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Nervous system/drugs Flashcards

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1
Q

Parasympathetics

A
  • Parasympathetics use neurons that are cholingergic (that is, ACh is the main neurotransmitter)
  • Pelvic splanchnic nerves and CN lll, Vll, lX, X
  • M2 (inhibitory) decrease HR and contra filing of atria
  • M3 (q) bladder contraction
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2
Q

Sympathetics

A
  • Sympathetics use neurons that are adrengergic use Epinephrine and NE as the main neurotransmitters)
  • Sweat glands are part of sym. Pathway but are innervated by cholinergic fibers
  • a1 -phospholipids C,protein kinase C, ca2+=smooth muscle contraction.
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3
Q

ACh receptors

A

Nicotinic ACh receptors are Ligand-gated Na+/K+ Channels: Nn (found in autonomic gangia, adrenal medulla) and Nm (neuromuscular junction in skeletal muscle)

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4
Q

direct cholingeric drugs

A

Bethanechol
Carbachol
Methacholine
pilocarpine

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5
Q

indirect cholinergic drugs

A
  • parasympathetic
  • donepezil, rivastigmine, galantamine
  • edrophonium
  • neostigmine
  • physostigmine
  • pryidostigmine
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6
Q

Bethanochol

A
  • No nictotinic activity
  • Resistant to AChE
  • Activates Bowel and bladder
  • uses:Postoperative Joey’s, neurogenic Josh’s, urinary retention.
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7
Q

Anti cholinergic drugs

A
  • atropine
  • anti dumbbelss
  • sympathetic; cant see, pee or shit.
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8
Q

Alzheimer’s drugs

A

Donepezil
Rivastigmine
Galantamine

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9
Q

Neostigmine

A
  • No CNS penetration

- used to reverse neuromuscular blockade (post op)

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10
Q

Physostigmine

A
  • PHreely Crosses BBB (tertiary amine)

- antidote (Phyxes) for atropine overdose

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11
Q

Pyridostigmine

A

-Increases muscle strength

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12
Q

Organophosphates

A
  • Irreversibly inhibit AChE = DUMBBELSS

- Antidote is atropine (competitive inhibitor) + pralidoxime (regenerates AChE if given early)

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13
Q

Pralidoxime

A

-Regenerates AChE

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14
Q

Atropine

A
  • Dilates eye

- Cycloplegia (paralysis of ciliary muscle leading to loss of accommodation)

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15
Q

Fenoldopam

A
  • D1

- Promotes Natriuresis

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16
Q

Isoproterenol

A
  • Can worsen ischemia
  • B1=B2
  • Reflex tachycardia (vs Norepinephrine)
  • Decreased MAP
  • Unopposed B2
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17
Q

Norepinephrine

A
  • Reflex bradycardia
  • a1>a2>B1
  • Unopposed a1
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18
Q

Phenylephrine

A
  • a1>a2
  • Used for ocular procedures to dilate eye.
  • Ischemic priapism (pain and rigidity of penis)
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19
Q

A1 stimulator drugs

A

Midodrine
Phenylephrine
Norepinephrine

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20
Q

Mirabegron

A
  • B3

- Used in urinary urge incontinency/overactive bladder (sudden urge to urinate followed by involuntary loss of urine)

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21
Q

Albuterol, Salmeterol, terbutaline

A
  • B2 > B1

- Albuterol used for acute asthma or COPD.

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22
Q

Terbutaline

A

-Acute bronchospasm in asthma and tocolysis (anti-contraction to prevent premature labor)

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23
Q

Salmeterol

A
  • Long term asthma

- COPD management

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24
Q

Anti-sympathetics

A
  • AKA a2 agonists
  • Anti-hypertensive drugs
  • Clonidine, guanfacine
  • a-methyldopa
  • tizanidine
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25
Clonidine | Guanfacine
- Used in hypertensive urgency - Symptoms control in opioid withdrawal - Rebound hypertension with abrupt cessation .
26
A-methyldopa
- HTN in pregnancy | - Side effect: Direct Coombs + hemolysis
27
Tizanidine
- Relief of spasticity | - Side effect: xerostomia (dry mouth)
28
Alpha blockers
``` -Non-selective: Phenoxybenzamine Phentolamine -a1 selective: Prazosin, terazosin, Doxazosin, tamsulosin -a2 selective: Mirtazapine ```
29
Phenoxybenzamine
- Irreversible - non selective alpha blocker - SE: reflex tachycardia and orthostatic hypotension
30
Phentolamine
- Reversible - non-selective - cocaine induced HTN - patients taking MAO inhibitors who eat tyramine containing foods. - SE: reflex tachycardia and orthostatic hypotension.
31
Selective a1 blockers
Tamsulosin Terazosin Doxazosin Prazosin
32
Tamsulosin
- Not given in HTN like other a1 blockers. | - 1st-dose orthostatic hypotension
33
Prazosin
- Used in PTSD - Urinary symptoms of BPH - 1st-dose orthostatic hypotension
34
Doxazosin side effects
-SE: dizziness, headache, 1st-dose orthostatic hypotension
35
Selective A2 blockers | Uses and Side effects
-Mirtazapine: Uses: -Depression SE: - increased cholesterol - Increased appetite - Sedation
36
BP response to epinephrine and when adding alpha blockade
-Epinephrine is b > a so when adding alpha blocker there is unopposed beta action: B1: reflex tachycardia B2: reversal of MAP from net increase to a net decrease.
37
BP response to phenylephrine and when adding alpha blockade
- a1 > a2 - Phenylephrine is a PURE alpha agonist therefore response is suppressed but NOT reversed (lacks beta agonist properties)
38
Selective B1 blockers
- A to M | - Acebutolol (partial agonist)
39
Non-selective B blockers
- B1 > B2 | - N to Z; nadolol, pindolol (partial agonist), propranolol, timolol
40
Both alpha and beta blockers
- Carvedilol | - Labetalol
41
Nebivolol
-Combination of B1 (cardiac selective) blockade with B3 blockade (increases NO and decreased SVR)
42
Anti-cholingergic, drugs that treat irritable bowel syndrome anti- spasmodics.
Hyoscyamine | Dicyclomine
43
Cholinergic drugs affect on bladder and GI
- Contracts bladder (treats urinary retention; bethanechol, neostigmine) - Contacts gut (treats ileus; lack of movement in the intestine leading to build up of stuff; neostigmine and bethanochol)
44
Ingested seafood
- Histamine (scombroid poisoning) - Ciguatoxin - Tetrodotoxin
45
Pufferfish
- Tetrodotoxin - Puffer Prevents depolarization - Blocks fast voltage gated Na+ channels - loss of reflexes
46
Histamine (scombroid poisoning)
- spoiled dark meat fish - mahi mahi, tuna, mackerel bonito - bacterial histidine decarboxylase converts histidine to histamine. - mimics anaphylaxis;flushing, burning sensation in mouth, angioedema, bronchospasm
47
Ciguatoxin
- reef fish; barracuda, snapper, moray eel - Cigua Causes depolarization - Perioral numbness - reversal of hot and cold sensations,
48
Argus to avoid in elderly patients (BEER CRITERIA-due to decreased efficacy or increased risk of adverse effects)
- A-BLOCKERS (hypotension) - anticholingergics, antidepressant, antihistamines, opioids (delirium, sensations, falls, constipation, urinary retention) - PPI’s, NSAIDS, Benzos
49
Acetaminophen toxicity antidote
N-acetylcysteine (replenishes glutathione)
50
AChE inhibitors, organophosphate toxicity antidote
Atropine > Pralidoxime
51
Arsenic toxicity antidote
Dimercaprol, succiner
52
Benzodiazepines antidote
Flumazenil
53
Carbon monoxide antidote
100% oxygen, hyperbaric oxygen
54
Copper toxicity antidote
Penicillamine, Trientine
55
Cyanide toxicity
Nitrite, thiosulfate, hydroxocobalamine
56
Digitalis toxicity
Anti-dig Fab fragments
57
Heparin toxicity antidote
Protamine sulfate
58
Iron antidote
Dexferoxamine, deferasirox, deferiprone.
59
Lead antidote
EDTA, Dimercaprol, succiner, penacilllamine
60
Mercury antidote
Dimercaprol, succimer
61
Methanol, ethylene glycol (antifreeze)
Fomepizole > ethanol, dialysis
62
Methemoglobin
Methylene blue, vitamin C (reducing agent)
63
Opioids
Naloxone
64
Salicylates
NaHCO3 (alkalyzes urine), dialysis
65
TCA’s
NaHCO3 (stabilizes cardiac cell membrane)
66
Warfarin
Vitamin K (delayed effect) fresh frozen plasma (immediate)

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