Autonomic Agents EC

Question 1

Bethanechol

Answer 1

Muscarinic agonist

Used for ileus and urinary retention

“BETHANY CALL me to activate your bowel and bladder”

Question 2

Carbachol

Answer 2

Muscarinic agonist

Used for Glaucoma, Miosis

“CARBon copy of AcetylCHOLine”

Question 3

Pilocarpine

Answer 3

Muscarinic agonist

Used for glaucoma, stimulates sweat, tears, and saliva

“you cry, drool, and sweat on your PILOw”

Question 4

Methacholine

Answer 4

Muscarinic agonist

Used for challenge in diagnosis of asthma

Question 5

Neostigmine

Answer 5

Anti-Cholinesterase

Used for ileus, urinary retention, myasthenia gravis, reversal of neuromuscular blockade post-op

Question 6

Pyridostigmine

Answer 6

Anti-Cholinesterase

Used for myasthenia gravis

“pyRIDOstiGMine gets RIDO Myasthenia Gravis”

Question 7

Physostigmine

Answer 7

Anti-Cholinesterase

Used for Anticholinergic toxicity (crosses BBB)

“PHYsostigmine PHYxes atopine OD”

Question 8

Edrophonium

Answer 8

Anti-Cholinesterase

Used for diagnosis myasthenia gravis (very short acting)

Question 9

Donepezil

Answer 9

Anti-Cholinesterase

Used in alzheimer’s

Question 10

Atropine

Answer 10

Anti-Muscarinic

Used to treat bradycardia and mydriasis/cycloplegia

Question 11

Tropicamide

Answer 11

Anti-Muscarinic

Used for mydriasis/cycloplegia

Question 12

Benztropine

Answer 12

Anti-Muscarinic

Used in Parkinson’s

“PARK by BENZ”

Question 13

Scopolamine

Answer 13

Anti-Muscarinic

Used in motion sickness

Question 14

Ipratropium and Tiotropium

Answer 14

Anti-Muscarinic

Used in COPD/asthma

Question 15

Oxybutynin

Answer 15

Anti-Muscarinic

Used to reduce urgency and reduce bladder spasm

Question 16

Glycopyrrolate

Answer 16

Anti-Muscarinic

Used to reduce airway secretions pre-op and for drooling/peptic ulcer

Question 17

What are the actions of alpha 1 & 2, and beta 1 & 2 receptors?

Answer 17

alpha 1 - vasoconstriction
alpha 2 - inhibits NE release – vasodilation
beta 1 - stimulates HR and contractility
beta 2 - vasodilation and bronchodilation

Question 18

Epinephrine (uses, receptors, effect on BP and HR)

Answer 18

anaphylaxis, open-angle glaucoma, asthma, & hypotension, vasoconstriction/local anesthesia

alpha 1, alpha 2, beta 1, beta 2

BP increases
HR increases

Question 19

Norepinephrine (uses, receptors, effect on BP and HR)

Answer 19

Hypotension (septic shock)

alpha 1, alpha 2

BP increases
HR decreases (reflex bradycardia)

Question 20

Phenylephrine (uses, receptors)

Answer 20

Hypotension, mydriatic, rhinitis

alpha 1, alpha 2 (some)

Question 21

Isoproterenol (uses, receptors, effect on BP and HR)

Answer 21

Torsade de pointes, bradyarrhythmias

beta 1, beta 2

BP decreases, HR increases dramatically

Question 22

Dopamine (uses, receptors)

Answer 22

Shock, Heart failure (inotropic and chronotripic)

alpha 1 (high dose), alpha 2(high dose), beta 1(med dose), beta 2 (med dose), D1 (low dose)

Question 23

Dobutamine (uses, receptors)

Answer 23

Heart failure, cardiac stress testing

beta 1

Question 24

Albuterol, Salmeterol, Terbutaline (uses, receptors)

Answer 24

Acute asthma, COPD

beta 2

Question 25

Terbutaline, Ritodrine (uses, receptors)

Answer 25

Reduce premature uterine contractions beta 2

Question 26

Amphetamine (uses&MOA)

Answer 26

Narcolepsy, obesity, ADHD Increase monoamine release

Question 27

Ephedrine (uses&MOA)

Answer 27

Decongestant, Urinary incontinence, Hypotension Increase monoamine release

Question 28

Cocaine (uses&MOA)

Answer 28

Vasoconstriction/local anesthesia Inhibits NE reuptake

Question 29

Clonidine, alpha-methyldopa (uses&MOA)

Answer 29

Hypertension w/ renal disease alpha 2 agonist (decrease sympathetic outflow)

Question 30

Phenoxybenzamine (uses&MOA)

Answer 30

Pheochromocytoma, (before removing tumor, followed by beta blockade) Irreversible Non-selective alpha blocker

Question 31

Phentolamine (uses&MOA)

Answer 31

Treat tyramine induced hypertension in pt's on MAOIs Reversible Non-selective alpha blocker

Question 32

Prazosin, Terazosin, Doxazosin, Tamsulosin (uses&MOA&S/E)

Answer 32

Hypertension, Urinary retention, BPH (esp tamsolusin) Alpha 1 blockers First dose orthostatic hypotension

Question 33

Mirtazapine (uses&MOA&S/E)

Answer 33

Depression (esp in elderly) Alpha 2 blocker Sedation, increased appetite, increased cholesterol

Question 34

What is the effect of adding epinephrine after an alpha blockade? Why?

Answer 34

Decrease in BP With alpha 1 receptors blocked, beta 2 vasodilation response predominates

Question 35

What is the effect of adding phenylephrine after an alpha blockade? Why?

Answer 35

No effect Since phenylephrine is alpha specific, an alpha blockade would negate its effects

Question 36

What beta blockers would you want to use in patients with comorbid pulmonary disease?

Answer 36

Beta 1 selective (A-BEAM) Acebutolol, Betaxolol, Esmolol, Atenolol, Metoprolol

Question 37

What are the non-selective beta blockers?

Answer 37

Propranolol, Timolol, Nadolol, Pindolol "Please Try Not Being Picky"

Question 38

Non selective alpha/beta blockers

Answer 38

Carvedilol, Labetalol

Question 39

Partial Beta Agonists

Answer 39

Pindolol, Acebutolol "PAPA"

Question 40

How can ACh lower blood pressure?

Answer 40

ACh receptors in vasculature lead to an increase in NO synthesis

Question 41

Succinylcholine (uses/MOA/SE)

Answer 41

Endotracheal intubation Depolarizing neuromuscular blocker (strong ACh agonist) Phase I depolarization Phase II repolarized but blocked Malignant hyperthermia (treated with Dantrolene - muscle relaxation via inhibition of Ca release)

Question 42

Tubocurarine (uses/MOA/se)

Answer 42

Endotracheal intubation Adjunct to general anesthesia Relax skeletal muscles during surgery Facilitate mechanical ventilation ACh receptor competitive antagonists Reverse blockade with cholinesterase inhibitors (-stigmine)