Autonomic Agents Flashcards
Bethanechol
Cholinomimetic - Activates bowel and bladder
Carbachol
Cholinomimetic
Treats glaucoma causes pupillary constriction
Pilocarpine
Cholinomimetic
Constricts ciliary muscle of eye - Glaucoma
Stim. sweat, tears, saliva
Methacholine
Stimulates muscarinic R in airway when inhaled
Asthma challenge test
Neostigmine
Blocks AChE
Activates bowel/bladder
MG
Reverse NMJ blockade
Physostigmine
Blocks AChE - Anticholinergic Toxicity (CNS)
Donepezil, rivastigmine, galantamine
Blocks AChE - Alzheimers
Edrophonium
Blocks AChE - Historically dx MG
What side effects do you have to watch for when using cholinomimetics?
Exacerbation of COPD, asthma, and peptic ulcers in susceptible patients
What drug irreversibly inhibits AChE? What are the symptoms?
Organophosphates/Insecticides
Diarrhea, urination, miosis, bronchospasm, bradycardia, excitation, lacrimation, sweating, salivation
How do you treat organophosphate poisoning?
Atropine and Pralidoxime (regenerate AChE)
Atropine, homatropine, tropicamide
Muscarinic Antagonist
Mydriasis and cycloplegia
Benztropine
Muscarinic Antagonist - CNS
Parkinsons
Scopolamine
Muscarinic Antagonist - CNS
Motion sickness
Ipratropium & tiotropium
Muscarinic Antagonist - Respiratory
COPD and asthma
Oxybutynin, darifenacin, slifenacin
Muscarinic Antagonist - GU
Reduce urgency in mild cystitis, reduce bladder spasms
Glycopyrrolate
Muscarinic Antagonist - GU/Resp
Parenteral: Preop to reduce airway secretions
Oral: drooling, peptic ulcer
What are signs of Atropine toxicity?
Inc. body temp, rapid pulse, dry mouth Dry flushed skin Cycloplegia Constipation Disorientation
What 3 populations are you worried about atropine in?
Elderly - acute angle closure
Men w/ BPH - urinary retention
Infants - hyperthermia
Epinephrine
β > α
Anaphylaxis, open angle glaucoma, asthma, hypotension
*high dose = α
Norepinephrine
α1 > α2 > β1
Hypotension (dec. renal perfusion)
Isoproterenol
β1 = β2
Electrophysiologic evaluation of tachyarrhythmias - worsen ischemia
Dopamine
D1 = D2 > β > α
Unstable bradycardia, heart failure, shock
*high dose = α
Dobutamine
β1 > β2, α
Heart failure, cardiac stress testing
Phenylephrine
α1 > α2
Hypotension
Ocular procedures - mydriatic
Rhinitis - decongestant
Albuterol, salmeterol, terbutaline
β2 > β1
Albuterol = acute asthma
Salmeterol = longterm asthma or COPD
Terbutaline = reduce premature uterine contractions
Amphetamine
MDMA - indirect general sympathetic agonist, blocks reuptake, releases stored catecholamines
Ephedrine
Indirect Sympathomimetic
Releases stored catecholamines
Nasal decongestion, urinary incontinence, hypotension
Cocaine
Indirect sympathomimetic - Reuptake inhibitor
Vasoconstriction and local anesthesia
**Never give β-blockers -> extreme HTN
Clonidine
α2 agonist
HTN urgency, ADHD, severe pain
α-methyldopa
α2 agonist- Treat HTN in pregnancy
Toxicity = direct coombs + hemolytic anemia
SLE-like syndrome
Phenoxybenzamine
Irr. α-blocker - Pheochromocytoma
Phentolamine
Reversible α-blocker - Pts on MAOIs who eat tyramine-containing foods
Prazosin, terazosin, tamsulosin
α1-blockers - Urinary symptoms of BPH, PTSD, HTN
1st dose orthostatic hypotension, dizziness, headache
Mirtazapine
α2-blocker
Sedations, inc. cholesterol, inc. appetite
What are the indications for β-blockers?
Angina pectoris MI SVT - metoprolol, esmolol HTN CHF Glaucoma - timolol
Pyridostigmine
AChE Inhibitor - MG - no CNS
