Autonomic meds

Question 0

Nicotine

Answer 0

nicotinic acetocholine receptor agonist
central action on cognitive function and reward pathways
found at neuromuscular junction, autonomic preganglionic terminals
brain
main metabolite is cotinine

Question 1

muscarine

Answer 1

muscarinic acetocholine receptor agonist
derived from certain mushrooms
decrease cardio funciton
increases secretion 
increase GI activity

Question 2

varenicline

Answer 2

partial agonist of alpha4beta1 neuronal nicotinic receptor

help tx nicotine dependence

Question 3

mivacurium, pancuronium, vecuronium

Answer 3

nicotinic receptor antagonst

non polarizing paralytic (neuromuscular blockers)

Question 4

neostigmine

Answer 4

acetylcholinesterase inhibitor
tx reverse of non-depolarization neuromuscular blockers (vecuronium, pancuronium, mivacurium)
tx myasthenia gravis

Question 5

pyridostigmine

Answer 5

tx myasthenia gravis

Question 6

donepezil, galantamine, rivastigmine

Answer 6

AChE inhibitors
palliative tx of alzheimer’s
not effective for long term tx

Question 7

parathion, malathion, chlorpyrifos

Answer 7

organophosphate AChE inhibitors

insecticides

Question 8

sarin, tabun, VX

Answer 8

organophosphate AChE inhibitors

Nerve Gases

Question 9

pralidoxime (2-pam)

Answer 9

prevents irreversible organophosphate binding

tx within 1-2 hours of exposures

Question 10

AChE inhibitor symptoms

Answer 10

Diarrhea
Urination
Miosis (constricted pupils)
Bronchoconstriction
Excitation (of muscles and CNS)
Lacrimation
Salivation
Sweating

Question 11

Bethanechol, carbachol, pilocarpine

Answer 11

muscarinic agonist
tx urinary retention (bethanechol)
tx Glaucoma

Question 12

Atrophine

Answer 12

Muscarinic antagonist
tertiary amine (from deadly night shade)
CNS penetrance
tx AChE inhibitor poisoning
tx severe bradycardia
AE: decreased secretion (dry mouth), mydriasis (dilated pupils), cycloplegia (decreased accommodation), hyperthermia, tachycardia, sedation, brochodilation, urinary retention and constipation, behavioral excitation with hallucinations

Question 13

scoplamine

Answer 13

muscarinic antagonist
tx motion sickness, sedative, amnesiac
AE: decreased secretion (dry mouth), mydriasis (dilated pupils), cycloplegia (decreased accommodation), hyperthermia, tachycardia, sedation, brochodilation, urinary retention and constipation, behavioral excitation with hallucinations

Question 14

glycopyrrolate

Answer 14

muscarinic antagonist

tx to dry secretions (no CNS penetration)

Question 15

benztropine

Answer 15

muscarinc antagonist
tx parkinsonism (including drug induced)

Question 16

tropicamide

Answer 16

muscarinic antagonist
topical opthalmology (dilate pupils 4-8 hours)

Question 17

Ipratropium

Answer 17

muscarinic antagonist
tx asthma and COPD
used with albuterol (combivent)

Question 18

tiotropium

Answer 18

muscarinic antagonist
tx COPD
pierced capsule inhalation device (spiriva)

Question 19

tolteroidine, oxybutynin, solifenacin

Answer 19

muscarinic antagonist

tx bladder spasm and urinary incontinence

Question 20

Phenylephrine

Answer 20

alpha 1 adrenergic receptor agonist
specific
tx nasal congestion
used iv to raise BP

Question 21

Clonidine

Answer 21

alpha 2 adrenergic receptor agonist
specific
decreases central NE release
tx HTN
AE rebound HTN

Question 22

Prazosin

Answer 22

alpha1 specific antagonist

tx HTN

Question 23

terazosin

Answer 23

alpha1 specific antagonist
tx BPH (relaxes prostatic smooth muscle)

Question 24

Phenoxybenzamine and phentolamine

Answer 24

``` alpha non-specific antagonist tx pheochromocytoma (catecholoamine secreting tumor) ```

Question 25

dobutamine

Answer 25

B1 specific agonist | tx cardiogenic shock and heart failure

Question 26

Albuterol

Answer 26

Beta 2 agonist short acting tx acute asthma AE tachycardia via some Beta 1 agonism

Question 27

salmeterol, formoterol, babuterol

Answer 27

``` Beta 2 selective agonist long acting often used with corticosteroid tx Chronic asthma AE associated with increased asthma deaths ```

Question 28

terbutaline

Answer 28

beta 2 agonist used as fast acting bronchodilator was used in stopping premature labor (myometrial quieting effect)

Question 29

isoproterenol

Answer 29

beta agonist non-selective decreases PVR and increases HR and contractility tx bradycardia AE antagonized by Beta blockers

Question 30

Mirabegron

Answer 30

beta 3 agonist | tx overactive bladder

Question 31

Norepinephron

Answer 31

``` Alpah and Beta 1 agonist (beta 2 less) used to raise BP (ICU): increases systolic and diastolic (strong pressor) Vagal reflex slows HR Cardiac output unchanged Increases PVR ```

Question 32

Epinephrine

Answer 32

alpha and beta agonist causes precapillary constriction, large vessel dilation, increased HR (spikes then stabilizes to above baseline after vagal reflex), increased contractility, bronchodilation, modest increase in MAP (increased systolic, decreased diastolic) tx cardiac arrest, anaphylaxis, servere asthma

Question 33

Beta blocker uses

Answer 33

``` antihypertensive tx arrhythmias tx heart failure tx angina tx tremors tx glaucoma (timolol) ```

Question 34

propranolol

Answer 34

``` non selective beta blocker AE bradycardia (b1), AV block (b1), aggravation of asthma (b2), blocks glycogenolysis (Hypoglycemia in DM) ```

Question 35

esmolol

Answer 35

``` Selective B1 blocker short acting (1/2 life 4 minutes) ```

Question 36

metoprolol

Answer 36

selective b1 blocker | intermediate 1/2 life

Question 37

acetutolol

Answer 37

``` selective b1 blocker partial agonist (acts as antagonist when adrenergic activity is high) theoretically would cause less AE bradycardia/AV block but not frequently utilized ```

Question 38

atenolol

Answer 38

selective b1 blocker | intermediate 1/2 life

Question 39

nadolol

Answer 39

``` non selective beta blocker long acting (24 hours) ```

Question 40

pindolol

Answer 40

beta blocker | partial agonist

Question 41

carvedilol

Answer 41

combined alpha + beta blocker | tx some heart failure

Question 42

labetalol

Answer 42

combined alpha + beta blocker | tx HTN in pregnancy

Question 43

amphetamines

Answer 43

increase NE release Increase peripheral sympathetic stimulation increase dopamine levels->psychosis like symptoms no antidote tx ADHD, short term weight loss and narcolepsy

Question 44

methamphetamine

Answer 44

affects CNS lasts 6-8 hours: stimulation and euphoria smoking vector associated with binge use legal use: levo isomer (vicks vapor inhalor); desoxyn tablets

Question 45

bath salts

Answer 45

large group of compounds mephedron, methylene dioxypryrovalerone, methylone AE hallucination and panic attacks

Question 46

other amphetamine

Answer 46

MDMA-ecstasy MDA cathinone

Question 47

cocaine

Answer 47

blocks NE reuptake blocks DA reuptake schedule II drug; used as local anesthetic in ENT surger no antidote complicated 1/2 life: main metabolites benzooylecgonine and ecgonine methylester

Question 48

AE of cocaine

Answer 48

``` enlarged fibrotic heart perforated nasal septum parrot beak nails crack thumb, crack lips injection sites heart attacks strokes seizures teratogen stim uterine contraction placental abruption ```