Autonomic Drugs Flashcards
What are the symptoms of Atropine Toxicity?
Think: Hot as a Hare, Dry as a bone, Red as a beet, Blind as a bat, Mad as a hatter
1) Increased body temperature (due to decreased sweating)
2) Rapid pulse
3) Dry, flushed skin
4) Cycloplegia
5) Disorientation
What do you give to a pt. who has an Atropine overdose?
1) Anticholineesterase that is able to cross the blood brain barrier (Physotigmine)
What sympathetic innervations have cholinergic fibers?
1) Adrenal medulla (Preganglionic cholinergic)
2) Sweat glands (Postganglionic cholinergic)
What is a nicotinic receptor?
1) Cholinergic receptor that is a ligand gated Na/K channel
2) Located in In muscle and Postganglionic neurons
What is a muscarinic receptor?
1) Cholinergic G protein receptor that are found in the parasympathetic as well as the sweat glands
What are the G protein classes?
1) G-stimulatory (s)
2) G- inhibitory (i)
3) G- IP3 (q)
How does the Gq protein work?
1) Activates phospholipase C
2) Cleaves PIP2 into IP3 and DAG (activates protein kinase C)
3) Results in increase amounts of Ca
Name all the G protein receptors
1) Alpha 1 = Gq
2) Alpha 2 = Gi
3) Beta 1 = Gs
4) Beta 2 = Gs
5) M1 = Gq
6) M2 = Gi
7) M3 = Gq
8) D1 = Gs
9) D2 = Gi
10) H1 = Gq
11) H2 = Gs
12) V1 = Gq
13) V2 = Gs
Where are alpha 2 receptors located?
1) Located on Preganglionic nerves
2) Regulate release of NE (Inhibit)
How does botulinum toxin affect the autonomic system?
1) Botulinum blocks the release of ACh resulting in flaccid paralysis
What increases the release of neurotransmitters from the presynaptic neuron?
1) Ca inflow
1) Bethanechol
2) Carbachol
3) Pilocarpine
4) Metacholine
direct cholinomimetic agonists
Think: CHOL
Drug used for postoperative ileus and urinary retenion; activates bowel and bladder smooth muscle
Bethanechol
Think: Bethany, call (Bethanechol) me if you want to activate your bladder and your bowels
Carbon copy of acetylcholine; used to treat glaucoma, pupillary contraction, and relief of intraoccular pressure
Carbachol
Drug that contracts ciliary muscles of the eye; stimulates sweating, tears, and saliva
Think: You can cry, drool, and sweat on your PILOw
1) Pilocarpine
Challenge test for asthma
Methacholine
What are indirect cholinomimetic agonists
Acetylcholine esterases inhibitors
Acetylcholine esterase inhibitor that does not penetrate the CNS
think: NeOstigmine = NO CNS penetration
1) Neostigmine
What acetylcholine esterase inhibitors are used for treatment of Alzheimer’s
1) Doepezil
2) Rivastigmine
3) Galantamine
Main purpose of Physostigimine
Think: Physostigmine “PHYxes” atropine overdose
1) Atropine overdose
Symptoms related to cholineesterase inhibitor toxicity
Think: DUMBBELLS or Everything is LEAKY
1) Diarrhea
2) Urination
3) Miosis
4) Bronchspasm
5) Bradycardia
6) Excitation of skeletal muslces
7) Lacrimation
8) Sweating/Salivation
What can act as an acetylcholine esterase inhibitor that can be found in your garage/shed?
Insecticides (organophosphates)
- Anticholine esterase inhibitor
What do you give to a pt. who is overdosed with an acetylchoine esterase inhibitor/pesticide poisoning?
1) They are in a acetylcholine overdose state
2) Give anti-muscarinic (atropine)
3) Give Pralidoxime (regenrates acetylcholine esterase)
What are the affects of atropine?
1) Blocks muscarinic effects
What is phenylephrine used for?
1) Alpha agonist
2) Good for hypotension, ocular procedures (causes mydriaosis), rhinitis
What does norepinephrine and phenylephrine act on?
Alpha receptors
Selectivity for alpha-1
What does isoproterenol act on?
Beta receptors
Alpha 2 agonists that decrease central sympathetic flow; results in vasodilation
Clonidine and alpha methyldopa
Phenoxybenazmine
Phentolamine
Non-selective alpha blockers
1) Phenoxybenzamine -irreversible
2) Phentolamine- reversible
Prazosine
Terazosin
Doxazosin
Tamsulosin
Alpha-1 selective blockers
Mirtazapine
Alpha 2 selective blocker
what should be used for a pt. on a MAO inhibitor who ate a tyramine containing food?
1) Remember that MAO decrease the reuptake of NE
2) Phentolamine (alpha non-selective blocker)
What should be given to a pt. before having a pheochromocytomoa removed?
1) Phenoxybenzamine
2) Irreversible agent used to prevent high levels of catecholamines overcoming blockage
Uses for alpha 1 blocker?
1) Hypertension
2) Urinary retention in BPH
Uses for Mitrazapine
1) Atypical antidepressant
2) Be aware of weight gain that can occur
Atenolol Betaxolol Esmolol Acebutolol Metoprolol
Beta 1 selective beta blockers
Pindolol
Timolol
Nadolol
Propranol
Non-selective beta blockers
What are the effects of the sympathetic nervous system?
1) Mydriasis
2) Constipation
3) Increased HR/contractility
4) Decreased salivation
5) Decreased bronchiolar smooth muscle
6) Increased tone of the bladder
7) Decreased peristalsis and contraction of sphincter
8) Ejaculation
What drug regenerates acetylcholine esterase
Pralidxoime
What drug is used in the Tensilon test?
1) Edrophonium (anticholine esterase)
2) Diagnosis of Myasthenia Gravis
1) Ptosis worsening throughout the day
2) Diplopia
3) Muscle weakness
4) Thymic hyperplasia, thymoma
Myasthenia gravis
What is used to improve COPD
Think: I PRAy i can breathe soon!
Ipratropium
What is the location of the following:
1) alpha-1
2) alpha-2
3) Beta-1
4) Beta-2
1) Vasculature
2) Presynaptic autonomic
3) Heart
4) Bronchus
Carvedilol
Labetolol
Non selective alpha and beta antagonist
MOA of Scopolamine
Muscarinic antagonist
Use of oxybutynin
Reduce urgency
Antimuscarinic
