Autonomic Agents

Question 1

Bethanechol

Answer 1

Cholinomimetic - Activates bowel and bladder

Question 2

Carbachol

Answer 2

Cholinomimetic

Treats glaucoma causes pupillary constriction

Question 3

Pilocarpine

Answer 3

Cholinomimetic
Constricts ciliary muscle of eye - Glaucoma
Stim. sweat, tears, saliva

Question 4

Methacholine

Answer 4

Stimulates muscarinic R in airway when inhaled

Asthma challenge test

Question 5

Neostigmine

Answer 5

Blocks AChE
Activates bowel/bladder
MG
Reverse NMJ blockade

Question 6

Physostigmine

Answer 6

Blocks AChE - Anticholinergic Toxicity (CNS)

Question 7

Donepezil, rivastigmine, galantamine

Answer 7

Blocks AChE - Alzheimers

Question 8

Edrophonium

Answer 8

Blocks AChE - Historically dx MG

Question 9

What side effects do you have to watch for when using cholinomimetics?

Answer 9

Exacerbation of COPD, asthma, and peptic ulcers in susceptible patients

Question 10

What drug irreversibly inhibits AChE? What are the symptoms?

Answer 10

Organophosphates/Insecticides

Diarrhea, urination, miosis, bronchospasm, bradycardia, excitation, lacrimation, sweating, salivation

Question 11

How do you treat organophosphate poisoning?

Answer 11

Atropine and Pralidoxime (regenerate AChE)

Question 12

Atropine, homatropine, tropicamide

Answer 12

Muscarinic Antagonist

Mydriasis and cycloplegia

Question 13

Benztropine

Answer 13

Muscarinic Antagonist - CNS

Parkinsons

Question 14

Scopolamine

Answer 14

Muscarinic Antagonist - CNS

Motion sickness

Question 15

Ipratropium & tiotropium

Answer 15

Muscarinic Antagonist - Respiratory

COPD and asthma

Question 16

Oxybutynin, darifenacin, slifenacin

Answer 16

Muscarinic Antagonist - GU

Reduce urgency in mild cystitis, reduce bladder spasms

Question 17

Glycopyrrolate

Answer 17

Muscarinic Antagonist - GU/Resp
Parenteral: Preop to reduce airway secretions
Oral: drooling, peptic ulcer

Question 18

What are signs of Atropine toxicity?

Answer 18

Inc. body temp, rapid pulse, dry mouth
Dry flushed skin
Cycloplegia
Constipation
Disorientation

Question 19

What 3 populations are you worried about atropine in?

Answer 19

Elderly - acute angle closure
Men w/ BPH - urinary retention
Infants - hyperthermia

Question 20

Epinephrine

Answer 20

β > α
Anaphylaxis, open angle glaucoma, asthma, hypotension
*high dose = α

Question 21

Norepinephrine

Answer 21

α1 > α2 > β1

Hypotension (dec. renal perfusion)

Question 22

Isoproterenol

Answer 22

β1 = β2

Electrophysiologic evaluation of tachyarrhythmias - worsen ischemia

Question 23

Dopamine

Answer 23

D1 = D2 > β > α
Unstable bradycardia, heart failure, shock
*high dose = α

Question 24

Dobutamine

Answer 24

β1 > β2, α

Heart failure, cardiac stress testing

Question 25

Phenylephrine

Answer 25

α1 > α2 Hypotension Ocular procedures - mydriatic Rhinitis - decongestant

Question 26

Albuterol, salmeterol, terbutaline

Answer 26

β2 > β1 Albuterol = acute asthma Salmeterol = longterm asthma or COPD Terbutaline = reduce premature uterine contractions

Question 27

Amphetamine

Answer 27

MDMA - indirect general sympathetic agonist, blocks reuptake, releases stored catecholamines

Question 28

Ephedrine

Answer 28

Indirect Sympathomimetic Releases stored catecholamines Nasal decongestion, urinary incontinence, hypotension

Question 29

Cocaine

Answer 29

Indirect sympathomimetic - Reuptake inhibitor Vasoconstriction and local anesthesia **Never give β-blockers -> extreme HTN

Question 30

Clonidine

Answer 30

α2 agonist | HTN urgency, ADHD, severe pain

Question 31

α-methyldopa

Answer 31

α2 agonist- Treat HTN in pregnancy Toxicity = direct coombs + hemolytic anemia SLE-like syndrome

Question 32

Phenoxybenzamine

Answer 32

Irr. α-blocker - Pheochromocytoma

Question 33

Phentolamine

Answer 33

Reversible α-blocker - Pts on MAOIs who eat tyramine-containing foods

Question 34

Prazosin, terazosin, tamsulosin

Answer 34

α1-blockers - Urinary symptoms of BPH, PTSD, HTN | 1st dose orthostatic hypotension, dizziness, headache

Question 35

Mirtazapine

Answer 35

α2-blocker | Sedations, inc. cholesterol, inc. appetite

Question 36

What are the indications for β-blockers?

Answer 36

``` Angina pectoris MI SVT - metoprolol, esmolol HTN CHF Glaucoma - timolol ```

Question 37

Pyridostigmine

Answer 37

AChE Inhibitor - MG - no CNS