Exam 2 Drugs

Question 1

2 classes of Direct Cholinomimetics (Para sympathomimetics)

Answer 1

Esters of choline and Plant alkaloids

Question 2

What are the 4 Esters of choline?

Answer 2

Acetylcholine
Methacholine- asthma dx
Carbachol- IOP
Bethanechol- bladder dysfx., GERD

Question 3

What are the subclasses of plant alkaloids and their respective drugs?

Answer 3

Muscarinic: Muscarine, Pilocarpine

Nicotinic: Nicotine, Arecoline (Betel nut)

Question 4

What are the 3 subclasses of Indirect cholinomimetics?

Answer 4

Simple alcohols- fast
Edrophonium- MG diagnosis

Carbamates- moderate
neostigmine, pyridostigmine- MG treatment, NMB reversal

Organophosphates- days
Echothiophate- glaucoma

Question 5

Direct Acting Sympathomimetics

Answer 5

Epinephrine – α, β1, β2 – treat hypotension, cardiac, respiratory

Norepinephrine - α, β1 - cardiac

Isoproterenol - β1, β2 - cardiac

Dopamine – D, β1 – dose dependent (vasodilation, vasoconstriction, cardiac)

Dobutamine - β1 – cardiogenic shock

Phenylephrine – α – decongestant

Midodrine – α1 – orthostatic hypotension

Clonidine (Catapres) – α2 – hypertension, hemodynamic instability

Dexmedetomidine - α2 – Anesthesia

Ephedrine – BOTH DIRECT AND INDIRECT – decongestant

Question 6

What are the 4 antimuscarinic drugs?

Answer 6

Atropine- organophosphate poisoning (with pralidoxime), bradycardia

Scopolamine- motion sickness

Tropicamide- mydriasis and cycloplegia diagnosis

Ipratropium- asthma

Question 7

2 Classes of sympatholytics

Answer 7

Alpha blockers

Beta blockers

Question 8

What are 3 reversible alphablockers

Answer 8

Phentolamine – α1,α2 – hypertension, cardiac stimulant

Prazosin – α1 - hypertension, BPH

Labetalol – BOTH α AND β

Question 9

What is the irreversible alpha blocker and why is it irreversible?

Answer 9

Irreversible- Forms a covalent bond with alpha adrenergic receptors

Phenoxybenzamine – pheochromocytoma

Question 10

What are the 4 beta blockers to know?

Answer 10

Propranolol – β1,β2

Metoprolol, Atenolol - β1 – safer in asthma, diabetics

Labetalol – α1, β1,β2 – hypertension (preeclampsia), pheochromocytoma

Esmolol – β1 – surgical tachycardia (fast)

Question 11

Endothelin receptor antagonist

Answer 11

Bosentan

Question 12

angiotensin inhibitors

Answer 12

ACE inhibitor-captopril

Angiotensin receptor blocker (ARB)- Losartan, valsartan

Question 13

Angina treatment

Answer 13

Nitroglycerin

Ca channel blockers and beta blockers for prophylaxis

Question 14

CHF drugs

Answer 14

Calcium

Digoxin

Milrinone

*Calcium sensitizer- Levosimendan. (not available in US)

Question 15

Centrally acting sympathoplegic drugs

Answer 15

Methyldopa- used for pregnancy induced hypertension

Clonidine- agonist of CNS alpha adrenoreceptors

Question 16

Vasodilators

Answer 16

Hydralazine – oral - K+ channel activation, hyperpolarization of smooth muscle

Minoxidil - oral - K+ channel activation, hyperpolarization of smooth muscle

Nitroprusside – parenteral - HT emergencies, Cardiac failure - CN accumulation

d. Fenoldopam - parenteral - Agonist of D1 receptors

e. Calcium channel blockers – bind alpha subunit and block L-Type calcium channels

Verapamil (more cardiac), Diltiazem, Dihydropyridines

Question 17

What are the antinicotinics?

Answer 17

NMJ-blockers:
Depolarizing- succinylcholine

Non-depolarizing- derivatives of curare