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autonomic drugs (brief) Flashcards

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1
Q

Bethanechol

A

cholinomimetic

Use: Non obstructed bowel constipation and urinary retention

MOA: cholinomimetic (non selective nicotinic and muscarinic). Increase secretion/motor activity gut

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2
Q

Pilocarpine

A

Cholinomimetic

Use: increase salivation, open and closed angle glaucoma

MOA: contract ciliary body (accommodation, open angle G), contract sphincter pupillae (miosis, closed angle G)

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3
Q

Methacholine

A

Cholinomimetic, inhaled

Use: Trigger asthma in asthma testing

MOA: contract bronchial smooth muscle

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4
Q

Carbachol

A

Cholinomimetic

Use: open angle glaucoma

MOA: Pupil constriction (muscarinic and nicotinic agonist).

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5
Q

Varenicline

A

Cholinomimetic

Use: cigarette cessation

MOA: partial agonist nicotinic

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6
Q

Neostigmine

A

Indirect cholinomimetic

Use: Myasthenia gravis (uncommon), postop neurogenic ileus/urinary retention, NMJ block reversal

MOA: Quaternary Ach esterase inhibitor

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7
Q

Pyridostigmine

A

Indirect cholinomimetic

Use: Myasthenia gravis (long acting)

MOA: quaternary ach esterase inhibitor

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8
Q

Edrophonium

A

Indirect cholinomimetic

Use: Myasthenia gravis dx, tensilon test

MOA: quaternary ach esterase inhibitor

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9
Q

Physostigmine

A

Indirect cholinomimetic

Use: Atropine toxicity

MOA: tertiary ach esterase inhibitor (goes into CNS)

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10
Q

cholinesterase inhibitor SE/poisoning

A

DUMBBELSS

Diarrhea, urination, miosis, bronchospasm, bradycardia, excitation (skeletal muscle/CNS), lacrimation, sweating, salivation

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11
Q

organophosphate (thiosulfates)

A

MOA: irreversible cholinesterase inhibitors used in insecticides

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12
Q

organophosphate poisoning treatment

A

Pralidoxime: hydrolyze covalent bond between cholinesterase/organophosphate. Not in CNS

Atropine: Reverse peripheral and CNS effects, can’t reverse NMJ blockade

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13
Q

Galantamine

A

Indirect cholinomimetic

Use: cognitive dysfx alzheimers

MOA: cholinesterase inhibitor that penetrates CNS. Increase ACh

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14
Q

Donepezil

A

Indirect cholinomimetic

Use: cognitive dysfx alzheimers

MOA: cholinesterase inhibitor that penetrates CNS. Increase ACh

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15
Q

Rivastigmine

A

Indirect cholinomimetic

Use: cognitive dysfx alzheimers

MOA: cholinesterase inhibitor that penetrates CNS. Increase ACh

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16
Q

Muscarinic antagonists MOA and SE overview

A

MOA: eye: increase pupil dilation, cycloplegia Airway: decrease secretions Stomach: decrease acid secretion Gut: decrease motility Bladder: Decrease urgency in cystitis
Heart: increase HR (SA node) reverse AV nodal HB

BLOCK DUMBBeLSS

SE: Increased temp (decreased sweating) Dry flushed skin, cycloplegia, disorientation, closed angle glaucoma

Hot as a hare, dry as a cracker, blind as a bat, high pressure as a kettle, mad as a hatter

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17
Q

Cycloplegia

A

paralysis of ciliary muscles in eye resulting in loss of accommodaiton

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18
Q

Atropine

A

Muscarinic antagonist

Use: eye: mydriasis, bradyarrhythmia, AV nodal block (IV)

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19
Q

Ipratropium

A

Muscarinic antagonist

Use: Inhaled treatment COPD

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20
Q

Tiotropium

A

Muscarinic antagonist

Use: inhalational drug COPD (long half life)

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21
Q

Oxybutynin

A

Muscarinic antagonist

Use: Incontinence, overactive bladder

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22
Q

Tolterodine

A

Muscarinic antagonist

Use: urinary incontinence

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23
Q

Scopolamine

A

Muscarinic antagonist

Use: motion sickness

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24
Q

Benztropine

A

Muscarinic antagonist

Use: tremor and rigidity parkinson’s, EPS, no help w/ bradykinesia

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25
Trihexyphenidyl
Muscarinic antagonist Use: tremor and rigidity parkinson's, EPS, no help w/ bradykinesia
26
Norepi
Use: Hypotension, septic shock MOA: a1>a2>b1 agonist arteriolar vasoconstriction, increased contractility, increased SBP, DBP, MAP. SE: reflex brady, wins out over b1 agonism. Widened pulse pressure (whenever b1 hit).
27
Brimonidine
Use: open angle glaucoma MOA: a2 agonist. Decrease aqueous humor production
28
Phenylephrine
Use: Hypotension, mydriatic for ocular procedures, rhinitis MOA: a1>a2 Increase SBP, DBP, MAP SE: reflex brady (doesn't occur w/ diabetic neuropathy)
29
Epi
Use: anaphylaxis, asthma, open angle glaucoma, cardiac resuscitation, shok MOA: all b & a. b predominate at low dose, a at high doses.
30
Norepi MAP tracing
BP: SBP, MAP, DBP increase. widened PP HR: reflex brady PR: Increased, unopposed a1
31
Norepi CO, HR, MAP, PP
CO: no change HR: decrease MAP: super increase PP: increase
32
Epi MAP tracing lower doses (I think)
BP: SBP, MAP increase, DBP decrease HR: Increase b1 PR: decrease, b2>a1
33
Epi CO, HR, MAP, PP
CO: increase HR: increase MAP: increase PP: increase
34
Isoproterenol MAP tracing
BP: SBP (slight increase) b1, DBP, MAP decrease HR: increase b1 and reflex tachy PR: decrease, unopposed b2
35
Isoproterenol CO, HR, MAP, PP
CO: super increase HR: super increase MAP: decrease PP: super increase
36
Dobutamine
Use: HF, cardiac stress testing, cardiogenic shock MOA: b1>b2 SBP, PP increase, DBP decrease, MAP stays about the same.
37
Isoproterenol
Use: Evaluation arrhythmias, can worsen ischemia MOA: b1=b2
38
Terbutaline
Use: prevent premature labor MOA: b2 agonist, relax uterus smooth muscle
39
Ritodrine
Use: prevent premature labor MOA: b2 agonist, relax uterus smooth muscle
40
Albuterol
use: asthma bronchospasm MOA: b2 agonist --> bronchodilation
41
Formoterol
use: asthma bronchospasm MOA: b2 agonist --> bronchodilation
42
Salmetrol
use: asthma bronchospasm MOA: b2 agonist --> bronchodilation
43
Catecholamine list
NE, Epi, Dopamine
44
Metyrosine
MOA: block conversion of tyrosine to L-DOPA
45
Cocaine
MOA: Inhibit NET/DAT, cause accumulation at synapse. Peripheral increase cause sympathetic stimulation SE: peripheral: HTN, mydriasis, tachy, coronary vasospasm (MI, angina) Central: Arousal, addiction, sz
46
Cocaine treatment
Supportive. Never give beta blocker
47
Ephedrine
Use: nasal decongestant, urinary incontinence, hypotension MOA: increase release stored catecholamines
48
Amphetamine
Use: narcolepsy, ADHD, obesity MOA: Displace NE and dopamine from vesicle into synapse, reuptake inhibition SE: appetite suppression
49
Methylphenidate
Use: narcolepsy, ADHD, obesity MOA: similar to amphetamines SE: appetite suppression
50
Modafinil
Use: narcolepsy MOA: stimulant SE: fewer then amphetamines
51
Atomoxetine
Use: ADHD MOA: selective inhibitor of NET
52
Reserpine
MOA: block VMAT, prevent monoamine transport into vesicles
53
Clonidine
Use: HTN urgency, ADHD, tourette MOA: alpha 2 agonist, inhibit sympathetic tone and reduce BP SE: CNS depression, brady, hypotension, respiratory depression, miosis, rebound HTN w/ cessation
54
alpha methyldopa
Use: HTN in pregnancy MOA: alpha 2 agonist --> converts to alpha methyldopamine and alpha methylNE SE: SLE-like syndrome, direct coombs + hemolysis
55
Tizanidine
Use: centrally acting muscle relaxant MOA: alpha 2 agonist
56
Phentolamine
Use: cocaine toxicity, pt's on MAO inhibitors eating tyramine. Pheochromocytoma (used intraop) to control HTN crisis MOA: a1 and 2 reversible antagonist. Lower peripheral resistance and BP SE: orthostatic hypotension, reflex tachy
57
Phenoxybenzamine:
Use: pheochromocytoma (preop) MOA: irreversible a1 and 2 antagonism SE: Orthostatic hypotension, reflex tachy
58
Prazosin
Use: Urinary retention BPH, HTN, PTSD MOA: a1 antagonist SE: Orthostatic hypotension, dizziness, HA
59
Doxazosin
Use: Urinary retention BPH, HTN MOA: a1 antagonist SE: orthostatic hypotension, dizziness, HA
60
Terazosin
Use: Urinary retention BPH, HTN MOA: a1 antagonist SE: Orthostatic hypotension, dizziness, HA
61
Tamsulosin
Use: Urinary retention BPH (NOT HTN) MOA: a1 antagonist SE: Orthostatic hypotension, dizziness, HA
62
Atenolol
B1 selective B blocker
63
Metoprolol
B1 selective B blocker
64
Esmolol
B1 selective B blocker
65
Betaxolol
B1 selective B blocker
66
Acebutolol
B1 selective B blocker w/ partial B agonist activity Avoid in MI or HF
67
Pindolol
Non selective B blocker w/ partial B agonist activity Avoid in MI or HF
68
Labetalol
Non selective B and a1 blocker
69
Carvedilol
Non selective B and a1 blocker
70
Timolol
Use: topically given for open angle glaucoma MOA: non selective B blocker. B2 blockade in eye decrease aqueous humor production by ciliary body
71
Drugs given for acute management aortic dissection
Labetalol, esmolol, propanolol
72
Propanolol
Non selective B blocker
73
Thyroid storm treatment
Propanolol, PTU, prednisolone
74
Essential tremor treatment
Propanolol, primidone
75
B blocker overview
Use: Angina, Post MI (reduce infarc size and mortality), ACS, HF, hypertrophic obstructive cardiomyopathy, migraine prophylaxis, thyroid storm, essential tremor, type 2 antiarrhythmic MOA: Decrease cardiac contractility, inhibit SA node (brady), decrease myocardial O2 demand, B1 block reduce renin. B2 antagonism on ciliary epi decrease aqueous humor production SE: impotence, brady, heart block B2: Exacerbate COPD/asthma
76
Glucagon and B blockers
Glucagon overcomes the most serious SE of B blockers (brady, HF, heart block)

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