Autonomic Drugs Flashcards by Erica Lee

Autonomic Drugs

Albuterol, salmeterol

Direct sympathomimetic
Action: β2 > β1
Applications: Albuterol for acute asthma or COPD. Salmeterol for long-term asthma or COPD control

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Autonomic Drugs

Dobutamine

Direct sympathomimetic
Action: β1 > β2, α
Applications: Heart failure (inotropic > chronotropic), cardiac stress testing

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Autonomic Drugs

Dopamine

Direct sympathomimetic
Action: D1=D2 > β > α
Applications: Unstable bradycardia, HF, shock; inotropic and chronic effects at lower doses due to β effects; vasoconstriction at high doses due to α effects

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Autonomic Drugs

Epinephrine

Direct sympathomimetic
Action: β > α
Applications: Anaphylaxis, asthma, open-angle glaucoma; α effects predominate at high doses. Significantly stronger effect at β2 receptor than norepinephrine

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Autonomic Drugs

Fenoldopam

Direct sympathomimetic
Action: D1
Applications: Postoperative hypertension, hypertensive crisis. Vasodilator (coronary, peripheral, renal, and splanchnic). Promotes natriuresis. Can cause hypotension and tachycardia.

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Autonomic Drugs

Isoproterenol

Direct sympathomimetic
Action: β1 = β2
Applications: Electrophysiologic evaluation of tachyarrhythmias. Can worsen ischemia

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Autonomic Drugs

Midodrine

Direct sympathomimetic
Action: α1
Applications: Autonomic insufficiency and postural hypotension. May exacerbate supine hypertension.

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Autonomic Drugs

Norepinephrine

Direct sympathomimetic
Action: α1 > α2 > β1
Applications: Hypotension, septic shock.

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Autonomic Drugs

Phenylephrine

Direct sympathomimetic
Action: α1 > α2
Applications: Hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)

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Autonomic Drugs

Amphetamine

Indirect sympathomimetic
Action: Indirect general agonist, reuptake inhibitor, also releases stored catecholamines
Applications: Narcolepsy, ADHD, obesity.

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Autonomic Drugs

Cocaine

Indirect sympathomimetic
Action: Indirect general agonist, reuptake inhibitor
Applications: Causes vasoconstriction and local anesthesia. Never give β blockers if cocaine intoxication is suspected.

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Autonomic Drugs

Ephedrine

Indirect sympathomimetic
Action: Indirect general agonist, releases stored catecholamines
Applications: Nasal decongestion, urinary incontinence, hypotension

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Autonomic Drugs

Atropine, homatropine, tropicamide

Muscarinic antagonist
Organ System: Eye
Application: Produce mydriasis and cycloplegia

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Autonomic Drugs

Benztropine

Muscarinic antagonist
Organ System: CNS
Application: Parkinson disease, acute dystonia.

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Autonomic Drugs

Glycopyrrolate

Muscarinic antagonist
Organ System: GI, respiratory
Application: 
Parenteral: perioperative use to reduce airway secretions
Oral: Drooling, peptic ulcer

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Autonomic Drugs

Hyoscyamine

Muscarinic antagonist
Organ System: GI
Application: Antispasmodics for irritable bowel syndrome

Autonomic Drugs

Ipratropium, tiotropium

Muscarinic antagonist
Organ System: Respiratory
Application: COPD, asthma

Autonomic Drugs

Oxybutynin, solifenacin, tolterodine

Muscarinic antagonist
Organ System: Genitourinary
Application: Reduce bladder spasms and urge urinary incontinence (overactive bladder)

Autonomic Drugs

Scopolamine

Muscarinic antagonist
Organ System: CNS
Application: Motion sickness

Autonomic Drugs

Atropine

Used to treat bradycardia and for ophthlamic applications
Actions:
Eye: ↑ pupil dilation, cycloplegia
Airway: ↓ secretions
Stomach: ↓ acid secretion
Gut: ↓ motility
Bladder: ↓ urgency in cystitis
Adverse Effects: ↑ body temperature ( due to ↓ sweating), rapid pulse, dry mouth, dry, flushed skin, cycloplegia, constipation, disorientation. Can cause acute close-angle glaucoma in elderly, urinary retention in men with BPH, and hyperthermia in infants.

Autonomic Drugs

Bethanechol

Direct cholinergic agonist
Action: Activates bowel and bladder smooth muscle; resistant to AChE.
Applications: Postoperative ileus, neurogenic ileus, urinary retention

Autonomic Drugs

Carbachol

Action: Direct cholinergic agonist
Applications: Constricts pupil and relieves intraocular pressure in open-angle glaucoma

Autonomic Drugs

Methacholine

Direct cholinergic agonist
Action: Stimulates muscarinic receptors in airway when inhaled
Applications: Challenge test for diagnosis of asthma

Autonomic Drugs

Pilocarpine

Direct cholinergic agonist
Actions: Contracts ciliary muscle of eye (open-angle glaucoma), pupillary sphincter (closed-angle glaucoma); resistant to AChE.
Applications: Potent stimulator of sweat, tears, and saliva. Open-angle and closed angle glaucoma, xerostomia (Sjogren syndrome)

# Autonomic Drugs Donepezil, galantamine, rivastigmine

Indirect cholinergic agonist (acetylcholinesterase) Action: ↑ ACh Applications: Alzehimer disease

# Autonomic Drugs Edrophonium

Indirect cholinergic agonist (acetylcholinesterase) Action: ↑ ACh Applications: Historically, diagnosis of myasthenia gravis (extremely short acting).

# Autonomic Drugs Neostigmine

Indirect cholinergic agonist (acetylcholinesterase) Action: ↑ ACh (No CNS penetration) Applications: Postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular junction blockade (postoperative)

# Autonomic Drugs Physostigmine

Indirect cholinergic agonist (acetylcholinesterase) Actions: ↑ ACh. Applications: Anticholinergic toxicity: crosses BBB (tertiary amine)

# Autonomic Drugs Pyridostigmine

Indirect cholinergic agonist Action: ↑ ACh; ↑ muscle strength Applications: Myasthenia gravis (long acting); does not penetrate CNS (quarternary amine)

# Autonomic Drugs Clonidine, guanfacine

Action: α2 agonist Applications: Hypertensive urgency (limited siutations), ADHD, Tourette syndrome Adverse Effects: CNS depression, bradycardia, hypotension, respiratory distress, miosis

# Autonomic Drugs α-methyldopa

Action: α2 agonist Applications: Hypertension in pregnancy Adverse Effects: Direct Coombs ⊕ hemolysis, SLE-like syndrome

# Autonomic Drugs Phenoxybenzamine

Irreversible nonselective α blocker Applications: Pheochromocytoma (used preoperatively) to prevent catecholamine (hypertensive) crisis Adverse Effects: Orthostatic hypotension, reflex tachycardia

# Autonomic Drugs Phentolamine

Reversible nonselective α blocker Applications: Give to patients on MAO inhibitors who eat tyramine-containing foods Adverse Effects: Orthostatic hypotension, reflex tachycardia

# Autonomic Drugs Prazosin, terazosin, doxazosin, tamsulosin

α1 selective blockers Applications: Urinary symptoms of BPH; PTSD (prazosin); hypertension (except tamsulosin) Adverse Effects: 1st dose orthostatic hypotension, dizziness, headache

# Autonomic Drugs Mirtazapine

α2 selective blockers Applications: Depression Adverse Effects: Sedation, ↑ serum cholesterol, ↑ appetite