Autonomic drugs and glaucoma drugs

Question 1

Direct Acting Muscarinic Drugs

Answer 1

Betanechol, Pilocarpine

MOA: Inhibits M3 receptors

Question 2

Indirect Acting Nicotinic Drugs

Answer 2

Nicotine and Varenicline

Question 3

Drugs used in Alzheimer’s Disease

Answer 3

Rivastigmine, Donepazil, Tacrine, Galantamine

Question 4

Drug used in bowel and bladder atony

Answer 4

Betanechol

Question 5

Indirect acting muscarinic receptor used for treatment of glaucoma

Answer 5

Physostigmine

Question 6

Antidotes for organophosphate poisoning

Answer 6

Atropine
Pralidoxime (should be given only within 6 hours)

Question 7

Nonselective Cholinergic Antagonist

Answer 7

Atropine, Tropicamide, Homatropine, Cyclopentolate

Question 8

Nonselective Cholinergic antagonist used in the treatment of Parkinsons disease

Answer 8

Benztropine, Biperiden, Trihexyphenidyl

Question 9

Cholinergic antagonist used in the treatment of asthma

Answer 9

Ipatropium and tiotropium

Side effect: Nasal dryness

Question 10

Why Ipatropium and tiotropium preferred as bronchodilators for combined COPD and heart disease patients?

Answer 10

less likely to cause tachycardia and cardiac arrhythmias

Question 11

Nonselective muscarinic antagonist used in the treatment of motion sickness

Answer 11

Scopolamine (has an additional histamine and serotonin antagonistic effect)

Question 12

Symptoms of atropine toxicity

Answer 12

Hot as a hare (hyperthermia)
Dry as a bone (decreased secretions and constipation)
Red as a a beet (atropine flush)
Blind as a bat (blurred vision)
Mad as a hatter (CNS toxicity, tachycardia, arrhythmia)

Question 13

Cholinergic antagonist that blocks Nicotinic AcH receptors (ganglion blockers) used in the treatment of hypertension? Side effect?

Answer 13

Hexamethonium, Trimethaphan

Side effect: Postural Hypertension

Question 14

What is the difference of dopamine and norepinephrine in their action in the blood vessels?

Answer 14

Dopamine: vasodilates the renal blood vessels
Norepinephrine: vasoconstricts the renal blood vessels

Question 15

Inhibitor of tyrosine hydroxylase

Answer 15

Metyrosine - prevents conversion of tyrosine to DOPA

Question 16

Vesicular transport of norepinephrine and epinephrine is inhibited by what drug

Answer 16

Reserpine

MAO’s increase stores of norepinephrine and epineprhine

Question 17

What drug inhibits entry of calcium which triggers interaction among SNARE proteins (VAMPs and SNAPS? What drugs promote them?

Answer 17

Inhibited by Guanethidine

Promoted by Amphetamines and Tyramine

Question 18

Diffusion and reuptake of norepi and epi via NET and DAT in the synaptic cleft is inihibited by what drugs?

Answer 18

Cocaine and TCA

Question 19

MOA of Epinephrine

Answer 19

Nonselective and Direct acting Sympathomimetic (activates alpha and beta)

a1: vasoconstriction, increases BP
b1: increases heart rate, conduction and contractility (cardiac arrest)
b2: bronchodilation (anaphylaxis)

Question 20

Uses and side effects of norepinephrine

Answer 20

Neurogenic shock, cardiogenic shock (last resort)

Extreme vasospasm, tissue necrosis and extensive blood pressure increase

Question 21

Dose dependent actions of dopamine

Answer 21

Low dose: 1 - 5 mcg/kg/min - vasodilation of the splanchnic and renal vascular beds via D1 receptors (thus increase in renal blood flow)
Medium Dose: 5-15 mcg/kg/min - D1 and B2 receptors
High dose: >15 mcg/kg/min - A1 receptors

Question 22

Beta nonselective sympathomimetic drug that is used in the treatment of asthma?

Answer 22

Isoproterenol
B1: increases heart rate, conduction and velocity
B2: bronchodilation
SE: cardiovascular disturbance, arrhythmias

Question 23

Selective alpha 1 agonist used as decongestant? Side effect?

Answer 23

Phenylephrine, Pseudoephrine
SE: rebound nasal congestion
Ocular administration may cause mydriasis without cyclopegia

Question 24

Selective alpha 2 agonist (decreases central sympathetic outflow)? Side effect?

Answer 24

Clonidine

SE: rebound hypertension - Treated using Phentolamine

Question 25

Selective alpha 2 agonist used in the treatment of hypertension which causes hemolytic anemia?

Answer 25

Methyldopa

Question 26

Selective alpha 2 agonist used in the treatment of glaucoma (decreases secretion of aqueous humor)?

Answer 26

Apraclonidine, Brimonidine

Question 27

Selective beta 1 agonist used in acute heart failure and cardiogenic shock? Side effect?

Answer 27

Dobutamine Side effect: tachyphylaxis Other uses: Used in cardiac stress testing

Question 28

Selective beta 2 agonists used in the treatment of asthma

Answer 28

Albuterol/Salbutamol | Terbutaline and Ritodrine

Question 29

Selective beta 2 agonists used as tocolytic in preterm labor

Answer 29

terbutaline and ritodrine Remember: beta 2 receptors - relaxation of uterine muscles vs alpha 1 and M3 receptors which causes contraction of uterine muscles

Question 30

Drugs used in the presurgical treatment of hypertension in pheochromocytoma?

Answer 30

Phenoxybenzamine and Phentolamine MOA: nonselective alpha blockers (alpha 1>alpha2) SE: Orthostatic hypotension

Question 31

Difference between phenoxybenzamine and phentolamine

Answer 31

Phenoxybenzamine: IRREVERSIBLE Inhibitor Phentolamine: REVERSIBLE Inhibitor, can also be used as treatment for rebound hypertension (e.g. Clonidine)

Question 32

Selective alpha 1 receptors used in the treatment of benign prostatic hyperplasia and hypertension?

Answer 32

Prazosin, Doxazosin, Terazosin, Tamsulosin, Silodosi | Side effect: First dose orthostatic hypotension

Question 33

Most selective for prostatic smooth muscle?

Answer 33

Tamsulosin

Question 34

Nonselective beta blockers

Answer 34

Propranolol, Pindolol, Timolol, Labetalol, Carvedilol, Nadolol SE: bronchospasm, erectile dysfunction

Question 35

Drug which has a combined alpha and beta blocker blockade (can also be used in the treatment of pheochromocytoma)

Answer 35

Labetalol

Question 36

Nonselective beta blockers which has an intrinsic sympathomimetic activity

Answer 36

Pindolol and acebutolol

Question 37

Beta blocker which has an absent Local anesthetic activity

Answer 37

timolol and betaxolol (local anesthetic activity is disadvantageous when used in the eye topically since it can decrease protective effects and increase the risk of corneal ulcerations)

Question 38

Beta blocker which has the longest half-life

Answer 38

Nadolol

Question 39

selective beta blockers

Answer 39

Betaxolol, esmolol, acebutolol, atenolol, and metoprolol

Question 40

Selective beta blockers used for supraventricular tachycardia

Answer 40

Esmolol

Question 41

Beta blocker which has the shortest half-life

Answer 41

Esmolol

Question 42

Flow of aqueous humor

Answer 42

Ciliary body - Posterior chamber - Angle of the anterior chamber - Pupil - Anterior chamber - trabecular meshwork - canal of schlemm - Uveoscleral veins

Question 43

Drugs that cause decreased secretion of aqueous humor from the ciliary epithelium

Answer 43

Beta blocker: Timolol Osmotic agents: Mannitol Alpha2 agonist: Apraclonidine Carbonic Anhydrase Inhibitor: acetazolamide, dorzolamide

Question 44

Drugs that cause ciliary muscle contraction, opening of trabecular meshwork and increased outflow through canal of schlemm

Answer 44

Cholanomimetics: Pilocarpine, Physostigmine

Question 45

Drugs that cause increased outflow through canal of Schlemm

Answer 45

Prostaglandins: latanoprost

Question 46

Drugs that causes increased outflow via uveoscleral veins

Answer 46

Epinephrine