Autonomous Nervous Sys. Drugs Flashcards
what are the types of cholinergic receptors?
nicotinic receptors (“smoker”)
muscarinic receptors (“motorcycle parking spots”)
where are n-ACHR found ?
-autonomic ganglia
(“ganglia like transformers”)
-skeletal muscle motor end plate
(“electric outlet near smoker”)
-adrenal glands
(“adrenal beanie on smoker”)
what type of receptor is n-ACHR ?
act as ion channels where influx of + ions occur
(“ion channel news behind smoker”)
What type of receptor is m-ACHR ? what are the subtypes ? where are they found ?
G-coupled receptors
M1 (Gq) - nerves , CNS
(“Brain helmet on 1st rider” , “3 DAGS”)
M2 (Gi) - SA node , AV node , atria
(“2nd rider shirt showing heart with jewels”)
M3 (Gq) - found on glands and smooth muscle (“glandular sponge with 3rd rider “ “3 DAGS”)
M3 stimulation effect on vessels ?
M3→ Gq→ IP3/DAG→ Ca+2 increase→ NO release → cGMP increase → VASODILATION →drop in BP
(“Dilated NO Exhaust on 3rd motorcycle”)
Name the Direct Cholinomimetics
Bethanecol (“Beth with Cola”)
Pilocarpine (“Pile of Carps”)
Carbachol (“constricted hood blocking carbon”)
Methacholine (“Marathon challenge”)
Varenicline
(“1-800 very-clean sign on pole next to smoker” )
Bethanecol (“Beth with Cola”)
-increases secretions and gastric motility
(“cement pouring out from colon”)
-to treat neurogenic ileus/bladder due to spinal cord injury / post operation/ post pregnancy
*non obstructive*
(“Beth holding Bladder hose”)
Pilocarpine
(“Pile of Carps”)
-increase Salivation -treat sjorgen
(“dripping carps mouths”)
-meiosis -activates sphincter pupilae muscle
(“constricted hood”)
- for treatment of acute angle Glaucoma
- contracts cilliary muscle (“smooth muscle crane”) causing accomodation and relaxation of zonular fibers (“fish net zonules”) as well as increasing the outflow of AQ.H
- treatment of Glaucoma
Carbachol
(“constricted hood blocking carbon fumes”)
-agonist of both muscarinic and nicotinic receptors
(“carbon fumes from smoker”)
-causes pupillary constriction
(“constricted hood”)
- to treat acute angle glaucoma
Methacholine
(“marathon challenge”)
- induce bronchoconstriction and may worsen asthma / COPD (“Wheezing Man”)
- may be used to intiate asthma for pulmonary testing
*Bronchial challenge test* Asthmatics react to lower doses .. then give Bronchodilator as a “reversibility test” to distinguish between ASTHMA/ COPD
Varenicline
(“1800-Very-clean sign on pole”)
-nicotinic **partial agonist
-**
for smoking cessation
(“smoking cessation hotline 1800-Very-clean” sign on pole)
indirect cholinomimetics do so by …
reversible/irreversible inhibition of Acetylcholine- Esterase therefore increasing Ach at the synapse
(dumpster spilling cola bottles with “Anti-Establishment” /”STIGMA” - suffix for these drugs )
what is the use of indirect cholinomimetics ?
- to treat myasthenia gravis which is an autoimmune diseasei in which anti-n-ACHR antibodies are generated (“gravis graffiti” on electric outlet)
- symptoms (“Gravis Graffiti” covers electric outlet)
- muscle weakness
- diplopia
- ptosis
how can we classify indirect cholinomimetics ?
Tertiary or Quaternary
(“Quarters only in phone booth”)
mention all the Quaternary indirect cholinomimetics
Edrophonium
(“phone booth”)
Pyridostigmine
(“community pride t-shirt on blacky”)
Neostigmine
(“neon sign stigma”)
Edrophonium
(“phone booth”)
Reverses muscle weakness in MG but not used for therapy only for diagnosis due to short half life used in Tensilon test (“phone wire tension”)
- Symptoms relieved (+ tensilon) → undertreated MG
- Symptoms not relieved,or even worsen ( - tensilon )→ cholinergic crisis
Pyridostigmine
(“community PRIDE shirt on blacky “)
used for long term treatment of Myasthenia Gravis by outcompeting with MG antibodies
(“community PRIDE blacky removing GRAVIS graffiti from electric outlet “)
Neostigmine
(“neon sign STIGMA”)
-can reverse non-depolarizing neuromuscular agents that are called CURARE-like
(tubocurarine ,pancuronium,cisatracurium)
(“Crayons stuck in electric outlet put by the asshole kid and neon sign store owner tells him to fuck off”)
-also used for treatment of Urinary retention
(“neon sign store owner holding bladder hose”)
-can reverse depolarizing neuromuscular agents such as Succinylcholine (“SUCKS graffiti”) but not during phase 1 which is irreversible
( “phase-1 cleanup guy get shocked”)
Physostigmine
(“PHYS ED center”)
-a tertiary indirect cholinomimetic that can cross BBB and has CNS effects
(“PHYS ED CENTER” / “YOUR BRAIN ON DRUGS SIGN IN PHYS ED GYM”)
-Physostigmine (AchEst inhibitors toxicity) causes the DUMBBLESS symptoms as well as flaccid paralysis due to nicotinic overstimulation.
(“weak kid smoking cigarette trying to lift dumbells” )
- Diarrhea
- Urination
- Miosis
- Bronchospasm
- Bradycardia
- Lacrimation
- Salivation
- Sweating
-Can reverse Atropine overdose both peripherally and centrally
-
Organophosphates
(“THIOL spray”)
- found in insecticides (e.g. echothiophate)
- major cause of acute cholinergic toxicity
(“green fumes from THIOL spray aiming towards weak smoking kid”)
-Pralidoxime can reverse Organophosphates overdose (“DUMBBLSS) by hydrolyzing covalent bonds and regenerate m/n-ACHRs ***Peripheral only***
(dumpster saying “ PUT A LID on TOXIC waste “ / “closing LID on TOXIC spray”)
-Atropine can cross BBB and has CNS effects therefore used as an antidote for Organophosphates overdose to treat both peripheral and CNS symptoms
(“atropine alice black graffiti on Open toxic dumpster”)
-Aging of Organophosphates creates irreversible binding complex and Pralidoxime is ineffective at that point
(“Old Pesticides control man spray and Corrodes the ACH dumpster” )
name the acetylcholine esterase inhibitors that are used in treatment of Alzheimer’s Disease
Galantamine
(“Alzheimer’s GALA” on the sign)
Rivastigmine
(“Reverse the Stigma” on the sign)
Donepezil
(“old farts done with their puzzle”)
*ALL OF THESE PENETRATE THE CNS (“brain puzzle”)
anti -muscarinic drugs are good for ..
blocking “DUMBBLLSS” symptoms
(“two dumb-fucks sitting on motorcycle and squeezing dumbells”)
name the anti-muscarinic drugs
Muscarinic antagonists
Atropine
(“alice in wonderland”)
Scopolamine
(“seasick seal sailor outfit holding telescope”)
M3 Antagonists
Ipratropium /Tiotropium
(“cat-ipa-tio tropillar” caterpillar sitting on mushroom”)
Oxybutynin
(“Ox butler”)
Tolterodine
(“Turtle butler”)
M1 Antagonists
Benztropine
(“BENZ Parked in M1”)
Trihexyphenidyl
(“car with 3 hexagons parked in M1”)
Atropine
(“alice in wonderland”)
from Belladona flower (“alice holding pink flower”) or Jimms weed(“Jimms weed tea bag incup next to alice”)
-antimuscarinics block M2 therefore block Parasympathetic activity on heart leading to elevated HR and AV conduction
(“crazy queen holding heart with jewel nodes “)
- increases heart rate (anti-M) and useful for bradycardia (“bunny elevates heart watch”)
- increase AV conduction (anti-M) and is useful for treatment of AV blocks
(“heart shield” resembels block “falling heart shields because of anti-M effect”)
- can cross BBB and and has CNS effects
(“CNS hat on sick sea sailor”)
Scopolamine
(“Sea Sick Seal sailor holding telescope “)
-can cross BBB (Anti-M) and has CNS effects
(“Sick Seal Sailor’s hat says CNS on it “)
- to treat motion sickness/ vestibular nausea
(“sea sick sailor”)
-administered in for of transdermal patch
(“sea sick seal sailor has eyepatch on”)
-antimuscarinics cause mydriasis and *cycloplegia
(“sea sick sailor holding telescope with dilated pupil”)
Ipratropium/Tiotropium-M3 antagonists
(“Cat-ipa-tio-tropillar” blue caterpillar smoking hookah sitting on mushroom)
- inhaled antimuscarinic bronchoDILATORS (“Caterpiller inhaling Shisha smoke”)
- useful in management of COPD since they act as bronchodilators as well as reduce secretions
(blue bloater- “blue caterpillar “ pink puffer -“pink shisha”)
-Tiotropium dissociates slower therefore is used as a long lasting bronchodilator
(“long lasting TIOoo smoke rings”)
Oxybutynin/Tolterodine-M3 antagonists
(“Ox butler / Turtle butler”)
-useful in treatment of Bladder spasms as well as Urinary incontinence
(“ox butler Turning off Bladder”)
Benztropine - M1 antagonist
(“BENZ car parked in M1)
Trihexyphenidyl-M1 antagonist
(“Car with 3 hexagons parked in M1”)
-M1 receptors are found in nerves and CNS
(M1 Parking spots below “Parking Center” sign)
-useful in treatment of tremors and rigidity seen in Parkinson’s disease
(BENZ and TRIHEX cars parked under the sign “PARKING CENTER” having “Shakey Antenas” to resemble tremors and rigidity of parkinson’s)
-antimuscarinics are useful in treatment of extrapyramidal side effects caused by antipsychotic drugs such as
- Dystonia
- Akathisia
- Parkinsonism
(falling cone next to M1 cars saying “EXTRA PARKING”)
What are the side effects of antimuscarinic drugs ?
-elevated HR
(“bunny elevates heart watch”)
-dry mouth/eyes
(“Dry as a cracker” , crackers on the table )
-blurred vision due to Mydriasis/Cycloplegia
(“blind as a bat” bat flying over kettle shaped like dilated eye with high pressure steam coming out “)
- decreased outflow of AQH increase intraocular pressure thus increase risk for
acute angle Glaucoma
(“high pressure steam from kettle towards already blind bat”)
- CNS Effects (“mad as a hatter” hatter’s hat says “M1”)
- Sedation
- Agitation
- Hallucination
- Coma
what are the subtypes of the adrenergic receptors ?
what type of receptor are they ?
α1/α2/β1/β2
Q I S S
G-coupled receptors
α1 activation
(“single lit candle”)
-G(q) coupled receptor →IP3/DAG cascade
(“scouts holding 3 DAGS Infront of α1 cabin “)
-increases T.P.R and venous return by vasocontriction
(“scouts pulling the DAGS red and blue leashes )
-increase M.A.P
(“Scout infront of α1 cabin holding a MAP”
-Mydriasis -α1 receptors are found of dilator pupillae muscle
(“3rd scout infront of α1 cabin holding binoculars wtih dilated pupills”
-Urinary retention due to Urethral sphincter/Prostatic Smooth muscle contraction
(“3rd scout pulling on drawstring and carrying a full bladder canteen”)
α2 activation
(“2 lit candles”)
-G(i) couples receptor that decreases [cAMP]
(“Dissassembling cAMP Tent infront of α2 cabin”)
-leads to inhibition of neurotransmitter release
(“α2 blacky scout rolling up presynaptic wire”)
-activation of α2 receptors leads to sympathoLYTIC effects (“no sympathy” graffiti on α2 cabin)
-decreases insulin release
(“welcome inside” mat rolled up infront of α2 dissassembled tent)
-inhibits lipolysis and release of fatty acids
(“α2 scout pouring water on roasting pig and turning off fire below him”)
-activation of α2 receptors on Cilliary body decreases AQ.H production
(“α2 scout holding eyeball pot and pouring the water out of it”)
β Adrenegic receptors are ..
G(s) coupled and therefor increase [cAMP] levels
(“Band cAMP”)
β1 activation
(“Bugle”)
-found on cardiac myocytes , SA, AV nodes thus increases Contractility and HR
(β1 milf wearing “i <3 Band cAMP” , holding up the heart watch {HR} and flexing her sexy Bicep {Contrc.} )
-increases cardiac output
(“red fire hydrant infront of β1 cabin squirting water”)
-increases Renin levels from JGA
(“open {incr.} yellow umbrella because Rainin from fire hydrant”)
β2 activation
(“Tuba”)
-Vasodilation and thus decrease in T.P.R
(“β2 milf wearing shirt with dilated sleeves”)
-Decrease Diastolic pressure
(β2 milf with Dangling Earings”)
-bronchoDILATION
(“β2 milf inhales extensivly before playing Le Tuba “)
-increase Lipolysis and release of FFA’s
(“roasting pig infront of β2 cabin”)
-increase Gluconeogenesis in the liver
(“β2 girl pulling marshmallows from liver shaped marshmallow bag)
-increase insulin release
(“welcome inside” mat infront of β2 tent)
-causes Hypokalemia
(“Banana peels on ground infront of β2 cabin”)
-activation of β2 receptors on ciliary body increases AQ.H production
(“β2 kid filling eye-shaped balloons with water”)
name the direct acting sympathomimetic drugs
α1 agonist
Phenylephrine
(“Flannel wearing Friends”)
α2 agonist
Brimonidine
(“brim of eyeball hat” infront of α2 cabin)
α>β1 agonist
Norepinephrine
(“scout leader with North compass holding a bugle”)
β > α agonist
Epinephrine
(“EPIC Qiss between α and β camps” raft low towards β means β agonist in low doses )
β1>β2 agonist
Dobutamine
(girl wearing “ just _do bu_gle” shirt infront of _β1 cabin )
β1=β2 agonist_
Isoproterenol
(“iso-pro-tunnel” between β1 and β2 camp tents )
β2 agonists
Terbutaline
(“pregnant β2 camp counsler sleeping on hammock with “DO NOT DIS_TURB”_ sign”)
Ritodrine
(pregnant β2 camp counsler sleeping on hammock wearing “I dream of Band camp” shirt”)
inhaled β2 agonists
(“ROL call sheet”)
-all have “ROL”- suffix (“β2 milf holding ROL call sheet”)
-Used as bronchoDILATION agents
SABA Short acting
- Albute-ROL
- Pirbute-ROL
LABA Long acting
- Formote-ROL
- Salmete-ROL
Phenylephrine
(“Flannel wearing Friends”)
-α1 agonist (“red flannel guy holding 1 lit candle)
-for treatment of nasal congestion and reduction of edema of nasal mucosa mediated by vasoconstriction
(“red flannel guy holding nasal spray”)
-increases M.A.P ,SysP, DiaP
(“blue flannel guy holding map with elevating figures”)
-causes reflex Bradycardia mediated by baroreceptor mechanism
(“flannel friends holding low dangling heart watches”
-causes mydriasis by activation of Dilator pupillae muscle
(“blue flannel guy holding binoculars with dilated pupills”)
Brimonidine
(“Brim of eyeball hat”)
-α2 agonist
(“scout holding eyeball hat infront of α2 cabin”)
-useful for treatment of chronic open angle glaucoma since activation of α2 receptor on cilliary body decreases AQ.H production
(“α2 scout emptys eyeball hat from water”)
Norepinephrine
(“camp leader with North complass and Bugle”)
-α>β1 agonist
(“found on α scout camp side but also holding a bugle”)
-increases T.P.R and therefore M.A.P , Psys , Pdia (“leader scout holding MAP with elevating figures” α1 )
-increase contractility of the heart
(“scout leader flexin dem Biceps” β1)
-increases Pulse Pressure between Psys and Pdia
-causes reflex Bradycardia
(“scout leader holding low dangling heart watch”)
-Useful in treatment (α1 agonists) of Distributive shock /Hypovolemic shock since it increases T.P.R and venous return *also Phenylephrine*
(“septic shock sign” infront of scout leader and flannel wearing friends” )
Epinephrine
(“EPIC qiss between scout camp and band camp”)
-β1>α agonist
-effective ,dose dependent vasoconstrictor and cardiac stimulator
-at LOW doses β effects predominate
(“low side of epic raft towards band camp”)
-
Bronchodilation
(“β tuba girl holding inhaler” β2) -
decrease Diastolic pressure via vasodilation and reduced T.P.R
(“epic DIAmond falls off low side of raft”β2) -
Increased HR
(“ β tuba girl elevating heart watch”β1) - Increase Contractility
(“β tuba girl flexin dem Biceps”β1)
-at HIGH doses α effects predominate
(“high side of raft elevated towards α scout camp)
- vasoconstriction
- Increased T.P.R
- Epinephrine increases Psys , decreases Pdia , increases M.A.P , Increases PP
(“map infront of EPIC QISS shows elevated figures except Pdia which is decreased”)
- Epinephrine is preffered treatment for Anaphylactic shock since it :
- α1 activation counteracts β2 vasodilation (via α1)
- increases contractility and improves blood flow (via β1)
- bronchoDILATION (via β2)
Dobutamine
(girl wearing “just do Bugle” shirt )
-β1>β2 agonist
(girl wearing “just do bugle” shirt next to friend with Tuba)
-useful for treatment of refractory heart failure since it increases HR , Contractility , and cardiac output
(“just do bugle “ girl holding heart flashlight”)
-useful for treatment of Cardiogenic Shock
(“fallen batteries from heart flashlight”
-increases Psys (β1 increase CO) decreases Pdia (β2 vasodilation) increases PP
(“Tuba girl holding map with elevated Psys . unchanged M.A.P and decreased Pdia”)
**Dobutamine can be used to induce a heart stress test in order to identify area of ischemia**
Isoproterenol
(“iso-pro-tunnel”)
-β1=β2 agonist
(“iso-pro-tunnel” between β1 and β2 tents”)
-increases HR and contractility
(“iso-pro-tunnel yellow camper elevating heart watch as well as flexin dem Biceps”- via β1)
-causes vasoDILATION and decreases T.P.R thus decrease Pdia
(“iso-pro-tunnel blue camper has dilated sleeves as well as dangling DIAmond earings”- via β2)
- since it has vasodilation effect → T.P.R decrease → Pdia+M.A.P Decrease →PP Increase
Terbutaline
(pregnant camp counsler sleeping on hammock with sign saying “do not disTURB”)
Ritodrine
(pregnant camp counsler sleeping on hammock with shirt saying “i DREAM of band camp”)
-β2 agonists
(“pregnant camp counsler sleeping on hammock infront of β2 cabin”)
-both drugs can prevent premature labor by relaxation of the uterine smooth muscles tone- tocolytic agents
(“pregnant camp counsler sleeping on hammock and seems to be very relaxed”)
*not shown in sketchy but can also act as fast-acting bronchodilators*
how are catecholamines synthetized and transported ?
-Tyrosine(“pulling Tire towards dock”) →enter nerve terminal (“dock”) →L-dopa(“L-shaped rope handle”) → dopamine(“wheel saying dope rope”) →enter vesicle(“sea vessel) →converted to NE by Dop-β-hydroxylase
(“North compass scout standing on sea vessel”)
- catecholamines enters snyaptic vesicles at nerve terminal through VMAT (“V-mat”)
- once the catecholamines(“catfish”) (NE, dopmaine) are released into synapse they re-enter nerve terminal through NET NorEpinephrine Transporter
(“hauled catfish in NET”)
name the Indirect sympathomimetics
Cocaine
(“Hot Cocoa”)
Atomoxetine
(“atom next to empty net”)
Amphetamines
(“a friend of mine releasing catfish”)
Methylphenidate
(“friend date show on HDTV”)
Modafinil
(sleeping scout hitting “sleep mode” clock)
Name the VMAT Inhibitor
Reserpine /tetrabenazine
(“serpent on Vmat”)
Name the Tyrosine Hydroxylase Inhibitor
Metyrosine
(camp counsler Mitch yelling “My Tire”)
Metyrosine
(sympatholytic)
(“camp counsler Mitch holding tire”)
- Tyrosine analog that inhibits the synthesis of L-DOPA from tyrosine and therefore catecholamine synthesis
- antihypertensive
(camp counsler Mitch holding tire and shouting “it’s MY TIRE !! “)
Cocaine
(“Hot Cocoa”)
-peripherally inhibits NET leading to sympathetic stimulation that includes :
- hypertension
- tachycardia
- mydriasis
- agitation
(“stimulated scouts drinking hot cocoa ignoring catfish net”)
-centrally inhibits DAT thus leading to increased dopamine concentration in CNS causing
- arousal
- addiction
- seizures
-bloody nose due to nasal mucosa atrophy / septal perforation due to vasoconstriction effect
(“hot cocoa scout girl bleeding from nose”)
-can cause coronary vasospasm and eventually MI
(“constricted red crown on hot cocoa mug ,constricted red tethers on anvil connected to catfish net “)
- can cause Angina
(“constricted net on anvil”)
-during cocaine intoxication, adminstration of β-blockers may cause severe hypertension due to unopposed α1 stimulation
(“hot cocoa scout putting his hand inside Bugle creating high pressure”)
Atomoxetine
(“Atom next to empty net”)
-NET inhibitor useful in treatment of ADHD
(“scout distracted from catfish NET because he’s watching HDTV”)
Reserpin/Tetrabenazine
(“Serpent snake”)
-inhibits VMAT transporter(“snakes sitting on v-mat”) found on synaptic vesicles and through which catecholamines enter the vesicle ,
-exhibits dose related depression due to depletion of catecholamines
(“scout kid next to the snake looks depressed AF!!!”)
Amphetamine
(kid on sea vessel wearing “A-friend of mine” shirt “)
Methylphenidate
(kid watching “friend date” on HDTV)
-displaces catecholamines into synapse
(kid wearing “A-friend of mine” shirt dumping catfish into water” )
-Methylphenidate is an Amphetamine derivatives that is useful for treatment of ADHD
(“kid distracted by “friend date “ show on HDTV)
-Stimulants including Amphetamines ,Methylphenidate, and Modafinil are known to decrease appeptite
(“note the untouched dinner next to kid watching friend date”)
Modafinil
(sleeping scout hitting “sleep mode” on clock)
-useful in treatment of **Narcolepsy
-**
MOA for sleep disorders uknown , acts as A-typical selective dopamine reuptake inhibitor
what are the dopamine receptors? what effects do they exert ?
“Dope Rope SWING”
-D1R G(s) coupled , D2R G(i) coupled
——————————————————————————–
D1 (“single rope swing”)
- at low doses D1 receptors stimulation
increases RBF,GFR, Na+ excretion
(“low kidney tied to single rope”) - at medium doses dopamine stimulated β1 receptors inducing cardiac activation
(“β bugler hanging in the middle of the rope”) - at high doses dopamine stimulates α1 receptors inducing pressor effects
(“α scout camp kid holding a single lit candle hanging on the top of the rope”)
**that’s why it can be use as a pressor for treatment of heart failure/shock in case NE treatment failed**
——————————————————————————–
D2 (“Double rope swing”)
-G(i) coupled
-found in the CNS
(“scout kid on swing wearing brain helmet”)
Name the α2 Agonists
Clonidine
(“Raul holding the claw”)
α-methyldopa
(“α shaped rope”)
Tizanidine
(“to-x-tine”)
*Brimonidine*
(“brim of eyeball shaped hat”)
*not on alpha drugs sketchy
-α2 agonists affect the CNS
(“Brain shaped platform”)
Clonidine
(“white shirt Raul holding Le-CLAW”)
-α2 agonist (“raul holding 2 lit candles”)
-has CNS effects
(“brain shaped platform on floor”)
-_inhibits t_he sympathetic tone and reduces blood pressure therefore is useful in treatment of hypertension
(crossd out “sympathy” under the stage next to “high pressure pipes”)
-useful in managment of Tourette’s syndrome
(“tourette’s marionette”)
-useful in treatment of ADHD
(Raul aint even lookin at the play he looking at “Distracting mirror”)
α-MethylDopa
(“α-methylROPA”)
-α2 agonist
(“whtie lady holding 2 lit candles”)
-has CNS effects
(“brain shaped platform”)
-useful for treatment of Gestational Hypertension
(“white lady is pregnant” “high pressure pipes next to α-methyl ropa”)
- can cause Lupus-like syndrome
(“sneaky wolf next to white lady”)
Tizanidine
(“to-x-tine”)
-α2 agonist (“2 lit candles next to chair”)
-central acting muscle relaxant
(“Relaxing chair”)
Name non-selective α antagonists
Phentolamine
(“Phantom of the Opera standing on chandelier”)
Phenoxybenzamine
(“phoenix tattoo on Phantom’s chest”)
Phentolamine
(“Phantom of the Opera standing on chandelier”)
-α1 α2 non selective antagonist
(“phantom of the Opera standing on chandelier with extinguished single and double candles”)
-reversible
-causes vasodilation via α1 antagonistic effect
(“phantom of the opera has dilated sleeves”)
- may cause orthostatic Hypotension (“tilt table”) via α antagonis,and as a result reflex tachycardia
(doc. hitting leg with heart reflex hammer”) - useful in treatment of cocaine toxicity
(“hot cocoa”)
-useful in case of Hypertensive crisis in which wine and cheese that contain tyramine(sympathomimetic) were consumed alongside MAO inhibitors
(“wine and cheese on table protected by mouse trap”)
-useful in treatment of Pheochromocytoma
(“frozen colorful dessert”)
- headaches (“kid having brain freeze”)
- hypertention
- palpitations
- sweating
*use pre/interoperatively
Phenoxybenzamine
(“Phoenix tattoo on Phantom’s chest”)
- α1 and α2 **non-selective antagonist
- irrevesible**
(“pheonix tattoo is irreverisble , permanent”)
-useful for treatment of Pheochromoctoma but usually given few days in advance to surgery
name the selective α1 antagonists
-“osin” suffix for all (“Opera singer”)
Praz /Teraz/Doxaz/Tamsul-OSIN
Terazosin
(“opera singer” -osin)
*also α1 antagonists in general*
-α1 antagonist
(“opera singer holding extinguished single candle”)
-causes Vasodilation
(“opera singer has dilated sleeves”)
-relaxes smooth muscles in urethra and prostate and therefore is useful treatment for BPH
(“opera singer sitting on banister that compresses his prostate”)
Prazosin
(_“pray_ing opera singer”)
-α1 antagonist
(“single extinguished candle next to praying opera singer”)
-can cause orthostatic hypotension
(“tilt table on stage”)
- can be used to treat PTSD
(praying opera singer holding dog tags saying “PT” “SD”)
Mirtazapine
(“Mirth and Misery”)
-atypical antidepressant
-α2 antagonist {+other receptors}
(“2 extinguished candles below 2 masks”)
-enhances serotonin release and useful for treatment of depression
(“happy mask / sad mask”)
β-blockers in General
- all have “LOL” suffix (“βrahm’s LOLlaby”)
- decrease cardiac contractility (“weak arm”)
-useful in treatment of chronic stable angina by reducing myocardial oxygen demand
(“ Anvil shaped xylophone with disconnected oxygen line next to it “)
-reduce mortality in CHF and post MI patients
(“Angel”)
-reduce cardiac remodelling by protecting heart from circulating catecholamines
(“remodelling sign behind angel”)
-useful in treatment of hypertension
(“high pressure pipes”)
-useful in treatment of hypertrophic obstructive cardiomyopathy {HOCM}
(“musician trying to play big obstructed heart bag”)
-useful as prophylactic treatment for episodic migraines
(“musician ponding head shaped bell”)
-useful for treatment of essential tremors
(“maestro conductor shaking hand holding baton”)
-have antiarrythmic properties
(“rythm inducing record”)
-the non-selective β-blockers are useful in topical treatment of Glaucoma since -the non-selective β2 antagonism decreases AQ.H production
(“muted β2 tuba player draining liquid from tuba”)
———————————————————————————–
-supress SA and AV nodes and can cause Bradycardia
(“low dangling heart watch from pianist pants”)
-inhibits renin production
(“closed yellow rain umbrella “)
-can exacerbate AV Heart block via β1 antagonism
(sign next to door says “ door to remain _un-β_locked)
-the non-selective β-blockers may exacerbate asthma/COPD via β2 antagonism
(“wheezing β2-tuba player infront”)
-can cause impotence in men
(“droopy tromboner”)
——————————————————————————–
***Glucagon is useful in case of β-blockers toxicity***
(“glucagon packets on and below maestro conductor table”)
——————————————————————————–
-useful in treatment of peripheral effects seen in thyroid storm
(“musician holding migraine bell is wearing big stormy bowtie”)
*3 P’s treatment for thyroid storm*
- Propanolol
- Prednisone
- Propothyouracil
**CAN’T REVERSE MYXEDEMA AND EXOPHTHALMUS**
Name non-selective β-blockers
- *Proprano**-LOL
- *Timo**-LOL
- *Sota**-LOL
selective β1-blockers
(“A-BEAM spotlight”)
“A-BEAM”-CARDIOSELECTIVE
(“Spotlight on muted β1 bugle player”)
- *Ateno**-LOL
- *Betaxo-**LOL
- *Esmo**-LOL
- *Acebuto**-LOL
- *Metopro**-LOL
-Useful in treatment of acute MI as well as ACS
(“A-BEAM spotlight on broken heart strings”)
-reduces tachycardia and high catecholamine levels on heart therefore it is useful for treatment of CHF
(“A-BEAM spotlight on Failing Heart balloon on stage”)
non-selective β blockers with α1 antagonist activity
Carvedi-LOL
(“carved candleholder with single extinguished candle”)
-useful in treatment of CHF
(“Failing heart balloon next to carved candleholder”)
Labeta-LOL
(“α/β organ not working and has single extinguished candle on it”)
-causes vasoDILATION via α1 antagoinsm
(“α/β organ player has dilated sleeves”)
-useful for treating Gestational hypertension
(“α/β organ player is pregnant”)
-useful in IV form for treatment of hypertensive emergency
(“emergency switch on high pressure pipes as well is poison ivy on α/β organ”)
-IV β-blockers are useful for treatment of Acute Aortic Dissection (“dissected organ pipe”)
Selective β-blockers with partial agonist activity
-Partial agonist activity
(“young kids=not full agonists”)
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Acebuto-LOL
- selective β1 antagonist with partial agonist acitivty
(“dad antagonizing young kid’s plastic β1 bugle”)
Pindo-LOL
(“agonizing pin”)
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***β-blockers with partial agonist activity should be avoided in patients with HF/history of MI***
