4 - Autonomic, Cold/Allergy

Question 1

List

• direct cholingeric agonists (4)
• indirect cholinergic agonists (5)

Answer 1

Direct: pilocarpine, acetylCHOLine, bethaneCHOL, carbaCHOL

Indirect: edrophonium, echothiophate, pyridostigmine, neostigmine, donepazil
*incr Ach by inhibiting ACHase

Question 2

List

-topical ophthalmic cholinergic antagonists

Answer 2

STop ACH:
Scopolamine
Tropicamide
Atropine
Cyclopentolate
Homatropine

Question 3

List

-classes of anticholinergics (6)

Answer 3

Anti-histamine
Anti-psychotics
Anti-depressants
Anti-anxiety
Muscle relaxants
Ipratropium

Question 4

List

• first-gen H1 blockers (4)
• anti-psychotics (2)
• anti-depressants (2 classes, 3 drugs)
• anti-anxiety (1)
• muscle relaxants (1)

Answer 4

AH: diphenhydramine, brompheniramine, chlorpheniramine, promethazine

AP: chlorpromazine, thiridazine

AD: TCAs (amitriptyline, imipramine), MAOI (phenelzine)

AA: diazepam

MR: cyclobenzaprine

Question 5

Ipratropium

• class of drug
• MOA

Answer 5

Cholinergic antagonist (decr PNS)

Muscarinic blockade -> bronchodilation

Question 6

3 main side effects of anti-cholinergics (anti’s)

Answer 6

Dry eye
Incr IOP
Angle-closure due to mydriasis

Question 7

List

• alpha2 agonist (1)
• beta1/2 agonist (1)
• beta2 agonists (5)
• non-specific alpha/beta agonist (1)

Answer 7

A2: clonidine

B1/2: isoproterenol

B2: alBUTerol, levalBUTerol, terBUTaline, METaproterenol, salMETerol

A/B: pseudoephedrine

Question 8

List

-drugs with DA agonist activity and caution

Answer 8

Bromocriptine (hyperprolactinemia tx)
ADHD drugs: methylphenidate, dextroamphetamine
Parkinson’s: amantadine

Caution in pts with narrow angles: angle closure glaucoma

Question 9

List

• alpha1 antagonists (3)
• non-selective beta antagonists (2)
• beta1 antagonists (4)

Answer 9

A1: tamsuLOSIN, teraZOSIN, praZOSIN (recall concern for floppy iris syndrome in cataract surgery)

NSB: labetolol, propranolol (recall N-Z is non-specific!)

B1: BEAM = betaxolol, e not on outline, atenolol, metoprolol (recall A-M is beta1-specific)

Question 10

Pseudophedrine

• MOA
• clinical indications
• adverse effects

Answer 10

Non-specific alpha + beta adrenergic receptor AGONIST

Cold medication: limits symptoms of nasal congestion

Systemic:
-tachycardia (B1)
-bronchodilation (B2)
-nervousness, agitation
Ocular:
-diplopia + blurred vision (ra1dial = mydriasis)
-caution in pts with high IOP (incr B2 at NPCE)

Question 11

Ocular effects of H1 receptor activation (3)

Answer 11

Itching, tearing, chemosis

*recall chemosis (-) itching is indicative of CCF (also pulsatile proptosis, ocular bruit)

Question 12

List

• 1st gen antihistamines (4)
• 2nd gen antihistamines (3)

Answer 12

1st: diPHENhydramine, chlorPHENiramine maleate, bromPHENiramine, promethazine (PHENergan)
2nd: loratadine (claritin), fexofenadine (allegra), cetirizine (zyrtec)

Question 13

Diphenhydramine, Chlorpheniramine maleate, Brompheniramine, Promethazine

• MOA
• clinical indications
• adverse effects

Answer 13

Block interaction b/w histamine and H1 receptor

Allergic skin rxns (hives, contact derm)

Systemic: sedation (CNS penetration), anticholinergic effects (incr SNS)
Ocular: dry eye, incr IOP, mydrasis (and possible angle closure)

Question 14

Promethazine

-additional ocular SE

Answer 14

Chemical structure similar to phenothiazines (antipsychs) -> pigementary changes:

• corneal endothelial pigmentation
• lenticular changes, incl pigmentation
• pigmentary retinopathy

Question 15

Loratadine, Fexofenadine, Cetirizine

• MOA
• clinical indications
• adverse effects

Answer 15

Block interaction b/w histamine and H1 receptors

Allergic rhinitis, chronic urticaria/hives

Less lipid soluble = less CNS penetration/effects
Cetirizine can cause OCULOGYRIC CRISIS (abnormal EOM contractions)
-antipsychs can also cause