ADRENERGIC - Sheet1 Flashcards
This agent has greater affinity for muscarinic receptors and used for postoperative and neurogenic ileus and urinary retention
Bethanechol
Muscarinic that is very lipid soluble and used in glaucoma
Pilocarpine
Muscarinic used to treat dry mouth in Sjögren’s syndrome
Pilocarpine or Cevimeline
Indirect-Acting ACh Agonist, alcohol, short DOA and used in diagnosis of myasthenia gravis
Edrophonium
Carbamate with intermediate action and used as off-label for postoperative paralytic ileus and urinary retention
Neostigmine
Treatment of atropine overdose and glaucoma (because lipid soluable). Enters the CNS rapidly and has a stimulant effect, which may lead to convulsions
Physostigmine
Treatment of myasthenia gravis and sometimes used prophylactically for organophosphate poisoning in chemical warfare
Pyridostigmine
Antiglaucoma organophosphate, indicated but not used much clinically anymore due to long duration of action
Echothiophate
Insecticide organophosphate
Malathion, parathion
Toxicity of cholinergics
DUMBELSS (diarrhea, urination, miosis, bronchoconstriction, excitation of skeletal muscle and CNS, lacrimation, salivation, and sweating)
The most important cause of acute deaths in cholinesterase inhibitor toxicity
Respiratory failure
Treatment of muscarinic symptoms in organophosphate overdose
Atropine
This agent competes for phosphorylated cholinesterase enzyme and regenerates enzyme if organophosphate-enzymes complex has not “aged”
Pralidoxime
Prototypical drug is atropine
Nonselective Muscarinic Antagonists
Treat manifestations of Parkinson’s disease and EPS
Benztropine, trihexyphenidyl
Treatment of motion sickness
Scopolamine
Produce mydriasis and cycloplegia
Atropine and other anti-muscarinic agents
Bronchodilation in asthma and COPD
Ipratropium, tiotropium
Reduce transient hyper GI motility
Dicyclomine, methscopolamine
Cystitis, postoperative bladder spasms, or incontinence
Oxybutynin, dicyclomine
Toxicity of anticholinergics
Anti-DUMBBELSS
Another pneumonic for anticholinergic toxicity
dry as a bone, red as a beet, mad as a hatter, hot as a hare, blind as a bat
Atropine fever is the most dangerous effect and can be lethal in this population group
Infants
Contraindications to use of atropine
Infants, closed angle glaucoma, prostatic hypertrophy
Ganglion blockers that were indicated (but not anymore) for severe hypertension
Hexamethonium, trimethaphan
Reversal of blockade by neuromuscular blockers
Cholinesterase inhibitors
Tubocurarine is the prototype, pancuronium, atracurium, vecuronium are newer short acting agent, produce competitive block at end plate nicotinic receptor, causing flaccid paralysis
Nondepolarizing Neuromuscular Blockers
Only member of depolarizing neuromuscular blocker, causes fasciculation during induction and muscle pain after use
Succinylcholine
Pneumonic for beta receptors
You have 1 heart (Beta 1) and 2 lungs (Beta 2)
This is the drug of choice for anaphylactic shock
Epinephrine
Phenylisopropylamines that are used legitimately and abused for narcolepsy, attention deficit disorder, and weight reduction
Amphetamines
Alpha agonist used to produce mydriasis and reduce conjunctival itching and congestion caused by irritation or allergy, it does not cause cycloplegia
Phenylephrine
Epinephrine and dipivefrin are used for
Glaucoma
Newer alpha 2 agonist (apraclonidine and brimonidine) treat glaucoma
Reduce aqueous synthesis
Short acting Beta 2 agonists that is drug of choice in treatment of acute asthma but not recommended for prophylaxis
Albuterol
Longer acting Beta 2 agonists is recommended for prophylaxis of asthma
Salmeterol
These agents increase blood flow and may be beneficial in treatment of acute heart failure and some types of shock
Beta1 agonists
These agents decrease blood flow or increase blood pressure, are local decongestant, and used in therapy of spinal shock (temporary maintenance of blood pressure which may help maintain perfusion)
Alpha1 agonists
Shock due to septicemia or myocardial infarction is made worse by
Increasing afterload and tissue perfusion declines
Often mixed with local anesthetic to
Reduce the loss from area of injection
Chronic orthostatic hypotension can be treated with
Midodrine
Beta 2 agonist used to suppress premature labor, but cardiac stimulatory effects may be hazardous to mother and fetus
Terbutaline
Long acting sympathomimetic, sometimes used to improve urinary continence in children and elderly with enuresis
Ephedrine
Alpha 1 agonist toxicity
Hypertension
Beta 1 agonist toxicity
Sinus tachycardia and serious arrhythmias
Beta 2 agonist toxicity
Skeletal muscle tremor
The selective agents lose their selectivity at
high doses
