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Flashcards in FA - Pharmacology II Deck (131):
1

Edrophonium - Application:

Historically --> MG diagnosis (extremely short-acting).
--> NOW diagnosed by anti-AChR Ab (anti-acetylcholine receptor antibody) test.

2

Neostigmine - Application:

1. Post-op + neurogenic ileus.
2. Urinary retention.
3. MG.
4. Reversal of neuromuscular blockade - Post-op.

3

Physostigmine - Application:

1. Anticholinergic toxicity.
2. Crosses BBB --> TERTIARY AMINE.

4

Pyridostigmine - Application:

Myasthenia gravis (long acting).
--> DOES NOT PENETRATE CNS (quaternary amine).

5

With ALL CHOLINOMIMETIC agents, WATCH FOR ...?

1. COPD exacerbation.
2. Asthma exacerbation.
3. Peptic ulcers.

6

Cholinesterase inhibitor poisoning - Often due to ...?

ORGANOPHOSPHATES - such as parathion, that IRREVERSIBLY inhibit AChE.

7

Cholinesterase inhibitor poisoning - Causes?

1. Diarrhea.
2. Urination.
3. Miosis.
4. Bronchospasm.
5. Bradycardia.
6. Excitation of skeletal muscle and CNS.
7. Lacrimation.
8. Sweating.
9. Salivation.
--> May lead to RESPIRATORY FAILURE if untreated.

8

Organophosphates are often components of ...?

Insecticides - Poisoning usually seen in farmers.

9

AChE inhibitor poisoning - Antidote:

ATROPINE + PRALIDOXIME (regenerates AChE if given early).

10

M antagonists:

1. Atropine + Homatropine + Tropicamide.
2. Benztropine.
3. Glycopyrrolate.
4. Hyoscyamine + Dicyclomine.
5. Ipratropium + Tiotropium.
6. Oxybutynin + Solifenacin + Tolterodine.
7. Scopolamine.

11

Atropine + Homatropine + Tropicamie - Organ systems:

EYE.

12

Atropine + Homatropine + Tropicamide - Applications:

MYDRIASIS + CYCLOPLEGIA.

13

Benztropine - Organ system:

CNS.

14

Benztropine - Applications:

1. Parkinson disease.
2. ACUTE DYSTONIA.

15

Glycopyrrolate - Organ systems:

1. GI.
2. Respiratory.

16

Glycopyrrolate - Applications:

1. PARENTERAL: Pre-op use to reduce airway secretions.
2. ORAL: Drooling, peptic ulcer.

17

Hyoscyamine + Dicyclomine - Organ systems:

GI.

18

Hyoscyamine + Dicyclomine - Applications:

ANTISPASMODICS for IBS.

19

Ipratropium + Tiotropium - Organ systems:

Respiratory.

20

Ipratropium + Tiotropium - Applications:

1. COPD.
2. Asthma.

21

Oxybutynin + Solifenacin + Tolterodine - Organ systems:

GU.

22

Oxybutynin + Solifenacin + Tolterodine - Applications:

1. Reduce bladder spasms.
2. Urge urinary incontinence (overactive bladder).

23

Scopolamine - Organ systems:

CNS.

24

Scopolamine - Application:

Motion sickness.

25

Atropine is used to treat?

1. Bradycardia.
2. Ophthalmic applications.

26

Atropine - Effect on eye?

1. Incr. pupil DILATION.
2. Cycloplegia.

27

Atropine - Effect on airways:

Decr. secretions.

28

Atropine - Effect on stomach:

Decr. acid secretion.

29

Atropine effect on gut:

Decr. motility.

30

Atropine effect on Bladder:

Decr. urgenry in cystitis.

31

Atropine can cause what in elderly?

Acute angle-closure glaucoma - Due to mydriasis.

32

Atropine can cause what in men with BPH:

Urinary retention.

33

Atropine can cause what in infants:

HYPERTHERMIA.

34

Albuterol, salmeterol - Action:

Beta-2 > Beta-1.

35

Albuterol - Use:

ACUTE asthma + COPD.

36

Salmeterol - Use:

LONG-TERM asthma or COPD control.

37

Dobutamine - Action:

Beta-1 > Beta-2, alpha.

38

Dobutamine - Use:

HF (inotropic > chronotropic).
--> Cardiac STRESS TESTING.

39

Dopamine - Action:

D1=D2 > Beta > Alpha.

40

Dopamine - Use:

1. Unstable bradycardia.
2. HF.
3. Shock.
4. INOTROPIC + CHRONOTROPIC effects at lower doses due to beta effects.
5. VASOCONSTRICTION at high doses due to alpha effects.

41

Epinephrine - Action:

Beta > Alpha.

42

Epinephrine - Use:

1. Anaphylaxis.
2. Asthma.
3. Open-angle glaucoma.
4. Alpha effects predominate AT HIGH DOSES.

43

Fenoldopam - Action:

D1.

44

Fenoldopam - Use:

1. Post-op HTN.
2. HTN Crisis.
3. Vasodilator ==> Coronary + Peripheral + Renal + Splanchnic.
4. PROMOTES NATRIURESIS.

45

Fenoldopam may cause:

1. Hypotension.
2. Tachycardia.

46

Isoproterenol - Action:

Beta-1 = Beta-2.

47

Isoproterenol - Use:

Electrophysiologic evaluation of tachyarrhythmias.

48

Isoproterenol - Can worsen ...?

ISCHEMIA.

49

Midodrine - Action:

Alpha-1.

50

Midodrine - Applications:

1. Autonomic insufficiency.
2. Postural hypotension.

51

Midodrine - May exacerbate ...?

SUPINE HTN.

52

NE - Action:

Alpha-1 > Alpha-2 > Beta-1.

53

NE - Use:

1. Hypotension.
2. Septic shock.

54

Phenylephrine - Action:

Alpha-1 > Alpha-2.

55

Phenylephrine - Use:

1. Hypotension (vasoconstrictor).
2. Ocular procedures (mydriatic).
3. Rhinitis (decongestant).

56

3 INDIRECT SNS-mimetics:

1. Amphetamines.
2. Cocaine.
3. Ephedrine.

57

Amphetamine - Action:

Indirect general agonist, reuptake inhibitor, also releases stored catecholamines.

58

Amphetamines - Use:

1. Narcolepsy.
2. Obesity.
3. ADHD.

59

Cocaine - Action:

Indirect general agonist + Reuptake inhibitor.

60

Cocaine - Use:

1. Causes vasoconstriction + Local anesthesia.
2. NEVER GIVE BETA-BLOCKERS if cocaine intoxication is suspected --> Can lead to unopposed alpha-1 activation --> EXTREME HTN.

61

Ephedrine - Action:

Indirect general agonist, releases stored catecholamines.

62

Ephedrine - Use:

1. Nasal decongestion.
2. Urinary incontinence.
3. Hypotension.

63

Sympatholytics (alpha-2 agonists):

1. Clonidine, guanfacine.
2. Alpha-methyldopa.

64

Clonidine + Guanfacine --> Use:

1. Hypertensive urgency (limited situations).
2. ADHD.
3. Tourette syndrome.

65

Clonidine + Guanfacine - Side effects:

1. CNS depression.
2. Bradycardia.
3. Hypotension.
4. Respiratory depression.
5. Miosis.

66

Alpha-methyldopa - Use:

HTN in PREGNANCY.

67

Alpha-methyldopa - Side effects:

1. DIRECT COOMBS (+) HEMOLYSIS.
2. SLE-like syndrome.

68

Alpha blockers - NON selective:

1. Phenoxybenzamine (IRREVERSIBLE).
2. Phenolamine (Reversible).

69

Phenoxybenzamine - Use:

Pheochromocytoma (pre-op) to prevent catecholamine (HTN) crisis.

70

Phenolamine - use:

Give to patients on MAOIs who eat tyramine-containing foods.

71

Phenoxybenzamine + Phentolamine - Side effects:

1. Orthostatic hypotension.
2. Reflex tachycardia.

72

Alpha-1 selective Blockers:

1. Prazosin.
2. Terazosin.
3. Doxazosin.
4. Tamsulosin.

73

Use of alpha-1 selective blockers:

1. Urinary symptoms of BPH.
2. PTSD (prazosin).
3. HTN (EXCEPT TAMSULOSIN).

74

Alpha-1 blockers - Side effects:

1. 1st dose hypotension.
2. Dizziness.
3. Headache.

75

Alpha-2 blocker:

Mirtazapine.

76

Mirtazapine - Use:

DEPRESSION.

77

Mirtazapine - Side effects:

1. Sedation.
2. Incr. serum cholesterol.
3. Incr. appetite.

78

12 Beta-blockers:

1. Acebutolol.
2. Atenolol.
3. Betaxolol.
4. Carvedilol.
5. Esmolol.
6. Labetalol.
7. Metoprolol.
8. Nadolol.
9. Nebivolol.
10. Pindolol.
11. Propranolol.
12. Timolol.

79

Beta-blockers - Use:

1. Angina pectoris.
2. MI.
3. SVT.
4. HTN.
5. HF.
6. Glaucoma.
7. Variceal bleeding.

80

Beta blockers in angina pectoris - Actions:

1. Decr. HR + Contractility.
2. Resulting in decr. O2 consumption.

81

Beta blockers in MI:

Decr. MORTALITY.

82

SVT - Which beta-blockers?

1. Metoprolol.
2. Esmolol.

83

Beta blockers in SVT - Actions:

Decr. AV conduction velocity (class II antiarrhythmics).

84

HTN - Beta blockers actions:

1. Decr. CO.
2. Decr. RENIN SECRETION.

85

Beta blockers in HF - Actions:

HF --> Decr. mortality.

86

HF - Which beta blockers?

1. Bisoprolol.
2. Carvedilol.
3. Metoprolol.

87

Beta blockers in glaucoma?

TIMOLOL --> Decr. SECRETION of aqueous humor.

88

Variceal bleeding (nadolol, propranolol) - Actions:

Decr. hepatic venous pressure gradient + Portal HTN.

89

Beta blockers - Side effects:

1. Erectile dysfunction.
2. CVS adverse effects = Bradycardia + AV block + HF.
3. CNS adverse effects = Seizures + Sedation + Sleep alterations.
4. Dyslipidemia = METOPROLOL.
5. Asthma/COPD exacerbations.

90

Beta blockers - Use with caution in ...?

COCAINE USERS - Risk of unopposed alpha-adrenergic receptor agonist activity.

91

Beta blockers in diabetics?

Despite the theoretical risk of MASKING HYPOGLYCEMIA in diabetics, benefits likely outweigh risks - NOT CONTRAINDICATED.

92

Beta-1 selectivity:

1. Acebutolol (partial agonist).
2. Atenolol.
3. Betaxolol.
4. Esmolol.
5. Metoprolol.

93

NON selective beta blockers:

1. Nadolol.
2. Pindolol (partial agonist).
3. Propranolol.
4. Timolol.

94

NON selective ALPHA + BETA blockers:

1. Carvedilol.
2. Labetalol.

95

Nebivolol combines ...?

Cardiac-selective beta-1 blockade WITH STIMULATION OF BETA-3 receptors --> Activate NO synthase in the vasculature.

96

Ingested seafood toxins - 3:

1. Tetradotoxin.
2. Ciguatoxin.
3. Histamine (scombroid poisoning).

97

Tetradotoxin - Source:

Pufferfish.

98

Tetradotoxin - Action:

1. Highly potent toxin.
2. Binds fast voltage-gated Na channels in cardiac/nerve tissue --> Preventing depolarization.

99

Tetradotoxin - Symptoms:

1. Nausea.
2. Diarrhea.
3. Paresthesias.
4. Weakness.
5. Dizziness.
6. Loss of reflexes.

100

Tetradotoxin - Tx:

Primarily supportive.

101

Ciguatoxin - Source:

Reef fish such as:
1. Barracuda.
2. Snapper.
3. Moray eel.

102

Ciguatoxin - Action:

Opens Na channels --> Depolarization.

103

Ciguatoxin - Symptoms:

Symptoms MIMIC CHOLINERGIC POISONING.

104

Ciguatoxin - Tx:

PRIMARILY SUPPORTIVE.

105

Histamine (scombroid poisoning) - Source:

Spoiled dark-meat fish such as TUNA, Mahi-mahi, mackerel, and bonito.

106

Histamine (scombroid poisoning) - Action:

1. Bacterial histidine decarboxylase converts histidine to histamine.
2. Frequently misdiagnosed as fish allergy.

107

Histamine (scombroid poisoning) - Symptoms:

1. Mimics anaphylaxis: Acute burning sensation of mouth + Flushing of face + Erythema + Urticaria + Itching.
2. May progress to bronchospasm + angioedema + hypotension.

108

Histamine (scombroid poisoning) - Tx:

1. Antihistamines.
2. Albuterol + epi if needed.

109

Specific toxicity Tx - Acetaminophen:

N-acetylcysteine (replenishes glutathione).

110

AChE inhibitors, organophosphates?

Atropine > Pralidoxime.

111

Amphetamines?

NH4Cl (acidify urine).

112

Antimuscarinic agents?

Physostigmine + Control hyperthermia.

113

Arsenic?

1. Dimecaprol.
2. Succimer.

114

Benzodiazepines?

Flumazenil.

115

Beta-blockers?

1. Saline.
2. Atropine.
3. Glucagon.

116

Carbon monoxide?

1. 100% O2.
2. Hyperbaric O2.

117

Copper?

1. Penicillamine.
2. Trientine.

118

Cyanide?

1. Nitrite + Thiosulfate.
2. Hydroxocobalamin.

119

Digoxin?

Anti-dig Fab fragments.

120

Gold?

1. Penicillamine.
2. Dimercaprol (BAL).
3. Succimer.

121

Heparin?

Protamine sulfate.

122

Iron?

1. Deferoxamine.
2. Deferasirox.
3. Deferiprone.

123

Lead?

1. EDTA.
2. Dimercaprol.
3. Succimer.
4. Penicillamine.

124

Mercury?

1. Dimercaprol.
2. Succimer.

125

Methanol, ethylene glycol?

Fomepizole > Ethanol, dialysis.

126

Methemoglobin?

1. Methylene blue.
2. VitC.

127

Opioids?

Naloxone.

128

AChE inhibitors - Used in Alzheimer?

1. Donepezil.
2. Galantamine.
3. Rivastigmine.

129

Salicylates?

1. NaHCO3 (alkalinize urine).
2. Dialysis.

130

TCA?

NaHCO3.

131

Warfarin?

1. VitK (DELAYED EFFECT).
2. FFP (IMMEDIATE EFFECT).

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