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ANS Treatment + Flashcards

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1
Q

Treatment:

Bradycardia
or Heart Block
Due to Excess Vagal Tone

A

Atropine

Natural, Tertiary Alkaloid, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker

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2
Q

Treatment:

Emergency
Cardiac Arrest
or Heart Block

A

Epinephrine

Agonist @ Alpha, Beta 1, Beta 2

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3
Q

Treatment:

Arrhythmia

A

1) Propranolol
(Non-Selective Beta Antagonist; High Lipid Solubility)

2) Metoprolol
(Selective Beta 1 Antagonist)

3) Atenolol
(Selective Beta 1 Antagonist)

4) Timolol
(Non-Selective Beta Antagonist)

5) Pindolol
(Non-Selective Beta Partial Agonist)

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4
Q

Treatment:

Angina

A

1) Propranolol
(Non-Selective Beta Antagonist; High Lipid Solubility)

2) Metoprolol
(Selective Beta 1 Antagonist)

3) Atenolol
(Selective Beta 1 Antagonist)

4) Timolol
(Non-Selective Beta Antagonist)

5) Pindolol
(Non-Selective Beta Partial Agonist)

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5
Q

Treatment:

Post-MI

A

1) Propranolol
(Non-Selective Beta Antagonist; High Lipid Solubility)

2) Metoprolol
(Selective Beta 1 Antagonist)

3) Atenolol
(Selective Beta 1 Antagonist)

4) Timolol
(Non-Selective Beta Antagonist)

5) Pindolol
(Non-Selective Beta Partial Agonist)

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6
Q

Treatment:

Acute Unstable CHF

A

Dobutamine
(Beta 1 Agonist, Direct-Acting; Acts @ Beta 1 and Alpha 1)

_Beta 1: Stimulate Heart

_Alpha 1: Vasoconstriction
⇒ Raise Blood Pressure

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7
Q

Treatment:

Chronic, Stable CHF

A

1) Propranolol
(Non-Selective Beta Antagonist; High Lipid Solubility)

2) Metoprolol
(Selective Beta 1 Antagonist)

3) Atenolol
(Selective Beta 1 Antagonist)

4) Timolol
(Non-Selective Beta Antagonist)

5) Pindolol
(Non-Selective Beta Partial Agonist)

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8
Q

Treatment:

Cardiac Manifestations of Hyperthyroidism

A

1) Propranolol
(Non-Selective Beta Antagonist; High Lipid Solubility)

2) Metoprolol
(Selective Beta 1 Antagonist)

3) Atenolol
(Selective Beta 1 Antagonist)

4) Timolol
(Non-Selective Beta Antagonist)

5) Pindolol
(Non-Selective Beta Partial Agonist)

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9
Q

Treatment:

Local Anesthesic Preps (for Vasoconstriction):

A

Epinphrine

Agonist @ Alpha, Beta 1, Beta 2

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10
Q

Treatment:

Anaphylactic Shock (IV) (Acute Hypersensitivity Reaction)

A

Epinephrine (Drug of Choice):
(Agonist @ Alpha, Beta 1, Beta 2)

_Alpha 1: Vasoconstriction
⇒ Raise Blood Pressure

_Beta 1: Stimulate Heart

_Beta 2: Bronchodilation

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11
Q

Treatment:

Shock

A

Dopamine
(Agonist @ Alpha 1, Beta 1, DA)
(Precursor of NE and Epi)

_Alpha 1: Vasoconstriction
⇒ Raise Blood Pressure

_Beta1: Stimulate Heart

_D1 Receptor: Renal Artery Dilation
(Protects Kidney, whereas NE vasoconstricts Renal)

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12
Q

Treatment:

Hypotension

A

1) Phenylephrine
(Alpha 1 Agonist, Direct-Acting)
(Vasoconstriction)

2) Oxymetazoline
(Alpha 1 Agonist, Direct-Acting)
(Vasoconstriction)

3) Pseudoephedrine
(Alpha 1 Agonist, Direct-Acting)
(Vasoconstriction)

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13
Q

Treatment:

Hypertension

A

(First-Line: Uncomplicated, Essential Chronic HTN; Less effective in Black Patients)

1) Propranolol
(Non-Selective Beta Antagonist; High Lipid Solubility)

2) Metoprolol
(Selective Beta 1 Antagonist)

3) Atenolol
(Selective Beta 1 Antagonist)

4) Timolol
(Non-Selective Beta Antagonist)

5) Pindolol
(Non-Selective Beta Partial Agonist)
______________________

1) Clonidine
(Alpha 2 Agonist, Direct-Acting)
(@ Brainstem Medulla to Inhibit Sympathetic)

2) Alpha-Methyldopa
(Alpha 2 Agonist, Direct-Acting)
(@ CNS to Inhibit Sympathetic)

3) Tizanidine
(Alpha 2 Agonist, Direct-Acting)
______________________

1) Prazosin
(Selective Alpha 1 Antagonist)
(Chronic HTN: oral; Emergency: Inj.)

2) Tamsulosin
(Selective Alpha 1 Antagonist)

3) Labetalol
(Competitive Block @ both Alpha 1 and Beta)

4) Carvedilol
(Competitive Block @ both Alpha 1 and Beta)
______________________

Reserpine:

(Inhibits intra-neuronal storage of NE: Inhibits Transport of NE from Cytosol to Vesicle)

_(Leads to Gradual Depletion of NE and 5-HT Stores) (Little use now)

_(Adverse Effects: Lethargy, Diarrhea, Depression-very long lasting)

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14
Q

Treatment:

COPD

A

1) Ipratropium
(Via BronchoDilation )
(Quaternary, Ionized;
Competitive Antagonist, Muscarinic Blocker)

2) Tiotropium
(Via BronchoDilation )
(Quaternary, Ionized;
Competitive Antagonist, Muscarinic Blocker)

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15
Q

Treatment:

Asthma

A

1) Epinphrine (Via Bronchodilation )
(Severe Asthma)
(Agonist @ Alpha, Beta 1, Beta 2)

2) Albuterol
(Beta 2 Agonist, Direct-Acting)
(Via Bronchodilation)

3) Salmeterol
(Beta 2 Agonist, Direct-Acting)
(Via Bronchodilation)

4) Ritodrine
(Beta 2 Agonist, Direct-Acting)
(Via Bronchodilation)

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16
Q

Treatment:

Constipation (lack of tone)

A

Bethanechol
(Direct-Acting, Agonist,
Selective on smooth muscle @ GI, @ Bladder)

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17
Q

Treatment:

Post-Operative Ileus (Atony)

A 
Neostigmine 
(Quaternary, Ionized; 
Indirect-Acting, 
Reversible Anti-Cholinesterase, 
False Substrate)
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18
Q

Treatment:

Diarrhea

A

Atropine (Lomotil)
(Source of atropine poisoning in children)

(Natural, Tertiary Alkaloid,
Lipid-Soluble, CNS;
Competitive Antagonist,
Muscarinic Blocker)

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19
Q

Treatment:

Motion Sickness (Emesis)

A 
Scopolamine 
(Natural, Tertiary Alkaloid, 
Lipid-Soluble, CNS; 
Competitive Antagonist, 
Muscarinic Blocker)
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20
Q

Treatment:

Bowel Spasms
Irritable Bowel Syndrome, IBS

A 
Dicyclomine 
(Synthetic, Tertiary, 
Lipid-Soluble, CNS; 
Competitive Antagnoist, 
Muscarinic Blocker)
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21
Q

Treatment:

Urinary Retention

A

Bethanechol
(Direct-Acting, Agonist,
Selective on smooth muscle @ GI, @ Bladder)

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22
Q

Treatment:

Benign Prostatic Hypertrophy (BPH): Relax Urethral Smooth Muscle; Promotes Urine Flow

A

1) Prazosin
(Selective Alpha 1 Antagonist)
(Chronic HTN: oral; Emergency: Inj.)

2) Tamsulosin*
(Selective Alpha 1 Antagonist)

3) Labetalol
(Competitive Block @ both Alpha 1 and Beta)

4) Carvedilol
(Competitive Block @ both Alpha 1 and Beta)

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23
Q

Treatment:

Urinary Frequency/Urgency, Overactive Bladder

A

1) Oxybutynin
(Quaternary; Some M3 Selectivity, Muscarinic Blocker)

2) Solifenacin
(Quaternary; Better M3 Selectivity, Muscarinic Blocker)

3) Tolteridine
(Quaternary; M3 Selective,
Muscarinic Blocker)

4) Mirabegron
(Beta 3 Agonist, Direct-Acting;
Beta 3 Relaxes Bladder Smooth Muscle)

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24
Q

Treatment:

Premature Labor

A

1) Albuterol
(Beta 2 Agonist, Direct-Acting)
(Uterine Relaxation @ Beta 2)

2) Salmeterol
(Beta 2 Agonist, Direct-Acting)
(Uterine Relaxation @ Beta 2)

3) Ritodrine*
(Beta 2 Agonist, Direct-Acting)
(Uterine Relaxation @ Beta 2)

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25
Treatment: Xerostomia
Pilocarpine (Direct-Acting, Agonist, Muscarinic, Tertiary Alkaloid, Lipid-Soluble, CNS)
26
Treatment: Excess Salivation (Hyperhidrosis)
1) Atropine (Natural, Tertiary Alkaloid, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker) 2) Botulinum Toxin (Inhibits ACh Release)
27
Treatment: Nasal Congestion
1) Phenylephrine (Alpha 1 Agonist, Direct-Acting) (Vasoconstriction) 2) Oxymetazoline (Alpha 1 Agonist, Direct-Acting) (Vasoconstriction) 3) Pseudoephedrine (Alpha 1 Agonist, Direct-Acting) (Vasoconstriction)
28
Treatment: Glaucoma
1) Clonidine (Alpha 2 Agonist, Direct-Acting; Reduces Aqueous Humor Formation) 2) Alpha-Methyldopa (Alpha 2 Agonist, Direct-Acting) 3) Tizanidine (Alpha 2 Agonist, Direct-Acting) _____________________ 1) Propranolol (Non-Selective Beta Antagonist; High Lipid Solubility) 2) Metoprolol (Selective Beta 1 Antagonist) 3) Atenolol (Selective Beta 1 Antagonist) 4) Timolol* (Non-Selective Beta Antagonist) (Reduces Aqueous Humor Formation) 5) Pindolol (Non-Selective Beta Partial Agonist) __________________ Pilocarpine (Direct-Acting, Agonist, Muscarinic, Tertiary Alkaloid, Lipid-Soluble, CNS)
29
Ophthalmologic Exam: Trigger Mydriasis (Dilated Pupils) and Cycloplegia (Ciliary Muscle Paralysis):
Tropicamide (Synthetic, Tertiary, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker)
30
Treatment: Migraine Prophylaxis
1) Propranolol (Non-Selective Beta Antagonist; High Lipid Solubility) 2) Metoprolol (Selective Beta 1 Antagonist) 3) Atenolol (Selective Beta 1 Antagonist) 4) Timolol (Non-Selective Beta Antagonist) 5) Pindolol (Non-Selective Beta Partial Agonist)
31
Treatment: Migraines
Botulinum Toxin | Inhibits ACh Release
32
Treatment: Wrinkles
Botulinum Toxin | Inhibits ACh Release
33
Treatment: Local Muscle Spasms
Botulinum Toxin (Inhibits ACh Rlease)
34
Treatment: Spasticity due to Neuropathy (e.g. Cerebral Palsy):
1) Clonidine* (Alpha 2 Agonist, Direct-Acting) (@ Spinal Cord to Reduce firing to motor neurons) 2) Tizanidine* (Alpha 2 Agonist, Direct-Acting) (@ Spinal Cord) 3) Alpha-Methyldopa (Alpha 2 Agonist, Direct-Acting)
35
Treatment: Tremor (of Peripheral origin)
1) Propranolol (Non-Selective Beta Antagonist; High Lipid Solubility) 2) Metoprolol (Selective Beta 1 Antagonist) 3) Atenolol (Selective Beta 1 Antagonist) 4) Timolol (Non-Selective Beta Antagonist) 5) Pindolol (Non-Selective Beta Partial Agonist)
36
Treatment: Alzheimer’s
1) Donepezil (Centrally-Acting Reversible Anti-Cholinesterase; Lipid-Soluble, CNS) 2) Rivastigmine (Centrally-Acting Reversible Anti-Cholinesterase; Lipid-Soluble, CNS) 3) Galantamine (Centrally-Acting Reversible Anti-Cholinesterase; Lipid-Soluble, CNS) 4) Tacrine (Centrally-Acting Reversible Anti-Cholinesterase; Lipid-Soluble, CNS)
37
Treatment: Parkinson’s
1) Benztropin (Synthetic, Tertiary, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker) 2) Trihexyphenidyl (Synthetic, Tertiary, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker) 3) Selegiline (MAO-B Inhibitor; Indirect-Acting; Inhibits Dopamine Metabolism @ Brain) 4) COMT Inhibitors (Indirect-Acting; Inhibit Dopamine Metabolism @ Brain)
38
Treatment: ADHD
``` 1) Amphetamine (Indirect-Acting; Stimulates NE Release; Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ``` ``` 2) Methamphetamine (Indirect-Acting; Stimulates NE Release; Greater CNS Activity than Amphetamine) (Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) __________________ ``` 1) Clonidine (Alpha 2 Agonist, Direct-Acting) (Not First-line; Not as effective as Central Stimulants) 2) Alpha-Methyldopa (Alpha 2 Agonist, Direct-Acting) 3) Tizanidine (Alpha 2 Agonist, Direct-Acting)
39
Treatment: Narcolepsy
``` 1) Amphetamine (Indirect-Acting; Stimulates NE Release; Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ``` ``` 2) Methamphetamine (Indirect-Acting; Stimulates NE Release; Greater CNS Activity than Amphetamine) (Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ```
40
Treatment: Depression
1) Tricyclic Antidepressants (Indirect-Acting; Inhibit NE Reuptake) 2) MAO-A Inhibitors (Indirect-Acting; Inhibits NT Metabolism)
41
Treatment: Pain Syndromes
1) Tricyclic Antidepressants (Indirect-Acting; Inhibit NE Reuptake) ``` 2) Cocaine (Indirect-Acting; Inhibit NE Reuptake and Inhibit Dopamine Reuptake) (Not Rx) ```
42
Treatment: | Antimuscarinic Poisoning e.g. Atropine Poisoning
``` 1) Physostigmine (Tertiary, Lipid-Soluble, CNS; Indirect-Acting, Reversible Anti-Cholinesterase, False Substrate) ``` ``` 2) Neostigmine (Quaternary, Ionized; Indirect-Acting, Reversible Anti-Cholinesterase, False Substrate) ```
43
Treatment: Organophosphate Poisoning:
1) Pralidoxime (Oxime; within 1 hour of poisoning, before Aging!) 2) (NO!!) Pyridostigmine (Reversible Anti-cholinesterase; Prophylaxis: Gulf War Syndrome with repeated use) (Gulf War Syndrome: Muscle Aches and Weakness, Diarrhea, Fatigue, Cognitive Problems)
44
Reversal of Competitive Muscle Blockers
Atropine + Reversible Anti-Cholinesterase ``` Atropine (Natural, Tertiary Alkaloid, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker) ```
45
Diagnostic: Myasthenia Gravis
``` Edrophonium (Truly Reversible, Competitive, Short-Acting; Indirect-Acting Anti-Cholinesterase) ```
46
Diagnostic: Asthma: Inhalation Challenge (Hyper Bronchoconstriction):
Metacholine (Direct-Acting, Agonist, Muscarinic, Affinity @ Heart; Inhalation Challenge: Bronchoconstriction)
47
Adverse Effects: Cholinergic Poison:
1) Echothiophate (Irreversible Anti-Cholinesterase, Organophosphate; Long-Acting Miotic) 2) Malathion (Irreversible Anti-Cholinesterase, Organophosphate; Insecticide) 3) Sarin (Irreversible Anti-Cholinesterase; Nerve Gas)
48
Adverse Effects: Anti-Muscarinic Poison:
``` Atropine (Natural, Tertiary Alkaloid, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker) ``` @ Low Therapeutic Doses: No Detectable CNS Effects @ Toxic Doses: CNS Stimulation, Restlessness, Irritability, Disorientation, Hallucinations. ``` @ Small Doses: 1) Hot, Flushed, Dry Skin, 2) Decreased Sweating (M3 Block), 3) Dry Mouth, Decreased Salivation (M3 Block), Thirst ``` @ Larger Doses: 1) Dilated Pupils (Photophobia) (Mydriasis) (M3 Circular Muscle Paralysis), 2) Blurry Near Vision (Cycloplegia) (M3 Ciliary Muscle Paralysis), 3) Tachycardia (Palpitations) (M2 Vagal Block) @ Even Larger Doses: Anti-Muscarinic Effects Red as a Beet, Hot as a Hare, Dry as a Bone, Blind as a Bat, Mad as a Hatter ______________________ Scopolamine (Natural, Tertiary Alkaloid, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker) 1) CNS Depressant: Drowsiness, Amnesia: Scopolamine @ Clinical Doses 2) CNS Excitation: Hallucinations: Scopolamine @ Patients w/ Severe Pain!
49
Adverse Effects: Cardiac Stimulation
1) @ Beta 1: Albuterol (Beta 2 Agonist, Direct-Acting) 2) @ Beta 1: Salmeterol (Beta 2 Agonist, Direct-Acting) 3) @ Beta 1: Ritodrine (Beta 2 Agonist, Direct-Acting) 4) @ Beta 1: Mirabegron (Beta 3 Agonist, Direct-Acting; Beta 3 Relaxes Bladder Smooth Muscle)
50
Adverse Effects: Arrhythmias
1) Metacholine (Direct-Acting, Agonist, Muscarinic, Affinity @ Heart; Inhalation Challenge: Bronchoconstriction) 2) @ Beta 1: Dobutamine (Beta 1 Agonist, Direct-Acting; Acts @ Beta 1 and Alpha 1)
51
Adverse Effects: Heart Block
Metacholine (Direct-Acting, Agonist, Muscarinic, Affinity @ Heart; Inhalation Challenge: Bronchoconstriction)
52
Adverse Effects: Hyperkalemia ⇒ Cardiac Depression
Succinylcholine (Depolarizing = Partial Agonist @ NMJ, Nicotinic; Plasma Pseudocholinesterase) (More common in Burn, Trauma pts; Dangerous if on Digoxin)
53
Adverse Effects: Bradycardia
Succinylcholine (Depolarizing = Partial Agonist @ NMJ, Nicotinic; Plasma Pseudocholinesterase) (Via Muscarinic Stimulation) _______________________ @ Alpha 1: Hypertension + Reflex Bradycardia: 1) Phenylephrine (Alpha 1 Agonist, Direct-Acting) 2) Oxymetazoline (Alpha 1 Agonist, Direct-Acting) 3) Pseudoephedrine (Alpha 1 Agonist, Direct-Acting)
54
Adverse Effects: Tachycardia
``` 1) Amphetamine (Indirect-Acting; Stimulates NE Release; Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ``` ``` 2) Methamphetamine (Indirect-Acting; Stimulates NE Release; Greater CNS Activity than Amphetamine) (Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ```
55
Adverse Effects: Reflex Tachycardia
1) Prazosin (Selective Alpha 1 Antagonist) (Chronic HTN: oral; Emergency: Inj.) 2) Tamsulosin (Selective Alpha 1 Antagonist) 3) Labetalol (Competitive Block @ both Alpha 1 and Beta) 4) Carvedilol (Competitive Block @ both Alpha 1 and Beta)
56
Adverse Effects: Hypotension
1) Succinylcholine (Depolarizing = Partial Agonist @ NMJ, Nicotinic; Plasma Pseudocholinesterase) (Via Histamine Release andGanglionic Block) ``` 2) d-Tubocurarine (Quaternary Alkaloid; Non-Depolarizing = Competitive Antagonist @ NMJ, Nicotinic) ``` (Via Histamine Release)
57
Adverse Effects: Postural Hypotension
(very Marked) Due to Blockage of Reflex Vasoconstriction 1) Prazosin (Selective Alpha 1 Antagonist) (Chronic HTN: oral; Emergency: Inj.) 2) Tamsulosin (Selective Alpha 1 Antagonist) 3) Labetalol (Competitive Block @ both Alpha 1 and Beta) 4) Carvedilol (Competitive Block @ both Alpha 1 and Beta)
58
Adverse Effects: Hypertension
@ Alpha 1: Dobutamine (Beta 1 Agonist, Direct-Acting; Acts @ Beta 1 and Alpha 1) ______________________ @ Alpha 1: + Reflex Bradycardia: 1) Phenylephrine (Alpha 1 Agonist, Direct-Acting) @ Alpha 1: + Reflex Bradycardia: 2) Oxymetazoline (Alpha 1 Agonist, Direct-Acting) @ Alpha 1: + Reflex Bradycardia: 3) Pseudoephedrine (Alpha 1 Agonist, Direct-Acting) ______________________ ``` 1) Amphetamine (Indirect-Acting; Stimulates NE Release; Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ``` ``` 2) Methamphetamine (Indirect-Acting; Stimulates NE Release; Greater CNS Activity than Amphetamine) (Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ```
59
Adverse Effects: Rebound Hypertension
1) Clonidine (Alpha 2 Agonist, Direct-Acting) (@ Brainstem Medulla to Inhibit Sympathetic) 2) Alpha-Methyldopa (Alpha 2 Agonist, Direct-Acting) (@ CNS to Inhibit Sympathetic) 3) Tizanidine (Alpha 2 Agonist, Direct-Acting)
60
Adverse Effects: Increased Bronchial Secretions
Succinylcholine (Depolarizing = Partial Agonist @ NMJ, Nicotinic; Plasma Pseudocholinesterase) (Via Muscarinic Stimulation)
61
Adverse Effects: Bronchoconstriction
(Via Beta 2 Block) Asthma Pts ⇒ Use Selective Beta 1 Blockers 1) Propranolol (Non-Selective Beta Antagonist; High Lipid Solubility) 2) Metoprolol (Selective Beta 1 Antagonist) 3) Atenolol (Selective Beta 1 Antagonist) 4) Timolol (Non-Selective Beta Antagonist) 5) Pindolol (Non-Selective Beta Partial Agonist)
62
Adverse Effects: Fasciculations of Abdominal Muscles ⇒ Increases Intragastric Pressure ⇒ Risk of Reflux
Succinylcholine (Depolarizing = Partial Agonist @ NMJ, Nicotinic; Plasma Pseudocholinesterase) (Most likely in pts w/ Delayed Gastric Emptying: Diabetics, Morbid Obesity)
63
Adverse Effects: Urinary Retention
``` Atropine (Natural, Tertiary Alkaloid, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker) ______________________ ``` 1) Phenylephrine (Alpha 1 Agonist, Direct-Acting) (@ Urinary Sphincter; esp. Old Men, Enlarged Prostate) 2) Oxymetazoline (Alpha 1 Agonist, Direct-Acting) (@ Urinary Sphincter; esp. Old Men, Enlarged Prostate) 3) Pseudoephedrine (Alpha 1 Agonist, Direct-Acting) (@ Urinary Sphincter; esp Old Men, Enlarged Prostate)
64
Adverse Effects: Increased Intraocular Pressure
Succinylcholine (Depolarizing = Partial Agonist @ NMJ, Nicotinic; Plasma Pseudocholinesterase)
65
Adverse Effects: Malignant Hyperthermia
⇒ Treat this with Dantrolene Succinylcholine (Depolarizing = Partial Agonist @ NMJ, Nicotinic; Plasma Pseudocholinesterase)
66
Adverse Effects: Post-Operative Muscle Pain
Succinylcholine (Depolarizing = Partial Agonist @ NMJ, Nicotinic; Plasma Pseudocholinesterase)
67
Adverse Effects: Tremors
@ Beta 2 @ Skeletal Muscle: 1) Albuterol (Beta 2 Agonist, Direct-Acting) 2) Salmeterol (Beta 2 Agonist, Direct-Acting) 3) Ritodrine (Beta 2 Agonist, Direct-Acting) ______________________ ``` 1) Amphetamine (Indirect-Acting; Stimulates NE Release; Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ``` ``` 2) Methamphetamine (Indirect-Acting; Stimulates NE Release; Greater CNS Activity than Amphetamine) (Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ```
68
Adverse Effects: Muscle Weakness
1) Clonidine (Alpha 2 Agonist, Direct-Acting) (@ Brainstem Medulla to Inhibit Sympathetic) 2) Alpha-Methyldopa (Alpha 2 Agonist, Direct-Acting) (@ CNS to Inhibit Sympathetic) 3) Tizanidine (Alpha 2 Agonist, Direct-Acting)
69
Adverse Effects: Rebound Nasal Congestion: (Rhinitis Medicamentosa)
1) Phenylephrine (Alpha 1 Agonist, Direct-Acting) (Vasoconstriction) 2) Oxymetazoline (Alpha 1 Agonist, Direct-Acting) (Vasoconstriction) 3) Pseudoephedrine (Alpha 1 Agonist, Direct-Acting) (Vasoconstriction)
70
Adverse Effects: Hypoglycemia
Via Beta 1 Block @ Liver of Compensatory Hyperglycemic Effects of Epinephrine Sweating is Only Remaining Symptom! (Loss of Tremor, Palpitations) Diabtic Pts ⇒ Use Selective Beta 1 Blockers 1) Propranolol (Non-Selective Beta Antagonist; High Lipid Solubility) 2) Metoprolol (Selective Beta 1 Antagonist) 3) Atenolol (Selective Beta 1 Antagonist) 4) Timolol (Non-Selective Beta Antagonist) 5) Pindolol (Non-Selective Beta Partial Agonist)
71
Adverse Effects: CNS Depressant: Drowsiness, Amnesia
Scopolamine @ Clinical Doses (Natural, Tertiary Alkaloid, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker)
72
Adverse Effects: Sedation
1) Clonidine (Alpha 2 Agonist, Direct-Acting) (@ Brainstem Medulla to Inhibit Sympathetic) 2) Alpha-Methyldopa (Alpha 2 Agonist, Direct-Acting) (@ CNS to Inhibit Sympathetic) 3) Tizanidine (Alpha 2 Agonist, Direct-Acting)
73
Adverse Effects: Nightmares/Sleep Disturbances
Propranolol has High Lipid Solubility. Atenolol is Less Lipid Soluble 1) Propranolol (Non-Selective Beta Antagonist; High Lipid Solubility) 2) Metoprolol (Selective Beta 1 Antagonist) 3) Atenolol (Selective Beta 1 Antagonist) 4) Timolol (Non-Selective Beta Antagonist) 5) Pindolol (Non-Selective Beta Partial Agonist)
74
Adverse Effects: CNS Stimulation: e.g. Insomnia
1) Phenylephrine (Alpha 1 Agonist, Direct-Acting) (Vasoconstriction) 2) Oxymetazoline (Alpha 1 Agonist, Direct-Acting) (Vasoconstriction) 3) Pseudoephedrine (Alpha 1 Agonist, Direct-Acting) (Vasoconstriction)
75
Adverse Effects: CNS Excitation: Hallucinations
Scopolamine @ Patients w/ Severe Pain! (Natural, Tertiary Alkaloid, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker)
76
Adverse Effects: CNS Excitation: Restlessness, Irritability, Disorientation, Hallucinations
Atropine @ Toxic Doses (No CNS @ Therapeutic Doses) (Natural, Tertiary Alkaloid, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker)
77
Adverse Effects: Psychosis, Convulsions, Dependence
``` 1) Amphetamine (Indirect-Acting; Stimulates NE Release; Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ``` ``` 2) Methamphetamine (Indirect-Acting; Stimulates NE Release; Greater CNS Activity than Amphetamine) (Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ```
78
Contraindications:
Atropine (Natural, Tertiary Alkaloid, Lipid-Soluble, CNS; Competitive Antagonist, Muscarinic Blocker) 1) Narrow Angle Glaucoma (Atropine causes Ciliary muscle to block flow) 2) Prostatic Hypertrophy (Old Men) _______________________ Beta Blockers: Propranolol, Atenolol, Metoprolol, Pindolol, Timolol 1) Unstable/Decompensated CHF 2) Acute CHF 3) Diabetic Pts: Use Selective Beta 1 Blockers 4) Asthma Pts: Use Selective Beta 1 Blockers
79
Drug Interactions: Diazepam
1) Increases Duration of Non-Depolarizing Blockers (Competitive Antagonists) 2) Decreases Duration of Depolarizing Blockers (Partial Agonists) (Succinylcholine)
80
Drug Interactions: Aminoglycosides
Increase Intensity and Duration of Muscle Blockers (Both Non-Depolarizers and Depolarizers) Large Doses can cause Muscle Block on its own
81
Drug Interactions: Ester Local Anesthetics
Increase Duration of Succinylcholine | b/c also Broken Down by Pseudocholinesterase
82
Drug Interactions: Cholinesterase Inhibitors
Neostigmine, Organophosphate Insecticides, etc. Increase Duration of Succinylcholine
83
Drug Interactions: MAO Inhibitors
⇒ Hypertensive Crisis ``` 1) Amphetamine (Indirect-Acting; Stimulates NE Release; Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ``` ``` 2) Methamphetamine (Indirect-Acting; Stimulates NE Release; Greater CNS Activity than Amphetamine) (Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ``` ``` 3) Ephedrine (Mixed Action: Direct @ Alpha, Beta; and Indirect @ Stimulates RE Release) (Milder than Amphetamines; Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis) ``` 4) Tyramine: @ Food (Indirect-Acting; Stimulates NE Release) (Tachyphylaxis; MAOI Intrxn: Hypertensive Crisis)

Pharm 2015 (22 decks)

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