Autonomic Flashcards
Bethanecol
Cholinomimetic agent
Activates bowel and bladder smooth muscle; resistant to AchE.
Post-operative ileus, neurogenic ileus, urinary retention
Carbachol
Cholinomimetic agent. Acetylcholine analog
Glaucoma, pupillary constriction, relief of intraocular pressure
Pilocarpine
Cholinomimetic agent
Contracts ciliary muscle of eye (open-angle), pupillary sphincter (closed-angle), resistant to AchE.
Potent stimulator of sweat, tears, and saliva. Open-angle and closed-angle glaucoma.
Methacholine
Cholinomimetic agent
Stimulates muscarinic receptors in airway when inhaled.
Challenge test for diagnosis of asthma
Neostigmine
Anticholinesterase
Increases endogenous Ach. No CNS penetration.
Postoperative and neurogenic ileus and urinary retention, myasthenia gravis, post-operative reversal of neuromuscular junction blockade.
Pyridostigmine
Anticholinesterase Increases endogenous Ach, increases strength. Does not penetrate CNS. Myasthenia gravis (long-acting)
Physostigmine
Anticholinesterase
Increases endogenous Ach, crosses BBB
Anticholinergic (atropine) toxicity
Donepezil
Anticholinesterase
Increases endogenous Ach
Alzheimer disease
Rivastigmine
Anticholinesterase
Increases endogenous Ach
Alzheimer disease
Galantamine
Anticholinesterase
Increases endogenous Ach
Alzheimer disease
Edrophonium
Anticholinesterase
Increases endogenous Ach
Extremely short acting. Historical use in diagnosis of myasthenia gravis.
Atropine
Muscarinic antagonist
Produces mydriasis, cycloplegia, decreases airway secretions, decreases stomach acid secretions, decreases gut motility, decreases urgency (cystitis)
Increases body temperature (decreased sweating), rapid pulse, dry mouth, dry, flushed skin, constipation, disorientation, acute angle-closure glaucoma (mydriasis), urinary retention in men with prostatic hyperplasia, hyperthermia in infants
Homatropine
Muscarinic antagonist (eye) Produces mydriasis, cycloplegia
Tropicamide
Muscarinic antagonist (eye) Produces mydriasis, cycloplegia
Benztropine
Muscarinic antagonist (CNS) Parkinson disease
Scopolamine
Muscarinic antagonist (CNS) Motion sickness
Ipratropium
Muscarinic antagonist (lungs) COPD, asthma
Tiotropium
Muscarinic antagonist (lungs) COPD, asthma
Oxybutynin
Muscarinic antagonist (GU) Reduce urgency in mild cystitis, reduce bladder spasms.
Darifenacin
Muscarinic antagonist (GU) Reduce urgency in mild cystitis, reduce bladder spasms.
Solifenacin
Muscarinic antagonist (GU) Reduce urgency in mild cystitis, reduce bladder spasms.
Glycopyrrolate
Muscarinic antagonist (GI, respiratory)
Parenteral: preoperative reduction of airway secretions
Oral: Drooling, peptic ulcers
Epinephrine
Sympathomimetic
β>α, α predominates at high doses
Anaphylaxis, open angle glaucoma, asthma, hypotension
Norepinephrine
Sympathomimetic
α1>α2>β1
Hypotension (decreases renal perfusion)
Isoproterenol
Sympathomimetic
β1=β2
Electrophysiologic evaluation of tachyarrhythmias. Can worsen ischemia
Dopamine
Sympathomimetic
D1=D2>β>α
Unstable bradycardia, heart failure, shock, inotropic and chronotropic α effects predominate at high doses
Dobutamine
Sympathomimetic
β1>β2,α
Heart failure (inotropic>chronotropic), cardiac stress testing
Phenylephrine
Sympathomimetic
α1>α2
Hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)
Albuterol
Sympathomimetic
β2>β1
Acute asthma
Salmeterol
Sympathomimetic
β2>β1
Long-term asthma, COPD control
Terbutaline
Sympathomimetic
β2>β1
Reduce premature uterine contractions
Amphetamine
Indirect sympathomimetic
Indirect general agonist, reuptake inhibitor, releases stored catecholamines
Narcolepsy, obesity, attention deficit disorder
Ephedrine
Indirect sympathomimetic
Indirect general agonist, releases stored catecholamines
Nasal decongestion, urinary incontinence, hypotension
Cocaine
Indirect sympathomimetic
Indirect general agonist, reuptake inhibitor
Causes vasoconstriction, local anesthesia, never give β-blockers if cocaine intoxication is suspected (can lead to unopposed α1 activation, extreme hypertension)
Clonidine
Sympatholytic (α2 agonist)
Hypertensive urgency. Does not decrease renal blood flow. ADHD, severe pain, off-label indications (ethanol and opioid withdrawal).
CNS depression, bradycardia, hypotension, respiratory depression, small pupil size
α-methyldopa
Sympatholytic (α2 agonist)
Hypertension in pregnancy
Direct Coombs (+) hemolytic anemia, SLE-like syndrome
Phenoxybenzamine
Irreversible non-selective α-blocker
Pheochromocytoma (used preoperatively to prevent catecholamine/hypertensive crisis)
Orthostatic hypotension, reflex tachycardia, diminished vasoconstriction, GI upset, headache, ED
Phentolamine
Reversible non-selective α-blocker
Given to patients on MAO inhibitors who eat tyramine-containing foods
Prazosin
α1-selective α-blocker
Urinary symptoms of BPH, PTSD, hypertension
1st dose orthostatic hypotension, dizziness, headache
Terazosin
α1-selective α-blocker
Urinary symptoms of BPH, hypertension
1st dose orthostatic hypotension, dizziness, headache
Doxazosin
α1-selective α-blocker
Urinary symptoms of BPH, hypertension
1st dose orthostatic hypotension, dizziness, headache
Tamsulosin
α1-selective α-blocker
Urinary symptoms of BPH
1st dose orthostatic hypotension, dizziness, headache
Mirtazapine
α2-selective α-blocker
Depression
Sedation, increased serum cholesterol, increased appetite
Metoprolol
β1>β2-selective antagonist
