B. 6- indirect sympathomimetics

Question 1

classify the indirect-acting sympathomimetics

Answer 1

1. release inducing agents
2. reuptake inhibitors
3. MAO inhibitors

Question 2

function of the release inducing agents

Answer 2

displace stored catecholamines from nerve endings (monoamines releasers)

Question 3

examples of release inducing agents

Answer 3

amphetamine
methylphenidate
tyramine
Ephedrine

Question 4

examples of reuptake inhibitors

Answer 4

cocaine
TCA- tricyclic antidepressants
atomoxetine
modafinil

Question 5

examples of MAO inhibitors

Answer 5

moclobemide
selegiline
tranylcypromine

Question 6

function of reuptake inhibitors (Modafinil)

Answer 6

increase the activity of neurotransmitters in the synapse by inhibiting their reuptake into the presynaptic nerve terminal

Question 7

function of MAO inhibitors (Selegiline)

Answer 7

inhibit the metabolism of catecholamines by MAO

Question 8

what is the “cheese effect”?

Answer 8

acute attack of hypertension caused by the interaction of MAO inhibitors and eating cheese which contains tyramine.

*the MAO Inhibitor results in ↑ bioavailability of tyramine, usually limited by rapid metabolism by MAO-A in the gut and liver

Question 9

which drug has both direct and indirect sympathomimetic effects?

Answer 9

ephedrine

Question 10

indications for amphetamine (5)

Answer 10

ADHD
Central nervous system disorders (narcolepsy)
Psychostimulant (due to release of DA, NE, 5-HT)
Appetite suppression
drug of abuse (high addiction liability)

Question 11

SE of amphetamine

Answer 11

seizures
aggression
insomnia
hypertension

Question 12

indications for methylphenidate

Answer 12

ADHD

narcolepsy

Question 13

where is tyramine found?

Answer 13

in fermented foods (red wine, cheese)

Question 14

when will we give tyramine?

Answer 14

there is no clinical use

Question 15

indications of Ephedrine

Answer 15

appetite suppressant
decongestant (nose drops)
hypotension associated with anesthesia

Question 16

which indirect-acting sympathomimetics inhibit both NET and DAT?

Answer 16

cocaine and Modafinil

Question 17

what is cocaine used for?

Answer 17

it's a drug of abuse
local anesthetic +vasoconstrictor 
phentolamine antidote (?)

Question 18

`what is Atomoxetine used for ?

Answer 18

ADHD

Question 19

What is modafinil used for ?

Answer 19

improve wakefulness in narcolepsy

Question 20

which MAO inhibitor is irreversible?

Answer 20

Tranylcypromine

Question 21

which MAO inhibitor is used for Parkinson’s disease?

Answer 21

selegiline

Question 22

which MAO inhibitors are used as antidepressants?

Answer 22

moclobemide

Tranylcypromine

Question 23

please list the 𝝰 agonists (non-catecholamines)

Answer 23

Phenylephrine 
oxymetazoline
clonidine
Rilmenidine
methyldopa 
Brimonidine 
Tizanidine

Question 24

which drugs are imidazole derivatives (agonists for both I₂ and 𝝰₂ receptors)

Answer 24

clonidine
Rilmenidine
moxonidine
oxymetazoline (is a local 𝝰₁-agonist and systemic 𝝰₂-agonist)

Question 25

which 𝝰 agonist is phenylephrine?

Answer 25

𝝰₁ agonist

Question 26

how is oxymetazoline given?

Answer 26

topically

Question 27

what is oxymetazoline?

Answer 27

decongestant

Question 28

what are the SE of oxymetazoline?

Answer 28

hypotension if given systemically (𝝰₂ effect)

Question 29

indications for phenylephrine (3)

Answer 29

ophthalmologic use -mydriatic agent (without blocking accommodation)
Decongestant
hypotension (↑ BP)

Question 30

SE of phenylephrine

Answer 30

reflex bradycardia
hypertension
stroke
MI

Question 31

which 𝝰₂ agonist drugs are antihypertensive drugs?

Answer 31

clonidine
Rilmenidine
methyldopa

Question 32

which 𝝰₂ agonist drug is for glaucoma?

Answer 32

brimonidine (↓ aqueous humor production)

Question 33

what is tizanidine?

Answer 33

centrally acting muscle relaxant

Question 34

which 𝝰₂ agonist drugs cause drug-induced lupus?

Answer 34

clonidine

methyldopa

Question 35

which 𝝰₂ agonist drugs have a milder SE compared to clonidine?

Answer 35

moxonidine

rilmenidine

Question 36

indications for clonidine

Answer 36

antihypertensive (↓ sympathetic activity)
ADHD
Tourettes’s syndrome
alcohol/ opiates withdrawal syndrome

Question 37

SE of clonidine

Answer 37

sedation, dry mouth, severe rebound hypertension if suddenly stopped, drug-induced lupus