Autonomic Agents EC Flashcards
Bethanechol
Muscarinic agonist
Used for ileus and urinary retention
“BETHANY CALL me to activate your bowel and bladder”
Carbachol
Muscarinic agonist
Used for Glaucoma, Miosis
“CARBon copy of AcetylCHOLine”
Pilocarpine
Muscarinic agonist
Used for glaucoma, stimulates sweat, tears, and saliva
“you cry, drool, and sweat on your PILOw”
Methacholine
Muscarinic agonist
Used for challenge in diagnosis of asthma
Neostigmine
Anti-Cholinesterase
Used for ileus, urinary retention, myasthenia gravis, reversal of neuromuscular blockade post-op
Pyridostigmine
Anti-Cholinesterase
Used for myasthenia gravis
“pyRIDOstiGMine gets RIDO Myasthenia Gravis”
Physostigmine
Anti-Cholinesterase
Used for Anticholinergic toxicity (crosses BBB)
“PHYsostigmine PHYxes atopine OD”
Edrophonium
Anti-Cholinesterase
Used for diagnosis myasthenia gravis (very short acting)
Donepezil
Anti-Cholinesterase
Used in alzheimer’s
Atropine
Anti-Muscarinic
Used to treat bradycardia and mydriasis/cycloplegia
Tropicamide
Anti-Muscarinic
Used for mydriasis/cycloplegia
Benztropine
Anti-Muscarinic
Used in Parkinson’s
“PARK by BENZ”
Scopolamine
Anti-Muscarinic
Used in motion sickness
Ipratropium and Tiotropium
Anti-Muscarinic
Used in COPD/asthma
Oxybutynin
Anti-Muscarinic
Used to reduce urgency and reduce bladder spasm
Glycopyrrolate
Anti-Muscarinic
Used to reduce airway secretions pre-op and for drooling/peptic ulcer
What are the actions of alpha 1 & 2, and beta 1 & 2 receptors?
alpha 1 - vasoconstriction
alpha 2 - inhibits NE release – vasodilation
beta 1 - stimulates HR and contractility
beta 2 - vasodilation and bronchodilation
Epinephrine (uses, receptors, effect on BP and HR)
anaphylaxis, open-angle glaucoma, asthma, & hypotension, vasoconstriction/local anesthesia
alpha 1, alpha 2, beta 1, beta 2
BP increases
HR increases
Norepinephrine (uses, receptors, effect on BP and HR)
Hypotension (septic shock)
alpha 1, alpha 2
BP increases HR decreases (reflex bradycardia)
Phenylephrine (uses, receptors)
Hypotension, mydriatic, rhinitis
alpha 1, alpha 2 (some)
Isoproterenol (uses, receptors, effect on BP and HR)
Torsade de pointes, bradyarrhythmias
beta 1, beta 2
BP decreases, HR increases dramatically
Dopamine (uses, receptors)
Shock, Heart failure (inotropic and chronotripic)
alpha 1 (high dose), alpha 2(high dose), beta 1(med dose), beta 2 (med dose), D1 (low dose)
Dobutamine (uses, receptors)
Heart failure, cardiac stress testing
beta 1
Albuterol, Salmeterol, Terbutaline (uses, receptors)
Acute asthma, COPD
beta 2
Terbutaline, Ritodrine (uses, receptors)
Reduce premature uterine contractions
beta 2
Amphetamine (uses&MOA)
Narcolepsy, obesity, ADHD
Increase monoamine release
Ephedrine (uses&MOA)
Decongestant, Urinary incontinence, Hypotension
Increase monoamine release
Cocaine (uses&MOA)
Vasoconstriction/local anesthesia
Inhibits NE reuptake
Clonidine, alpha-methyldopa (uses&MOA)
Hypertension w/ renal disease
alpha 2 agonist (decrease sympathetic outflow)
Phenoxybenzamine (uses&MOA)
Pheochromocytoma, (before removing tumor, followed by beta blockade)
Irreversible Non-selective alpha blocker
Phentolamine (uses&MOA)
Treat tyramine induced hypertension in pt’s on MAOIs
Reversible Non-selective alpha blocker
Prazosin, Terazosin, Doxazosin, Tamsulosin (uses&MOA&S/E)
Hypertension, Urinary retention, BPH (esp tamsolusin)
Alpha 1 blockers
First dose orthostatic hypotension
Mirtazapine (uses&MOA&S/E)
Depression (esp in elderly)
Alpha 2 blocker
Sedation, increased appetite, increased cholesterol
What is the effect of adding epinephrine after an alpha blockade? Why?
Decrease in BP
With alpha 1 receptors blocked, beta 2 vasodilation response predominates
What is the effect of adding phenylephrine after an alpha blockade? Why?
No effect
Since phenylephrine is alpha specific, an alpha blockade would negate its effects
What beta blockers would you want to use in patients with comorbid pulmonary disease?
Beta 1 selective (A-BEAM)
Acebutolol, Betaxolol, Esmolol, Atenolol, Metoprolol
What are the non-selective beta blockers?
Propranolol, Timolol, Nadolol, Pindolol
“Please Try Not Being Picky”
Non selective alpha/beta blockers
Carvedilol, Labetalol
Partial Beta Agonists
Pindolol, Acebutolol
“PAPA”
How can ACh lower blood pressure?
ACh receptors in vasculature lead to an increase in NO synthesis
Succinylcholine (uses/MOA/SE)
Endotracheal intubation
Depolarizing neuromuscular blocker (strong ACh agonist)
Phase I depolarization
Phase II repolarized but blocked
Malignant hyperthermia (treated with Dantrolene - muscle relaxation via inhibition of Ca release)
Tubocurarine (uses/MOA/se)
Endotracheal intubation
Adjunct to general anesthesia
Relax skeletal muscles during surgery
Facilitate mechanical ventilation
ACh receptor competitive antagonists
Reverse blockade with cholinesterase inhibitors (-stigmine)
