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Step pharm > autonomic drugs (brief) > Flashcards

autonomic drugs (brief) Flashcards

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
Q

Trihexyphenidyl

A

Muscarinic antagonist

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

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26
Q

Norepi

A

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).

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27
Q

Brimonidine

A

Use: open angle glaucoma

MOA: a2 agonist. Decrease aqueous humor production

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28
Q

Phenylephrine

A

Use: Hypotension, mydriatic for ocular procedures, rhinitis

MOA: a1>a2
Increase SBP, DBP, MAP

SE: reflex brady (doesn’t occur w/ diabetic neuropathy)

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29
Q

Epi

A

Use: anaphylaxis, asthma, open angle glaucoma, cardiac resuscitation, shok

MOA: all b & a. b predominate at low dose, a at high doses.

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30
Q

Norepi MAP tracing

A

BP: SBP, MAP, DBP increase. widened PP

HR: reflex brady

PR: Increased, unopposed a1

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31
Q

Norepi CO, HR, MAP, PP

A

CO: no change

HR: decrease

MAP: super increase

PP: increase

32
Q

Epi MAP tracing lower doses (I think)

A

BP: SBP, MAP increase, DBP decrease

HR: Increase b1

PR: decrease, b2>a1

33
Q

Epi CO, HR, MAP, PP

A

CO: increase

HR: increase

MAP: increase

PP: increase

34
Q

Isoproterenol MAP tracing

A

BP: SBP (slight increase) b1, DBP, MAP decrease

HR: increase b1 and reflex tachy

PR: decrease, unopposed b2

35
Q

Isoproterenol CO, HR, MAP, PP

A

CO: super increase

HR: super increase

MAP: decrease

PP: super increase

36
Q

Dobutamine

A

Use: HF, cardiac stress testing, cardiogenic shock

MOA: b1>b2
SBP, PP increase, DBP decrease, MAP stays about the same.

37
Q

Isoproterenol

A

Use: Evaluation arrhythmias, can worsen ischemia

MOA: b1=b2

38
Q

Terbutaline

A

Use: prevent premature labor

MOA: b2 agonist, relax uterus smooth muscle

39
Q

Ritodrine

A

Use: prevent premature labor

MOA: b2 agonist, relax uterus smooth muscle

40
Q

Albuterol

A

use: asthma bronchospasm

MOA: b2 agonist –> bronchodilation

41
Q

Formoterol

A

use: asthma bronchospasm

MOA: b2 agonist –> bronchodilation

42
Q

Salmetrol

A

use: asthma bronchospasm

MOA: b2 agonist –> bronchodilation

43
Q

Catecholamine list

A

NE, Epi, Dopamine

44
Q

Metyrosine

A

MOA: block conversion of tyrosine to L-DOPA

45
Q

Cocaine

A

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
Q

Cocaine treatment

A

Supportive. Never give beta blocker

47
Q

Ephedrine

A

Use: nasal decongestant, urinary incontinence, hypotension

MOA: increase release stored catecholamines

48
Q

Amphetamine

A

Use: narcolepsy, ADHD, obesity

MOA: Displace NE and dopamine from vesicle into synapse, reuptake inhibition

SE: appetite suppression

49
Q

Methylphenidate

A

Use: narcolepsy, ADHD, obesity

MOA: similar to amphetamines

SE: appetite suppression

50
Q

Modafinil

A

Use: narcolepsy

MOA: stimulant

SE: fewer then amphetamines

51
Q

Atomoxetine

A

Use: ADHD

MOA: selective inhibitor of NET

52
Q

Reserpine

A

MOA: block VMAT, prevent monoamine transport into vesicles

53
Q

Clonidine

A

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
Q

alpha methyldopa

A

Use: HTN in pregnancy

MOA: alpha 2 agonist –> converts to alpha methyldopamine and alpha methylNE

SE: SLE-like syndrome, direct coombs + hemolysis

55
Q

Tizanidine

A

Use: centrally acting muscle relaxant

MOA: alpha 2 agonist

56
Q

Phentolamine

A

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
Q

Phenoxybenzamine:

A

Use: pheochromocytoma (preop)

MOA: irreversible a1 and 2 antagonism

SE: Orthostatic hypotension, reflex tachy

58
Q

Prazosin

A

Use: Urinary retention BPH, HTN, PTSD

MOA: a1 antagonist

SE: Orthostatic hypotension, dizziness, HA

59
Q

Doxazosin

A

Use: Urinary retention BPH, HTN

MOA: a1 antagonist

SE: orthostatic hypotension, dizziness, HA

60
Q

Terazosin

A

Use: Urinary retention BPH, HTN

MOA: a1 antagonist

SE: Orthostatic hypotension, dizziness, HA

61
Q

Tamsulosin

A

Use: Urinary retention BPH (NOT HTN)

MOA: a1 antagonist

SE: Orthostatic hypotension, dizziness, HA

62
Q

Atenolol

A

B1 selective B blocker

63
Q

Metoprolol

A

B1 selective B blocker

64
Q

Esmolol

A

B1 selective B blocker

65
Q

Betaxolol

A

B1 selective B blocker

66
Q

Acebutolol

A

B1 selective B blocker w/ partial B agonist activity

Avoid in MI or HF

67
Q

Pindolol

A

Non selective B blocker w/ partial B agonist activity

Avoid in MI or HF

68
Q

Labetalol

A

Non selective B and a1 blocker

69
Q

Carvedilol

A

Non selective B and a1 blocker

70
Q

Timolol

A

Use: topically given for open angle glaucoma

MOA: non selective B blocker. B2 blockade in eye decrease aqueous humor production by ciliary body

71
Q

Drugs given for acute management aortic dissection

A

Labetalol, esmolol, propanolol

72
Q

Propanolol

A

Non selective B blocker

73
Q

Thyroid storm treatment

A

Propanolol, PTU, prednisolone

74
Q

Essential tremor treatment

A

Propanolol, primidone

75
Q

B blocker overview

A

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
Q

Glucagon and B blockers

A

Glucagon overcomes the most serious SE of B blockers (brady, HF, heart block)

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