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autonomic drugs (detailed) Flashcards

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1
Q

bethanechol: clinical use

A

postop ileus, neurogenic ileus, urinary retention

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2
Q

bethanechol: action

A

activates bowel and bladder smooth muscle

resistant to AChE

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3
Q

carbachol: clinical use

A

glaucoma, pupillary contraction, relief of intraocular pressure

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4
Q

carbachol: action

A

carbon copy of ACh

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5
Q

pilocarpine: clinical use

A

potent stimulator of sweat, tears, and saliva

open-angle and closed-angle glaucoma

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6
Q

pilocarpine: action

A 
contracts ciliary muscle of eye (open-angle glaucoma)
pupillary sphincter (closed-angle glaucoma)

resistant to AChE

“you cry, drool, and sweat on your pilow”

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7
Q

methacholine: clinical use

A

challenge test for diagnosis of asthma

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8
Q

methacholine: action

A

stimulates muscarinic receptors in airway when inhaled

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9
Q

neostigmine: clinical use

A

postop/neurogenic ileus and urinary retention
MG
reversal of NMJ blockade (postop)

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10
Q

neostigmine: action

A

antiChE = increase endogenous ACh

“Neo CNS = No CNS penetration”

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11
Q

pyridostigmine: clinical use

A

MG (long acting)

doesn’t penetrate CNS

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12
Q

pyridostigmine: action

A

antiChE = increase endogenous ACh
increase strength

“pyRIDostiGMine gets rid of MG”

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13
Q

edrophonium: clinical use

A

diagnosis of MG (extremely short acting)

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14
Q

edrophonium: action

A

antiChE = increase endogenous ACh

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15
Q

physostigmine: clinical use

A

anticholinergic toxicity

crosses BBB => CNS

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16
Q

physostigmine: action

A

antiChE = increase endogenous ACh

“PHYsostigmine PHYxes atropine overdose”

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17
Q

donepezil: clinical use

A

alzheimer’s disease

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18
Q

donepezil: action

A

antiChE = increase endogenous ACh

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19
Q

what to watch out for when giving a cholinomimetic agent?

A

exacerbation of COPD, asthma, peptic ulcers

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20
Q

cholinergic toxicity: features

A 
DUMBBELLSS:
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Emesis/Excitation of skeletal muscle and CNS
Lacrimation
Lethargy
Sweating
Salivation
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21
Q

cholinergic toxicity: cause

A

AChE inhibitor poisoning

often due to organophosphates that irreversibly inhibit AChE

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22
Q

cholinergic toxicity: antidote

A

atropine + pralidoxime

regenerates active AChE

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23
Q

atropine, homatropine, tropicamide: organ and action

A

eye

produce mydriasis and cycloplegia

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24
Q

benztropine: organ and action

A

CNS

parkinson’s disease

“park my benz”

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25
scopolamine: organ and action
CNS motion sickness
26
ipratropium, tiotropium: organ and action
respiratory COPD, asthma "I PRAy i can breath soon"
27
oxybutynin: organ and action
genitourinary reduce urgency in mild cystitis and reduce bladder spasms
28
glycopyrrolate: organ and action
gastrointestinal, respiratory parenteral: preop use to reduce airway secretions oral: drooling, peptic ulcer
29
which organs does ATROPINE affect?
eye: increase pupil dilation, cycloplegia airway: decrease secretions stomach: decrease acid secretion gut: decrease motility bladder: decrease urgency in cystitis
30
atropine: toxicity
``` increase body temperature (due to decreased sweating) rapid pulse dry mouth dry flushed skin cycloplegia constipation disorientation ``` HOT as a hare, DRY as a bone, RED as a beet, BLIND as a bat, MAD as a hatter -- anticholinergic toxicity can cause acute angle-closure glaucoma in elderly, urinary retention in men with BPH, and hyperthermia in infants
31
epinephrine: clinical use
anaphylaxis glaucoma (open-angle) asthma hypotension
32
norepinephrine: clinical use
hypotension (but decrease renal perfusion)
33
isoproterenol: clinical use
torsade de pointes (tachycardia decreases QT interval) | bradyarrhythmias (but can worsen ischemia)
34
dopamine: clinical use
shock (renal perfusion) | heart failure: inotropic, chronotropic
35
dobutamine: clinical use
heart failure, cardiac stress testing: inotropic, chronotropic
36
phenylephrine: clinical use
``` hypotension (vasoconstrictor) ocular procedures (mydriatic) rhinitis (decongestant) ```
37
albuterol, salmeterol, terbutaline: clinical use
metaproterenol and albuterol for acute asthma salmeterol for long-term asthma or COPD control terbutaline to reduce premature uterine contractions
38
ritodrine: clinical use
reduces premature uterine contractions
39
epinephrine: target
B 1/2 > A 1/2
40
norepinephrine: target
A 1/2 >> B1
41
isoproterenol: target
B 1/2
42
dopamine: target
high dose: A 1/2 medium dose: B1 > B2 low dose: D1
43
dobutamine: target
B1 >>> B2/A1/A2
44
phenylephrine: target
A1 > A2
45
albuterol, salmeterol, terbutaline: target
B2 >>> B1
46
ritodrine: target
B2
47
amphetamine: target
indirect general agonist, releases stored catecholamines
48
ephedrine: target
indirect general agonist, releases stored catecholamines
49
cocaine: target
indirect general agonist, reuptake inhibitor
50
amphetamine: clinical use
narcolepsy obesity ADD
51
ephedrine: clinical use
nasal decongestion urinary incontinence hypotension
52
cocaine: clinical use
causes vasoconstriction and local anesthesia never give B-blockers if cocaine intoxication is suspected (can lead to unopposed A1 activation and extreme hypertension)
53
clonidine, a-methyldopa: target
centrally acting A2-agonists | decreased central sympathetic outflow
54
clonidine, a-methyldopa: clinical use
hypertension (esp with renal disease since there is no decrease in blood flow to kidney)
55
phenoxybenzamine: clinical use
irreversible pheochromocytoma (use before removal of tumor, since high levels of released catecholamines will not be able to overcome blockage)
56
phentolamine: clinical use
reversible give to patients on MAO-I's who eat tyramine-containing foods
57
phenoxybenzamine, phentolamine: toxicity
orthostatic hypotension | reflex tachycardia
58
prazosin, terazosin, doxazosin, tamsulosin: clinical use
hypertension | urinary retention in BPH
59
prazosin, terazosin, doxazosin, tamsulosin: toxicity
1st dose orthostatic hypotension, dizziness, headache
60
mirtazapine: clinical use
depression
61
mirtazapine: toxicity
sedation increase serum cholesterol increase appetite
62
what situations do B-blockers have use for?
``` angina pectoris MI SVT HTN CHF glaucoma ```
63
B-blockers: use in angina pectoris
decrease heart rate and contractility = decrease O2 consumption
64
B-blockers: use in MI
decrease mortality | specifically metoprolol, carvedilol, bisoprolol
65
B-blockers: use in SVT
metoprolol, esmolol decrease AV conduction velocity (class II antiarrhythmic)
66
B-blockers: use in HTN
decrease CO | decrease renin secretion (due to B1-block on JGA cells)
67
B-blockers: use in CHF
slows progression of chronic failure
68
B-blockers: use in glaucoma
timolol decrease secretion of aqueous humor
69
B-blocker: toxicity
impotence exacerbation of asthma CV ADRs: bradycardia, AV block, CHF CNS ADRs: seizures, sedation, sleep alterations use with caution in diabetics
70
B-blocker: B1 selective (B1 > B2)
A BEAM ``` Acebutolol (partial agonist) Betaxolol Esmolol (short) Atenolol Metoprolol ```
71
B-blocker: nonselective (B1 = B2)
Please Try Not Being Picky Propranolol Timolol Nadolol Pindolol
72
B-blocker: nonselective (vasodilatory) A/B-blockers
carvedilol | labetalol
73
B-blocker: partial B-agonists
PAPA Pindolol Acebutolol

Pharmacology (10 decks)

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