SNS/PNS drugs

Question 1

Used for post op Ileus;, neurogenic ileus and urinary retention via Activating bowel and bladder smooth muscles.

Answer 1

Bethanechol

Direct Ach Agonists or Cholomimetic

Bethany activates your Bowels and Bladder

Question 2

What drug can we use for Gluacoma because it cause pupillayr contriction and provides relief of introcular pressure?

Answer 2

Carbachol

= Carbon copy of acetycholine

Question 3

Used to treat people with Open angle and Closed angle glaucoma but causes stimulation of sweat, tears and saliva

Answer 3

Pilocarpine

Ach Direct agonist; contracts ciliary mucle of the eye (for open angle)

in closed angle is causes pupillary CONSTRICTION

You cry, sweat, and drool on your PILlow

Question 4

Stimulates the muscarinic receptors in airway when inhaled

used to dx asthma

Answer 4

Methacholine

Question 5

Drug used post-operatively for neurogenic ileus and urinary retention.

Helps with mysethenia gravis

What is it’s mechanism?

Answer 5

Neostigmine

Indirect agnosist or Achecholinesterase Inhibitor

Question 6

What is the MOA of Neostigmine?

When do we use it?

What are it’s limitiation?

Answer 6

Neostigmine = Acetylcholinesterase inhibitor thus INCREASE endogenous Ach

Uses: Post op ileus and to Tx urinary retention, Myasthenis Gravis

Neo or NO ≠CNS penetration

Question 7

If you wanted to give someone medication for Myasthenia Gravis that they didn’t have to take often, what would it be?

MOA?

Answer 7

Pryidostigmine (long acting)

Acetlcholinesterase inhibitor, Increase Ach and increase pts Strength

PyRIDostiGMine gets RID of Myasthenia Gravis

Question 8

What NT is low in Alzeihmers? How can help with this?

Answer 8

Alzeihmers have Low Ach: give acetycholinesterase inhibitor

Donepezil, Rivastigmine, Galatamine

Question 9

Old man comes in after working outside. He’s flushed, red and very aggitated. He has dry oral mucosal membranes and cycloplegia (loss of ability to accomidate with ciliary musl).

What could he have been exposed to while outiside to cause symptoms?

What is the treatement and why?

Answer 9

Think Jimsonweed = alkaloid which causes ATROPINE overdose

Give pts PHysiostigmine

Physiostigmine, phyxes atropine OD (it’ an acetlycholinesterase inhibitor)

Question 10

When do we use PHysiostigmine?

What’s it’s mechanism of action?

Answer 10

Used for Anticholinergic toxicity (like atropine overdose)

Acetycholinesterase inhibitor

will cross the BBB

may be used for glaucoma

Question 11

What once use to dx Myasthenia Gravis?

What the MOA?

Answer 11

Edrophoinum

short acting acetycholinesterase inhibitor to increase endogenouch Ach

Question 12

What is the clinical applicaiton of Doneprizil?

Answer 12

Used for Alzheihmers: it’s and Acetycholinesterase inhibitor

Question 13

What is a side affect we need to be aware of when prescribing Acetycholinesterase inhibitors?

Answer 13

Exacerbation of COPD, asthma and Peptic ulcers

” most end in imine”

Neostigmine, Pyridostigmine, Physostigmine, Edrophinium and Donepezil, rvastigmine, galantamine

Question 14

Pt comes in with Diarrhea, cough, excessive sweating and his eyes are tearing

HR: 55 but he feels very jittery.

What did he OD on?

What do you rx?

Answer 14

DUMBELLS for too much Ach: seen in organophosphate poisoning = acetycholinesterase inhibitor

Tx = Atropine (competitive inhibitor) + Pralidoxime (regenerates AchE if given early)

Question 15

What two meds do we rx for pt with Acetycholinesterase inhibitor poisoning?

Answer 15

Give atropine (muscarininc antagonist) which is a competitive inhibitor

*Atropine will not correct skeletal muscle excitation)

And Pralidoxine which can regenerate AchE (this will correct skeletal muscle excitation)

Question 16

What is the action you see with Atropine, Homotropoine and Tropicamide?

What receptor do they act on?

Answer 16

Used as eye drops to cause Mydriasis or pupil dialation

Blocks binding of Ach to the Muscarinic receptor thus NO pupil constriction

Question 17

What different actions does pilocarpine and atropine have on the eye?

Answer 17

Pilocarpine is a cholimimetic or Ach drug. Binds to M3 to cause pupil cnx

Atropine is an muscarininic competitive antagonist; blocks site where Ach thus INHIBITING the pupil constriction

Question 18

When would you give a patient Benztropine?

What is it’s mechanism of action?

Answer 18

Benztropine is used in Parkinosns

muscarining antagonist on the GABA receptor

“Park my Benz”

Question 19

When would we prescribe Scopolamine?

How does it work?

Answer 19

Scopolamine is motion sickness pathc

muscarinic antagonist (targets M1 in CNS)

Question 20

Why would we prescribe Ipratropium or Tiotriupium to asthmatic patient?

Answer 20

Ipratropium and Tiotropium are muscarinic antagonists

compete at M3 receptor = Bronsoconstriciton which asthmatics don’t like

Question 21

What is teh clincal application of Oxybutynin?

What is it’s MOA?

Answer 21

Oxybutynin is muscarinig antagonist

Used to tx OVERACTIVE bladder (when Ach binds M3 receptores = bladder cnx)

Oxybutynin is competitive antagonist to inhibit binding

Oxybutynin = OxybuTOILET

Question 22

What drugs are used to treat Spastic bladder?

How do they work?

Answer 22

Oxybutynin, Tolterodine, Darfenacin and Trospium

= On The Darn Toilet

musc. antagonist at the M3 receptors to decreased bladder tone.

Question 23

This drug is used pre-op to reduce drool in pts

Answer 23

Glycopyrrolate (muscarinic antagonist)

Question 24

What affect does Atropine have on the body?

When do we use it?

Answer 24

Pupil Dilation/ cycloplegia

Decrease Airway secreations

Decrease stomach secreation

Decrease gut motility

Decreast bladder ugency

Blocks the DUMBBeLSS : but NO effect on skeletal muscle

Use: Organophasphate poisoning (too much AchE inhibitor) or to dialate the eye

Question 25

What is the toxicity profile of Atropine? What pts should NOT be given atropine?

Answer 25

Causes acute cl**ose angle glaucoma in elderly** **Urinary retention** in _men with BPH_ _Hyperthermia in infants_ Hot (decreased sweating), rapid pulse, dry mouth, flushed skin, cycoplegia, constipation and disorientation Phix with Physiostigmine

Question 26

Why is Epinephrine used to treat cardiac arrest and dyssrhythmias?

Answer 26

**increase peripheral resistance** via **_α1receptor-_**dependent vasoconstriction and to **increase cardiac output** via its binding to **β1 receptors.** The goal of reducing peripheral circulation is to increase coronary and cerebral perfusion pressures and therefore increase oxygen exchange at the cellular level.

Question 27

What receptors does Epinephrine have the most effect on? What about at high doses?

Answer 27

**B1 \> a1** **B1 = Increase HR, Increases cnx thus Increase CO** **High doses ALPHA predominates**

Question 28

What is the most common use of epinephrine? What are some other uses for epinephrine?

Answer 28

Use for anaphylaxsis Used for ashtma as well (B2 causes bronchodiation) For open angle glaucoma

Question 29

What receptors does Nepi act on? When do we use it?

Answer 29

**Alpha 1**\> Alpha 2 \> Beta 1 epinEVERYYTHING Used for Hypotention or SHOCK It's a sympathomimetic

Question 30

Where is epinephrine made? What is it's precursor? When is it released?

Answer 30

Made in Noradrenergic axons Tyrosine----\> DOPA-----\> Dopamine----\> to vesicle Made to Nepi in vesicle then released from Ca+ influx

Question 31

How does Reserpine inhibit the release of Norepinerphrine (and other neurotransmiters?)

Answer 31

**Blocks VMAT** which normally transports free intracellular norepinephrine, serotonin, and dopamine in the presynaptic nerve terminal into presynaptic vesicles for subsequent release into the synaptic cleft

Question 32

What is the effect of drugs like TCAs, Cocaine and Amphetamines on Nepi?

Answer 32

All block the reuptake of Nepi into the presynpatic cleft

Question 33

How does Guanethidine decrease release of Norepinphrine

Answer 33

Guanethidine is transported by uptake into the presynaptic terminal transported by (NET). + competes with Nepi It becomes concentrated in Nepi transmitter vesicles, replacing Nepi in these vesicles. --\> **gradual depletion of norepinephrine** stores in the nerve endings. Once inside the terminal it **blocks the release of norepinephrine** in response to arrival of an action potential

Question 34

Compare and Contrast Nepi and Isoproteroals affect on Blood pressure and heart rate? \*\*\*\*

Answer 34

1. **Norepinephrine** will _INCREASE_ ? systolic and diastolic pressures as a result of **α1-mediated** vasoconstriction--\> INCREASE ??mean arterial pressure? Result = _reflex bradycardia._ 2. I**soproterenol** has little α effect but causes **β2-mediated vasodilation,** resulting in? **DECREASED** and? **INCREASED** _HR t_hrough _β1 and reflex activity._

Question 35

What receptors does **Isoproteronol** act on?

Answer 35

B1= B2 Actions: B1 which causes INCREASE heart rate and vaso constriction while B2 causes vasodialation Overall see **Decreaesd Blood pressure (B2 effects)**

Question 36

**Dopamine** acts on what receptors in the body? What is it used for?

Answer 36

**D1=D2 \>B\>a** D1: relax kidney D2: modulates release of NT in brain Uses: Unstable bradycardia, heartfail; shock; inotropic and chornotropic Alpha effects which predominate at **HIGH doses**

Question 37

What B1 sympathomimetic would use use on **Heart Fail** pts or in a **Stress test**?

Answer 37

Dobutamine! B1\> B2 or Dobutam**1**ne (for B1 selectivity) B1= increase HR, vasoconx, increase renin release

Question 38

What receptor does **phenyephrine** work on? What does it do?

Answer 38

Phenylephrine: **Alpha 1** \> alpha 2 **alpha 1:** increas vas sm sml cx, Pupil dilation, Increase bladder sphinter

Question 39

Sympathomimetic that prefers **Alpha 1 R** use for Hypotension (cause vasocnx) Ocular procedures (results in mydriasis) rhinitis (decongestant)

Answer 39

Phenylephrine

Question 40

What **B2 sympathomimetics** can be used for long acting asthma control or COPD control? What about acute asthma?

Answer 40

B2 sympathomimetic short acting = **Albuterol** B2 long acting = **Salmeterole** for long acting and COPD

Question 41

**B2 sympathomimeti**c used to DECREASE premature UTERINE contractions

Answer 41

**Terbultaline** bc it's TWO soon B2: decreases uterine tone

Question 42

When would we prescribe Amphetamines to a pt? Whats the MOA?

Answer 42

Amphetmaines for Narcolepsy, Obesity, ADD MOA: indirect sympathomimetic agonist via blocking reuptake and encouraging release of stored cathecolamines

Question 43

Sympathomimetic used to tx nasal decongestion, Urinary incontincenc and Hypotension

Answer 43

Ephedrine Indirect general agonist of cathecholamines: causes release of stores Nasal decongestion and hypotension: via vasocnx Urinary incontisnece: increase bladder tone

Question 44

What is the mechanism of action of Cocaine? What should we avoid giving to someone who has taken cocaine to decrease their HR?

Answer 44

Cocain is indrect general agonist: inhibits reuptake of cathecholamines Causes vasocnx adn local anesthesia; but B-blocker can lead to **UNAPPOSED Alpha 1 activation** and e_xtreme HYPERTENSION_

Question 45

Drug used for : **ADHD, Tourette syndrome** Hypertensive urgency (limited situations); does not decrease renal blood flow MOA? Toxicity?

Answer 45

**Clonidine** ## Footnote Its an **alpha 2 agonist**: autoregulation, _Decreases SNS_ **Toxicty**: CNS depression, Bradycardia, Hypotension, Respiritory depression and small pupils

Question 46

What drug can you give to pt that is pregnant and has Hypertension? MOA of drug? What side effect do we need to be careful for?

Answer 46

**Methyldopa: a-2 agonist** : thus decreases SNS Toxicity: Direc Coombs + hemolytic anemia and SLE-like syndrome

Question 47

What is Direct Coombs + Hemolytic anemia? What drug may cause this rxn?

Answer 47

Warm antibody hemolytic anemia Warm antibody hemolytic anemia is the most common form of autoimmune hemolytic anemia (AIHA); it is more common among women. Autoantibodies in warm antibody hemolytic anemia generally react at temperatures ≥ 37° C. Stimulate production of autoantibodies against Rh antigen: hemolysis occurs primarily in the spleen. Methyldopa does this!

Question 48

What drug would you give pre-op to a pts with _pheochromocytoma_? What is it's MOA? What about toxicity?

Answer 48

**Phenoxybenzamine** to tx pheo! IRREVERsible Alpha BLOCKER Toxcity: orthostatic hypotension, reflex tachycardia

Question 49

What could you give to pts that are on MAOIs that ate tyramine because they are idiots?

Answer 49

**Phentolamine** **Alpha-2** Blocker and reversible

Question 50

Alpha 2 blocker used to treat depression Increases appetite but causes sedation and increased cholesterol

Question 51

What effect does a large dose of Epinephrine have on blood pressure BEFORE and AFTER Alhpa blockade?

Answer 51

The **epinephrine** response exhibits **_reversal_** of the mean blood pressure change, from a **net increase BP (the α response)** ----\> **net decrease BP(the β2 response)** after alpha blockade Goes from

Question 52

What effect does PHenylephrine have on Blood pressure before and after Alhpa blockade?

Answer 52

Phenylephrine has net pressor or INCREASE in Blood Pressure after alpha blockade Phenylephrine is suppressed but NOT reveresed (like Ephinenphrine) because it only has Alpha activity

Question 53

Why do we give **Beta blockers** to patients with Angina Pectoris?

Answer 53

B1: Increases HR and Increase muscle contraction BB will Decrease HR, Decrease Contractility resulting in less O2 conumption by the heart

Question 54

What B blockers are recommened to tx MI?

Answer 54

Metoprolol, Carvedilol and Bisoprolol BB will DECREASE mortality

Question 55

What medications can we give to pt with Supraventricular Tachycardia? How will they work?

Answer 55

Metoprolol or Esmolol (class II antiarrythmics) ## Footnote **DECREASE AV conductance**

Question 56

Why do we use B blockers to treat hypertension? What is the reason we give B blockers to Heart Fail pt?

Answer 56

?DECREASE cardiac output,? DECREASE renin secretion (due to β1-receptor blockade on JGA cells) Decrease Mortality HF pts.

Question 57

What B blockers are B1 selective?

Answer 57

β1-selective antagonists **(β1 \> β2)**—acebutolol (partial agonist), Atenolol, Betaxolol, Esmolol, Metoprolol \*Selective antagonists mostly go from A to M (β1 with 1st half of alphabet)