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Flashcards in Autonomic Drugs Deck (94)
1

Name the direct cholinomimetic agonists

Bethanechol, carbachol, methacholine, pilocarpine

2

Use of bethanechol

postoperative ileus, neurogenic ileus, urinary retention

3

Action of bethanechol

Activate bowel and bladder smooth muscle

resistant to AChE

4

Use of cabachol

constricts pupil and relieves intraocular pressure in glaucoma

5

Use of methacholine

challenge test for diagnosing asthma

6

Mech of methacholine

stimulates muscarinic receptors in airway when inhaled --> bronchoconstriction

7

Use of pilocarpine

potent stimulator of sweat, tears and saliva
open-angle and closed-angle glaucoma

8

Action of pilocarpine

constricts the ciliary muscle of the eye (good for open-angle glaucoma)
constricts the pupillary sphincter (good for closed-angle glaucoma)

resistant to AChE

9

Name the indirect cholinergic agonists

donepezil, galantamine, rivastigmine, edrophonium, neostigmine, physostigmine, pyridostigmine

10

Use of donepezil, galantamine and rivastigmine

alzheimers disease --> increase in ACh

11

Use of edrophonium

historically to dx myasthenia gravis

now dx MG via anti-AChR antibody test

12

Use of neostigmine

postoperative and nuerogenic ileus and urinary retention
myasthenia gravis
reversal of neuromuscular junction blockade (postoperative)

DOES NOT CROSS BBB

13

Use of physostigmine

anticholinergic toxicity
CROSS BBB

14

Use of pyridostigmine

myastenia gravis (long-acting)

DOES NOT CROSS BBB

15

Caution with cholinomimetic agents in who?

Asthmatics and pts with COPD to avoid exacerbation of disease

also peptic ulcers

16

Cholinesterase inhibitor poisoning

often due to organophosphates (irreversibly inhibit AChE)

DUMBBELSS
diarrhea, urination, miosis, bradycardia, bronchoconstriction, excitation of muscle, lacrimation, sweating, salivation

17

Antidote to organophosphate poisoning

atropine (competitive inhibitor) + pralidoxime (regenerates AChE if given early)

18

Name the muscarinic antagonists

atropine, homatropine, tropicamide, benztropine, glycopyrrolate, hyoscyamine, dicyclomine, ipratropium, tiotropium, oxybutynin, solifenacin, tolterodine, scopolamine

19

Organ system affected by atropine, homatropine, and tropicamide

eye

20

Action of atropine, homatropine, and tropicamide

produce mydriasis and cycloplegia

21

Organ system action of benztropine

CNS

22

Action of benztropine

Parkinson disease
Acute dystonia

23

Organ system action of glycopyrrolate

GI and respiratory

24

Action of glycopyrrolate

parenteral: preoperative use to reduce airway secretions
oral: drooling, peptic ulcers

25

Organ system for hyoscyamine, dicyclomine

GI

26

Action of hyoscyamine, dicyclomine

antispasmodics for irritable bowel syndrome

27

Organ system for ipratropium and tiotropium

respiratory

28

Action of ipratropium and tiotropium

inhibit bronchoconstriction so good for asthmatics and pts with COPD

29

Organ system for oxybutynin, solifenacin, tolterodine

Genitourinary

30

Action of oxybutynin, solifenacin, tolterodine

use to tx patients with urinary incontinence/overactive bladder

reduce bladder spasms

31

Organ system for scopolamine

CNS

32

Action of scopolamine

motion sickness

33

Multiple effects of atropine

Eye - pupil dilation and cycloplegia
Airway - decrease secretions
Stomach - decrease acid secretion
Gut - decrease motility
Bladder - decrease urgency in cystitis

blocks DUMBBeLLS (excitation is nicotinic receptors)

34

Toxicity of atropine

HOT (due to decreased sweating), DRY (no secretions), RED (flushed), BLIND (cycloplegia), MAD (disoriented)

can cause acute angle-closure glaucoma in elderly due to mydriasis, urinary retention in men with BPH, and hypertermia in infants

35

Jimson weed (Datura)

causes gardener's pupil (mydriasis due to plant alkaloids)

36

Mech of tetrodotoxin

binds fast voltage-gated Na+ channels in cardiac and nerve tissue, preventing depolarization (blocks AP without changing resting potential)

37

Effects of tetrodotoxin

nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes

38

Tx of tetrodotoxin poisoning

supportive

39

How acquire tetrodotoxin

eating improperly prepared pufferfish (Japan)

40

Mech of ciguatoxin

opens Na+ channels causing depolarization (symptoms often confused with colinergic poisoning)

41

Effects of ciguatoxin

DUMBBELS PLUS

temperature-related dysesthesia (cold feels hot, hot feels cold)

42

How acquire ciguatoxin

consumption of reef fish (ciguatera fish, barracuda, snapper, moray eel)

43

Treatment of ciguatoxin

supportive

44

Effects of scombroid poisoning

acute-onset burning sensation of the mouth, flushing of the face, erythema, urticaria, pruritis, headache

may be anaphylaxis-like presentation (brhoncospasms, angioedema, hypotension)

45

Mech of scombroid poisoning

bacterial histidine decarboxylase converts histidine --> histamine
histamine not degraded by cooking (misdiagnosed as allergy to fish)

46

How acquire scombroid poisoning

caused by consumption of dark-meat fish (bonito, mackerel, mahi-mahi, tuna) improperly stored at warm temperature

47

Treatment of scombroid poisoning

antihistamines

if needed give antianaphylactics (epi)

48

Albuterol, salmeterol receptors

B2 > B1

49

Use of albuterol and salmeterol

albuterol for acute asthma; salmeterol for long-term asthma or COPD control

50

Dobutamine receptors

B1 > B2, alpha

51

Use of dobutamine

heart failure (HF) (inotropic > chronotropic), cardiac stress testing

52

Dopamine receptors

D1 = D2 > beta > alpha

53

Use of dopamine

unstable bradycardia, HF, shock; inotropic and chronotropic alpha effects predominate at high doses

54

Epinephrine receptors

beta > alpha

55

Use of epi

anaphylaxis, asthma, open-angle glaucoma

alpha effects predominate at high doses

significantly stronger effects at beta2 receptors than norepinephrine

56

Isoproterenol receptors

B1 = B2 with NO alpha effects

57

Use of isoproterenol

electrophysiologic evaluation of tachyarrhythmias
can worsen ischemia

58

Norepinephrine receptors

alpha 1 > alpha 2 > beta 1

NO beta2 effects

59

Use of norepinephrine

hypotension (but decreases renal perfusion)

60

Phenylephrine receptors

alpha 1 > alpha 2

61

Use of phenylephrine

hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)

62

Effect of amphetamine

indirect general agonist, reuptake inhibitors, also releases stored catecholamines

63

Use of amphetamine

Narcolepsy, obesity, ADHD

64

Effect of cocaine

indirect general agonist, reuptake inhibitor (NET)

65

Use of cocaine

causes vasoconstriction and local anesthesia

never give beta blockers if cocaine intox is suspected because can cause unopposed alpha activation and extreme hypertension

66

Effect of ephedrine

indirect general agonist, releases stored catecholamines

67

Use of ephedrine

nasal decongestion, urinary incontinence, hypotension

68

Clonidine receptor

alpha2- agonist

69

Use of clonidine

hypertensive urgency
does not decrease renal blood flow
ADHD and Tourette syndrome

70

Toxicity of clonidine

CNS depression, bradycardia, hypotension, respiratory depression, miosis

71

alpha-methyldopa receptor

alpha-2 agonist

72

Use of alpha-methyldopa

used for hypertension in pregnancy

73

Toxicity of alpha-methyldopa

direct Coombs positive hemolysis
SLE-like syndrome (also seen with procainamide and hydralazine)

74

Name the non-selective alpha blockers

phenoxybenzamine (irreversible)
phentolamine (reversible)

75

Toxicity of the non-selective alpha blockers

orthostatic hypotension, reflex tachycardia

76

Use of phenoxybenzamine

pheochromocytoma (used preoperatively) to prevent catecholamine (hypertensive) crisis

77

Use of phentolamine

give to patients on MAO-inhibitors who eat tyramine-containing foods (to prevent the vasoconstriction and hypertensive crisis)

78

Name the alpha1 selective antagonist

(-osin ending)

prazosin, terazosin, doxazosin, tamsulosin

79

Use of alpha 1 selective antagonist

urinary symptoms of BPH

Prazosin - PTSD
All BUT TAMSULOSIN - hypertension

80

Toxicity of alpha1 selective antagonist

1st dose orthostatic hypotension, dizziness, headache

81

Name the alpha2 selective antagonist

mirtazapine

82

Use of mirtazapine

depression

83

Toxicity of mirtazapine

sedation, increased serum cholesterol, increased appetite

84

Name the B1 selective antagonists

acebutolol (partial agonist), atenolol, betaxolol, esmolol, metoprolol

85

Name the non-selective beta antagonists

nadolol, pindolol (partial agonist), propranolol, timolol

86

Name the non-selective alpha and beta antagonists

carvedilol and labetalol

87

What is special about nebivolol?

cardiac selective B1 blockade with stimulation of B3 receptors, which activate NO synthase in the vasculature

88

Use of beta-blockers in angina pectoris

decrease heart rate and contractility, resulting in decreased O2 consumption

89

Use of beta-blockers in MI

beta-blockres (metoprolol, carvedilol and bispropolol) decrease mortality

90

Use in SVT of metoprolol and esmolol

short acting
Decrease AV conduction velocity (class II antiarrhythmics)

91

Use of beta-blockers in hypertension

decrease cardiac output, decrease renin secretion (due to B1-receptor blockade on JGA cells)

92

Use of beta-blockers in HF

decrease mortality in chronic HF

93

Use of beta-blockers in glaucoma (timolol)

decrease secretion of aqueous humor)

94

Toxicity of beta-blockers

impotence, CV adverse effects (bradycardia, AV block, HR), CNS adverse effects (seizures, sedation, sleep alterations), asthma/COPD exacerbations

dyslipidemia specifically in metoprolol use