Autonomics Flashcards
Bethanechol
1) Activates Bowel and Bladder smooth m. Post-op and neurogenic ileus and urinary retention.
2) Direct Cholinomimetic.
4) Resistant to AchE.”Bethany call me if you want to move your bowel and bladder”
Carbachol
1) Glaucoma, pupillary contraction, and relief of intraocular pressure.
2) Direct Cholinomimetic.
4) “Carbon copy of Ach”
Pilocarpine
1) Potent stim of sweat, tears, saliva. Use in Open-angle and Closed-angle Glaucoma. Contracts ciliary m of eye (open angle) and pupillary sphincter (narrow angle)
2) Direct Cholinomimetic
4) Resistant to AchE”cry, drool, and sweat into your PILO”
Methacholine
1) Challenge test –> dx of asthma.
2) Direct Cholinomimetic, stim muscarinic r in airway –> bronchoconstriction
Neostigmine
1) Post-op and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular jxn blockade (post-op).
2) Indirect Cholinomimetic; increases Ach (anticholinesterase)
4) No CNS penetration (“Neo CNS penetration”)
Pyridostigmine
1) Myasthenia gravis (long acting)
2) Indirect Cholinomimetic; increases endogenous Ach, increases strength. (Anticholinesterase)
4) No CNS penetration”pyRIDostiGMine RIDs you of your MG”
Edrophonium
1) Diagnosis of myasthenia gravis (SHORT acting).
2) Indirect Cholinomimetic; increases endogenous Ach (Anticholinesterase)
Physostigmine
1) Anticholinergic toxicity
2) Indirect Cholinomimetic; increases Ach. (Anticholinesterase)
4) crosses BBB”Physostigmine PHYxes Atropine overdose”
Donepezil
1) Alzheimers
2) Indirect Cholinomimetic; increases Ach (anticholinesterase)
ADE of all Cholinomimetics
Exacerbation of COPD, asthma, and peptic ulcers
Organophosphate poisoning (e.g. Parathion)*Farmers!
Irreversibly inhib AchE. (DUMBBELSS) Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal m and CNS, Lacrimation, Sweating, and Salivation
Rx for Organophosphate poisoning
Atropine + Pralidoxime = regenerate active AchE
Atropine Use/MOA
1) Blocks Organophosphate poisoning. Used to treat bradycardia and opthalmic applications
2) Muscarinic antagonist.
Atropine ADE
3) Increase body temp, rapid pulse, dry mouth, dry/flushed skin, cycloplegia, constipation. Can cause acute angle-glaucoma in elderly, urinary retention in men with BPH, hyperthermia in infantsHot as a hareDry as a boneRed as a BeetBlind as a BatMad as a HatterBowel and Bladder lose their toneand the Heart runs alone
Homatropine
1) Produce mydriasis and cycloplegia (paralysis of ciliary m, loss of accomodation)
2) Muscarinic antagonist
Tropicamide
1) Produce mydriasis and cycloplegia (paralysis of ciliary m, loss of accomodation)
2) Muscarinic antagonist
Benztropine
1) Rx for Parkinsons**
2) Muscarinic Antagonist”PARK my BENZ”
Scopolamine
1) Motion sickness.
2) Muscarinic antagonist
Tiotropium
1) Rx for COPD, Asthma.
2) Muscarinic antagonist
Ipratropium
1) Rx for COPD, Asthma.
2) Muscarinic antagonist
Oxybutynin
1) Reduce urgency in mild cystitis and reduce bladder spasms.
2) Muscarinic AntagonistPut a BUUT in your FOXY Bladder
Glycopyrrolate
1) Parenteral: preop –> reduce airway secretions. PO: Rx for drooling, peptic ulcer
2) Muscarinic Antagonist Sit by the PYRR and dry yourself up
Epinephrine
1) Anaphylaxis, glaucoma (open angle), asthma, hypotension
2) Sympathomimetics; A1, A2, B1, B2. LOW dose selective for B2**
NE
1) Hypotension (but low renal perfusion)
2) Sympathomimetics; A1, A2 > B1
Isoproterenol
1) Torsade de pointes (tachycardia decr low QT interval), bradyarrhythmias (but can worsen ischemia)
2) Sympathomimetics; B1=B2”Iso” = 1 (only B’s) “proter” sounds like german Brother (begins w B)
Dopamine
1) Shock (incr renal perfusion), heart failure
2) Sympathomimetic; D1 (low dose) >B (medium dose) >A (high dose), inotropic and chronotropicdopamine relaxes renal vascular smooth m
Dobutamine
1) Heart failure, cardiac stress testing.
2) Sympathomimetic; B1>B2, inotropic and chronotropic)
Phenylephrine
1) Hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)
2) Sympathomimetic; A1>A24) decr NE synthesis leads to “Rebound congestion”/Tachyphalaxis. (nasal mucosa is edematous, red, bleeding)
Albuterol
1) Acute asthma
2) Sympathomimetic; Selective B2-agonist (B2>B1)
Salmeterol
1) Long-term treatment of asthma or COPD control
2) Sympathomimetic; Selective B2-agonist (B2>B1)
Terbutaline
1) Reduce premature uterine contractions*
2) Sympathomimetic; Selective B2-agonist (B2>B1)
Ritodrine
1) Reduces premature uterine contractions**
2) Sympathomimetic; B2so you deliver at the “Rite” “Drine/time”
Amphetamine
1) Narcolepsy, obesity, ADD
2) Indirect Sympathomimetic/general agonist, releases stored catecholamines
Ephedrine
1) Nasal decongestion, urinary incontinence, hypotension
2) Indirect sympathomimetic/general agonist, releases stored catecholamines
Cocaine
1) Causes vasoconstriction and local anesthesia
2) Indirect sympathomimetic/general agonist. Uptake inhibitor.
4) People use this to get high. Don’t give B-blockers if cocaine intoxication suspected. (can lead to unopposed A1 activation and extreme HTN)
Clonidine
1) HTN esp w renal disease (no decr in blood flow to kidney)
2) Sympathoplegics. Centrally acting A2-agonist. Decr central sympathetic outflow
Alpha-methyldopa
1) HTN esp w renal disease (no decr in blood flow to kidney)
2) Sympathoplegics. Centrally acting A2-agonist. Decr central sympathetic outflow
4) Rx for HTN in pregnancy also
Phenoxybenzamine
1) Pheochromocytoma (b4 removing tumor - so that release of catecholamines will not be able to overcome receptor blockage)
2) IRREVERSIBLE, Nonselective alpha blocker
3) Orthostatic hypotension, reflex tachycardia
Phentolamine
1) Give to pts on MAO-i who eat tyramine-containing foods
2) REVERSIBLE, Nonselective alpha blocker
Prazosin
1) HTN, urinary retention in BPH, PTSD
2) A1 blocker
3) 1st dose orthostatic hypotension, dizziness, HA
Terazosin
1) HTN, urinary retention in BPH
2) A1 blocker
3) 1st dose orthostatic hypotension, dizziness, HA
Doxazosin
1) HTN, urinary retention in BPH
2) A1 blocker
3) 1st dose orthostatic hypotension, dizziness, HA
Tamsuolosin
1) urinary retention in BPH
2) A1 blocker
3) 1st dose orthostatic hypotension, dizziness, HA
Mirtazapine
1) Atypical Antidepressant
2) A2 antagonist and 5HT2/3 blocker
3) Sedation, incr serum cholesterol, incr appetite, dry mouth
Acebutolol
1) HTN, Angina pectoris,MI, SVT, CHF, Glaucoma
2) Beta1-antagonist (partial Beta-agonist)
3) Impotence, exacerbations of asthma, cardio (bradycardia, AV block, CHF), CNS (sedation, seizure, sleep alteration). Use with caution in diabetics
Betaxolol
1) HTN, Angina pectoris,MI, SVT, CHF, Glaucoma
2) Beta1-antagonist
3) Impotence, exacerbations of asthma, cardio (bradycardia, AV blok, CHF), CNS (sedation, seizure, sleep alteration). Use with caution in diabetics
Esmolol
1) HTN, Angina pectoris,MI, SVT, CHF, Glaucoma
2) Beta1-antagonist (short acting)
3) Impotence, exacerbations of asthma, cardio (bradycardia, AV blok, CHF), CNS (sedation, seizure, sleep alteration). Use with caution in diabetics ESM: Extra Short-acting Medicine
Atenolol
1) HTN, Angina pectoris,MI, SVT, CHF, Glaucoma
2) Beta1-antagonist
3) Impotence, exacerbations of asthma, cardio (bradycardia, AV blok, CHF), CNS (sedation, seizure, sleep alteration). Use with caution in diabetics
Metoprolol
1) HTN, Angina pectoris, MI, SVT, CHF, Glaucoma
2) Beta1-antagonist
3) Impotence, exacerbations of asthma, cardio (bradycardia, AV blok, CHF), CNS (sedation, seizure, sleep alteration). Use with caution in diabetics
Propanolol
1) HTN, Angina pectoris,MI, SVT, CHF, Glaucoma
2) Non-selective B-antagonist. Decr conversion of T4 –> T3*** (use in thyroid storm) (SPECIFIC TO PROPANOLOL)
3) Impotence, exacerbations of asthma, cardio (bradycardia, AV blok, CHF), CNS (sedation, seizure sleep alteration). Use with caution in diabetics
Timolol
1) HTN, Angina pectoris,MI, SVT, CHF, Glaucoma (decreases secretion of aqueous humor)
2) Non-selective B-antagonist
3) Impotence, exacerbations of asthma, cardio (bradycardia, AV blok, CHF), CNS (sedation, seizure, sleep alteration). Use with caution in diabetics
Pindolol
1) HTN, Angina pectoris,MI, SVT, CHF, Glaucoma
2) Non-selective B-antagonist (partial B-agonist)
3) Impotence, exacerbations of asthma, cardio (bradycardia, AV blok, CHF), CNS (sedation, seizure, sleep alteration). Use with caution in diabetics
Labetalol
1) HTN, Angina pectoris,MI, SVT, CHF, Glaucoma
2) Non-selective (vasodilatory) A and B antagonist
3) Impotence, exacerbations of asthma, cardio (bradycardia, AV blok, CHF), CNS (sedation, seizure, sleep alteration). Use with caution in diabetics
Carvedilol
Non-selective (vasodilatory) A and B antagonist
Nadolol
Non-selective B antagonist
Alpha 1
Gq-Incr vasc smooth m contraction, incr pupillary dilator m contraction (mydriasis), incr intestinal and bladder sphincter m contractionincr bp, don’t poop or pee, see in the dark
Alph 2
Qi-decr NE release, decr insulin release, decr lipolysis, incr platelet aggregation
Beta1
Qs-Incr HR/contractility, incr renin release (via JGA cells***), incr lipolysisB1 wants to get your bp back up (incr HR/contractility, blood volume) and break down all that fat in the way
Beta2
Qs-Vasodilation, bronchodilation, incr HR/contractility, incr lipolysis, Incr Insulin release, decr uterine tone (tocolysis), ciliary m relaxation (see far distance), incr aqueous humor production (protect the lens)
M1
QqCNS, enteric nervous system
M2
Qi-decr HR and contractility of atria, decr NE release
M3
Qq-Incr exocrine gland secretions (lacrimal, gastric), incr gut peristalsis, incr bladder contraction, bronchoconstriction, incr pupillary sphincter muscle contraction (miosis), ciliary muscle contraction (accomodation)wnat to be able to digest and poop and pee in a smelly (don’t breathe!) and brightly lit bathroom (small pupils) and accomodate person who wants to go next
D1
Qs-Relaxes renal vasc smooth m
D2
Qi-Modulates transmitter release, esp in brain
H1
Qq-Incr nasal and bronchial mucus production, contraction of brionchioles, pruritus, pain(allergic rxn basically: snotty, can’t breathe, itchy, in pain!)
H2
Qs-Gastic acid secretion
V1 (Vasopressin)
Qq-Incr vasc smooth m contraction/vasoconstriction
V2 (ADH)
Qs-Incr H2O permeability and reabsorption in the collecting tubules of the kidney (V2 is found in 2 Kidneys)=ADH
Hemicholinium
blocks Choline uptake in presynaptic cholinergic neurons
Vesamicol
blocks Ach uptake into vesicles of cholinergic presynaptic neurons (in cytosol)
Metyrosine
blocks Tyrosine –> Dopa in presynaptic noradrenergic neuron
Reserpine
blocks dopamine uptake into vesicles of presynaptic noradrenergic neuron
Bretylium, guanethidine
blocks NE release from presynaptic neuron
Pralidoxime
antidote to cholinesterase inhibitor poisoning (organophosphate poisoning). Regenerates active AchE.
Symptoms of cholinesterase inhibitor poisoning (cholinergic poisoning)
SLUDGE–> salivation, lacrimation, urination, defecation, GI hyperactive, emesis
Symptoms of antimuscarinic poisoning
eg atropine poisoning.
Hot as a hare, Dry as a bone, Red as a beet, Blind as a bat, Mad as a hatter
Nebivolol
combines B1 block with B3 stimulation (activates NO in vasculature)
partial beta agonists
Pindolol, Acebutolol
Tx for cyanide poisoning
Nitriate + thiosulfate: nitrites convert Hb–> methemoglobin (Fe 3+), which binds CN-. Thiosulfate chelates CN- to excrete it.
Or can use hydroxycobalamin, which has affinity for CN-
Methylene blue
reduces methemoglobin–> heme. (antidote)
Aminocaproic acid
inhibits tPA, streptokinase, urokinase. Derivative of lysine
