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Autonomic Drugs Flashcards

0
Q

What is carbachol?

A

It is a direct agonist of cholinergic receptors (cholinomimetic).
It is a carbon copy of acetylcholine

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1
Q

What is bethanecol?

A

It is a direct agonist of cholinergic receptors (cholinomimetic)

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2
Q

What is pilocarpine?

A

It is a direct agonist of cholinergic receptors (cholinomimetic)

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3
Q

What is methacoline?

A

It is a direct agonist of cholinergic receptors (cholinomimetic)

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4
Q

What does bethanecol do?

A

Activates bowel and bladder smooth muscle; resistant to AChE

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5
Q

What is bethanecol used for?

A

Post op ileus
Neurogenic ileus
Atonic bladder
Urinary retention

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6
Q

What is carbachol used for?

A

Glaucoma
Pupillary contraction
Relief of intraocular pressure
Action: iris moves further from the cornea increasing the angle –> more flow of aqueous humor

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7
Q

What is pilocarpine used for?

A

Open angle and closed angle glaucoma

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8
Q

How does pilocarpine work?

A

Contracts ciliary muscle and pupillary sphincter

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9
Q

What is methacoline used for?

A

Challenge test for the diagnosis of asthma since it stimulates the muscarinic receptors in the airway when they are inhaled

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10
Q

What are the acetylcholinesterases?

A 
Neostigmine
Pyridostigmine 
Edrophonium
Physostigmine
Donezepil
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11
Q

What is neostigmine used for?

A

Postoperative and neurogenic ileus
Urinary retention
Myasthenia gravis
Reversal of NMJ blockade postop

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12
Q

What is pyridostigmine used for?

A

Myasthenia gravis

Longer acting than neostigmine

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13
Q

What is edrophonium used for?

A

Diagnosis of myasthenia gravis

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14
Q

What is physostigmine used for?

A

Crosses the bb barrier so used in anticholinergic toxicity (atropine OD)
Also- control hyperthermia if atropine OD

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15
Q

What are the side effects of cholinomimetics?

A

Lacrimaton, sweating, salivation, incontinence, decrease contractility of the heart, miosis, vasodilation, increase GI motility and secretion.

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16
Q

What can cholinomimetics exacerbate?

A

COPD
Asthma
Peptic ulcer disease

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17
Q

What do organophosphates do?

A 
Penetrate the bb barrier and Irreversibly inhibit AchE
So get DUMBBELSS:
Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Excitation of skeletal muscle and CNS
Lacrimaton 
Salivation
Sweating

(Ex: parathion)

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18
Q

What is the tx for organophosphate poisoning?

A

Atropine and pralidoxime
If you treat with only physostigmine the patient will still have muscle paralysis because atropine only works on muscarinic receptors

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19
Q

What are the antimuscarinics?

A 
Atropine
Homatropine
Tropicamide
Benztropine
Scopolamine
Ipratropium, tiotropium
Oxybutynin
Glycopyrrolate
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20
Q

What are the toxicities of anti-muscarinics?

A 
Increased body temp due to decreased sweating
Rapid pulse
Dry mouth
Dry, flushed skin
Cycloplegia
Constipation
Disorientation 
Urinary retention
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21
Q

What is atropine, homatropine, tropicamide used for?

A

Bradycardia

Eye stuff

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22
Q

What is benztropine used for?

A

Parkinson’s -decreases muscle tremor

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23
Q

What is scopolamine used for?

A

Motion sickness

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24
Q

What is ipratropium used for?

A

COPD, asthma

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25
Q

What is oxybutynin used for?

A

To reduce urgency in mild cystitis and reduce bladder spasms

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26
Q

What is glycopyrrate used for?

A

IV pre-op to reduce airway secretions

Oral: to tx peptic ulcer, drooling

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27
Q

What are the sympathomimetics?

A 
Epi, norepinephrine 
Isoproterenol
DA, dobutamine 
Phenylephrine 
Albuterol, salmeterol, terbutaline
Ritodrine
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28
Q

What is epi used for?

A

Anaphylaxis
Hypotension
Asthma
Open angle glaucoma

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29
Q

What is norepinephrine used for?

A

Hypotension

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30
Q

What is isoproterenol used for?

A

Torsades de pointes

Brandy arrhythmias

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31
Q

Which receptors does dopamine act on?

A

All of them

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32
Q

What receptors does norepinephrine act on?

A

Alpha 1
Alpha 2
Beta 1
Acts more on the alphas! Even more than epi - used in hypotension

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33
Q

What receptors does epi act on?

A

All except D1

Has more effects on betas than alphas - used in anaphylaxis

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34
Q

What receptors does isoproterenol act on?

A

Betas - used in Bradyarrythmias and torsades

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35
Q

What is dopamine used for?

A

Increase renal perfusion in shock

Heart failure

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36
Q

What receptor is dobutamine most active on?

A

Beta 1 - used for heart failure and cardiac stress testing

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37
Q

What is unique about dopamine and dobutamine?

A

They are inotropic and chronotropic

Inc both contractility and HR

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38
Q

What receptors does phenylephrine act on?

A

Alphas

Alpha 1 more than alpha 2 - used for hypotension, ocular procedures and rhinitis

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39
Q

What receptors does albuterol, salmeterol, terbutaline act on?

A

Betas

Beta 2 more than beta 1 - used in asthmatics and COPD

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40
Q

What’s terbutaline used for?

A

To reduce premature contractions

41
Q

What receptor does ritodrine act in?

A

Beta 2 - used for tocolysis

42
Q

What are the indirect sympathomimetics?

A

Amphetamine
Cocaine
Ephedrine

43
Q

How does amphetamine work?

A

Indirect agonist - releases stored catecholamines

Reverses the DAT

44
Q

What are amphetamines used in?

A

Narcolepsy
Obesity
ADD

45
Q

What is MOA of ephedrine?

A

Same as amphetamines

46
Q

What is ephedrine used for?

A

Nasal decon
Urinary incontinence
Hypotension

47
Q

What should never be given during a cocaine intoxication?

A

Beta blockers - causes unopposed alpha 1

Severe hypotension

48
Q

What are the sympathoplegics?

A

Centrally acting alpha 2 agonist –> central SNS out flow
Clonidine
Alpha-methyl dopa

49
Q

What are sympathoplegics used for?

A

HTN especially with renal disease

No dec in blood flow to kidneys

50
Q

What is phenoxybenzamine?

A

Irreversible alpha blocker (non-selective)

51
Q

What is phenoxybenzamine used for?

A

Pheochromocytoma before removing the tumor

52
Q

What are the side effects of phenoxybenzamine?

A

Orthostatic hypotension

Reflex tachycardia

53
Q

What is phentolamine?

A

A reversible alpha blocker (non-selective)

54
Q

What is phentolamine used for?

A

People on MAOIs who eat tyramine containing foods

55
Q

What are the alpha 1 antagonists?

A
  • osin

- ozins

56
Q

What are prazosin, terazosin, doxazosin, and tamsulosin used for?

A

HTN

Urinary retention due to BPH

57
Q

What are the side effects of the -osins?

A

1st dose orthostatic hypotension*
Dizziness
Headache

58
Q

What is mirtazapine?

A

An alpha 2 antagonist

59
Q

What is mirtazapine used for?

A

Depression

Inc NE and 5-HT3

60
Q

What are the side effects of mirtazapine?

A

Sedation
Increases in serum cholesterol
Increased appetite

61
Q

What are the beta blockers?

62
Q

What is timolol used for?

A

Glaucoma - decreases the secretion of aqueous humor

63
Q

What are metoprolol and esmolol used for?

A

SVT - decreases AV conduction velocity

64
Q

What are the beta 1 selective antagonists?

A 
A BEAM
Acebutalol
Betaxolol
Esmolol
Atenolol
Metoprolol
65
Q

What are the Nonselective beta antagonists?

A

Propranolol
Timolol
Nadolol
Pindolol

(Please Try Not being (Beta) Picky)

66
Q

What are the partial beta agonists?

A

Pindolol

Acebutolol

67
Q

What is the antidote/tx for beta blocker toxicity?

68
Q

What is the tx for digitalis toxicity?

A 
Normalize potassium
Lidocaine
Anti-dig Fab
Magnesium
= KLAM
69
Q

What is the tx for iron toxicity?

A

Deferoxamine

Deferasirox

70
Q

What is the tx for methemoglobin?

A

Methylene blue and vitamin C

71
Q

What is the tx for carbon monoxide poisoning?

A

100% oxygen

72
Q

What is the tx for methanol or antifreeze poisoning?

A

Fomepizole, dialysis

73
Q

What is the tx for lead poisoning?

A

CaEDTA, dimercaprol, succimer, penicillamine

74
Q

What is the tx for mercury, arsenic, gold?

A

Dimercaprol, succimer

75
Q

What is the tx for copper, arsenic, gold?

A

Penicillamine

76
Q

What is the tx for Cyanide poisoning?

A

Nitrite+thiosulfate, hydro cobalamin

77
Q

What is the tx for opioid tox?

A

Naloxone/naltrexone

78
Q

What is the tx for TCA poisoning?

A

NaHCO3

Same as Tx for salicylate tox

79
Q

What’s the tx for heparin tox?

80
Q

What is the tx for theophylline tox?

A

Beta-blocker

81
Q

What are the P450 inducers?

A 
Momma Barb Steals Phen-Phen and Refuses Greasy Carbs Chronically:
Modafinil 
Barbiturates
St. John's wort 
Phenytoin
Rifampin
Griseofulvin 
Carbamazepine 
Chronic alcohol use
82
Q

What are the P450 inhibitors?

A 
MAGIC RACKS GQ
Macrolides
Amiodarone 
Grapefruit juice
Isoniazid
Cimetidine
Ritonavir 
Acute alcohol abuse
Cipro
Ketoconazole
Gemfibrozil 
Quinidine
83
Q

What is the MOA of pralidoxime?

A

Reactivates cholinesterase by removing the phosphate group that had been added by organophosphates

84
Q

What are all the effects of phenylephrine?

A

Increases peripheral vascular resistance
Decreases pulse pressure (due to reflex decrease in stroke volume and increased afterload)
Increases systolic pressure
Decreases heart rate

85
Q

What does epi do?

A

Increase pulse and pulse pressure

Decreases peripheral vascular resistance (beta 2)

86
Q

What are the 2 sympathetic innervations that are cholinergic?

A

The sweat glands and the adrenal medulla

87
Q

What are the autonomic receptors that use Gq?

A 
Alpha 1
M1 
M3 (increase exocrine glands, lacrimal, gastric acid, gut peristalsis, bladder contraction, bronchoconstriction, miosis, accommodation) 
H1 
V1
88
Q

What are the autonomic receptors that use Gi?

A

Alpha 2
M2 (decreases heart rate and contractility of the atria)
D2

89
Q

What are the autonomic receptors that use Gs?

A 
B1
B2
D1
H2
V2
90
Q

What is th MOA of pralidoxime?

A

Reactivates cholinesterase by removing a phosphate group

91
Q

What is labetolol?

A

An alpha 1, beta 1, and beta 2 reversible competitive antagonist

92
Q

What is donepazil?

A

Indirect cholinergic agonist (inc endogenous ACh)

Treat- Alzheimer’s

93
Q

Norepinephrine vs isoproterenol

A

Norepinephrine = a > b activity

  • inc both systolic (b1)
  • inc diastolic BP (a1)
  • reflex bradycardia

Isoproterenol = b > a

  • dec systolic (b1)
  • dec diastolic (b2)
  • reflex tachycardia (b1)
94
Q

Epi vs phenylephrine responses to alpha-blockade

A

Before alpha block = both net inc BP (pressor effect)
After alpha block =
- Epi has net depressor effect (hypotension) - bc alpha & b2 action
- phenylephrine levels out BP (no hypotension) - bc pure alpha action

95
Q

What are the non selective alpha and beta antagonists?

A

Carvedilol

Labetolol

96
Q

What is the tx for tPA, streptokinase or urokinase tox?

A

Aminocaproic acid

97
Q

What is the tx for warfarin tox?

A

Vit K

Fresh frozen plasma

98
Q

What is the tx for amphetamine tox?

A

NH4Cl

Acidifies the urine

99
Q

What is the tx for salicylate tox?

A

NaHCO3
Alkalinizes the urine

Dialysis

100
Q

What is the tx for actaminophen tox?

A

N-acetylcysteine

Replenishes glutathione

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