Autonomic

Question 1

Bethanecol

Answer 1

Cholinomimetic agent
Activates bowel and bladder smooth muscle; resistant to AchE.
Post-operative ileus, neurogenic ileus, urinary retention

Question 2

Carbachol

Answer 2

Cholinomimetic agent. Acetylcholine analog

Glaucoma, pupillary constriction, relief of intraocular pressure

Question 3

Pilocarpine

Answer 3

Cholinomimetic agent
Contracts ciliary muscle of eye (open-angle), pupillary sphincter (closed-angle), resistant to AchE.
Potent stimulator of sweat, tears, and saliva. Open-angle and closed-angle glaucoma.

Question 4

Methacholine

Answer 4

Cholinomimetic agent
Stimulates muscarinic receptors in airway when inhaled.
Challenge test for diagnosis of asthma

Question 5

Neostigmine

Answer 5

Anticholinesterase
Increases endogenous Ach. No CNS penetration.
Postoperative and neurogenic ileus and urinary retention, myasthenia gravis, post-operative reversal of neuromuscular junction blockade.

Question 6

Pyridostigmine

Answer 6

Anticholinesterase
Increases endogenous Ach, increases strength. Does not penetrate CNS.
Myasthenia gravis (long-acting)

Question 7

Physostigmine

Answer 7

Anticholinesterase
Increases endogenous Ach, crosses BBB
Anticholinergic (atropine) toxicity

Question 8

Donepezil

Answer 8

Anticholinesterase
Increases endogenous Ach
Alzheimer disease

Question 9

Rivastigmine

Answer 9

Anticholinesterase
Increases endogenous Ach
Alzheimer disease

Question 10

Galantamine

Answer 10

Anticholinesterase
Increases endogenous Ach
Alzheimer disease

Question 11

Edrophonium

Answer 11

Anticholinesterase
Increases endogenous Ach
Extremely short acting. Historical use in diagnosis of myasthenia gravis.

Question 12

Atropine

Answer 12

Muscarinic antagonist
Produces mydriasis, cycloplegia, decreases airway secretions, decreases stomach acid secretions, decreases gut motility, decreases urgency (cystitis)
Increases body temperature (decreased sweating), rapid pulse, dry mouth, dry, flushed skin, constipation, disorientation, acute angle-closure glaucoma (mydriasis), urinary retention in men with prostatic hyperplasia, hyperthermia in infants

Question 13

Homatropine

Answer 13

Muscarinic antagonist (eye)
Produces mydriasis, cycloplegia

Question 14

Tropicamide

Answer 14

Muscarinic antagonist (eye)
Produces mydriasis, cycloplegia

Question 15

Benztropine

Answer 15

Muscarinic antagonist (CNS)
Parkinson disease

Question 16

Scopolamine

Answer 16

Muscarinic antagonist (CNS)
Motion sickness

Question 17

Ipratropium

Answer 17

Muscarinic antagonist (lungs)
COPD, asthma

Question 18

Tiotropium

Answer 18

Muscarinic antagonist (lungs)
COPD, asthma

Question 19

Oxybutynin

Answer 19

Muscarinic antagonist (GU)
Reduce urgency in mild cystitis, reduce bladder spasms.

Question 20

Darifenacin

Answer 20

Muscarinic antagonist (GU)
Reduce urgency in mild cystitis, reduce bladder spasms.

Question 21

Solifenacin

Answer 21

Muscarinic antagonist (GU)
Reduce urgency in mild cystitis, reduce bladder spasms.

Question 22

Glycopyrrolate

Answer 22

Muscarinic antagonist (GI, respiratory)
Parenteral: preoperative reduction of airway secretions
Oral: Drooling, peptic ulcers

Question 23

Epinephrine

Answer 23

Sympathomimetic
β>α, α predominates at high doses
Anaphylaxis, open angle glaucoma, asthma, hypotension

Question 24

Norepinephrine

Answer 24

Sympathomimetic
α1>α2>β1
Hypotension (decreases renal perfusion)

Question 25

Isoproterenol

Answer 25

Sympathomimetic β1=β2 Electrophysiologic evaluation of tachyarrhythmias. Can worsen ischemia

Question 26

Dopamine

Answer 26

Sympathomimetic D1=D2>β>α Unstable bradycardia, heart failure, shock, inotropic and chronotropic α effects predominate at high doses

Question 27

Dobutamine

Answer 27

Sympathomimetic β1>β2,α Heart failure (inotropic>chronotropic), cardiac stress testing

Question 28

Phenylephrine

Answer 28

Sympathomimetic α1>α2 Hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)

Question 29

Albuterol

Answer 29

Sympathomimetic β2>β1 Acute asthma

Question 30

Salmeterol

Answer 30

Sympathomimetic β2>β1 Long-term asthma, COPD control

Question 31

Terbutaline

Answer 31

Sympathomimetic β2>β1 Reduce premature uterine contractions

Question 32

Amphetamine

Answer 32

Indirect sympathomimetic Indirect general agonist, reuptake inhibitor, releases stored catecholamines Narcolepsy, obesity, attention deficit disorder

Question 33

Ephedrine

Answer 33

Indirect sympathomimetic Indirect general agonist, releases stored catecholamines Nasal decongestion, urinary incontinence, hypotension

Question 34

Cocaine

Answer 34

Indirect sympathomimetic Indirect general agonist, reuptake inhibitor Causes vasoconstriction, local anesthesia, never give β-blockers if cocaine intoxication is suspected (can lead to unopposed α1 activation, extreme hypertension)

Question 35

Clonidine

Answer 35

Sympatholytic (α2 agonist) Hypertensive urgency. Does not decrease renal blood flow. ADHD, severe pain, off-label indications (ethanol and opioid withdrawal). CNS depression, bradycardia, hypotension, respiratory depression, small pupil size

Question 36

α-methyldopa

Answer 36

Sympatholytic (α2 agonist) Hypertension in pregnancy Direct Coombs (+) hemolytic anemia, SLE-like syndrome

Question 37

Phenoxybenzamine

Answer 37

Irreversible non-selective α-blocker Pheochromocytoma (used preoperatively to prevent catecholamine/hypertensive crisis) Orthostatic hypotension, reflex tachycardia, diminished vasoconstriction, GI upset, headache, ED

Question 38

Phentolamine

Answer 38

Reversible non-selective α-blocker | Given to patients on MAO inhibitors who eat tyramine-containing foods

Question 39

Prazosin

Answer 39

α1-selective α-blocker Urinary symptoms of BPH, PTSD, hypertension 1st dose orthostatic hypotension, dizziness, headache

Question 40

Terazosin

Answer 40

α1-selective α-blocker Urinary symptoms of BPH, hypertension 1st dose orthostatic hypotension, dizziness, headache

Question 41

Doxazosin

Answer 41

α1-selective α-blocker Urinary symptoms of BPH, hypertension 1st dose orthostatic hypotension, dizziness, headache

Question 42

Tamsulosin

Answer 42

α1-selective α-blocker Urinary symptoms of BPH 1st dose orthostatic hypotension, dizziness, headache

Question 43

Mirtazapine

Answer 43

α2-selective α-blocker Depression Sedation, increased serum cholesterol, increased appetite

Question 44

Metoprolol

Answer 44

β1>β2-selective antagonist