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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
What is ipratropium used for?
COPD, asthma
25
What is oxybutynin used for?
To reduce urgency in mild cystitis and reduce bladder spasms
26
What is glycopyrrate used for?
IV pre-op to reduce airway secretions | Oral: to tx peptic ulcer, drooling
27
What are the sympathomimetics?
``` Epi, norepinephrine Isoproterenol DA, dobutamine Phenylephrine Albuterol, salmeterol, terbutaline Ritodrine ```
28
What is epi used for?
Anaphylaxis Hypotension Asthma Open angle glaucoma
29
What is norepinephrine used for?
Hypotension
30
What is isoproterenol used for?
Torsades de pointes | Brandy arrhythmias
31
Which receptors does dopamine act on?
All of them
32
What receptors does norepinephrine act on?
Alpha 1 Alpha 2 Beta 1 Acts more on the alphas! Even more than epi - used in hypotension
33
What receptors does epi act on?
All except D1 | Has more effects on betas than alphas - used in anaphylaxis
34
What receptors does isoproterenol act on?
Betas - used in Bradyarrythmias and torsades
35
What is dopamine used for?
Increase renal perfusion in shock | Heart failure
36
What receptor is dobutamine most active on?
Beta 1 - used for heart failure and cardiac stress testing
37
What is unique about dopamine and dobutamine?
They are inotropic and chronotropic | Inc both contractility and HR
38
What receptors does phenylephrine act on?
Alphas | Alpha 1 more than alpha 2 - used for hypotension, ocular procedures and rhinitis
39
What receptors does albuterol, salmeterol, terbutaline act on?
Betas | Beta 2 more than beta 1 - used in asthmatics and COPD
40
What's terbutaline used for?
To reduce premature contractions
41
What receptor does ritodrine act in?
Beta 2 - used for tocolysis
42
What are the indirect sympathomimetics?
Amphetamine Cocaine Ephedrine
43
How does amphetamine work?
Indirect agonist - releases stored catecholamines | Reverses the DAT
44
What are amphetamines used in?
Narcolepsy Obesity ADD
45
What is MOA of ephedrine?
Same as amphetamines
46
What is ephedrine used for?
Nasal decon Urinary incontinence Hypotension
47
What should never be given during a cocaine intoxication?
Beta blockers - causes unopposed alpha 1 | Severe hypotension
48
What are the sympathoplegics?
Centrally acting alpha 2 agonist --> central SNS out flow Clonidine Alpha-methyl dopa
49
What are sympathoplegics used for?
HTN especially with renal disease | No dec in blood flow to kidneys
50
What is phenoxybenzamine?
Irreversible alpha blocker (non-selective)
51
What is phenoxybenzamine used for?
Pheochromocytoma before removing the tumor
52
What are the side effects of phenoxybenzamine?
Orthostatic hypotension | Reflex tachycardia
53
What is phentolamine?
A reversible alpha blocker (non-selective)
54
What is phentolamine used for?
People on MAOIs who eat tyramine containing foods
55
What are the alpha 1 antagonists?
- osin | - ozins
56
What are prazosin, terazosin, doxazosin, and tamsulosin used for?
HTN | Urinary retention due to BPH
57
What are the side effects of the -osins?
1st dose orthostatic hypotension* Dizziness Headache
58
What is mirtazapine?
An alpha 2 antagonist
59
What is mirtazapine used for?
Depression | Inc NE and 5-HT3
60
What are the side effects of mirtazapine?
Sedation Increases in serum cholesterol Increased appetite
61
What are the beta blockers?
-olol
62
What is timolol used for?
Glaucoma - decreases the secretion of aqueous humor
63
What are metoprolol and esmolol used for?
SVT - decreases AV conduction velocity
64
What are the beta 1 selective antagonists?
``` A BEAM Acebutalol Betaxolol Esmolol Atenolol Metoprolol ```
65
What are the Nonselective beta antagonists?
Propranolol Timolol Nadolol Pindolol (Please Try Not being (Beta) Picky)
66
What are the partial beta agonists?
Pindolol | Acebutolol
67
What is the antidote/tx for beta blocker toxicity?
Glucagon
68
What is the tx for digitalis toxicity?
``` Normalize potassium Lidocaine Anti-dig Fab Magnesium = KLAM ```
69
What is the tx for iron toxicity?
Deferoxamine | Deferasirox
70
What is the tx for methemoglobin?
Methylene blue and vitamin C
71
What is the tx for carbon monoxide poisoning?
100% oxygen
72
What is the tx for methanol or antifreeze poisoning?
Fomepizole, dialysis
73
What is the tx for lead poisoning?
CaEDTA, dimercaprol, succimer, penicillamine
74
What is the tx for mercury, arsenic, gold?
Dimercaprol, succimer
75
What is the tx for copper, arsenic, gold?
Penicillamine
76
What is the tx for Cyanide poisoning?
Nitrite+thiosulfate, hydro cobalamin
77
What is the tx for opioid tox?
Naloxone/naltrexone
78
What is the tx for TCA poisoning?
NaHCO3 | Same as Tx for salicylate tox
79
What's the tx for heparin tox?
Protamine
80
What is the tx for theophylline tox?
Beta-blocker
81
What are the P450 inducers?
``` Momma Barb Steals Phen-Phen and Refuses Greasy Carbs Chronically: Modafinil Barbiturates St. John's wort Phenytoin Rifampin Griseofulvin Carbamazepine Chronic alcohol use ```
82
What are the P450 inhibitors?
``` MAGIC RACKS GQ Macrolides Amiodarone Grapefruit juice Isoniazid Cimetidine Ritonavir Acute alcohol abuse Cipro Ketoconazole Gemfibrozil Quinidine ```
83
What is the MOA of pralidoxime?
Reactivates cholinesterase by removing the phosphate group that had been added by organophosphates
84
What are all the effects of phenylephrine?
Increases peripheral vascular resistance Decreases pulse pressure (due to reflex decrease in stroke volume and increased afterload) Increases systolic pressure Decreases heart rate
85
What does epi do?
Increase pulse and pulse pressure | Decreases peripheral vascular resistance (beta 2)
86
What are the 2 sympathetic innervations that are cholinergic?
The sweat glands and the adrenal medulla
87
What are the autonomic receptors that use Gq?
``` Alpha 1 M1 M3 (increase exocrine glands, lacrimal, gastric acid, gut peristalsis, bladder contraction, bronchoconstriction, miosis, accommodation) H1 V1 ```
88
What are the autonomic receptors that use Gi?
Alpha 2 M2 (decreases heart rate and contractility of the atria) D2
89
What are the autonomic receptors that use Gs?
``` B1 B2 D1 H2 V2 ```
90
What is th MOA of pralidoxime?
Reactivates cholinesterase by removing a phosphate group
91
What is labetolol?
An alpha 1, beta 1, and beta 2 reversible competitive antagonist
92
What is donepazil?
Indirect cholinergic agonist (inc endogenous ACh) | Treat- Alzheimer's
93
Norepinephrine vs isoproterenol
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
Epi vs phenylephrine responses to alpha-blockade
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
What are the non selective alpha and beta antagonists?
Carvedilol | Labetolol
96
What is the tx for tPA, streptokinase or urokinase tox?
Aminocaproic acid
97
What is the tx for warfarin tox?
Vit K | Fresh frozen plasma
98
What is the tx for amphetamine tox?
NH4Cl | Acidifies the urine
99
What is the tx for salicylate tox?
NaHCO3 Alkalinizes the urine Dialysis
100
What is the tx for actaminophen tox?
N-acetylcysteine | Replenishes glutathione

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