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Pharmacology > autonomic drugs (detailed) > Flashcards

autonomic drugs (detailed) Flashcards

1
Q

bethanechol: clinical use

A

postop ileus, neurogenic ileus, urinary retention

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2
Q

bethanechol: action

A

activates bowel and bladder smooth muscle

resistant to AChE

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3
Q

carbachol: clinical use

A

glaucoma, pupillary contraction, relief of intraocular pressure

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4
Q

carbachol: action

A

carbon copy of ACh

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5
Q

pilocarpine: clinical use

A

potent stimulator of sweat, tears, and saliva

open-angle and closed-angle glaucoma

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6
Q

pilocarpine: action

A 
contracts ciliary muscle of eye (open-angle glaucoma)
pupillary sphincter (closed-angle glaucoma)

resistant to AChE

“you cry, drool, and sweat on your pilow”

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7
Q

methacholine: clinical use

A

challenge test for diagnosis of asthma

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8
Q

methacholine: action

A

stimulates muscarinic receptors in airway when inhaled

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9
Q

neostigmine: clinical use

A

postop/neurogenic ileus and urinary retention
MG
reversal of NMJ blockade (postop)

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10
Q

neostigmine: action

A

antiChE = increase endogenous ACh

“Neo CNS = No CNS penetration”

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11
Q

pyridostigmine: clinical use

A

MG (long acting)

doesn’t penetrate CNS

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12
Q

pyridostigmine: action

A

antiChE = increase endogenous ACh
increase strength

“pyRIDostiGMine gets rid of MG”

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13
Q

edrophonium: clinical use

A

diagnosis of MG (extremely short acting)

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14
Q

edrophonium: action

A

antiChE = increase endogenous ACh

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15
Q

physostigmine: clinical use

A

anticholinergic toxicity

crosses BBB => CNS

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16
Q

physostigmine: action

A

antiChE = increase endogenous ACh

“PHYsostigmine PHYxes atropine overdose”

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17
Q

donepezil: clinical use

A

alzheimer’s disease

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18
Q

donepezil: action

A

antiChE = increase endogenous ACh

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19
Q

what to watch out for when giving a cholinomimetic agent?

A

exacerbation of COPD, asthma, peptic ulcers

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20
Q

cholinergic toxicity: features

A 
DUMBBELLSS:
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Emesis/Excitation of skeletal muscle and CNS
Lacrimation
Lethargy
Sweating
Salivation
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21
Q

cholinergic toxicity: cause

A

AChE inhibitor poisoning

often due to organophosphates that irreversibly inhibit AChE

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22
Q

cholinergic toxicity: antidote

A

atropine + pralidoxime

regenerates active AChE

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23
Q

atropine, homatropine, tropicamide: organ and action

A

eye

produce mydriasis and cycloplegia

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24
Q

benztropine: organ and action

A

CNS

parkinson’s disease

“park my benz”

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25
Q

scopolamine: organ and action

A

CNS

motion sickness

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26
Q

ipratropium, tiotropium: organ and action

A

respiratory

COPD, asthma

“I PRAy i can breath soon”

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27
Q

oxybutynin: organ and action

A

genitourinary

reduce urgency in mild cystitis and reduce bladder spasms

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28
Q

glycopyrrolate: organ and action

A

gastrointestinal, respiratory

parenteral: preop use to reduce airway secretions
oral: drooling, peptic ulcer

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29
Q

which organs does ATROPINE affect?

A

eye: increase pupil dilation, cycloplegia
airway: decrease secretions
stomach: decrease acid secretion
gut: decrease motility
bladder: decrease urgency in cystitis

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30
Q

atropine: toxicity

A 
increase body temperature (due to decreased sweating)
rapid pulse
dry mouth
dry
flushed skin
cycloplegia
constipation
disorientation

HOT as a hare, DRY as a bone, RED as a beet, BLIND as a bat, MAD as a hatter – anticholinergic toxicity

can cause acute angle-closure glaucoma in elderly, urinary retention in men with BPH, and hyperthermia in infants

31
Q

epinephrine: clinical use

A

anaphylaxis
glaucoma (open-angle)
asthma
hypotension

32
Q

norepinephrine: clinical use

A

hypotension (but decrease renal perfusion)

33
Q

isoproterenol: clinical use

A

torsade de pointes (tachycardia decreases QT interval)

bradyarrhythmias (but can worsen ischemia)

34
Q

dopamine: clinical use

A

shock (renal perfusion)

heart failure: inotropic, chronotropic

35
Q

dobutamine: clinical use

A

heart failure, cardiac stress testing: inotropic, chronotropic

36
Q

phenylephrine: clinical use

A 
hypotension (vasoconstrictor)
ocular procedures (mydriatic)
rhinitis (decongestant)
37
Q

albuterol, salmeterol, terbutaline: clinical use

A

metaproterenol and albuterol for acute asthma

salmeterol for long-term asthma or COPD control

terbutaline to reduce premature uterine contractions

38
Q

ritodrine: clinical use

A

reduces premature uterine contractions

39
Q

epinephrine: target

A

B 1/2 > A 1/2

40
Q

norepinephrine: target

A

A 1/2 &raquo_space; B1

41
Q

isoproterenol: target

A

B 1/2

42
Q

dopamine: target

A

high dose: A 1/2
medium dose: B1 > B2
low dose: D1

43
Q

dobutamine: target

A

B1&raquo_space;> B2/A1/A2

44
Q

phenylephrine: target

A

A1 > A2

45
Q

albuterol, salmeterol, terbutaline: target

A

B2&raquo_space;> B1

46
Q

ritodrine: target

A

B2

47
Q

amphetamine: target

A

indirect general agonist, releases stored catecholamines

48
Q

ephedrine: target

A

indirect general agonist, releases stored catecholamines

49
Q

cocaine: target

A

indirect general agonist, reuptake inhibitor

50
Q

amphetamine: clinical use

A

narcolepsy
obesity
ADD

51
Q

ephedrine: clinical use

A

nasal decongestion
urinary incontinence
hypotension

52
Q

cocaine: clinical use

A

causes vasoconstriction and local anesthesia

never give B-blockers if cocaine intoxication is suspected (can lead to unopposed A1 activation and extreme hypertension)

53
Q

clonidine, a-methyldopa: target

A

centrally acting A2-agonists

decreased central sympathetic outflow

54
Q

clonidine, a-methyldopa: clinical use

A

hypertension (esp with renal disease since there is no decrease in blood flow to kidney)

55
Q

phenoxybenzamine: clinical use

A

irreversible

pheochromocytoma
(use before removal of tumor, since high levels of released catecholamines will not be able to overcome blockage)

56
Q

phentolamine: clinical use

A

reversible

give to patients on MAO-I’s who eat tyramine-containing foods

57
Q

phenoxybenzamine, phentolamine: toxicity

A

orthostatic hypotension

reflex tachycardia

58
Q

prazosin, terazosin, doxazosin, tamsulosin: clinical use

A

hypertension

urinary retention in BPH

59
Q

prazosin, terazosin, doxazosin, tamsulosin: toxicity

A

1st dose orthostatic hypotension, dizziness, headache

60
Q

mirtazapine: clinical use

A

depression

61
Q

mirtazapine: toxicity

A

sedation
increase serum cholesterol
increase appetite

62
Q

what situations do B-blockers have use for?

A 
angina pectoris
MI
SVT
HTN
CHF
glaucoma
63
Q

B-blockers: use in angina pectoris

A

decrease heart rate and contractility = decrease O2 consumption

64
Q

B-blockers: use in MI

A

decrease mortality

specifically metoprolol, carvedilol, bisoprolol

65
Q

B-blockers: use in SVT

A

metoprolol, esmolol

decrease AV conduction velocity (class II antiarrhythmic)

66
Q

B-blockers: use in HTN

A

decrease CO

decrease renin secretion (due to B1-block on JGA cells)

67
Q

B-blockers: use in CHF

A

slows progression of chronic failure

68
Q

B-blockers: use in glaucoma

A

timolol

decrease secretion of aqueous humor

69
Q

B-blocker: toxicity

A

impotence
exacerbation of asthma
CV ADRs: bradycardia, AV block, CHF
CNS ADRs: seizures, sedation, sleep alterations

use with caution in diabetics

70
Q

B-blocker: B1 selective (B1 > B2)

A

A BEAM

Acebutolol (partial agonist)
Betaxolol
Esmolol (short)
Atenolol
Metoprolol
71
Q

B-blocker: nonselective (B1 = B2)

A

Please Try Not Being Picky

Propranolol
Timolol
Nadolol
Pindolol

72
Q

B-blocker: nonselective (vasodilatory) A/B-blockers

A

carvedilol

labetalol

73
Q

B-blocker: partial B-agonists

A

PAPA

Pindolol
Acebutolol

Pharmacology (10 decks)

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