Autonomic Drugs

Question 1

What drug inhibits VMAT?

Answer 1

Reserpine (the snake on the VMAT biting the scout who’s trying to toss the catecholamine fish back into the sea vessel)

Question 2

Labetalol is used in what population?

Answer 2

Pregnant women (the pregnant organist playing the alpha-beta-lol organ) – “la-babies-ok”

Question 3

Phentolamine is used to treat ___________ overdoses.

Answer 3

cocaine (guy with hot cocoa being scared by the phantom) because you don’t want to use beta-blockers; also tyramine toxicity (the aged wine and cheese), because tyramine inhibits MAO

Question 4

What two plants contain atropine?

Answer 4

Atropa belladonna (used to be used to dilate women’s eyes to make them more beautiful) and Jimson weeds

Question 5

Cholinomimetics mimic ____________; they are also called parasympathomimetics.

Answer 5

acetylcholine (“enjoy an acetyl-Cola”)

Question 6

__________ should be included as first-line therapy for acute coronary syndrome.

Answer 6

Beta-1-blockers (such as atenolol or metoprolol)

Question 7

What adrenergic receptor mediates renin release?

Answer 7

Beta-1 (the girl standing next to the fire hydrant –representing increased cardiac output)

Question 8

Phentolamine is a ____________.

Answer 8

reversible alpha-1 and -2 antagonist (the phantom appears and disappears, extinguishing the candles)

Question 9

In addition to aggravating asthma and COPD, what disorder can cholinomimetics aggravate?

Answer 9

Peptic ulcer disease (think of methacholine)

Question 10

Where do M2 muscarinic channels affect the heart?

Answer 10

The atria – specifically through the SA and AV nodes (think of the girl with the lower part of her jacket torn off)

Question 11

The Gq receptors couple to the ________ pathway.

Answer 11

IP3-DAG (think of the three dogs riding with the man on the motorcycle)

Question 12

Which beta-blocker is used in those with aortic dissection?

Answer 12

Labetalol (recall the dissected organ pipe)

Question 13

In the CNS, antimuscarinics can be used to treat __________.

Answer 13

Parkinson’s (think of the parking sign)

Question 14

What are some side effects of antimuscarinic overdose?

Answer 14

“Mad as a hatter (from blocking M1 in the CNS), blind as a bat (cycloplegia), dry as a cracker (decreased salivation), hot as a hare (suppressed sweating), and glaucoma”

Question 15

__________ is used to treat ADHD refractory to stimulants.

Answer 15

Clonidine

Question 16

What drug can correct organophosphate poisoning?

Answer 16

Pralidoxime (“Put a LID on the tOXic pesticide”) for the peripheral side effects and atropine

Question 17

In what circumstances do you administer bethanecol?

Answer 17

For non-obstructive bowel and bladder disorders (such as post-op ileus, megacolon, or neurogenic bladder); think of beth the construction worker pouring cement next to the “do not obstruct” sign

Question 18

What is the mechanism of action of tizanidine?

Answer 18

Alpha-2 agonist; centrally acting muscle relaxant (think of the letter “to X-tine” on the relaxing chair)

Question 19

What is the clinical role of edrophonium?

Answer 19

Because it is short-acting, it is not useful for treating MG. However, some patients with MG might present with worsening weakness that could be due to insufficient acetylcholine or too much acetylcholine (called cholinergic crisis – results from refractory synapses). Giving edrophonium can differentiate the two.

Question 20

What kind of drug is phenoxybenzamine?

Answer 20

Irreversible alpha antagonist (the phantom has an irreversible tattoo of a phoenix)

Question 21

Parkinson’s results from decreased _________ activity and increased __________ activity.

Answer 21

dopamine; cholinergic

Question 22

What are two beta-blockers that have partial agonist activity?

Answer 22

Acebutolol (the plastic bugle played by the young –partial –player in the audience) Pindolol (the boy popping the heart-shaped balloon)

Question 23

Alpha-1 activation leads to what ophthalmologic and GI/GU effects?

Answer 23

Mydriasis (constriction of the pupillary dilator muscle) and urinary/fecal retention (constriction of the urethra and anal sphincter)

Question 24

Alpha-1 activation leads to a _____________ in blood pressure.

Answer 24

dose-dependent increase (because of the vasoconstriction in veins and arteries –think of the red leashes)

Question 25

At low doses, epinephrine primarily affects ____________; at high doses it affects __________.

Answer 25

beta receptors; alpha receptors

Question 26

________ storms are also treated with beta-blockers. Why?

Answer 26

Thyroid; because the increase in thyroid activity leads to increased catecholamine levels, and beta-blockers such as propranolol can help tamp down those effects.

Question 27

Which antimuscarinic can be applied transdermally?

Answer 27

Scopalamine (the eyepatch on the walrus)

Question 28

Why does M3 activation lead to vasodilation?

Answer 28

Because the receptor also activates NO; without this (such as in the case of endothelial cell damage) muscarinic agonists do lead to vasoconstriciton

Question 29

What three acetylcholinesterase inhibitors can treat Alzheimer’s?

Answer 29

Galantamine (think of the gala of old people) Rivastigmine (“reverse the stigma!”) Donepazil (“done with the puzzle!”)

Question 30

What antimuscarinics are used to treat COPD and asthma?

Answer 30

Ipratropium and tiotropium, which block the M3 receptor (think of the caterpillar inhaling smoke: “cat-ipra-tio-tropillar”)

Question 31

Why is atropine used to treat bradycardia?

Answer 31

Because the M2 receptors on the heart cause relaxation and decreased HR; blocking this input stimulates tachycardia

Question 32

What does activation of alpha-2 receptors in the CNS do?

Answer 32

Decreases blood pressure

Question 33

The increase in blood pressure when standing is mediated by ___________.

Answer 33

alpha-1 receptors, so inhibiting these with an antagonist can produce orthostatic hypotension

Question 34

Prazosin can also treat ___________.

Answer 34

PTSD (think of the praying man on the alpha-antagonist stage with the dog tags)

Question 35

Explain how succinylcholine is a depolarizing agent.

Answer 35

It mimics acetylcholine and depolarizes the membrane, but it does not get degraded as easily – preventing further action potentials.

Question 36

List the classification and mnemonic for mirtazapine.

Answer 36

Alpha-2 antagonist and serotonin effect enhancer (two drama faces –mirth and misery –above a double extinguished candle)

Question 37

Where are most alpha-2 receptors located?

Answer 37

In the central nervous system (Raul with the 2 candles in the water next to the brain)

Question 38

What drugs (and what targets) are used to prevent premature labor?

Answer 38

Terbutaline (“do not disturb) and ritodrine (“I DReam of band camp”)

Question 39

What is the main use of pilocarpine?

Answer 39

Stimulate salivary glands (useful for those with Sjögren’s or radiation damage) and reduce IOP for glaucoma

Question 40

What receptor mediates vasodilation?

Answer 40

Beta-2 (the girl with the beta-2-tuba with dilated, loose sleeves)

Question 41

What is an important contraindication of beta-blockers?

Answer 41

Any situation with increased risk of AV block; beta-blockers slow conduction through the AV node, so do not give beta-blockers to a patient is taking drugs that slow conduction or to a patient with a 2nd or 3rd degree heart block

Question 42

What receptor induces lipolysis?

Answer 42

Beta-2 (the pig roasting next to the beta-2-tuba

Question 43

Describe the role of alpha-2 activation.

Answer 43

It decreases the sympathetic response; it is a Gi protein that decreases cAMP in presynaptic terminals – thus preventing the release of more norepinephrine – and decreases insulin release in the pancreatic islet cells (think of the rolled up mat and tent and power sources). Also, it decreases lipolysis (think of the fire being extinguished with the pig over it) and decreases aqueous humor production (think of the eyeball hat being poured out –brimonidine).

Question 44

Where is norepinephrine synthesized?

Answer 44

In the synaptic vesicles (“northbound scout in the sea vessel”)

Question 45

What NET inhibitor is used to treat ADHD?

Answer 45

Atomextine (think of the scout beneath the dock –neglecting the NET –watching the ATOM on HD tv)

Question 46

What is an analog of clonidine that is used in pregnancy?

Answer 46

Alpha-methyldopa (the alpha dope rope above Christine’s head)

Question 47

Alpha-methyl dopa can cause a _____________.

Answer 47

lupus-like syndrome (think of the wolf next to pregnant Christine beneath the alpha dope rope)

Question 48

Where do M3 channels exist?

Answer 48

The smooth muscles and glands (think of the rear-most motorcycle rider with the smooth-muscle paint job and glandular sponge)

Question 49

What is cycloplegia?

Answer 49

Inability to control the ciliary muscle, leading to far sightedness; antimuscarinics can cause this, because the parasympathetic response is needed to focus on objects up close (think of the walrus with the scope – scopalamine is an antimuscarinic)

Question 50

What is the dumbbells mnemonic for parasympathetic symptoms?

Answer 50

All things that come from muscarinic activation: DiarrheaUrinationMiosisBradycardiaBronchospasmLacrimationSalivation

Question 51

What receptors does norepinephrine activate?

Answer 51

Primarily alpha, but also some beta-1; think of the north-facing scout with the beta-1 bugle

Question 52

Dobutamine activates ______________.

Answer 52

beta-1 (“do-beta-one = dobutamine”)

Question 53

Muscarinic agonists _________ intraocular pressure.

Answer 53

reduce

Question 54

What is the technical name for dilated pupils?

Answer 54

Mydriasis

Question 55

Cocaine blocks the reuptake of ________________.

Answer 55

norepinephrine and dopamine

Question 56

Why would you not give a beta-blocker to someone overdosing on cocaine?

Answer 56

Because cocaine leads to increased alpha and beta stimulation –if you only knock out the beta then you might lead to unrestricted alpha effects, namely vasoconstriction

Question 57

How does beta-2 activation affect potassium levels?

Answer 57

It decreases K, because it induces insulin release

Question 58

Pralidoxime binds to organophosphate-bound acetylcholinesterase, which helps treat organophosphate poisoning, but it only works ___________.

Answer 58

quickly after poisoning (think of the old man spraying poison on the dumpster)

Question 59

What drug treats beta-blocker overdose?

Answer 59

Glucagon, because it stimulates the glucagon receptors of the heart (think of the conductor with the glucagon packets underneath his stand)

Question 60

What does amphetamine do?

Answer 60

It –like methylphenidate – stimulates increased release of catecholamines.

Question 61

What three side effects of nonselective beta-blockers are shown in the tuba orchestra?

Answer 61

Impotence (the floppy tromboner) Increased mucus secretions (the blue-bloater with the leaking spit valve) Decreased aqueous humor production (eyeball block with leaking fluid)

Question 62

What does the metal head signify in this drawing?

Answer 62

Migraines! Nonspecific beta-blockers can treat migraines

Question 63

What cholinergic receptors does carbacol stimulate?

Answer 63

Both nicotinic and muscarinic – think of the guy inhaling the cigarette smoke from below while looking at the motorcycles

Question 64

What two antimuscarinics distribute best to the CNS?

Answer 64

Benztropine (think of the Benz parked at the M1 spot) and trihexiphenidyl (think of the tri-hexi car)

Question 65

What two antimuscarinics are used to treat overactive bladder?

Answer 65

Oxybutynin and tolterodine (think of the ox and the turtle shutting off the bladder-shaped vessel at the table)

Question 66

What is the difference between norepinephrine and epinephrine?

Answer 66

Epinephrine acts as a hormone while norepinephrine acts as a neurotransmitter.

Question 67

What long-term drug is used to treat myasthenia gravis?

Answer 67

Pyridostigmine

Question 68

What’s one of the main distinctions between direct-acting muscarinic agonists and indirect-acting cholinesterase inhibitors?

Answer 68

The inhibitors stimulate the nicotinic acetylcholine receptors, too.

Question 69

_____________ (an antimuscarinic) can be used to treat heart block.

Answer 69

Atropine

Question 70

Where are D1 and D2 receptors located?

Answer 70

D1s are in the kidney (think of the kidney swing hanging by one rope) and D2s are in the brain (think of the scout on the swing with two ropes wearing the brain helmet)

Question 71

Beta-2 activation leads to what in the liver?

Answer 71

Gluconeogenesis (the girl roasting marshmallows over the beta-2 fire)

Question 72

What syndrome – presenting with intermittent headaches, sweating, and palpitations – can be treated with phentolamine?

Answer 72

Pheochromocytoma

Question 73

Beta-blockers have been shown to reduce mortality in what two groups of cardiac conditions?

Answer 73

ACS and heart failure

Question 74

Why do antimuscarinics make you hot?

Answer 74

Because they suppress the sweating response (sympathetic input, but uses acetylcholine)

Question 75

Explain how physostigmine can correct atropine overdose.

Answer 75

Atropine blocks muscarinic receptors, leading to parasympatholytic symptoms (“mad as a hatter, blind as a bat, hot as a hare”). Physostigmine can generate more acetylcholine, thus outcompeting atropine for muscarinic sites.

Question 76

Increased pulse pressure is a side effect of which kind of adrenergic receptor activation?

Answer 76

Ones that have beta-1 (inotropic agents) and beta-2 (vasodilatory)