CURS 4 PARASIMPATICOLITICE

Question 1

Exemple alcaloizi naturali

ANTIMUSCARINICE

Answer 1

Atropina si Scopolamina

Question 2

Amine cuaternare indicate in terapia bolilor gastro-intestinale, exemple
(ANTIMUSCARINICE)

Answer 2

Butilscopolamina
Propantelina
Metantelina
Cidinium
Isopropamida
Mepenzolat
Metscopolamina
Oxifenonium

Question 3

Amine cuaternare indicate in incontinenta urinara

ANTIMUSCARINICE

Answer 3

Trospium si Emepronium

Question 4

Amine tertiare antispastice

ANTIMUSCARINICE

Answer 4

Pirenzepina(M1 M3)
Telenzepine(M1 M3)
Diciclomin
Oxifeniciclimin

Question 5

Antimuscarinice tertiare neselective pentru incontinenta urinara
(ANTIMUSCARINICE)

Answer 5

Oxibutinin
Tolterodin
Propiverin

Question 6

Antimuscarinice tertiare selective pentru incontinenta urinara
(ANTIMUSCARINICE)

Answer 6

Darifenacin (M3)

Solifenacin (M1 M3)

Question 7

Amine cuaternare indicate in astm bronsic

ANTIMUSCARINICE

Answer 7

Scurta durata: Ipratropium si Oxitropium

Lunga durata: Tiotropium

Question 8

Amine tertiare indicate pt Parkinson si pseudoparkinson

ANTIMUSCARINICE

Answer 8

Benztropina
Trihexifenidil
Orfenadrina
Biperiden
Prociclidina
Difenciclimin

Question 9

Anticolinergice centrale indicate ca miorelaxante

ANTIMUSCARINICE

Answer 9

Clorzoxazona
Ciclobenzaprina
Carisoprodol
Clorfenezina
Metaxalone
Orfenedrina

Question 10

In oftalmologie? (ANTIMUSCARINICE)

Answer 10

Homatropina
Ciclopentolat
Tropicamida

Question 11

Efecte atropina asupra aparatului cardiovascular

Answer 11

Cord: Cresterea frecventei ( e de obicei precedata de o bradicardie + tulburari de ritm)
Vascular: vasodilatatie + hipotensiune

Question 12

Efecte atropina glob ocular

Answer 12

• Midriaza = paralizia sfincterului irian(7-10 zile in administrare locala) + reducerea scurgerii umorii apoase prin canalul lui Schlemm
• Cicloplegie - impiedica acomodarea

Question 13

Efecte atropina muschi neted

Answer 13

Reducerea tonusului muscular (favorizeaza retentia urinara deoarece contracta sfincterul simultan deci pot fi folosita in incontinenta urinara)

• dupa 3 zile nu mai are efect la nivelul motilitatii digestive din cauza plexului auerbach
• bronhodilatatie (doar la pers cu astm bronsic )

Question 14

Efecte atropina glande exocrine

Answer 14

inhiba puternic glandele salivare si sudoripare si secretia apoasa a glandelor bronsice, avand ca efect advers cresterea vascozitatii secretiei

Question 15

Efecte atropina asupra SNC

Answer 15

Antiemetic
Amelioreaza simptomele parkinsonului
Miorelaxare

Question 16

Pe ce cai are absorbtie buna atropina?

Answer 16

Orala
Parenterala
Conjunctivala

Question 17

Traverseaza atropina BHE ?

Cine nu?

Answer 17

Da

Derivatii cuaternari NU.

Question 18

Care e T1/2

Answer 18

2 ore

Question 19

INDICATII Atropina

Answer 19

• intravenos : asistolie, bradiaritmii, antidot, antispastic, premedicatie
• topic : midriaza terapeutica
• antiemetic
• adjuvant
• diagnostic WPW

Question 20

CONTRAINDICATII Atropina

Answer 20

Glaucom
Hiperplazie benigna de prostata
Leziuni ateromatoase coronariene/insuf cardiaca/tulburari de ritm
Nou-nascuti/copii mici/varstnici
Boala ulceroasa
\+ trebuie evitata expunerea la soare

Question 21

Atropina EFECTE ADVERSE

Answer 21

• tulburari de vedere, fotofobie
• reducerea motilitatii gastro-int
• reducerea secretiei salivare, sudoripare, lacrimale
• retentie de urina daca este hiperplazie benigna de prostata

Question 22

Antidot pentru intoxicatia cu atropina?

Answer 22

Pilocarpina sau Neostigmina iv.

Question 23

Efecte Scopolamina

Answer 23

Ca la atropina DAR efecte mai puternice pe globii oculari si secretia salivara si mai slabe pe cord si abdomen,
DIFERENTA : pe SNC determina sedare, efect hipnotic si amnezie retrograda

Question 24

Indicatii scopolamina

Answer 24

antispastic
antiemetic
agitatie psihomotorie
premedicatie in anestezie

Question 25

Contraindicatii/Efecte adverse?

Answer 25

Ca la atropina. zi-leeeeeee

Question 26

Butilscopolamina: mecanism si indicatii

Answer 26

Antagonist neselectiv pe RM | indicat ca antispastic la niv digestiv si genito-urinar, premedicatie si antiemetic (de electie)

Question 27

Pirenzepina/Telenzepina: mecanism, efecte, indicatii

Answer 27

Antagonist selectiv pe M1 Inhiba secretia acida gastrica si de pepsina Indicat ca antispastic

Question 28

Propantelina: indicatii

Answer 28

Antispastic digestiv

Question 29

Trospium: indicatii

Answer 29

Incontinenta urinara

Question 30

Diciclomin:efect si indicatii

Answer 30

Antispastic | indicat in tratamentul colonului iritabil

Question 31

Oxibutinin efecte si indicatii

Answer 31

Contractia sfincterului vezical, relaxarea m. neted al peretelui vezical Indicat in incontinenta uriara

Question 32

Darifenacin/Solifenacin: mecanism, indicatii

Answer 32

Antagonisti selectivi pe M3/M1M3 | Indicate in incontinenta urinara, vezica neurologica

Question 33

Ipratropium/Oxitropium/Tiotropium: indicatii, dezavantaj

Answer 33

Astm bronsic / determina o crestere a vascozitatii.

Question 34

``` Benztropina Trihexifenidil Orfenadrina Biperiden Prociclidina Difenciclimin. Mecanism si indicatii ```

Answer 34

``` Antagonisti pe M ai neuronilor intercalari medulari Indicate in (pseudo)parkinson ```

Question 35

``` Clorzoxazona Ciclobenzaprina Carisoprodol Clorfenezina Metaxalone Orfenedrina. Mecanism si indicatii ```

Answer 35

Antagonisti pe M ai neuronilor intercalari medulari | Indicate in spasm al m. striate

Question 36

Homatropina/Tropicamida/Ciclopentolat. Indicatii

Answer 36

midriaza in scop terapeutic, prolaps irian

Question 37

Toxina botulinica: Cine o produce si care e mecanismul?

Answer 37

Clostridium botulinum/ inhibarea eliberarii de Ach

Question 38

Toxina botulinica: indicatii

Answer 38

- spasm m globilor oculari - analgezic - cosmetica

Question 39

Toxina botulinica efecte adverse si contraindicatii

Answer 39

- disfagie, uscarea gurii, ptoza palpebrala, reactii imunologice - sarcina, alaptare, miastenia gravis, tratament cu chimioterapice

Question 40

Derivati cu amoniu cuaternar (GANGLIOPLEGIC)

Answer 40

Hexametoniu, Tetraetilamoniu Pentolinium Decametoniu

Question 41

Structuri cu functii amidice secundare | GANGLIOPLEGIC

Answer 41

Mecamilamina

Question 42

Structuri cu functii amidice tertiare (GANGLIOPLEGIC)

Answer 42

Pempidina

Question 43

Derivati sulfonici | GANGLIOPLEGIC

Answer 43

Camsilat de Trimetafan

Question 44

Camsilat de trimetafan indicatii

Answer 44

- crize acute de HTA | - realizarea unei hipotensiuni controlate

Question 45

Camsilat de Trimetafan. Efecte adverse

Answer 45

- simpatoplegie - parasimpatoplegie - reactii alergice

Question 46

Exemple curarizante nedepolarizante

Answer 46

D-Tubocurarina, Atracurium, Cisatracurium, Pipecuronium, Pancuronium, Galamina

Question 47

Exemplu curarizant depolarizant

Answer 47

Succinilcolina

Question 48

Pahicurare- mecanism/ traverseaza BHE?

Answer 48

antagonisti competitivi pe Nm la poarta canalelor de Na/K -> blocheaza canalele in pozitie deschisa NU traverseaza BHE

Question 49

Pahicurare indicatii

Answer 49

- miorelaxare in interventii chirurgicale - laringoscopii /esofagoscopii /bronhoscopii - manevre ortopedice

Question 50

D-Tubocurarina - efecte adverse

Answer 50

- Nu produce buna relaxare a glotei - Elibereaza histamina - Hipotensiune - Scade coagulabilitatea

Question 51

Atracurium particularitate

Answer 51

- metabolizare de tip hoffman | - det eliberare redusa de histamina

Question 52

Cisatracurium/Doxacurium

Answer 52

- Nu au efecte pe Nn si M2 | - Nu elib histamina

Question 53

Mivacurium

Answer 53

- Nu actioneaza pe Nn sau M2 | - Elibereaza putin histamina

Question 54

Pancuronium

Answer 54

blocheaza moderat M2

Question 55

Rocuronium

Answer 55

Blocheaza redus M2

Question 56

Galamina

Answer 56

Antagonist alosteric pe M2 => tahicardie - Nu elibereaza histamina si nu actioneaza pe Nn - Nu produce buna relaxare a glotei

Question 57

Avantaje/Dezavantaje Succinilcolina

Answer 57

- instalare si incetare rapida + buna relaxare a glotei | - lipsa antidot + dureri musculare