Drugs

Question 1

Direct cholinergic agonists

Answer 1

Bethancol: bowel and bladder
Methachol: diagnose asthma
Pilocarpine: Stimulator of sweat, tears and salvia. Used in closed and open angle glaucoma
Carbachol: Releives intraocular pressur in glaucoma

Question 2

Indirect agonists: Acetyl cholinesterase antagonists

Answer 2

Physostigmine: tx of atropine OD (cross BBB)
Edrophonium: diagnose MG
Pyridostigmine: tx of MG
Neostigmine: Reversal of neuromuscular blockade
Donepezil, Galantamine, Rivastigmine: AD (used to increase ACh levels)

Question 3

With cholinergic agonists what pt populations should be monitored closely

Answer 3

COPD, asthma and peptic ulcers

Question 4

Symptoms with cholinesterase inhibitor poisoning (organophosphates)

Answer 4

DUMBBELSS:
Diarrhea, urination, miosis, bradycardia, bronchoconstriction, excitation of skeletal muscle and CNS, lacrimation, salivation, sweating

Question 5

Tx of organophosphate poisoining

Answer 5

Atropine and Pralidoxime

Question 6

Tx of organophosphate poisoining

Answer 6

Atropine and Pralidoxime

Question 7

Muscarinic antagonists:

Answer 7

Atropine, homatropine, tropicamide:
Benztropine: Parkinson, acute dystonia
Glycopyrrolate: Reduce airway secretions
Iprotropium/tiotropium: COPD, asthma
Oxybutynin, Solifenacin, tolterodine: Urge urinary incontinence:
Scopolamine: motion sickness and decrease oral secretions.
Dicyclomine: antispasomodics for IBS

Question 8

Toxicity of atropine:

Answer 8

Hot as a hare- hyperthermia
Dry as a bone- decreases salivation
Red as a beet- flushing
blind as a bat- loss of cyloplegia and miosis
Mad as a hatter:CNS confusion
Bloated as a toad: constipation and urinary retention
Can cause acute angle closure glaucoma in elderly

Question 9

Direct sympathomimetics

Answer 9

Albuterol/salmeterol: B2>B1; albuterol acute asthma and salmeterol is long term asthma
Dobutamine: B1>B2, alpha; HF and cardiac stress test
Dopamine: D1,2> Beta > Alpha;
Epinephrine: Beta > Alpha; ANAPHYLAXIS
Isopreternol: B1=B2
Norepi: Alpha1> alpha 2 > beta 1; hypotension (cardiogenic shock)
Phenylephrine: Alpha 1> alpha 2; hypotension and rhinitis

Question 10

Direct sympathomimetics

Answer 10

Albuterol/salmeterol: B2>B1; albuterol acute asthma and salmeterol is long term asthma
Dobutamine: B1>B2, alpha; HF and cardiac stress test
Dopamine: D1,2> Beta > Alpha;
Epinephrine: Beta > Alpha; ANAPHYLAXIS
Isopreternol: B1=B2
Norepi: Alpha1> alpha 2 > beta 1; hypotension (cardiogenic shock)
Phenylephrine: Alpha 1> alpha 2; hypotension and rhinitis
Terbutaline: B2> B1; bronchospasm and tocolysis

Question 11

What releases stored catecholamines:

Answer 11

Amphetamine and ephedrine

Question 12

What inhibits reuptake of catecholamines:

Answer 12

Cocaine and TCAs

Question 13

What inhibits reuptake of catecholamines:

Answer 13

Cocaine and TCAs

Question 14

Alpha 2 agonists

Answer 14

Clonidine and alpha methyldopa

Question 15

Non selective alpha blockers

Answer 15

Phentolamine: pts on MAO inhibitors who eat tyramine containing foods
phenoxynbenzamine: pheochromocytoma and prevent catecholamine crisis

Question 16

Alpha 1 selective blockers:

Answer 16

Prazosin, terazosin, doxazosin, and tamsulosin: Urinary symptoms of BPH and HTN (except tamsulosin- more selective for just prostate)

Question 17

Alpha 2 selective

Answer 17

Mirtazapine: used in depresssion

Question 18

Alpha 2 selective

Answer 18

Mirtazapine: used in depresssion

Question 19

Selective beta one blockers:

Answer 19

A-M

Atenolol, metropolol, esmolol, acebutolol, betaxolol

Question 20

Non selective beta bockers:

Answer 20

N-Z

Timolol, Propanolol, Nadolol, Pindolol

Question 21

Non selective alpha and beta blockers:

Answer 21

Carvedilol, Labetolol