First Semester Test 2 Cholinergics / Adrenergics Flashcards
Cholinergics Table
Cholinergic overdose
D - Defication/Diarrhea
U - Urination
M - Miosis
B - Bronchorrhea/Bronchospasm/Bradycardia
E - Emesis/ExcitationLacrimation
S - Salivation/Sweating
DUMBELS
Cholinergic PNS Receptor subtypes
Cholinergic (PANS - Parasympathetic (rest& digest) Autonomic Nervous System)
M1 - CNS Neurons
M2 - Myocardium smooth M.
M3 - Exocrine glands vessels (smooth & endo)
M4 - CNS neuron, Vagal nerve endings
M5 - Vascular endothelium, cerebral vessels, CNS neurons
Nn (Nicotinic Neuronal) - Post ganglionic nuerons, some presynaptic ACh ternimals, CNS
Nm (Nicotinic Muscular) - Skeleral Muscle (nueromuscular end plates)
Muscarinic Agonists
Muscarinics - Methacholine
Can - Carbachol
Be - Bethanechol
Pretty - Pilocarpine
Cool - Cevimeline
Actions:
Bradycardia INC Urination
Bronchoconstriction Vasodilation
Miosis INC Cognition
INC Secretions Tremor
INC GI Motility
Muscarinic Agonist Specifics
Methacholine - Asthma testing
Bethanechol - Post-op urinary retention
Carbachol - Glaucoma
Pilocarpine - Glaucoma/Xerostomia
Cevimeline - Xerostomia
Indirect Muscarinic Agonist (Acetylcholinesterase inhibitor) Agents
Don’t - Donepezil
Test - Tacrine
Griffin - Galantamine
Rogers - Rivastigmine
Indirect Muscarinic Agonist (Acetylcholinesterase inhibitor) Actions / ADRs
Actions:
Enhance cognition, mood, and behavior
ADRs:
Bradycardia
Dizziness/Lightheadedness
INC urinary frequency
Nausea
Diarrhea
Indirect Muscarinic Agonist (Acetylcholinesterase inhibitor) Specifics
Tacrine - off market, hepatoxic
Donepezil - For severe Alzheimer’s
Rivastigmine - mild/moderate AD, parkinsons
Galantamine - mild/moderate AD
Indirect Muscarinic Agonist (non-Alzheimers Acetylcholinesterase Inhibitor (NAAI))
Even - Edrophonium
Now - Neostigmine
People - Pyridostigmine
Are - Ambenonium
Praying - Physostigmine
Often - Organophosphate
NAAI Actions/ADRs
Actions:
Increase ACh at the NMJ
ADRs:
Muscarinic receptor activation
Muscle cramping
Cholinergic crisis
Myasthenic Crysis
Organophosphate Toxicity
NAAI Specifics
Edrophonium - Assess Cholinergic/myasthenic crisis
Neostigmine/Pyridostigmine/Ambenonium - Myasthenia Gravis
Physostigmine - Anticholinergic Toxidrome
Organophosphates: Sarin, Parathion And Malathion
Covalently bond enzyme active site leading to irreversible inhibition of AChE (prevents clearance of ACh)
Nicotinic Agonists
Varenicline - Used for smoking cessation (Partial agonist a4B2
Actions: Suppress nicotine withdrawal symptoms
ADRs:
Vivid/abnormal dreams
N/V
Constipation
Neuropsychiatric disorders
Nicotinic non-depolarizing Muscular Blockers (NMB)
Nicotinic muscular (Nm) antagonists
Always - Atracurium
Come - Cisatracurium
Round - Rocuronium
Very - Vecuronium
Patiently - Pancuronium
Actions: Competitively bind receptor at NMJ inhibiting muscle contraction
ADRs: Prolonged apnea from diaphragm paralysis
Neostigmine to clear NMB w/Atropine to Antagonize muscarinic receptor
Nicotinic Depolarizing NMB (Agonist)
Succinylcholine - Short-acting
Actions: Continual depolarization of NMJ
ADRs: Malignant hypothermia (uncontrolled calcium release)
Dantrolene to treat malignant Hypothermia
Other Nicotinics
Bupropion - Antidepressant & some use in smoking cessation
ADRs:
Agitation, Insomnia, Irritability, Dry Mouth, Nausea, Tachycardia
*can lower Seizure threshold-> dosing limitations
Wightloss-> can be a favorable adverse effect
Alpha 1 Adrenergic Table
Alpha 2 Adrenergic Table
Direct Antimuscarinic (antagonists) Agents
Antimuscarinic (antagonists) Actions/ADRs
Actions: Tachycardia, Bronchodilation, Mydriasis, DEC secretions, DEC GI motility, DEC urination, DEC cognition, DEC tremor, Vasoconstriction
ADRs:
Anticholinergic Toxidrome
Anticholinergic Toxidrome
Hot / Dry / Crazy
Adrenergics - Amphetamines
Mad - Methamphetamine
About - Amphetamine/Dextroamphetamine
Dead - Dextroamphetamine
Lizards - Lisdexamphetamine - Binge eating, prodrug of Dextroamphetamine
Actions: Promotes release of NE and some Dopamine
Specifics: ADHD, Obesity, Narcolepsy, Central Stimulants
Adrenergics - Non-Amphetamines
M. - Methylphenidate
D. - Dexmethylphenidate
Actions: Promotes release of dopamine and some NE
Adrenergics - Others
C - Cocaine
A - Atomoxetine
Mo - Modafinil
Actions: Increase SANS effect
Specifics: ADHD, Topical anaesthesia, Narcolepsy, Circadian Rythm disturbance
Adrenergics - Selective Alpha 1 Agonists
- rine
- oline
Many - Midodrine
People - Pseudoephedrine
Never - Naphazoline
Order - Oxymetazoline
Pizza - Phenylephrine
Actions: Vasoconstriction, Nasal mucosal vasoconstriction, Contraction of bladder/urethra/prostate, Mydriasis (eye vasoconstriction (dilated pupil))
Alpha Agonizes over 1 select Midodrine
Selective Alpha 1 Agonists ADRs/Specifics
ADRs:
Any unintended action
Midodrine - Orthostatic HTN
Phenylephrine - Cough/cold IV vasopressor
Pseudoephedrine - Decongestant
Oxymetazoline - Nasal Spray for Rhinitis
Naphazoline - Eyedrops for red eye
Alpha Agonizes over 1 select Midodrine
Adrenergics - Selective Alpha 1 Antagonists
- Zosin
- Osin
Please - Prazosin - PTSD, HTN, & BPH
Tell - Terazosin - HTN & BPH
Dexter - Doxazosin - HTN & BPH
A - Afluzosin - BPH
Scary - Silodosin - BPH (Least hypotensive)
Tale - Tamsulosin - BPH
Actions: Decrease BP, Relaxation of prostate smooth muscle
ADRs: Hypotension via vasodilation (vascular, mucosa, eye), Reflex tachycardia, First dose phenomenon, Dizzyness
-Zosin antagonizes 1 select alpha male
Adrenergics - Selective Alpha 2 Agonists
C - Clonidine - HTN, ADHD, Withdrawal, Muscle spasm
T - Tizanidine /
Men - Methyldopa - HTN in pregnancy
Grow - Guanfacine - Peds ADHD, Old HTN drug
Big - Brimonide - Glaucoma (drops)
And - Apraclonidine /
Douchey - Dexmedetomidine - IV sedative w/ analgesic properties
Clon I Dine** with **2 select agonizing alphas
Selective Alpha 2 Antagonists
Yohimbine - Antagonizes a2
Used for ED (non-FDA approved)
Adrenergics - Nonselective Alpha Antagonists
Phenoxybenzamine - Antagonize all a - Oral
Phentolamine - Antagonize all a - IV/IM
Used for diagnosis/treatment of pheochromocytoma
May be used for treatment of extravasation from IV a1 agonist
ADRs: Nasal congestion, miosis, orthostatic HTN
Beta 1 Adrenergic Table
Beta 2 Adrenergic Table
Adrenergics - Selective Beta 1 Agonists
Dobutamine - Beta 1 agonist
Specifics: Cardiogenic shock; Septic shock; Acute CHF; Vasopressor
Adrenergics - Selective Beta 1 Antagonists
Always - Acebutolol
Always - Atenolol
Buy - Betaxolol
Big - Bisoprolol
Epic - Esmolol
Modern - Metoprolol - Most common
Novels - Nebivolol - Generally maintains selectivity
ADR:
Non-selective at high dose
Beta Blockers, LOL!
Adrenergics - Selective Beta 2 Agonists
Albert - Albuterol - Short acting
Left - Levalbuterol /
For - Formoterol
Sydney - Salmeterol
Today - Terbutaline
Specifics: Local admin for Asthma/Bronchospasm
Beta -rol 2 sydney Agon
Adrenergics - Non-Selective Beta Antagonists
Tender - **Timolol **
Loving - Levobunolol - Eye Drops
Care - Carteolol /
Never - Nadalol - Portal HTN
Produces - Propranolol - Migraine
Strong - Sotalol - Anti-arrhythmic
People - Pindolol
Adrenergics - Beta 3 Agonists
Mirabegron - Overactive bladder
Actions: Relaxation of detrusor muscle (INC bladder capacity)
ADR: INC BP, Tachycardia
Adrenergics - Beta 1,2, and Alpha 1 Antagonists
Labetalol - Tachy and HTN (HTN from hitting A1, treats HTN in Pregnancy)
Carvedilol - Same as above plus great for Systolic HF (along with metoprolol and Bisoprolol)
ADRs:
First dose Phenomenon, reflex tachy
Adrenergics - Vasopressors (adrenergic agonists)
Selective a1 Agonist
Phenylephrine (IV) - INC Vascular Resistance
Selective B Agonist
Dobutamine (IV) - Cardiogenic shock, septic shock, and acute CHF
Non-Selective B Agonist
Isoproterenol (IV) - Positive inotrope
Adrenergics - Vasopressors (adrenergic agonists) - Catecholamines
Agonist at a1, a2, & B1
Norepinephrine (IV) - (Primarily a1, with negligible a2, and B1) Hypotension, Shock, and Sepsis
Nonselective Adrenergic Agonist
Epinephrine - (Low dose: B, High dose: a as well as B), Shock, Anaphylaxis, Asystole, Hypotension (Can be used with topical anaesthetics as vasoconstriction prolongs anaesthetic effect)
Adrenergics - Vasopressors (adrenergic agonists) Dopamine receptor Agonists (D1)
Dopamine (IV) - (Low dose hits D1, Moderate dose adds B1, and at High dose add a1) (loosely mimics epinephrine) a1 and B1 override D1 activation. Renal benefit lost at high dose
Actions: Vasodilation of Coronary Vessels, INC GFR (renal vasodilation)
ADRs: Hypoperfusion, Dysrhythmias, Peripheral IV concerns
