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S3M1 > Pharmacology: Autonomics > Flashcards

Pharmacology: Autonomics Flashcards

1
Q

Epinephrine site of action

A

a1, a2, b1, b2

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2
Q

NE site of action

A

a1, a2, b1

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3
Q

Name an a-agonist, with a1&raquo_space; a2

A

Phenylephrine

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4
Q

Name an a-agonist with a2»a1

A

Clonidine

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5
Q

Name an a-agonist used for open-angle glaucoma; what is it’s selectivity?

A

Apraclonidine; a2

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6
Q

Name a SANS agonist used for spinal cord spasticity.

A

Tizanidine; a-agonist

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7
Q

Name a drug that causes extreme reflex tachycardia. What is it’s class and therapeutic uses

A

Isoproterenol; non-selective b-agonist; T/U: ER when contractility & HR are low, but TPR high OR with Torsade de Pointe OR b-blocker OD

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8
Q

What class of drug would be used for cardiogenic shock or cardiac failure with severely depressed ventricular function. Give an example.

A

B1-agonist; Dobutamine

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9
Q

Name a drug used to treat a patient with COPD or asthma.

A

Albuterol (b2»>b1-agonist)

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10
Q

How does dopamine play into adrenergic pharmacology?

A

Dopamine –> L-Dopa –> NE. Thus, tx with dopamine can eventually stimulate a- and b-receptors

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11
Q

What is tyramine? Where does it come from? What happens if it is administered parenterally (or used along with MAOA inhibitor)?

A

Product of Tyrosine metabolism; found in fermented foods; ingestion or parenteral admin can cause HTN crisis due to large NE release

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12
Q

What is the MOA of cocaine?

A

blocks catecholamine reuptake in CNS & periphery

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13
Q

What is the MOA of amphetamine?

A

Blocks catecholamine reuptake AND stimulates release of monoamines from periphery.

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14
Q

What distinguishes Phenoxybenzamine from other a-blockers? What is its clinical use?

A

Irreversible blockade -> longer half-life; Pheochromocytoma (preop– lower BP)

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15
Q

Name 2 selective a1-blockers and a possible clinical use.

A

Parazosin, Tamsulosin. Aid in urine voiding (esp due to BPH)

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16
Q

What mnemonic could you use for selective B-blockers?

A

Selective B-blockers AME for B1:
Atenolol
Metoprolol
Esmolol

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17
Q

Which anti-adrenergic drug can be used to treat social phobias?

A

Propranolol (crosses BBB); non-selective b-agonist

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18
Q

Which non-selective b-agonist is a partial agonist?

A

Pindolol

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19
Q

What does Millie take for her glaucoma?

A

Timolol

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20
Q

Sari Kasper uses what b-blocker to treat cardiac arrhythmias?

A

Sotalol: blocks K+ channels

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21
Q

What anti-adrenergic would be used in A-fib?

A

Atenolol (B1-blocker)

22
Q

What anti-adrenergic is used in cardiac emergency?

A

Esmolol (B1-blocker) - “E”mergency

23
Q

What drugs are non-selective a-b-blockers?

A

Labetalol, Carvedilol

24
Q

What a-b-blocker causes reflex tachycardia?

A

Carvedilol (C-cardiac)

25
Q

What a-b-blocker would you use in HTN crisis?

A

Labetalol

26
Q

What INdirect-acting anti-adrenergic is used for pheochromocytoma?

A

Metyrosine

27
Q

What is the MOA of Metyrosine?

A

Inhibit Tyrosine Hydroxylase (rate-lim step), thereby inhibiting catecholamine synth.

28
Q

What drug is resistant to cholinesterase and lower intraocular pressure after cataract extraction?

A

Carbachol

29
Q

What routes of administration are C/I with which M-agonist, due to activity at Nn terminals?

A

Carbachol;

Oral, transdermal, IV… anything that -> systemic

30
Q

2 days after abdominal surgery, a patient still has not had a bowel movement. What might you prescribe the patient to increase GI motility?

A

Bethanechol (M-agonist)

31
Q

T/F: Carbachol will cause miosis with cycloplegia.

A

True. Miosis from sphincter m. contraction; cycloplegia from ciliary m. contraction

32
Q

A woman comes in complaining of a dry mouth and frequent nose-bleeds, along with painful intercourse. How might you treat her symptoms?

A

Pilocarpine to treat Sjörgen Synd. 3o amine M-agonist

33
Q

What is the chemical structure of Muscarine?

A

4o ammonium

34
Q

A pt comes in with ptosis and weakness in her limbs. What drug would you use to dx her with Myasthenia Gravis?

A

Edrophonium. (reversibly binds AChE)

35
Q

Pt diagnosed with Myasthenia Gravis. What do you treat her with?

A

Neostigmine (4o amine); directly activate Nm receptors

36
Q

A patient with recently diagnosed Myasthenia Gravis is taking Neostigmine. She comes into your office complaining that her symptoms have returned? What is your next course of action?

A

Give her Edrophonium to determine whether sx are caused by too much Neostigmine (cholinergic crisis) or too little (MG).

37
Q

A pt with alzheimer’s is treated with a cholinesterase inhibitor. What drug might this be?

A

Donepezil

38
Q

What cholinesterase inhibitor has a similar MOA as organophosphates?

A

Parathion (irreversibly binds esteractic site)

39
Q

A day laborer is found having convulsions in the field. He slips into a coma as he is taken to the hospital. Immediately, you know to administer what drug?

A

Pralidoxime: can reverse the effect of organophosphate OD (AChE INH) until aging occurs (6-8h)

40
Q

What drug selectivly blocks M3 receptors? What are its clinical uses?

A

Darfenacin; used for urinary incontinence

41
Q

What effects are seen with different dosages of Atropine.

A

Low dose: block pre-syn M2 -> dec. HR

Medium dose: block post-syn M2 -> inc. HR

42
Q

What is a known adverse effect of Atropine?

A

Atropine Flush Fever: decrease secretions = decreased sweat -> inc. body temp -> vaso-dilation.
Characterized by RED, HOT, DRY skin

43
Q

What is the chemistry & MOA of scopalamine?

A

Non-selective R-NH2; acts at M1 receptor of vestibular nuclei to depress vestibular fx

44
Q

If you want to examine your patient for age-related macular degeneration, would you rather use Homatropine or Atropine?

A

Homatropine- shorter half-life

45
Q

“PARK my BENZ” refers to what?

A

The use of Benztropine (3o non-selective amine) to treat Parkinson’s tremors

46
Q

A man comes in with severe abdominal cramping that you determine is due to hypermotility. What drug would you treat him with? How often does he need to take this drug?

A

Glycopyrolate (R-NH3+)- t1/2= 10 hours so once a day?

47
Q

Ipratropium is a R-NH3+ that blocks M and Nn receptors. It is used to treat asthma, COPD… by preventing bronchospasm and decreasing bronchociliary secretion. Why does this not further aggravate symptoms?

A

Ipatropium decreases the VOLUME of bronchociliary secretions, but does not affect the VISCOSITY (as seen in CF)

48
Q

One of your COPD patients mentions his poor compliance is due to the fat that he has to take his medication (ipratropium) so often that he just forgets and misses doses all the time. What other treatment option might you consider?

A

Tiotropium- longer duration of action

49
Q

Your patient, a smoker, decides he finally wants to quit. What drug would you prescribe that activates Nn and Nm receptors?

A

Nicotine (ie transdermal)

50
Q

Your patient who stopped smoking 3 days ago gets into a fight with his girlfriend and cannot stop thinking about smoking. But, because she took his car, he cannot buy cigarettes, so he decides to cover himself in the nicotine patches you prescribed for him. When his girlfriend returns 4 hours later to apologize, what will she find?

A

Boyfriend possibly dead due to overstimulation of Nm and Nn receptors -> desensitization. Flaccid paralysis ensues, causing CV collapse, respiratory failure, and paralytic ileus

51
Q

One of your patients has been struggling with cocaine addiction for years. You wish to prescribe her a medication but before you let her go you need to make sure she understands that she canNOT have it anywhere where her 3-year old daughter can find it. What might this medication be and what is its MOA?

A

Mecamylamine: blocks Nn (therefore entire ANS); VERY toxic to children

S3M1 (4 decks)

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