Autonomics - DRUGS

Question 1

Hemicholinium

Answer 1

Blocks choline transporter (presynaptic)

Question 2

Vesamicol

Answer 2

Blocks ACh transporter into vesicle

Question 3

Metyrosine (a-methyltyrosine)

Answer 3

Blocks Tyrosine to DOPA (competitive inhibitor of tyrosine hydroxylase)
- malignant pheochromocytoma

Question 4

Reserpine

Answer 4

Irreversible Blocks VMAT (dopamine uptake into vesicle)

- HT

Question 5

Bretylium, Guanethidine

Answer 5

Inhibit NE release

Question 6

High dose ACh + atropine

Answer 6

Symp gang stimulation (Nn) causes vasoconstriction (atropine blocks muscarinic effects)

Question 7

Carbachol

Answer 7

Glaucoma

Question 8

Pilocarpine

Answer 8

• Sweat, tear, saliva stimulator
• Open and closed angle glaucoma
• AChE resistant

Question 9

Anti-AChE for Alzheimer’s

Answer 9

Donepezil, Rivastigmine, Galantamine, Tacrine

Question 10

Neostigmine

Answer 10

• post-op/neurogenic ileus and urinary retention
• MG
• reverse NMJ blockage (post-op)

(No CNS penetration)

Question 11

Physostigmine

Answer 11

Atropine OD (NOT TCA)
- Crosses BBB

Question 12

Pyridostigmine

Answer 12

MG (long acting)

No CNS

Question 13

Cholinomimetic AE

Answer 13

Exacerbation: COPD, asthma, peptic ulcer

Question 14

Organophosphates

Answer 14

• Echothiophate (glaucoma), parathion, malathione

- Tabun, sarin, soman

Question 15

Antimuscarinics: mydriasis and cycloplegia

Answer 15

Atropine, homatropine, tropicamide, cyclopentolate

Question 16

Antimuscarinics: Parkinson disease, EPS of anti-psychotics, acute dystonia
(CNS)

Answer 16

Benztropine, Trihexyphenidyl

Question 17

Antimuscarinics:

• Parenteral: pre-op airway secretion reduction
• Oral: drooling, peptic ulcer

Answer 17

Glycopyrrolate

Question 18

Antimuscarinics: IBS

Answer 18

Hyoscyamine, dicyclomine

Question 19

Antimuscarinics: reduce bladder spasms and urinary incontinence

Answer 19

Oxybutynin, solifenacin, tolterodine

Question 20

Antimuscarinics: motion sickness (CNS)

Answer 20

Scopolamine

Question 21

Atropine

Answer 21

Bradycardia, opthalmic, amantia muscaria, cholinergic agonist antidote

Question 22

Hexamethonium

Answer 22

Anti-nicotinic (ganglion blocker)

Question 23

Muscarinic antagonist contraindications

Answer 23

Closed angle glaucoma, BPH, elderly (dementia)

Question 24

Albuterol, salmeterol, terbutaline, formoterol

Answer 24

B2 > B1

- Asthma/COPD

Question 25

Dobutamine

Answer 25

B1 > B2, a - HF, cardiac stress testing - Ionotropic > chronotropic - No sig increase in O2 demand

Question 26

Dopamine

Answer 26

D1=D2 > B > a - unstable bradycardia, HF, shock - Ionotropic AND chronotropic at high dose

Question 27

Epinephrine

Answer 27

B > a - Anaphylaxis, asthma, open-angle glaucoma, cardiac arrest, local anesthetic - low=isoproterenol, med=dobutamine, high=NE

Question 28

Isoproterenol

Answer 28

B1=B2 - Electrophysiologic evaluation of tachyarrhythmias - Can worsen ischemia - Decrease MAP (TPR > SBP), increased PP

Question 29

NE

Answer 29

a1 > a2 > B1 - Hypotension - can never decrease BP

Question 30

Phenylephrine

Answer 30

a1 > a2 | - Hypotension, ocular procedures (w/out cycloplegia), rhinitis

Question 31

Before giving beta blocker....

Answer 31

Check for COKE, asthma/COPD, diabetes?

Question 32

Atomoxetine

Answer 32

Selective NE re-uptake inhibitor for ADHD

Question 33

Fenoldopam

Answer 33

Selective D1 partial agonist for emergency HT

Question 34

Clonidine

Answer 34

Partial a2 agonist - HT urgency (no decrease in RBF), ADHD, Tourette's - AE: CNS depression, brady, hypotension, respiratory depression, miosis

Question 35

a-methyldopa (converted to a-methylnorepinephrine)

Answer 35

a2 agonist - HT in pregnancy - AE: direct coombs +ve hemolysis, SLE-like synd.

Question 36

Brimonidine

Answer 36

a2 agonist | - glaucoma (decrease B2 (production) and a1 (outflow))

Question 37

Phenoxybenzamine

Answer 37

nonselective irreversible alpha blocker | - pheochromocytoma (pre-op)

Question 38

Phentolamine

Answer 38

nonselective reversible alpha blocker | - w/ tyramine food if on MAO inhibitors, diagnose pheochromocytoma, prevent dermal necrosis w/ NE extravastion

Question 39

a1 selective blockers - drugs and use

Answer 39

Prazosin, terazosin, doxazosin, tamsulosin - for BPH - prazosin - PTSD - HT - not tamsulosin

Question 40

Phentolamine and Phenoxybenzamine: AE

Answer 40

orthostatic hypotension and reflex tachycardia

Question 41

a1 selective blocker: AE

Answer 41

- orthostatic hypotension (1st dose) - dizziness - headache - Na and H20 retention (renin reflex) - NO REFLEX TACHYCARDIA

Question 42

Mirtazapine

Answer 42

a2 selective blocker - Depression AE: sedation, increased serum cholesterol, increased appetite

Question 43

B1 selective blocker (B1 > B2)

Answer 43

acebutolol (partial agonist), atenolol, betaxolol, esmolol, metoprolol

Question 44

B blocker (non-selective) B1 = B2

Answer 44

nadolol, pindolol (partial agonist), propranolol, timolol

Question 45

Nonselective a and B antagonists

Answer 45

carvedilol, labetalol

Question 46

Cardiac selective B1 blocker + B3 agonist (increases NO synthase in vasculature)

Answer 46

Nebivolol

Question 47

B-blocker uses

Answer 47

- Angina pectoris - MI (metoprolol, carvedilol, bisoprolol) - decrease mortality - SVT (metoprolol, esmolol) - HT - HF - Glaucoma (timolol)

Question 48

B-blocker AE

Answer 48

Impotence, brady, AV block, HF, CNS (seizures, sedation, sleep alterations), dyslipidemia (metoprolol), asthma/COPD exacerbations

Question 49

B-blocker for ptn w/ decreased cardiac reserve or Hx or bardycardia

Answer 49

Pindolol