ANS

Question 1

Acetyl Choline

Answer 1

Direct acting Cholinergic Agonist

Question 2

Bethanechol

Answer 2

Direct Acting Cholinergic Agonist
Lacks nicotinic action
1 hr duration of action

Action : Effects on smooth muscle of bladder and GI tract

Indication: In urologic treatment, to stimulate atonic bladders, particularly in postpartum, postoperative , non obstructive urinary retention
To treat neurogenic atony & megacolon.

Question 3

Carbachol

Answer 3

Class: Direct Acting Cholinergic Agonist

Action: muscarinic & nicotinic
On CVS and GI tract, eye miosis

Indication: Miotic agent to treat Glaucoma. Intraocular pressure reduced for 4 - 8 hrs

Question 4

Pilocarpine

Answer 4

Therapeutic Class: Direct Acting Cholinergic Agonist

Chemical class: tertiary Amine alkaloid

Action: non selective, powerful secretagogue,

Indication: Sjögren’s Syndrome for dry mouth and lack of tears,
For Glaucoma , decreasing intraocular pressure by increased drainage of aq. Humor

Adverse effects: diaphoresis, salivation, CNS disturbance, same effects as mushrooms genus INOCYB

Question 5

Edrophonium

Answer 5

Therapeutic Class: Indirect Acting Cholinergic Agonist
Chemical class: Quaterney Amine

Short duration of action 10 to 20 min

Indication: Diagnosis of Myasthenia Gravis,
Differentiation b/w Cholinergic Crisis and Myasthenic Crisis
Reversing effects of non-depolarizing neuromuscular Blockers after surgery.

Question 6

Physostigmine

Answer 6

Therapeutic Class: Indirect Acting Cholinergic Agonist
Chemical class: Nitrogenous Carbamic Acid

Action: muscarinic , nicotinic and NMJ sites
Duration: 2 to 4 hr

Action: for Atony of Bladder and intestine
Glaucoma treatment, antidote for overdose of Atropine , phenothiazine and TCAs

Question 7

Neostigmine

Answer 7

Therapeutic Class: Direct Acting Cholinergic Agonist

Chemical class: Carbamic Acid ester (quaternary N)

Duration : 30 min to 2h

Action: bladder GI, treat symptoms of Myasthenia gravis,
Antidote for tubocurarine

Question 8

Pyridostigmine

Ambenonium

Answer 8

Therapeutic Class: Direct Acting Cholinergic Agonist

For chronic management of Myasthenia gravis
Duration : 3 to 6 h & 4 to 8 h respectively

Question 9

Tacrine
Donepezil
Rivastigmine
Galantamine

Answer 9

Therapeutic Class: Direct Acting Cholinergic Agonist
Anti Alzheimer’s

Alzheimer’s Disease (for loss of cognitive function)

Tacrine causes hepatotoxicity
All cause GI distress.

Question 10

Echothiophate

Answer 10

Therapeutic Class: Indirect Acting Cholinergic Agonist (Irreversible)
Chemical Class: organophosphate

Duration: 1 week

Indication: treatment for chronic open angle glaucoma
Potential risk for causing cataracts and Cholinergic poisoning

Question 11

Pralidoxime (PAM)

Answer 11

For reactivation of Acetylcholinesterase

Used in organophosphate poisoning along with Atropine

Question 12

Atropine

Answer 12

Therapeutic Class: Antimuscarinic

Chemical class: tertiary Amine (bella donna alkaloid)

Duration : 4 hrs

Indication: mydriatic and cycloplegic effect for eye examination
L-hyoscyamine isomer as antispasmodic
Antidote for Cholinergic and mushroom poisoning
Prophylaxis in surgery to block secretion in respiratory tract

Question 13

Scopolamine

Answer 13

Anti muscarinic
Tertiary amine
Anti motion sickness (prophylaxis)
Blocks short term memory (adjunct with anesthesia)
May produce euphoria

Question 14

Ipratropium

Tiotropium

Answer 14

Therapeutic Class: anti muscarinic

Chemical class: quaternary derivative of Atropine

Inhaled

Bronchodilator for treatment of bronchospasm (COPD)

Tiotropium (once daily)
Ipratropium ( 4 times per day)

Question 15

Tropicamide

Cyclopentolate

Answer 15

Therapeutic Class: anti muscarinic

Mydriasis and cycloplegia
Short acting (6 & 24 h respectively)

Question 16

Benztropine

Trihexyphenidyl

Answer 16

Therapeutic Class: anti muscarinic

Parkinson disease

Question 17

Darifenacin 
Fesoterodine
Oxybutynin
Solifenacin
Tolterodine
Trospium Cl

Answer 17

Therapeutic Class: anti muscarinic

Treatment of over active bladder

Oxybutynin ( transdermal patch) causes less dry mouth

Question 18

Nicotine

Answer 18

Ganglionic Blocker

Question 19

Mecamylamine

Answer 19

Ganglionic Blocker

Question 20

Atracurium
Cis atracurium
Pancuronium
Rocuronium
Vecuronium

Tubocurarine (discontinued)

Answer 20

Non-depolarizing competitive
Neuromuscular Blocker

Used in surgery to have complete muscle relaxation
To facilitate intubation
And for orthopedic surgery

Question 21

Succinyl Choline

Answer 21

Depolarizing competitive
Neuromuscular Blocker

Muscle relaxant

Adverse effects:
- Hyperthermia (with Halothane)
- Apnea in:
(people deficient in plasma cholinesterase)
(patients with electrolyte imbalance)
(patients taking Digoxin or diuretics)
- hyperkalemia (especially in burn patients)

Question 22

Epinephrine

Answer 22

Aderenergic Agonist (Direct)
Catecholamine Neurotransmitter
Synthesized from TYROSINE in Adrenal Medulla
Low dose –> B- rec , causes vasodilation
High dose–> a-rec (vasoconstriction)

Question 23

Epinephrine action

Answer 23

Action:
Cardiovascular : increase contractility & rate of contraction

Renal: B1 rec kidney to cause renin release —> forms angiotensin II (vasoconstrictor) . causes peripheral constriction and systemic dilation

Respiratory: B2 , bronchodilation , inhibits release of histamines

Hyperglycemia: B2 Increase glucagon 2, a2 decrease insulin

Lipolysis: b rec, stimulate lipase, hydrolyzes triacylglycerols to fatty acids & glycerols

Question 24

epinephrine therapy

Answer 24

bronchospasm
anaphylactic shock
cardian arrest
Adjucnt with local anethesia

Question 25

epinephrine adverse effects and interactions

Answer 25

``` Ad effects: CNS: anxiety, fear, tension, headache, tremor Hemorrhage cardiac arrhythmias Pulmonary edema ``` ``` Interaction: Hyperthyroidism Cocaine Diabetes B blocker Inhalation anesthetics ```

Question 26

Nor epinephrine

Answer 26

neuromediator of adrenergic nerves | used to treat shock

Question 27

Isoproterenol

Answer 27

Adrenergic agonist (direct) Synthetic catecholamine B1 and B2 stimulate heart in emergency situation

Question 28

Dopamine

Answer 28

``` direct adrenergic agonist Metabolic precursor of norepinephrine occurs in CNS and adrenal medulla a1, B1, D1, D2 D1 renal and peripheral mesentric vascular beds. Vasodilatio. D2 mediate nor epinephrine release for cardiogenic and septic shock ```

Question 29

Fenoldopam

Answer 29

D1 agonist affinity for a2 receptors to treat severe hypertension

Question 30

Dobutamine

Answer 30

adrenergic agonist direct Synthetic catecholamine To increase cardiac output in congestive heart failure tolerance from prolonged use.

Question 31

Oxymetazoline

Answer 31

Direct adrenergic agonist a1 & a2 eye and nose as vasoconstrictor for nasal decongestion, redness of eye from swimming, cold, lenses.

Question 32

Phenylephrine

Answer 32

``` Direct acting adrenergic agonist a1 nasal decongestant, for mydriasis to raise BP and terminate supraventricular tachy cardia ```

Question 33

Clonidine

Answer 33

a2 agonist direct | used in withdrawal therapy of opiates, benzodiazepines and tobacco

Question 34

Metaproterenol

Answer 34

adrenergic agonist direct

Question 35

Albuterol | Terbutaline

Answer 35

B2 Agonist Direct short acting metered dose inhalers Terbutaline: uterine relaxant to suppress premature labor

Question 36

Salmeterol & Formeterol

Answer 36

``` B2 agonist Metered dose inhalers for bronchodilation combo with corticosteroids for nocturnal asthma Death in overuse ```

Question 37

Amphetamine

Answer 37

``` Adrenergic agonist indirect by blockade of norepinephrine uptake & cellular release of stored catecholamines. ADHD in children Narcolepsy Appetite Control ```

Question 38

Tyramine

Answer 38

adrenergic agonist indirect | Enters nerve terminal and displaces stored epinephrine

Question 39

Cocaine

Answer 39

Indirect adrenergic agonist Blocks Na+/K+ activated ATPase , required for cellular uptake of norepinephrine. CNS stimulant

Question 40

Ephedrine | Pseudoephedrine

Answer 40

Mixed adrenergic agonist Release stored epinephrine & directly stimulate a & B rec Longer action as poor substrate for MAO & COMT can cause CVS adverse effects