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Flashcards in Reverse pharmacology Deck (47):
1

Direct cholinnomimetic agonist

Postoperative ileus, neurogenic ileus, urinary retention

Activates bladder and bowel smooth muscle

bethanacol

2

Direct cholinomimetic agonist

Constricts pupil and relieves intraocular pressure in glaucoma

carbachol

3

Direct cholinomimetic agonist

challenge test for diagnosis of asthma

methacholine

4

Direct cholinomimetic agonist

Potent stimulator of seat, tears, and saliva
Open angle and closed angle glaucoma

Constracts ciliary muscle of eye (open angle glaucoma)
and pupilary sphincter (closed angle glaucoma)

pilocarpine

5

Anticholinesterases (3)

Alzheimers

donezipil, galantamine, and rivastigmine

6

Anti AChE

Historically, diagnosis of myasthenia gravis (extremely short acting)

edrophonium

7

Anti AChE

Postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of NMJ blockage

No CNS penetration

neostigmine

8

Anti AChE

Anticholinergic (atropine) toxicity; crosses blood rain barrier

physostigmine

9

Anti AChE

Myasthenia gravis (long acting)

No CNS penetration

pyridostigmine

10

Muscarinic antagonists (3)

Mydriasis and cycloplegia

atropine
homatropine
tropicamide

11

Muscarinic antagonists

Parkinsons
Acute dystonia

Benztropine

12

Muscarinic antagonists

Parenteral: Pre op use to reduce airway secretions
Oral: Drooling, peptic ulcer

glycopyrrolate

13

Muscarinic antagonists (2)

Antispasmodics for irritable bowel syndrome

hyoscyamine
dicyclomine

14

Muscarinic antagonists (2)

COPD, asthma

ipratropium, tiotropium

15

Muscarinic antagonists (3)

Reduce bladder spasms and urge incontinence

oxybutynin, solifenacin, tolterodine

16

Muscarinic antagonists

Motion sickness (CNS)

scopolamine

17

Musc. antag

Incr. pupil dilation/cycloplegia
Decr. airway secretions
Decr. acid secretion in stomach
Decr. motility in gut
Decr. urgency in cystitis

Treats bradycardia
Opthalmic applications
Blocks DUMBBLSS (not CNS or skel. muscle=nicotinic)

Toxicity:

Incr. body temp (decr. 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

Acute angle closure glaucoma in elderly (mydriasis)
urinary retention in men with prostatic hyperplasia
hyperthermia in infants

Jimson Weed leads to gardner's pupil (mydriasis due to plant alkaloids)

Atropine

18

Dark meat fish improperly stored at warm temp.

Bacterial histidine decarboxyl. converts histadine to histamine which isn't degraded by cooking.

Misdiagnosed as allergy to fish

Acute onset burning sensation of the mouth, flushing of face, erythema, urticaria, pruritus, headache
Anaphylaxis like presenation is possible

Antihistamines
Possible antianaphylactics

Scombroid

19

Reef fish

Opens Na channels causing depolarization

Similar to cholinergic poisoning

Temperature related dysthesias are a specific finding

Supportive

Ciguatoxin

20

Very potent: binds fast voltage gated Na channels and prevents depolarization

Pufferfish

Nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes

Supportive

tetrodotoxin

21

Direct sympathomimetics

beta 2 > beta 1

Acute asthma

albuterol

22


Direct sympathomimetics

beta 1 > beta 2
alpha

Heart failure (inotropic > chronotropic)
Cardiac stress testing

dobutamine

23


Direct sympathomimetics

D1=D2 > beta > alpha

unstable bradycardia
HF
Shock
Inotropic and chronotropic alpha effects predominate at high doses.

dopamine

24


Direct sympathomimetics

Beta > alpha

Anaphylaxis
asthma
open angle glaucoma
Alpha effects predominate at high doses

epinephrine

25


Direct sympathomimetics

Beta 1 = beta 2

electrophysiologic eval. of tachyarrythmias
Can worsen ischemia

isoproterenol

26


Direct sympathomimetics

alpha 1 > alpha 2 > beta 1

hypotension (but decr. renal perfusion)

NE

27


Direct sympathomimetics

alpha 1 > alpha 2

hypotensin (vasoconstrictor)
ocular procedures (mydriatic)
rhinitis (decongestant)

Phenylephrine

28


Direct sympathomimetic

Beta 2 > beta 1

Long term asthma or COPD control

salmeterol

29

Indirect sympathomimetic

Indirect general agonist
Reuptake inhibitor
Releases stored catecholamines

Narcolepsy
Obesity
ADHD

amphetamine

30


Indirect sympathomimetic

Indirect general agonist
reuptake inhibitor

Vasoconstriction and local anesthesia

Never give beta blocker in intoxication b/c it can lead to unopposed alpha 1 activation and extreme hypertension

Cocaine

31

Indirect sympathomimetic

Indirect general agonist
Releases stored catecholamines

Nasal congestion
Urinary incontinence
Hypotension

Ephedrine

32

sympatholytic (alpha 2 agonist)

Hypertensive urgency; does not decr. renal blood flow
ADHD
Tourette Syndrome

CNS Depression
bradycardia
hypotension
resp. depression

clonidine

33

sympatholytic (alpha 2 agonist)

Hypertension in pregnancy

Direct coombs + hemolysis
SLE like syndrome

alpha methyl dopa

34


Non selective alpha blocker

pheochromocytoma (operatively) to prevent catecholamine crisis

phenoxybenzamine

35


non select alpha blocker

Give to pts. on MAOIs who eat tyramine containing food

orthostatic hypertension
Reflex tachycardia

\phentolamine\

36


Alpha 1 selective blockers (2)

urinary symptoms of BPH
Hypertension

1st dose orthostatic hypotension
dizziness
headache

terazosin, doxazosin

37

Alpha 2 selective alpha blocker

Depression

Sedation
Incr. serum cholesterol
Incr. appetite

mirtazapine

38

Alpha 1 selective blockers

urinary symptoms of BPH
PTSD
Hypertension

1st dose orthostatic hypotension
dizziness
headache

prazosin

39

Alpha 1 selective blockers

urinary symptoms of BPH

1st dose orthostatic hypotension
dizziness
headache

tamsulosin

40

Angina: decr. HR and contractility leading to decr. O2 consumption

MI: Decr. mortality (3?)

SVT: Decr. AV conduction velocity (2?)

Hypertension: Decr. CO, Decr. renin secretion

HF: Decr. mortality

Glaucoma: Decr. secretion of aqu. humor (1?)

Beta blockers

(metoprolol, carvedilol, bisoprolol) (class II antiarryth)

Metoprolol, esmolol

timolol

41

Beta 1 selective antagonists

acebutolol, atenolol, betaxolol, esmolol, and metoprolol?

42

Non selective beta antagonists

nadolol, pindolol, propranolol, and timolol?

43

Partial beta agonists

pindolol and acebutolol

44

non selective alpha and beta antagonists

carvedilol and labetalol

45

cardiac selective beta 1 blockade
stimulation of beta 3 leading to NO synthase in vasculature

nebivolol

46

Toxins fixed by these antidotes?

N-acetylcysteine (replenishes glutathione)
Atropine > pralidoxime
NH4Cl (acidify urine)
Physostigmine salicylate, control hyperthermia
Flumazenil
glucagon
100% O2, hyperbaric O2
penicillamine
nitrate + thiosulfate, hydroxocobalamin
Anti dig Fab fragments
Protamine sulfate
Deferoxamine, deferasirox
EDTA, dimercaprol, succimer, penicillamine
Dimeraprol (BAL), succimer
Fomepizole > ethanol, dialysis
methylene blue, vitamin C
naloxone, naltrexone
NAHCo3 (alkalinize urine), dialysis
NaHCO3 (plasma alkalinize)
Aminocaproic acid
Vitamin K (delayed) FFP (immediate)

acetaminophen: N-acetylcysteine (replenishes glutathione)
AChe Inhibitors, organophosphates: Atropine > pralidoxime
Amphetamines: NH4Cl (acidify urine)
Antimuscarinic/anticholinergic: Physostigmine salicylate, control hyperthermia
Benzodiazepines: Flumazenil
Beta blockers: glucagon
CO: 100% O2, hyperbaric O2
Copper, arsenic, gold: penicillamine
Cyanide: nitrate + thiosulfate, hydroxocobalamin
Digitalis (digoxin): Anti dig Fab fragments
Heparin: Protamine sulfate
Iron: Deferoxamine, deferasirox
Lead: EDTA, dimercaprol, succimer, penicillamine
Mercury, arsenic, gold: Dimeraprol (BAL), succimer
methanol/ethylene glycol (antifreeze): Fomepizole > ethanol, dialysis
Methemoglobin: methylene blue, vitamin C
Opiods: naloxone, naltrexone
Salicylates: NAHCo3 (alkalinize urine), dialysis
TCAs: NaHCO3 (plasma alkalinize)
tPA, streptokinase, urokinase: Aminocaproic acid
Warfarin: Vitamin K (delayed) FFP (immediate)

47

What do these groups of drugs cause?

Cocaine, sumatriptan, ergot elkaloids

Vancomycin, adenosine, niacin, Ca channel blockers

Anthracyclines (doxorubicin, daunorubicin); prevent with dexrazoxane

Class III and Class IA antiarrythmics, macrolides, antipsychotics, TCAs

What drugs cause coronary vasospasm? Cutaneous flushing? Dilated Cardiomyopathy? Torsades de Pointes?