Flashcards in First Aid pharmacology Deck (79)
safer drugs have higher TI values
Examples of drugs with low TI values
digoxin, lithium, theophylline, warfarin
Sweat glands and adrenal medulla are innervated by what?
sympathetic nervous system; cholinergic nerve fibers
Nicotinic Ach receptors ligand gated Na/K channels. what are the 2 receptors, where are they found
N(N) autonomic ganglia; N(M) (neuromuscular junction)
What type of receptors do muscarinic Ach act through?
G protein coupled receptors . M1-5
qiss qiq siq sqs
alpha 1, alpha2, beta1, beta 2, M1, M2, M3, D1, D2, H1, H2, V1, V2
decrease sympathetic outflow, decrease insulin release, decrease lipolysis, increase platelet aggregation
vasodilation, bronchodilation, increase heart rate, increase contractility, increase lipolysis, increase insulin release, decrease uterine tone (tocolysis), ciliary muscle relaxation, increase aqueous humor production
CNS, enteric nervous system
decrease HR and contractility of atria
increase exocrine gland secretions (lacrimal, salivary, gastric acid), increase gut peristalsis, increase bladder contraction, bronchoconstriction, increase pupillary sphincter contraction (miosis), ciliary muscle contraction (accomodation)
relaxes renal vascular smooth muscle
modulates transmitter release, especially in brain
increase nasal and bronchial mucus production, increase vascular permabliity, contraction of bronchioles, pruritis, and pain
increase gastric acid secretion
vascular smooth muscle contraction
H20 permability and absorption in the collecting tublus of the kidney (V2 is found in the 2 kidneys)
blocks conversion of tyrosin to DOPA
blocks dopamine entry into vesicles
stimulates release and blocks reuptake
located on presynaptic membrane, increases release of NE at synapse
inhibits release of NE on presynaptic membrane
Clinical use of Bethanechol
postoperative ileus, neurogenic ileus, and urinary retention
Action of Bethanechol
Activates Bowel and Bladder smooth muscle; resistant to AChE. Bethany, call (bethanechol), me maybe, if you want to activate your bowels and bladder
Carbachol clinical use
Glaucoma, pupillary constriction, and relief of intraocular pressure.
Pilocarpine clinical use
Potent stimulator of sweat, tears, and saliva; open-angle and closed angle glaucoma
contracts ciliary muscle of eye (open-angle glaucoma), pupillary sphincter (closed angle glacoma); resistant to AChE. " you cry, drool, and sweat on your PILOow"
postoperative an neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular junction blockade (postoperative)
myasthenia gravis (long acting) 'gets rid of myasthenia gravis'
What are he anticholinesterases to treat Alzheimer disease?
Donepezil, Rivastigmine, Galantamine
What to use for Dx of myasthenia gravis? why?
Edrophonium. short acting; myasthenia gravis now diagnosed with antibody-AChR Ab test
With all cholinomimetic agents, what should you watch out for?
Exacerbaions of COPD,Athsma, Peptic ulcers
Give an example of an oranophosphate
Parathion; Organophosphates common in insecticides; posoning usually seen in farmers.
What is the antidote for organophosphate posioning (irreversibel acetylchoinesterase inhibitor)?
Atropine (antimuscarinic) + Pralidoxime (regenerates AChE if given early)
Muscarinic antagonists: Atropine, Homatropine, Tropicamide
produces mydriasis and cycloplegia
Muscarinic antagonists: Benztropine
PARKinson disease: 'PARK my BENZ'
Muscarinic antagonists: Scopolamine
Muscarinic antagonists:Ipratropium, Tiotropium
Respiratory: COPD, Athsma
Muscarinic antagonists:Oxybutynin, darifenacin, solifenacin
Genitouinary. Reduce urgency in mild cystitis and reduce bladder spasms. Other agents: tolterodine, fesoterodine, trospium
Muscarinic antagonists: Glycopyrrolate
Gastrointestinal, respiratory: Parentaral: preoperative use to reduce airway secretions. Oral: drooling, peptic ulcer.
used to treat bradycardia and for ophthalmic applications
can cause acute angle closure in elderly (due to mydriasis), urinary retention in men with prostatic hypertension, and hyperthermia in infants
Jimson weeed (Datura)
gardeners pupil (mydriasis due to plant alkaloids)
beta > alpha
a1 > a2> beta
beta1=beta2; electrophysiologic evaluation of tachyarrhythmias. can worsen ischemia
D1=D2>beta>alpha; Use: ustable bradycardia, HF, shock; inotropic and chronotpic alpha effects predominate at high doses.
beta1 > beta2 > alpha. Use: Heart failure (inotropic>chronotropic), cardiac stress testing
alpha1 > alpha 2. Use: hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis ( decongestant)
Albuterol, salmeterol, terbutaline
beta2 > beta1. terbutaline to reduce premature uterine contractions
Ephedrine mech and use
indirect general agonist, releases stored catecholamines; Nasal decongestion, urinary incontinence, hypotension
indirect general agonist, reuptake inhibitor. Causes vasoconstriction and local anesthesia; never give beta blockers if cocaine intoxication is suspected (leads to unopposed alpha1 activation and extreme hypertension
What are the sympatholytics (alpha 2 agonists)?
Clonidine and alpha methyl-dopa
Clinical use of clonidine
hypertensive urgency (limited situations); does not decrease renal blood flow. ADHD, severe pain, and a variety of off label indications (ethanol and opioid withdrawal).
Clonidine CNS toxicity
CNS depression, bradycardia, hypotension, respiratory depresssion, and small pupil size
alpha-methyldopa clinical use
Hypertension in pregnancy; safe in pregnancy
Direct Coombs positive hemolytic anemia, SLE-like syndrome
phenoxybenzamine reversible or irreversible?
phentolamine reversible or irreversible?
pheochromocytoma (used preoperatively) to prevent catecholamine hypertensive crisis
orthostatic hypotension, reflex tachycardia
give to patients on MAO inhibitors who eat tyramine containing foods
phenoxybenzamine and phentolamine selective or nonselective?
what are the alpha1 selective alpha inhibitors?
prazosin, terazosin, doxazosin, tamsulosin
Use of alpha 1 selective antagonists?
urinary symptoms of BPH; PTSD (prazosin); hypertension (except except tamsulosin)
Toxicity of alpha 1 selective blockers
1st dose orthostatic hypotension, dizziness, headache
alpha 2 selective alpha BLOCKER
sedation, increased serum cholesterol, increased appetite
What beta blockers reduce mortality in MI?
metoprolol, cervedilol, and bisoprolol
what beta blockers for a SVT?
decrease secretion of aqueous humor
toxicity of beta blockers
impotence, CV adverse effects, CNS adverse effects (seizures, sedation, sleep alterations), dyslipidemia, and asthmatics
What beta blocker can cause dyslipidemia?
What are the B1 selective antagonists?
acebutolol (partial agonist) , atenolol, betaxolol, esmolol, metoprolol
what are the nonselective antagonists?
nadolol, pindolol (partial agonist) , propranolol, timolol
what are the nonselevtive alpha beta antagonists?