Exam 4 Flashcards
Bethanecol
- Cholinergic Agonist
- Direct acting cholinesterase inhibitor
- Contraindications
peptic ulcers
gastrointestinal obstruction
urinary obstruction
Cevimeline
- Cholinergic Agonist
- Direct acting cholinesterase inhibitor
Sjogren’s syndrome
Pilocarpine
- Cholinergic Agonist
- Direct acting cholinesterase inhibitor
open angle glycoma
produce miosis during ophthalmic surgery
decreased night vision
Edrophonium
- Cholinergic agonists
- Indirect acting cholinesterase inhibitor
used in differential diagnosis of muscle weakness (suspected myasthenia gravis)
Neostigmine and Pyridostigmine
- Cholinergic agonists
- Indirect acting cholinesterase inhibitor
Myasthenia gravis
Antidote - nondepolarizing neuromuscular blocking agents toxicity - reverse the effects of paralyzing agents
Donepezil
Galantamine
Rivastigmine
- Cholinergic agonists
- Indirect acting cholinesterase inhibitor
Alzheimer’s disease
Minimum of 24-48 hours must pass before nitrates can be used
Taladafil
Avanafil
Sildenafil
Tadalafil
Vardenafil
- Cholinergic agnonist
- 5-Phosphodiester inhibitor
Erectile dysfunction
Drug interaction w/ nitrates/nitroglycerine; nitrates increase nitric oxide which increases cyclic GMP
Alpha 1 may lead to hypotension
3A4 inhibitors - increase levels of PDE5 inhibitors
Organophosphates
- Cholinergic agonist
- Irreversible cholinesterase inhibitor
Highly lipid soluble - toxicity can occur after dermal exposure
Benign Prostatic Hypertrophy (BHP)
Tadalafil
Pulmonary Arterial Hypertension
Sildenafil
Tadalafil
Ipratropium
Cholinergic antagonist
COPD
Short Acting
Atropine
Cholinergic antagonist Produces mydriasis DOC for bradycardia Used to treat iritis, cyclitis Associated w/ infection, trauma, surgery (reduce muscle spasm and pain)
Dicyclomine
Cholinergic antagonist
Intestinal spasms
Oxybutynin
Cholinergic antagonist
OAB
Tolterodine
Cholinergic antagonist
OAB
Solifenacin
Cholinergic antagonist
OAB
Aclidinium
Cholinergic antagonist
COPD
Long acting
Scopolamine
Cholinergic antagonist
Prevent motion sickness
Trospium
Cholinergic antagonist
OAB
Darifenacin
Cholinergic antagonist
OAB
Overdose symptoms of cholinergic antagonists
Hot
Dry
Red
Mad
Atracurium
Mivacurium
Vercuronium
- Nicotinic antagonists (neuromuscular blockers)
- Competitive antagonist of Ach and NM receptors
Induce muscle relaxation during surgery, facilitate intubation - Potentiated by various inhalation anesthetic agents
- Potentiated by aminoglycosides and calcium channel blockers (CCB)
- Effects more pronounced in patients w/ neuromuscular disorders (myasthenia gravis)
Adverse effects / contraindications of cholinergic antagonists
Causes constipation Do not use in: intestinal obstruction urinary obstruction Caution w/ GERD and patients w/ dementia
Succinylcholine
Nicotinic antagonists (neuromuscular blockers)
- Depolarizing
- Binds to NM receptors and causes persistent depolarization of motor end plate
- NOT REVERSED BY CHOLINESTERASE INHIBITOR (NO ANTIDOTE)
- Do not use in individuals w/ ATYPICAL CHOLINESTERASE (prolonged apnea and neuromuscular paralysis)
Norepinephrine
- Adrenergic agonist
- Catecholamine
- Beta 1 > Beta 2
vasoconstriction and increase peripheral resistance - Used for shock when organ function is impaired due to low BP
- Fluid accumulation
Epinephrine
- Adrenergic agonist
- Catecholamine
- Potent agonist for both Alpha and Beta receptors
- Increases systolic and decreases diastolic at lower doses
- Anaphylactic shock
- Vasoconstriction: reduces bleeding and prolong action of local anesthesia
- Pulseless Rhythm
Isoproterenol
- Adrenergic agonist
- Catecholamine
- Activates both Beta
- Causes tachycardia and arrhythmias
Dobutamine
- Adrenergic agonist
- Catecholamine
- B1 > B2 > a
Stimulates B1 but has minor effects on B2 and a receptors
Increase CO and decrease vascular resistance (B2) - Acute heart failure
Dopamine
- Adrenergic agonist
- Catecholamine
- D1 > B1 > a1
D1 - low doses, vasodilation, increases renal flow
B1 - slightly higher doses, increases CO
B2 - Even higher doses, vasoconstriction - Used for septic and cardiogenic shock
Midodrine
- Adrenergic agonist
- Noncatecholamine
a1 agonist - Orthostatic hypotension
Can cause hypertension
Phenylephrine
- Adrenergic agonist
- Noncatecholamine
Selective a1 agonist
Vasoconstriction and ocular (mydriasis)
Maintain BP during surgery
Makes BPH worse
Increases intraocular pressure
Albuterol
- Adrenergic Agonist
- Short acting Beta 2 agonist
Inhalation
Asthma, COPD
Formoterol
- Adrenergic agonist
- Long Acting Beta 2 Agonist
Asthma, COPD
Indacaterol
- Adrenergic agonist
- Long Acting Beta 2 Agonist
COPD only
Mirabegron
- Adrenergic agonist
- Long Acting Beta 2 Agonist
B3 agonist
Relaxes detrusor muscle during storage phase of urinary bladder fill-void cycle
Treatment of OAB
Increases BP, UTI
Apraclonidine
Brimonidine
- Adrenergic Agonist
- Imidazoline
Ocular a2
Reduces aqueous humor secretion
Used for open angle glaucoma
Salmeterol
- Adrenergic agonist
- Long Acting Beta 2 Agonist
Asthma, COPD
Avoid in 3A4 inhibitors (clindamycin) - due to increased risk of cardiovascular effects
Clonidine
- Adrenergic Agonist
- Imidazoline
a2 in CNS
Mediate reduction of sympathetic outflow from CNS - Hypertensive emergency
- Long acting for ADHD
Facial Erythema of Rosacea
Brimonidine
Amphetamine
- Adrenergic Agonist
- Indirect-acting adrenergic
Increases NE and dopamine release in CNS and peripheral - vasoconstriction, cardiac stimulation, increase BP, CNS stimulation - Narcolepsy
- ADHD
Phentolamine
- Adrenergic antagonist
- nonselective Alpha antagonist
Blocks a1 and a2, vasodilation - Hypertensive episodes
Pseudophedrine
- Adrenergic Agonist
- Mixed-acting adrenergic
Activates a, very little Beta - Nasal decongestant
Cocaine
- Adrenergic Agonist
- Indirect-acting adrenergic
Increases NE and dopamine by inhibiting reuptake
Drugs not preferred as single drug regimen for HTN
Doxazosin
Terazosin
Metoprolol
- Adrenergic antagonist
- Selective Beta antagonist
Tamsulosin
Uroselective, causes less vasodilation
Only indicated in BPH
Doxazosin
Terazosin
Tamsulosin
- Adrenergic antagonist
- Selective Alpha antagonist
Blocks a1 receptors
Relaxes vascular and other smooth muscles of bladder and prostate - First dose syncope
- Inoperative Floppy Iris Syndrome
- Asthenia
Propanol
Timolol
- Adrenergic antagonist
- Nonselective Beta antagonist
Blockade of B1 - reduces negative chronotropic, inotropic, and dromotropic effect
- reduces renin secretion
- Masks signs of hypoglycemia
- Reduces aqueous humor secretion
Blockade of B2 - Bronchoconstriction
- Inhibits glyogenolysis
Tiotropium
Cholinergic Antagonist
COPD
Long acting
Timolol
- Adrenergic antagonist
- Nonselective Beta antagonist
Atenolol
- Adrenergic antagonist
- Selective Beta antagonist
Nebivolol
- Adrenergic antagonist
- Selective Beta antagonist
Causes vasoconstriction by increasing release of NO
Carvedilol
- Adrenergic antagonist
- Alpha and non-selective Beta antagonist
Heart failure
Fatigue
Labetalol
- Adrenergic antagonist
- Alpha and non-selective Beta antagonist
Metoprolol XL
- Adrenergic antagonist
- Selective Beta antagonist
Indicated for HEART FAILURE
Precautions w/ Alpha and Beta Antagonists
- Caution in asthma, COPD, diabetes
- Should be avoided in ACUTE SETTING OF COCAINE TOXICITY in patients w/ cocaine-associated chest pain and/or MI
- Do not abruptly disontinue
