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Esther's Step 1 Topics > Autonomic Drugs > Flashcards

Autonomic Drugs Flashcards

1
Q

Non-selective Alpha blockers?

A

Phenoxybenzamine (irreversible), phentolamine (reversible)

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2
Q

What is phenoxybenzamine? Application? Tox?

A

Irreversible non-selective alpha blocker. Use preoperatively for pheochromocytomas to prevent hypertensive crisis
Toxicity: orthostatic hypotension, reflex tachycardia

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3
Q

What is phentolamine? Application?

A

Reversible non-selective alpha blocker. Use for patients who are on MAO inhibitors who eat tyramine containing foods to prevent serotonin syndrome

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4
Q

Alpha1 selective blockers?

A

(ending in -osin). Prazosin, terazosin, doxazosin, tamsulosin

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5
Q

Alpha1 selective blockers used for? tox?

A

Prazosin, terazosin, doxazosin, tamsulosin. Urinary symptoms of BPH, hypertension (except tamsulosin).
Toxicity: 1st dose orthostatic hypotension, dizziness, headache

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6
Q

Alpha2 blocker? what is it used for? Toxicity?

A

Mirtazipine. Used for depression. Toxicity: sedation, increased serum cholesterol, increased appetite.

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7
Q

Effects of beta blockers on angina pectoris?

A

Decreases heart rate and contractility, resulting in decreased oxygen consumption

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8
Q

Effects of beta blockers on MI? Which ones are frequently used

A

Metoprolol, carvedilol and bisoprolol. Decreases mortality

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9
Q

Effects of beta blockers on SVT? Which ones are frequently used

A

Metoprolol and esmolol. Decreases AV conduction velocity (class II anti-arrhythmic)

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10
Q

Effects of beta blockers on hypertension?

A

Decreases cardiac output, decreases renin secretion (due to beta 1 receptor blockade on JGA cells)

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11
Q

Effects of beta blockers on CHF

A

Slows progression of chronic failure

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12
Q

Effects of beta blockers on glaucoma? What drug is used?

A

timolol, betaxolol, carteolol. Decreases aqueous humor secretion synthesis

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13
Q

Which beta blockers have beta1 selectivity

A

generally antagonists go from A TO M for beta 1 blocker activity (beta 1 for first HALF of alphabet)
Acebutolol (partial), atenolol, betaxolol, esmolol, metoprolol

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14
Q

Which beta blockers are nonselective?

A

N through Z = beta 2, second half. Nadolol, pindolol (partial), propanolol, timolol

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15
Q

What are carvedilol and labetalol

A

nonselective alpha AND beta antagonists.

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16
Q

What is nebivolol?

A

beta 1 blockade for cardiac-selective blockade with stimulation of beta three receptors = which activate NO synthase in vasculature.

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17
Q

What are the direct cholinomimetics?

A

Bethanechol, carbechol, pilocarpine, methacholine

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18
Q

Bethanechol - application? Action?

A

Direct cholinomimetic
Application: Post-operative ileus, neurogenic ileus, urinary retention
Action: activates bowel and bladder smooth muscle. resistant to AchE. bethany call me (bethanchol) to activate your Bowels and Bladder

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19
Q

Carbachol - application? Action?

A

Cholinomimetic

Application: glaucoma, pupillary constriction, and relief of ocular pressure. CARbon copy of acethyCHOLine

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20
Q

Pilocarpine - application? Action?

A

Cholinomimetic
Application: Potent stimulator of tears, sweat, and saliva. Open and closed angle glaucoma.
Action: Contracts ciliary muscle (open angle glaucoma), pupillary sphincter muscle (closed angle glaucoma). resistant to AchE. you cry, drool sweat and your PILlOw

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21
Q

Methacholine - application? Action

A

Cholinomimetic
Application: Challenge test for asthma diagnosis.
Action: Stimulates muscarinic receptors in airway when inhaled.

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22
Q

Indirect cholinomimetics examples?

A

Anticholinesterases. Neostigmine, pyridostigmine, physostigmine, donepezil, rivastigmine, galantamine, edrophonium.

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23
Q

Neostigmine - application and action?

A

Anticholinesterase
Application: Postoperative and neurogenic ileus, urinary retention, MG, reversal of NM blockade (post operative).
Action: increases endogenous Ach. NEO cns = NO cns penetration

24
Q

Pyridostigmine - application and action?

A

Anticholinesterase
Increases endogenous ACh.
Application: MG (long acting), does not penetrate CNS
pyRIDostigmine gets RID of Mg

25
Q

Physostigmine - application and action?

A

Anticholinesterase
Application: Anticholinergic activity and toxicity (crosses BBB into CNS)
Action: increases endogenous Ach. PHYSostimine PHYses atropine overdose.

26
Q

Donepezil, rivastigmine, galantamine

A

Anticholinesterase

Applications: Alzheimers. increases endogenous Ach

27
Q

Edrophonium

A

Historically, dx of MG. extremely short acting form of anticholienstrase.

28
Q

Adverse effects of cholinomimetics in general?

A

Exacerbation of COPD, asthma and peptic ulcers

29
Q

Cholinesterase inhibitor poisoning often due to? Causes what?

A

Often due to organophoshphates such as parathion that IRREVERSIBLY inhibit AchE
Causes DUMBBELSS
diarrhea, urination, miosis, bradycardia, bronchospasm, excitation of skeletal muscle and CNS, lacrimation, sweating, salivation

30
Q

organophosphate poisoning antidote?

A

Atropine (muscarininc antagonist) + pralidoxime (regenerates AchE if given early)

31
Q

Example of muscarinic antagonist used in eye? Application?

A

Atropine, homatropine, tropicamide

Produces mydriasis and cycloplegia (paralysis of ciliary muscle/decreased accommadation)

32
Q

Example of muscarinic antagonist used in CNS?

A

Benztropine - used for parkinsons PARK my BENZ

33
Q

Example of muscarinic antagonist used in CNS for motion sickness

A

Scopolamine

34
Q

Example of muscarinic antagonist used for COPD/asthma

A

ipratropium, tiotropium I PRAy i can breathe soon

35
Q

Example of muscarinic antagonist used for GU? application?

A

oxybutynin. Reduces urgency in mild cystitis and reduces bladder spasms.

36
Q

What is glycopyrrolate? Affects what organ system? Applications?

A

Muscarinic antagonist used in GI respiratory systems.

Parenteral: preop use to reduce airway secretions. Oral: drooling, peptic ulcer.

37
Q

What is atropine? What is used for?

A

Muscarinic antagonist. used to treat bradycardia and for opthalmic applications.

38
Q

What does atropine NOT block

A

nicotinic receptors, i.e., skeletal and cns excitation

39
Q

What does atropine do for the 1) eye 2) airway 3) stomach 4) gut 5) bladder

A

1) mydriasis 2) decrease secretion 3) decrease acid secretion 4) decrease motility 5) decrease urgency in cystitis

40
Q

Atropine Side effects can be remembered with what phrase?

A

HOT as a hare (increased body temperature due to DECREASED SWEATING), DRY as bone, BLIND as a bad (decreased ciliary muscle contraction => less accommodation => cycloplegia), MAD as a hatter

Can cause acute angle closure glaucoma, urinary retention in men with prostatic hyperplasia, and hyperthermia in infants

41
Q

What is jimson weed?

A

Garnders pupil (mydriasis) due to it’s anticholinergic activity.

42
Q

Epinephrine? what receptors does it work on? Application? what effects predominate at high doses

A

Beta>alpha

Applications: anaphylaxis, open angle glaucoma, asthma, hypotension. alpha effects predominate at high doses.

43
Q

NE? What receptors does it work on? Application?

A

alpha1>alpha2>beta1

Application: hypotension (decreases renal perfusion)

44
Q

Isoproterenol? What receptors does it work on? Application?

A

Beta1=Beta2

Applications: Electrophysiologic evaluation of tachyarrythmias. Can worse ischemia.

45
Q

Dopamine? What receptors does it work on? Application?

A

D1=D2>beta>alpha

Unstable bradycardia, heart failure, shock; inotropic and chronotropic alpha effects predominate at high doses

46
Q

Dobutamine? What receptors does it work on? Application?

A

Beta1>beta2, alpha.

Applications: heart failure (inotropic>chronotropic), cardiac stress testing

47
Q

Phenylephrine? What receptors does it work on? Application?

A

Alpha1>alpha2

Applications: hypotension (vasocontrictor), ocular procedures (mydriatic), rhinitis (decongestant)

48
Q

Albuterol, salmeterol, terbutaline? What receptors does it work on? Application?

A

beta2>beta1
Albuterol for acute asthma, salmeterol for long-term asthma or COPD control, terbutaline to reduce premature uterine contractions

49
Q

What are examples of indirect sympathomimetics?

A

Amphetamine, ephedrine and cocaine?

50
Q

Amphetamine as indirect sympathomimetic - Effect? Applications

A

Effect: indirect general agonist, reuptake inhibitor, also releases stored catecholamines.
Application: narcolepsy, obesity, ADD

51
Q

Ephedrine as indirect sympathomimetic - Effect? Applications?

A

Effect: indirect general agonist, releases stored catecholamines.
Application: nasal congestion, urinary incontinence, hypotension

52
Q

Cocaine as indirect sympathomimetic indirect sympathomimetic - Effect? Applications?

A

Effect: indirect general agonist, reuptake inhibitor.
Applications: causes vasoconstriction. local anesthesia. never give beta blockers if cocaine intoxication is suspected due to unopposed alpha1 activation and extreme hypertension

53
Q

What are sympatholytics?

A

alpha2 agonists

54
Q

What is clonidine? Application? Toxicity?

A

alpha 2 agonist - sympatholytic.
Application: hypertensive urgency (limited situation, does not decrease renal blood flow. Used for ADHD, severe pain.
Tox: CNS depression, bradycardia, hypotension, respiratory depression, small pupil size.

55
Q

What is alpha methyldopa?

A

Alpha2 agonist/sympatholytic
Application: hypertension in pregnancy/safe in pregancy
Toxicity: direct coombs + hemolytic anemia, SLE like syndrome.

Esther's Step 1 Topics (13 decks)

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