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Flashcards in Autonomic Drugs Deck (101):
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What is bethanecol?

It is a direct agonist of cholinergic receptors (cholinomimetic)

1

What is carbachol?

It is a direct agonist of cholinergic receptors (cholinomimetic).
It is a carbon copy of acetylcholine

2

What is pilocarpine?

It is a direct agonist of cholinergic receptors (cholinomimetic)

3

What is methacoline?

It is a direct agonist of cholinergic receptors (cholinomimetic)

4

What does bethanecol do?

Activates bowel and bladder smooth muscle; resistant to AChE

5

What is bethanecol used for?

Post op ileus
Neurogenic ileus
Atonic bladder
Urinary retention

6

What is carbachol used for?

Glaucoma
Pupillary contraction
Relief of intraocular pressure
Action: iris moves further from the cornea increasing the angle --> more flow of aqueous humor

7

What is pilocarpine used for?

Open angle and closed angle glaucoma

8

How does pilocarpine work?

Contracts ciliary muscle and pupillary sphincter

9

What is methacoline used for?

Challenge test for the diagnosis of asthma since it stimulates the muscarinic receptors in the airway when they are inhaled

10

What are the acetylcholinesterases?

Neostigmine
Pyridostigmine
Edrophonium
Physostigmine
Donezepil

11

What is neostigmine used for?

Postoperative and neurogenic ileus
Urinary retention
Myasthenia gravis
Reversal of NMJ blockade postop

12

What is pyridostigmine used for?

Myasthenia gravis
(Longer acting than neostigmine)

13

What is edrophonium used for?

Diagnosis of myasthenia gravis

14

What is physostigmine used for?

Crosses the bb barrier so used in anticholinergic toxicity (atropine OD)
Also- control hyperthermia if atropine OD

15

What are the side effects of cholinomimetics?

Lacrimaton, sweating, salivation, incontinence, decrease contractility of the heart, miosis, vasodilation, increase GI motility and secretion.

16

What can cholinomimetics exacerbate?

COPD
Asthma
Peptic ulcer disease

17

What do organophosphates do?

Penetrate the bb barrier and Irreversibly inhibit AchE
So get DUMBBELSS:
Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Excitation of skeletal muscle and CNS
Lacrimaton
Salivation
Sweating

(Ex: parathion)

18

What is the tx for organophosphate poisoning?

Atropine and pralidoxime
If you treat with only physostigmine the patient will still have muscle paralysis because atropine only works on muscarinic receptors

19

What are the antimuscarinics?

Atropine
Homatropine
Tropicamide
Benztropine
Scopolamine
Ipratropium, tiotropium
Oxybutynin
Glycopyrrolate

20

What are the toxicities of anti-muscarinics?

Increased body temp due to decreased sweating
Rapid pulse
Dry mouth
Dry, flushed skin
Cycloplegia
Constipation
Disorientation
Urinary retention

21

What is atropine, homatropine, tropicamide used for?

Bradycardia
Eye stuff

22

What is benztropine used for?

Parkinson's -decreases muscle tremor

23

What is scopolamine used for?

Motion sickness

24

What is ipratropium used for?

COPD, asthma

25

What is oxybutynin used for?

To reduce urgency in mild cystitis and reduce bladder spasms

26

What is glycopyrrate used for?

IV pre-op to reduce airway secretions
Oral: to tx peptic ulcer, drooling

27

What are the sympathomimetics?

Epi, norepinephrine
Isoproterenol
DA, dobutamine
Phenylephrine
Albuterol, salmeterol, terbutaline
Ritodrine

28

What is epi used for?

Anaphylaxis
Hypotension
Asthma
Open angle glaucoma

29

What is norepinephrine used for?

Hypotension

30

What is isoproterenol used for?

Torsades de pointes
Brandy arrhythmias

31

Which receptors does dopamine act on?

All of them

32

What receptors does norepinephrine act on?

Alpha 1
Alpha 2
Beta 1
Acts more on the alphas! Even more than epi - used in hypotension

33

What receptors does epi act on?

All except D1
Has more effects on betas than alphas - used in anaphylaxis

34

What receptors does isoproterenol act on?

Betas - used in Bradyarrythmias and torsades

35

What is dopamine used for?

Increase renal perfusion in shock
Heart failure

36

What receptor is dobutamine most active on?

Beta 1 - used for heart failure and cardiac stress testing

37

What is unique about dopamine and dobutamine?

They are inotropic and chronotropic
(Inc both contractility and HR)

38

What receptors does phenylephrine act on?

Alphas
Alpha 1 more than alpha 2 - used for hypotension, ocular procedures and rhinitis

39

What receptors does albuterol, salmeterol, terbutaline act on?

Betas
Beta 2 more than beta 1 - used in asthmatics and COPD

40

What's terbutaline used for?

To reduce premature contractions

41

What receptor does ritodrine act in?

Beta 2 - used for tocolysis

42

What are the indirect sympathomimetics?

Amphetamine
Cocaine
Ephedrine

43

How does amphetamine work?

Indirect agonist - releases stored catecholamines
Reverses the DAT

44

What are amphetamines used in?

Narcolepsy
Obesity
ADD

45

What is MOA of ephedrine?

Same as amphetamines

46

What is ephedrine used for?

Nasal decon
Urinary incontinence
Hypotension

47

What should never be given during a cocaine intoxication?

Beta blockers - causes unopposed alpha 1
(Severe hypotension)

48

What are the sympathoplegics?

Centrally acting alpha 2 agonist --> central SNS out flow
Clonidine
Alpha-methyl dopa

49

What are sympathoplegics used for?

HTN especially with renal disease
(No dec in blood flow to kidneys)

50

What is phenoxybenzamine?

Irreversible alpha blocker (non-selective)

51

What is phenoxybenzamine used for?

Pheochromocytoma before removing the tumor

52

What are the side effects of phenoxybenzamine?

Orthostatic hypotension
Reflex tachycardia

53

What is phentolamine?

A reversible alpha blocker (non-selective)

54

What is phentolamine used for?

People on MAOIs who eat tyramine containing foods

55

What are the alpha 1 antagonists?

-osin
-ozins

56

What are prazosin, terazosin, doxazosin, and tamsulosin used for?

HTN
Urinary retention due to BPH

57

What are the side effects of the -osins?

1st dose orthostatic hypotension*
Dizziness
Headache

58

What is mirtazapine?

An alpha 2 antagonist

59

What is mirtazapine used for?

Depression
(Inc NE and 5-HT3)

60

What are the side effects of mirtazapine?

Sedation
Increases in serum cholesterol
Increased appetite

61

What are the beta blockers?

-olol

62

What is timolol used for?

Glaucoma - decreases the secretion of aqueous humor

63

What are metoprolol and esmolol used for?

SVT - decreases AV conduction velocity

64

What are the beta 1 selective antagonists?

A BEAM
Acebutalol
Betaxolol
Esmolol
Atenolol
Metoprolol

65

What are the Nonselective beta antagonists?

Propranolol
Timolol
Nadolol
Pindolol

(Please Try Not being (Beta) Picky)

66

What are the partial beta agonists?

Pindolol
Acebutolol

67

What is the antidote/tx for beta blocker toxicity?

Glucagon

68

What is the tx for digitalis toxicity?

Normalize potassium
Lidocaine
Anti-dig Fab
Magnesium
= KLAM

69

What is the tx for iron toxicity?

Deferoxamine
Deferasirox

70

What is the tx for methemoglobin?

Methylene blue and vitamin C

71

What is the tx for carbon monoxide poisoning?

100% oxygen

72

What is the tx for methanol or antifreeze poisoning?

Fomepizole, dialysis

73

What is the tx for lead poisoning?

CaEDTA, dimercaprol, succimer, penicillamine

74

What is the tx for mercury, arsenic, gold?

Dimercaprol, succimer

75

What is the tx for copper, arsenic, gold?

Penicillamine

76

What is the tx for Cyanide poisoning?

Nitrite+thiosulfate, hydro cobalamin

77

What is the tx for opioid tox?

Naloxone/naltrexone

78

What is the tx for TCA poisoning?

NaHCO3
(Same as Tx for salicylate tox)

79

What's the tx for heparin tox?

Protamine

80

What is the tx for theophylline tox?

Beta-blocker

81

What are the P450 inducers?

Momma Barb Steals Phen-Phen and Refuses Greasy Carbs Chronically:
Modafinil
Barbiturates
St. John's wort
Phenytoin
Rifampin
Griseofulvin
Carbamazepine
Chronic alcohol use

82

What are the P450 inhibitors?

MAGIC RACKS GQ
Macrolides
Amiodarone
Grapefruit juice
Isoniazid
Cimetidine
Ritonavir
Acute alcohol abuse
Cipro
Ketoconazole
Gemfibrozil
Quinidine

83

What is the MOA of pralidoxime?

Reactivates cholinesterase by removing the phosphate group that had been added by organophosphates

84

What are all the effects of phenylephrine?

Increases peripheral vascular resistance
Decreases pulse pressure (due to reflex decrease in stroke volume and increased afterload)
Increases systolic pressure
Decreases heart rate

85

What does epi do?

Increase pulse and pulse pressure
Decreases peripheral vascular resistance (beta 2)

86

What are the 2 sympathetic innervations that are cholinergic?

The sweat glands and the adrenal medulla

87

What are the autonomic receptors that use Gq?

Alpha 1
M1
M3 (increase exocrine glands, lacrimal, gastric acid, gut peristalsis, bladder contraction, bronchoconstriction, miosis, accommodation)
H1
V1

88

What are the autonomic receptors that use Gi?

Alpha 2
M2 (decreases heart rate and contractility of the atria)
D2

89

What are the autonomic receptors that use Gs?

B1
B2
D1
H2
V2

90

What is th MOA of pralidoxime?

Reactivates cholinesterase by removing a phosphate group

91

What is labetolol?

An alpha 1, beta 1, and beta 2 reversible competitive antagonist

92

What is donepazil?

Indirect cholinergic agonist (inc endogenous ACh)
Treat- Alzheimer's

93

Norepinephrine vs isoproterenol

Norepinephrine = a > b activity
-inc both systolic (b1)
-inc diastolic BP (a1)
-reflex bradycardia

Isoproterenol = b > a
- dec systolic (b1)
-dec diastolic (b2)
-reflex tachycardia (b1)

94

Epi vs phenylephrine responses to alpha-blockade

Before alpha block = both net inc BP (pressor effect)
After alpha block =
- Epi has net depressor effect (hypotension) - bc alpha & b2 action
- phenylephrine levels out BP (no hypotension) - bc pure alpha action

95

What are the non selective alpha and beta antagonists?

Carvedilol
Labetolol

96

What is the tx for tPA, streptokinase or urokinase tox?

Aminocaproic acid

97

What is the tx for warfarin tox?

Vit K
Fresh frozen plasma

98

What is the tx for amphetamine tox?

NH4Cl
Acidifies the urine

99

What is the tx for salicylate tox?

NaHCO3
Alkalinizes the urine

Dialysis

100

What is the tx for actaminophen tox?

N-acetylcysteine
Replenishes glutathione