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Autonomic Drugs Flashcards

1
Q

Name the direct cholinomimetic agonists

A

Bethanechol, carbachol, methacholine, pilocarpine

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2
Q

Use of bethanechol

A

postoperative ileus, neurogenic ileus, urinary retention

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3
Q

Action of bethanechol

A

Activate bowel and bladder smooth muscle

resistant to AChE

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4
Q

Use of cabachol

A

constricts pupil and relieves intraocular pressure in glaucoma

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5
Q

Use of methacholine

A

challenge test for diagnosing asthma

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6
Q

Mech of methacholine

A

stimulates muscarinic receptors in airway when inhaled –> bronchoconstriction

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7
Q

Use of pilocarpine

A

potent stimulator of sweat, tears and saliva

open-angle and closed-angle glaucoma

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8
Q

Action of pilocarpine

A

constricts the ciliary muscle of the eye (good for open-angle glaucoma)
constricts the pupillary sphincter (good for closed-angle glaucoma)

resistant to AChE

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9
Q

Name the indirect cholinergic agonists

A

donepezil, galantamine, rivastigmine, edrophonium, neostigmine, physostigmine, pyridostigmine

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10
Q

Use of donepezil, galantamine and rivastigmine

A

alzheimers disease –> increase in ACh

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11
Q

Use of edrophonium

A

historically to dx myasthenia gravis

now dx MG via anti-AChR antibody test

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12
Q

Use of neostigmine

A

postoperative and nuerogenic ileus and urinary retention
myasthenia gravis
reversal of neuromuscular junction blockade (postoperative)

DOES NOT CROSS BBB

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13
Q

Use of physostigmine

A

anticholinergic toxicity

CROSS BBB

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14
Q

Use of pyridostigmine

A

myastenia gravis (long-acting)

DOES NOT CROSS BBB

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15
Q

Caution with cholinomimetic agents in who?

A

Asthmatics and pts with COPD to avoid exacerbation of disease

also peptic ulcers

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16
Q

Cholinesterase inhibitor poisoning

A

often due to organophosphates (irreversibly inhibit AChE)

DUMBBELSS
diarrhea, urination, miosis, bradycardia, bronchoconstriction, excitation of muscle, lacrimation, sweating, salivation

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17
Q

Antidote to organophosphate poisoning

A

atropine (competitive inhibitor) + pralidoxime (regenerates AChE if given early)

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18
Q

Name the muscarinic antagonists

A

atropine, homatropine, tropicamide, benztropine, glycopyrrolate, hyoscyamine, dicyclomine, ipratropium, tiotropium, oxybutynin, solifenacin, tolterodine, scopolamine

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19
Q

Organ system affected by atropine, homatropine, and tropicamide

A

eye

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20
Q

Action of atropine, homatropine, and tropicamide

A

produce mydriasis and cycloplegia

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21
Q

Organ system action of benztropine

A

CNS

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22
Q

Action of benztropine

A

Parkinson disease

Acute dystonia

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23
Q

Organ system action of glycopyrrolate

A

GI and respiratory

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24
Q

Action of glycopyrrolate

A

parenteral: preoperative use to reduce airway secretions
oral: drooling, peptic ulcers

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25
Organ system for hyoscyamine, dicyclomine
GI
26
Action of hyoscyamine, dicyclomine
antispasmodics for irritable bowel syndrome
27
Organ system for ipratropium and tiotropium
respiratory
28
Action of ipratropium and tiotropium
inhibit bronchoconstriction so good for asthmatics and pts with COPD
29
Organ system for oxybutynin, solifenacin, tolterodine
Genitourinary
30
Action of oxybutynin, solifenacin, tolterodine
use to tx patients with urinary incontinence/overactive bladder reduce bladder spasms
31
Organ system for scopolamine
CNS
32
Action of scopolamine
motion sickness
33
Multiple effects of atropine
``` Eye - pupil dilation and cycloplegia Airway - decrease secretions Stomach - decrease acid secretion Gut - decrease motility Bladder - decrease urgency in cystitis ``` blocks DUMBBeLLS (excitation is nicotinic receptors)
34
Toxicity of atropine
HOT (due to decreased sweating), DRY (no secretions), RED (flushed), BLIND (cycloplegia), MAD (disoriented) can cause acute angle-closure glaucoma in elderly due to mydriasis, urinary retention in men with BPH, and hypertermia in infants
35
Jimson weed (Datura)
causes gardener's pupil (mydriasis due to plant alkaloids)
36
Mech of tetrodotoxin
binds fast voltage-gated Na+ channels in cardiac and nerve tissue, preventing depolarization (blocks AP without changing resting potential)
37
Effects of tetrodotoxin
nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes
38
Tx of tetrodotoxin poisoning
supportive
39
How acquire tetrodotoxin
eating improperly prepared pufferfish (Japan)
40
Mech of ciguatoxin
opens Na+ channels causing depolarization (symptoms often confused with colinergic poisoning)
41
Effects of ciguatoxin
DUMBBELS PLUS temperature-related dysesthesia (cold feels hot, hot feels cold)
42
How acquire ciguatoxin
consumption of reef fish (ciguatera fish, barracuda, snapper, moray eel)
43
Treatment of ciguatoxin
supportive
44
Effects of scombroid poisoning
acute-onset burning sensation of the mouth, flushing of the face, erythema, urticaria, pruritis, headache may be anaphylaxis-like presentation (brhoncospasms, angioedema, hypotension)
45
Mech of scombroid poisoning
bacterial histidine decarboxylase converts histidine --> histamine histamine not degraded by cooking (misdiagnosed as allergy to fish)
46
How acquire scombroid poisoning
caused by consumption of dark-meat fish (bonito, mackerel, mahi-mahi, tuna) improperly stored at warm temperature
47
Treatment of scombroid poisoning
antihistamines if needed give antianaphylactics (epi)
48
Albuterol, salmeterol receptors
B2 > B1
49
Use of albuterol and salmeterol
albuterol for acute asthma; salmeterol for long-term asthma or COPD control
50
Dobutamine receptors
B1 > B2, alpha
51
Use of dobutamine
heart failure (HF) (inotropic > chronotropic), cardiac stress testing
52
Dopamine receptors
D1 = D2 > beta > alpha
53
Use of dopamine
unstable bradycardia, HF, shock; inotropic and chronotropic alpha effects predominate at high doses
54
Epinephrine receptors
beta > alpha
55
Use of epi
anaphylaxis, asthma, open-angle glaucoma alpha effects predominate at high doses significantly stronger effects at beta2 receptors than norepinephrine
56
Isoproterenol receptors
B1 = B2 with NO alpha effects
57
Use of isoproterenol
electrophysiologic evaluation of tachyarrhythmias | can worsen ischemia
58
Norepinephrine receptors
alpha 1 > alpha 2 > beta 1 NO beta2 effects
59
Use of norepinephrine
hypotension (but decreases renal perfusion)
60
Phenylephrine receptors
alpha 1 > alpha 2
61
Use of phenylephrine
hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)
62
Effect of amphetamine
indirect general agonist, reuptake inhibitors, also releases stored catecholamines
63
Use of amphetamine
Narcolepsy, obesity, ADHD
64
Effect of cocaine
indirect general agonist, reuptake inhibitor (NET)
65
Use of cocaine
causes vasoconstriction and local anesthesia never give beta blockers if cocaine intox is suspected because can cause unopposed alpha activation and extreme hypertension
66
Effect of ephedrine
indirect general agonist, releases stored catecholamines
67
Use of ephedrine
nasal decongestion, urinary incontinence, hypotension
68
Clonidine receptor
alpha2- agonist
69
Use of clonidine
hypertensive urgency does not decrease renal blood flow ADHD and Tourette syndrome
70
Toxicity of clonidine
CNS depression, bradycardia, hypotension, respiratory depression, miosis
71
alpha-methyldopa receptor
alpha-2 agonist
72
Use of alpha-methyldopa
used for hypertension in pregnancy
73
Toxicity of alpha-methyldopa
direct Coombs positive hemolysis | SLE-like syndrome (also seen with procainamide and hydralazine)
74
Name the non-selective alpha blockers
phenoxybenzamine (irreversible) | phentolamine (reversible)
75
Toxicity of the non-selective alpha blockers
orthostatic hypotension, reflex tachycardia
76
Use of phenoxybenzamine
pheochromocytoma (used preoperatively) to prevent catecholamine (hypertensive) crisis
77
Use of phentolamine
give to patients on MAO-inhibitors who eat tyramine-containing foods (to prevent the vasoconstriction and hypertensive crisis)
78
Name the alpha1 selective antagonist
(-osin ending) prazosin, terazosin, doxazosin, tamsulosin
79
Use of alpha 1 selective antagonist
urinary symptoms of BPH Prazosin - PTSD All BUT TAMSULOSIN - hypertension
80
Toxicity of alpha1 selective antagonist
1st dose orthostatic hypotension, dizziness, headache
81
Name the alpha2 selective antagonist
mirtazapine
82
Use of mirtazapine
depression
83
Toxicity of mirtazapine
sedation, increased serum cholesterol, increased appetite
84
Name the B1 selective antagonists
acebutolol (partial agonist), atenolol, betaxolol, esmolol, metoprolol
85
Name the non-selective beta antagonists
nadolol, pindolol (partial agonist), propranolol, timolol
86
Name the non-selective alpha and beta antagonists
carvedilol and labetalol
87
What is special about nebivolol?
cardiac selective B1 blockade with stimulation of B3 receptors, which activate NO synthase in the vasculature
88
Use of beta-blockers in angina pectoris
decrease heart rate and contractility, resulting in decreased O2 consumption
89
Use of beta-blockers in MI
beta-blockres (metoprolol, carvedilol and bispropolol) decrease mortality
90
Use in SVT of metoprolol and esmolol
``` short acting Decrease AV conduction velocity (class II antiarrhythmics) ```
91
Use of beta-blockers in hypertension
decrease cardiac output, decrease renin secretion (due to B1-receptor blockade on JGA cells)
92
Use of beta-blockers in HF
decrease mortality in chronic HF
93
Use of beta-blockers in glaucoma (timolol)
decrease secretion of aqueous humor)
94
Toxicity of beta-blockers
impotence, CV adverse effects (bradycardia, AV block, HR), CNS adverse effects (seizures, sedation, sleep alterations), asthma/COPD exacerbations dyslipidemia specifically in metoprolol use

STEP 1 (26 decks)

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