving in your cubicle all by yourself
You got your
What is one before you go to one of the road was always the place to start
If you look at your margin if you look at your margin there any forms of monoamine oxidase look at the forms of Mao
Type A and type B how about an easy way to remember anywhere over the place
Might be much more limited how about before Brain before brain
High metabolism or it be serotonin and tyramine but type be found in the brain mainly metabolizes dopamine
So an easy way to remember
The question about what you would do for a hypertensive crisis nitroprusside is it a good option labetalol is a good option
Those are both good options besides a very good choice we'll talk about that drug in a couple of nights there's a problem with me
For too long the battle probably my mom or preferred because I don't have to worry about finding that right
How about this question folks think
Mainly in the brain causes
Remember drug Type Beat Justin Bieber Type Beat Justin Hibbert scheduling very good I called selective selective selective
If it's going to raise the levels of government raises the levels of dopamine is good for a patient with Parkinson's disease
Makes sense right if you stop the metabolism of me who needs more people with Parkinson's
But it was just pointed out if you're only inhibiting type be if you're only inhibiting type B you're not going to interact with
Because I realized I typed
Rasagiline is the other things Wonder we're going to mention I was but there are others out there
Okay back to the middle of page social they're going to act as indirect Agnes amphetamines including methylphenidate causing the release of
Increasing demand for narcolepsy
ADHD
Ephedrine usually prescribed are available in the form of pseudoephedrine can also act as a ruler very similar to amphetamines
And finally the reuptake inhibitors
Okay what CCS cocaine or TCS
Daffodils similar probably have some real take inhibitor effects
So it's still going to increase the amount of neurotransmitter in the sentence so everybody to the margin they're called classic clue
Classic
Here's what hotels is all of these drugs that we call indirect Agonist they only work on innervated tissues make that connection
Work on innervated tissues
If your exam decided just to have some fun and they decided to dinner of a tissue
They decided to remove the organ I'm sorry I remove the nerve going to the organ needle organ remove the nerve going to the Oregon
The heart transplant patient if you have it or none of these drugs are going to work to work not talking to me my email
The homework on the nerve that's when a heart transplant patient you don't expect him to do anything directly to the heart
Because there's no nerve there
Be careful if you see a question like this I believe because I did this myself I believe that sometimes
If the exam shows you a question and it involves some type of experiment first of all if you see an experiment what's going to happen
Little anxious understand little anxious because it's an experiment here it goes
Keep working on that is going to keep getting better but sometimes when we see an experiment here's what happens
Jump right into the question way too fast and we don't spend a few seconds thinking about the design of experiment so listen to this
Show you a problem and in this experiment there are two trucks
There are two trucks one of those drugs Works directly on a receptor website it's an alpha 1 Agonist ok
What kind of drug is phenylephrine
In the second row
Let's just say it's a drug like cocaine
Before you jump into that experiment try to figure out what's going on here so I want you to do
Directions
Cocaine have to work on a nerve to block the reuptake
And then you got to increase norepinephrine and maybe it will do the same thing as been a reference but here's what happens in the
Give cocaine the same thing happens to direct Agonist and antagonist in the first part of the experiment
Do something in the middle
First time
Cocaine does nothing
Do nothing what happened in the middle there maybe it was generation maybe it was removal of the nerve and I know that sounds very
But I want you to think the point is they're trying to illustrate how direct I can ask can still work even without the nerve
Indirect Agnes has to have the nerve or else it's not going to do anything it stops working the nerve is gone the nerve is gone
Okay sit back and relax let's do something funny real quick are you ready let's do something fun so you're studying for an exam
You got one coming up at some point if you got a cold so you take some pseudoephedrine and you know the pharmacist you can get sued
But you know I'm hungry bring something in your life never really heard anything right but you know the beer makes you sleepy
Look around the house hey there's an amphetamine I'll take some of those to stay awake but it's such a tough exam that I really really do
Describe utca or better yet somebody give you an email that would be fantastic right thing but you're still depressed you're still
You look around the house one more time thank goodness there's some cocaine with to pick you back up OK that is ridiculous is that
What does your dad know what is post pseudoephedrine causes the release of norepinephrine
Hiram causes the release of norepinephrine amphetamines causes the release of norepinephrine
Tca's block the reuptake of Norway
New York
Okay block the reuptake of norrath
Hey any two of these together makes any two of these together what do I get hypertensive crisis no doubt about it shortly thereafter
Our favorite for the irony
Which email was not a good idea not a good idea that was supposed to be ridiculous that's not something that could be a pro
What happened to the shower now talk about alpha blockers alpha blockers what are the side effects that you get from India
Whatever you need to think about something in the detail your car to no reflex tachycardia Alpha blocker what my car looks like
Here's my blood vessel with a powerful one here's my heart with his favor once
If I block out for one stay with me if I walked out for one of a Rhode Island in my pressure go down if my pressure goes down you know
What's next week's reflex tachycardia
Reflex tachycardia and that's the negative feedback receptor will help to control the reflex tachycardia
Didn't tell me this
Okay also welcomed back so we're going to continue that we were talking about alpha blockers and really from this life
Didn't really introduce the possible side effects for these drugs and that is reflex tachycardia and really thinking about
Alpha 1 blockers
The walking alpha 1 and Alpha 2 date and certainly if you're blocking outfit is certainly if you're blocking out for Tuesday then you're more
Tachycardia and walking without crutches conditions hypertension and BPH talk about the use of these drugs
How long can I keep in the very bottom of page 61 what's the most of these two drugs are both used for pheochromocytoma
Boat used for pheochromocytoma there's a difference between these two drugs and that one is competitive and wanted some Soca music
Alpha 1 and Alpha 2
Of course they're all kinds of ways to remember things some of which are really good some of which are kind of a stretch you know what I'm talking about some
Are you coming to remember something so ridiculous I'm not even going to share it with my best friend I'm just going to keep that one too
I don't think about correctness or necessarily but it is definitely a stretch to see if you can come up with something like this
But both of these drugs are used for pheochromocytoma by the way if you were to write that workout video promo side, it's a word about
And it starts with the letters
No to drugs you're going to use the treatment are both kind of long drug names they both start with the letters pH a ride
The shorter name is the one that's competitive because competitive is a shorter word for non competitive
You can be truly desperate you realize that the drug phenoxybenzamine has exactly the same number of letters in Scrabble
Pheochromocytoma phenoxybenzamine so maybe when you start remembering the room maybe it's the rule was 16 maybe it's true
Because they're 16 letters in the drugs 9:16 letters in the mail box
Noncompetitive long half-life
Long half-life
Florida surgery
Favorite thing to do for pheochromocytoma
It's a tumor cut it out surgery of my favorite things for that condition but you might use drug therapy prior to surgery with Vanoss
We got the selective alpha 1 blockers
Zosyn as an indestructible for one of these for drugs is different from the other there's a drug called tamsulosin you might notice
The ocean but not an ocean
Are you there it's an awesome but not as awesome so this one is special the special thing about tamsulosin is it blocks a subtype of the
Alpha 1s
No one's found in the prostate
So this receptor highly concentrate
The prostate
Highly concentrated in prostate
Specifically for BPH specifically for BPH but it would have gluten affect on your blood pressure
What wood is zosyn be used for what would have to be used for
Associate would be used for both hypertension and BPH
Baker's Dozen blocks all Alpha ones including those in the process it so hypertension and BPH
Both for the Sosa
Okay so that's the idea behind comparing those guys
The question about the non-selective drugs in the
Back to the idea of treating for not sure you tell me you're not convincing me to treat an advantage of these is there an alpha 1 receptor
Because those individuals have high blood pressure so they really blocking the alpha one is what's most important they're blocking the app
But certainly these are indicated for pheochromocytoma not answer your question that's what they're used for
I would argue that there are some better options though but that's what we're using today
We have one selected for to blocker and selective Alpha 2 blocker is mirtazapine which is used as an antidepressant
Such a drug that inhibits and Alpha 2 receptor if you block it out for 2 that means you're going to cause norepinephrine
And that's how you help in the treatment of depression
What is better for longer lasting longer lasting
Would being a non-competitive inhibitor
That's right
So there's are alpha blockers so let's move on to talk about beta blockers now would you look at the beta blockers of course
Trader Joe's
If you block me that's the way I like to say it blocking the beta to it's almost over
Walking the baby to cause a lot of problems and I just want you to know about this for example if you'd like me to Choose You by
Asthma attack bronchospasm in asthmatic
Blocking the beta to my cause vasospasm not good for somebody who's got basil spastic disorders like basil spastic angina
White people their vessels are spasming right Prince metals are very and I know you don't want to give him a beta 2 blocker that would actually
AutoZone
Of course blocking the beta 2 can cause Raynaud's disease is another good example right passes basil spastic disorder blocking the bay
Also can change your blood glucose levels of potential problem in diabetics so altering your blood glucose
They also prevent the breakdown of triglycerides
And this happens primarily in adipocytes and that can lead to increase LDL and triglycerides metabolic effects from blocking the
Also be a problem you look at all the reasons why you want to avoid blocking the beta 2
Before I talk about the I let me just tell you this it's easy to remember if you're going to use a beta blocker for car
If you use a beta blocker for somebody's heart condition it's going to be better once elected that's the rule if you're going to use them
But many many times when we use a beta blocker for an
Cardiac condition guess what we use non-selective blockers
An example of that is in the treatment of glaucoma it's because it's
No problem
Intrinsic sympathetic activity which is a fancy way of saying
And actually work
No problem no problem
What is a general
Accessibility
Because of that that means that actually can possibly increase the heart rate and it should be competing with it being more happy and slow
Military activity those drugs wouldn't be the best thing in that situation
Automatic activity is defined towards the bottom of the page
It's basically it means partial Agonist what that means
Okay folks there's two notes in the margin was thinking look at the first one at the top of the page the first notes and you
You up regulator receptors therefore never abruptly discontinue your beta blocker always taper to avoid excessive rebound effect on
People do sometimes to get it refilled and what happens if you discontinue a beta blocker you can increase your rebound increasing
Back of your
I mean obviously if you're taking a beta blocker because you had a previous and I you can certainly get some angina and Ankle
No doubt about it
No actually someone asked about this earlier notice that you can use glucagon as an antidote and beta blocker overdose
So here's why he didn't see that note that I wrote earlier this week Works to increase
And that overcomes the beta blocker which of course decreases cyclic AMV
Paper means to reduce the dose over time
So you.
Principal uses for beta blocker overdose
There's a lot of cardiac conditions and that's our next section are next section is all cardiac coming up tomorrow
Is a beta blocker
Glaucoma
Non selective beta-blockers
Migraine prevention migraine prevention
Propranolol non-selective beta
Thyrotoxicosis
Propranolol non-selective beta blocker
Essential tremor
Nonselective beta-blockers
Printable
Cardiac condition condition
Most commonly
Selective beta-blockers if it's a cardiac condition
Beta 1 selective
There are a couple of special special beta blockers require an additional room let me help you out with these guys
If the beta blocker ends in oh LOL it's a beta blocker only and you can already determine is it made one so like it or is it not
What is the spelling is a little bit different but if it's spelled I LOL or LOL no that's a special type of drug so LOL still tells me
Liquor with the a for the eye
Says plus something else okay that's the rule I LOL oh LOL is it combination
Examples of labetalol I love whoever spelled the name of this drug I give him big thumbs-up I give him lots
Because it was spelled lol so what is LOL LOL makes you think of think of water LOL
What does it make you think of about alpha alpha beta blocker is Alpha 1 and beta
I love it love labetalol spelling that's perfect
Did somebody got a little too creative here and I know what they were thinking so we have a drug called Carvedilol LOL so there LOL
Beta blocker for well you guessed it is for Alpha
Mr. perfect
Here's the drug called so LOL for beta blocker and a good time to ask or you just
It's so sad how hard would it have been to spell these two drugs with an A and this one will deny that would have been so much
So much better
Okay
How about if you do this how about you do this is a shortcut
Solo
If you just remember sotalol sotalol is the potassium blocker and a beta blocker other drugs with an alternate spelling
Alpha blockers hope you all know what is the other to follow the rule of being alpha blockers you came first the other two are just alpha blockers
What's better step it up real quick in the state of PA
It's time for practice questions
Get rid of questions for you right so quickly they're not quite as smooth as I like to be all right we're going to try some questions
Not like this
Try to be smooth sometimes it works sometimes it doesn't
Lakers
We're still working on that pole you guys keep thinking about the question
Okay so you have plenty of time to think about it so I'm going to give you just a couple more seconds to vote on this one
OK hey this is a good start did you recognize these clothes here it looks like you did so you got a 76 year old man history of Pi
Recent onset of increased difficulty urinating his symptoms began when he started taking the nasal decongestant right you got to
Who is the guy with prostatic hypertrophy and he's taking a nasal decongestant both of those should make you think of
Alpha 1 receptors both of those should make you think of alpha-1 receptors
Okay so very good job on that it looks like a whole decided to do a couple of funny things on it I can tell you it was 88%
88% was excellent on that question couple of good Clues on that one
Question number 2
Have to be careful as you read this one which drug causes bradycardia but not tachycardia make sure you read that carefully
Okay I'm just a little bit longer if you haven't voted yet
Curious people who want to know what intracellular second Messenger will be activated in the cells well first of all you got to come up with
What is the receptors of the sympathetic nervous system is going to activate on that will try and get the blood pressure up what's the
Tell me the name of the specific what is alpha-1 if you identify this receptor is Alpha One now it's just
Purple ones are GQ that's possible let me see that of course would be ip3 and I said what's wrong I be 3 so only 44% of the group
Question correct
No 28 almost 29% increase in psychic AMV
Recycle KMP would actually relax smooth muscle and that would lower your blood pressure not a good thing
That decrease in size with AT&T but again you gotta think about what receptor would be mediating that we don't have a receptionist
Indecisive
Okay will be challenged on that one
What's the altitude of D2 that are going to decrease cyclic A&P but none of the
Animated when your blood pressure is low
Question number 4
Why didn't you answer the question that I asked him not to question that you wanted me to ask sometimes those are two different things
I will get you the phone just a second hang on folks
Okay few more seconds on this one
Last chance
OKC
So what you think about this question you think about this question
Did you check out the questions that I wrote for you here cuz I can tell that some of you were thinking about the question but you also
Cells secrete catecholamines of the sympathetic nervous system is powerfully stimulated Which transmitter activates the chromatin cells
Which transmitter activates the Adrenal medulla the question didn't say what does the Adrenal medulla release
Cuz those are different questions
What's the first neurotransmitter in sympathetic person
Pathways the first neurotransmitter is always a single Cohen that's what activates the chromatin cells have been produced
And you're happy so we had a response of about 62% there 62% 22% 710 %
Soap 8:40 is exactly
840 one more time
Yeah but it's not going to be used to activate nicotinic receptors
Yesterday's Tractor
Okay question number 5
How you doing this to make this point earlier let's see how you do
Okay few more seconds on this question
Okay last chance
Okay 25 year old woman 32 weeks gestation take the drug to delay the onset of preterm Labor you gotta figure out what the drug war
What type of drug is she going to use to relax the uterus
Beta 2 Agonist when you take a beta 2 Agonist certainly one of the things that can happen is you can be there by late and dropped the blow
When you drop the blood pressure so it's not going to be hypertension you can get a reflex tachycardia so it's not bradycardia
Your basil dilating so you shouldn't raise the temperature you should actually decrease the temperature but certainly you got me
Hand Tremor you're not going to get your attention from Bay tattoos okay that's mostly going out for one mediated effect
So Hand Tremor because of my tattoos on skeletal muscles remember the shaky asthma can taking too much of his albuterol inhaler
YouTube YouTube YouTube
Good job on those questions so that is a better question
Last few things for tonight we should get to page we have to go back and get that pic let's go back to page 43 we need to make
Stage 43 so let's go back to that let's go back to that page
Logical but you don't do very well is that
So I should say let me see how you're going to get this one right let me watch you get this one correct so I won't say that anymore
Yes I'll just be quiet 4343 at the top of this diagram noticed that we've got the parasympathetic action in the parasympathetic
Where to buy mustard
Young preacher muscle contractures finger muscle giving you my office so this is the parasympathetic effect in the eye
If you look at the bottom of the diagram of alpha-1 receptors in the radio muscle when you stimulate alpha 1 receptors you're going to come
Regular people needing to drive everybody covered meiosis and the
Parasympathetic or sympathetic effect so those are things we've already reviewed here so we haven't really touched on bus
How much about accommodation
Accommodation
Accommodation at nothing
All about the shape of the lens
So what's the point here the point is when you think about a comedy
Combination is mediated by muscarinic receptors found on the ciliary muscle
Accommodation is
Parasympathetic sympathetic have no accommodation
No effect on accommodation
There's kind of a summary
Parasympathetic you're going to cause meiosis and they're going to stimulate the muscarinic receptors on the ciliary muscle
Accommodations
What is a muscarinic antagonist going to do it again this is going to give you the opposite of those things I must do in Atlanta
Pupil
And paralyze accommodation
Buy complete paralysis of accommodation
Dial paralyzes accommodation
How is the muscarinic antagonist different from the alpha 1 Agonist
The alpha 1 Agonist will also dilate the pupil
What has no effect on the combination
No effect on the combination so here's the thing if the test question talks about a page
Numbers coming in for a dilated eye exam
If they're given a drug and it dilates the pupil but it has no effect on a conversation
What was the drug photos
If the if the drug dilates the pupil but has no effect on the combination
Hotel alpha 1 Agonist and your favorite alpha 1 Agonist is what drug
Is phenylephrine is phenylephrine exactly right I gave him a drug and it dilated pupil and paralyzed accommodation
Dilated pupil and paralyzes accommodation
That was the most erotic blocker like to pick them up exactly right
Okay that's my point off of page 43
843 South turn back to page 65 everybody turned back to page 65
I just like talking about that one time we wrapped up the eye on page 4
64 disgusting so we talked a little bit about glaucoma little bit more detail on it here when you look at the bottom of the page there the difference
Closed angle glaucoma both cases you're going to see an increase in intraocular pressure and both are going to see an increase in
Opening a slow rise in pressure but closed angle is a medical
The medical emergency because of the rapid rise in intraocular pressure but I like to have you think about it this way that when you think about
Air pressure there's really only two reasons really only two reasons why intraocular pressure goes up
One of those reasons is you're making too much aqueous humor if you have an increase in aqueous humor production will cause an increase in
If you decrease the drainage of humor
If you're not draining the fluid the pressure goes up
So in the case of closed-angle
Walking the canal slim blocks drainage
The pressure goes way up let me say it again two ways the intraocular pressure increase in fluid formation
Decreasing fluid drainage and those both are going to increase the pressure
So with that being the case can you tell me the two strategies that we used to treat glaucoma what are the two strategies that work
Number one we're going to do what we're going to formation decrease with formation
Number 2
Increase fluid drainage increased drainage to decrease secretions increased drainage and those are ways we can manage this condition
If you look at the diagram on this page and show you the angle here which is the endocardium
Angle and glaucoma
Of course what we see is block of the canal as well as closed angle leaves
Walking Dead we want to stay away from drugs that might further close that angle down
There's a note in the bottom right corner of this page that was a couple of anti muscarinic drugs or rather at least anti mustard
Alpha 1 Agonist
You want to avoid both of these types of drugs in patients with closed angle glaucoma
Pizza restaurants in alpha 1 Agonist contraindicated in closed angle glaucoma
You don't forget about the beta 2 Agonist but certainly would you think about giving beta 2 Agonist most commonly those
Topically applied topically like my inhaler so they have an effect but I understand what you're saying
Okay so let's go to 66 drugs
Pilocarpine
Echothiophate not a big fan of this drug
Hannibal big fan of this one
And then just to be complete I'm going to go ahead and list for you three other types of drugs that we like to use for glaucoma
Information later on and so is carbonic anhydrase inhibitor
Can be used because it decreases aqueous humor formation
Mannitol can be used
It's an osmotic diuretic
Increase outflow is increasing the drainage of the fluid
And of course my favorite
My favorite and our favorite glaucoma drug
Are the prostaglandin drugs like what Anna frost
What kind of processor pgf2 Alpha drug that also increases fluid drainage
So we love the prostaglandin drugs Louisville
I guess the question there's about how to treat these things you know very popular treatment for open-angle glaucoma
Enterprise just got to increase drainage right absolutely also if you're thinking about treating closed angle
Multiple blockers can be used across can we use Mannitol but even drugs like to see the soul of might can work very quickly to decrease
Malaysian actually considered somebody who's got closed angle glaucoma
So only have two strategies increasing the drainage and that's what we see here is our strategy
Okay thanks that was a couple more practice questions
Number to
Okay last few seconds on this question
So we're trying to figure out this notice that constricts the pupil bronchoconstriction and it dilates the blood vessels
Start with the pupil constricted that could either be
Muscarinic Agonist and Alpha 1 antagonist to be an alpha one
Ramona Gardens
Low sex drive also bronchoconstriction bronchoconstriction that could be a muscarinic Agonist or it could be a beta 2
You gotta come to these conclusions you know those receptors you have to know the receptors for the eye for the loans and for the blood vessels and you
The heart after looking at the first two organs by the way it's either alpha-1 blocker beta
Muscarinic Agonist muscarinic Agonist I'm really thinking about muscarinic Agonist because I don't see any alpha beta blockers
The difference is going to dilate the pupil
Amphetamine amphetamines cause the release of norepinephrine norepinephrine at the pupil is going to die it doesn't fit
Very popular answer was low dose epinephrine low dose Epi is beta 1 beta 2 beta 1 beta 2 no effect on the eye
And what is logos ever going to do the lawn Bronco dilate
Happy Motors
Acetylcholinesterase inhibitor
That would construct the people
Post nasal drip
McCarthy muscarinic Agonist
Stimulates the pupil to constrict stimulates belongs to Bronco constrict D&D 5th the first 2 parts
How do you pick between DNA and look at the blood vessel only one of those two drugs is going to dilate the blood vessel
Blood vessel muscarinic receptors are not innervated indirect Agonist have no effect it's Gotta Be The muscarinic Agonist for car
Story about the 36.5%
The question correct that is a very excellent way to finish out your night it if you missed it hopefully you understand why
What is the type of question again have a great night preciate you join me I'll come back for tomorrow night we have 3 hours of class
Next two nights we got three hours of class so come on back we got
Portland to do an autonomic and then tomorrow night we start a cardiac section
Everyone have a good night we'll stick around and answer questions for a few minutes