Other One-Liners Flashcards
The selective agents lose their selectivity at
high doses
Another pneumonic for anticholinergic toxicity
“dry as a bone, red as a beet, mad as a hatter, hot as a hare, blind as a bat”
These beta blockers are less lipid soluble
Acebutolol and atenolol
This diuretic decreases aqueous secretion due to lack of HCO3- ion. Causes drowsiness and paresthesias, alkalinization of the urine may precipitate calcium salts, hypokalemia, acidosis
Acetazolamide
Short acting Beta 2 agonists that is drug of choice in treatment of acute asthma but not recommended for prophylaxis
Albuterol
Phenylisopropylamines that are used legitimately and abused for narcolepsy, attention deficit disorder, and weight reduction
Amphetamines
Toxicity of anticholinergics
Anti-DUMBBELSS
Selective alpha agonists that decreases aqueous secretion
Apraclonidine, brimonidine
Treatment of muscarinic symptoms in organophosphate overdose
Atropine
Clinical uses of these agents include treatment of HTN, angina, arrhythmias, and chronic CHF
Beta blockers
Toxicity of these agents include bradycardia, AV blockade, exacerbation of acute CHF, signs of hypoglycemia may be masked (tachycardia, tremor, and anxiety)
Beta blockers
These agents increase blood flow and may be beneficial in treatment of acute heart failure and some types of shock
Beta1 agonists
Reversal of blockade by neuromuscular blockers
Cholinesterase inhibitors
Reduce transient hyper GI motility
Dicyclomine, methscopolamine
Antiglaucoma organophosphate, indicated but not used much clinically anymore due to long duration of action
Echothiophate
Indirect-Acting ACh Agonist, alcohol, short DOA and used in diagnosis of myasthenia gravis
Edrophonium
Long acting sympathomimetic, sometimes used to improve urinary continence in children and elderly with enuresis
Ephedrine
This is the drug of choice for anaphylactic shock
Epinephrine
Nonselective alpha agonists that decrease aqueous production and increase aqueous outflow
Epinephrine, dipivefrin
This parenteral beta blocker is a short acting
Esmolol
Epinephrine and dipivefrin are used for
Glaucoma
Ganglion blockers that were indicated (but not anymore) for severe hypertension
Hexamethonium, trimethaphan
Shock due to septicemia or myocardial infarction is made worse by
Increasing afterload and tissue perfusion declines
Atropine fever is the most dangerous effect and can be lethal in this population group
Infants
Contraindications to use of atropine
Infants, closed angle glaucoma, prostatic hypertrophy
Combined alpha and beta blocking agents that may have application in treatment of CHF
Labetalol and carvedilol
Insecticide organophosphate
Malathion, parathion
Chronic orthostatic hypotension can be treated with
Midodrine
This beta blocker is the longest acting
Nadolol
Carbamate with intermediate action and used as off-label for postoperative paralytic ileus and urinary retention
Neostigmine
Tubocurarine is the prototype, pancuronium, atracurium, vecuronium are newer short acting agent, produce competitive block at end plate nicotinic receptor, causing flaccid paralysis
Nondepolarizing Neuromuscular Blockers
Prototypical drug is atropine
Nonselective Muscarinic Antagonists
Cystitis, postoperative bladder spasms, or incontinence
Oxybutynin, dicyclomine
Nonselective alpha-blocking drug, long acting and irreversible, and used to treat pheochromocytoma. Blocks 5-HT, so occasionaly used for carcinoid tumor. Blocks H1 and used in mastocytosis
Phenoxybenzamine
Nonselective alpha-blocking drug, short acting and reversible, used for rebound HTN from rapid clonidine withdrawal, and Raynaud’s phenomena
Phentolamine
Alpha agonist used to produce mydriasis and reduce conjunctival itching and congestion caused by irritation or allergy, it does not cause cycloplegia
Phenylephrine
Treatment of atropine overdose and glaucoma (because lipid soluable). Enters the CNS rapidly and has a stimulant effect, which may lead to convulsions
Physostigmine
Muscarinic that is very lipid soluble and used in glaucoma
Pilocarpine
Muscarinic used to treat dry mouth in Sjˆgren’s syndrome
Pilocarpine or Cevimeline
Cholinomimetics that increase outflow, open trabecular meshwork, and cause ciliary muscle contraction
Pilocarpine, carbachol, physostigmine
Beta blockers partial agonist activity (intrinsic sympathomimetic activity) cause some bronchodilation and may have an advantage in treating patients with asthma
Pindolol and acebutolol
This agent competes for phosphorylated cholinesterase enzyme and regenerates enzyme if organophosphate-enzymes complex has not “aged”
Pralidoxime
This beta blocker is highly lipid soluble and may account for side effects such as nightmares
Propranolol
This agent cause increased aqueous outflow
Prostaglandin PGF2a (latanoprost, travoprost, unoprostone)
Treatment of myasthenia gravis and sometimes used prophylactically for organophosphate poisoning in chemical warfare
Pyridostigmine
Newer alpha 2 agonist (apraclonidine and brimonidine) treat glaucoma
Reduce aqueous synthesis
Often mixed with local anesthetic to
Reduce the loss from area of injection
The most important cause of acute deaths in cholinesterase inhibitor toxicity
Respiratory failure
Longer acting Beta 2 agonists is recommended for prophylaxis of asthma
Salmeterol
Beta 1 agonist toxicity
Sinus tachycardia and serious arrhythmias
Beta 2 agonist toxicity
Skeletal muscle tremor
Only member of depolarizing neuromuscular blocker, causes fasciculation during induction and muscle pain after use
Succinylcholine
Beta 2 agonist used to suppress premature labor, but cardiac stimulatory effects may be hazardous to mother and fetus
Terbutaline
Selective Alpha 2 blocker used for impotence (controversial effectiveness)
Yohimbine
NSAID avoided in gout because low doses increases uric acid levels
Aspirin
Period of time of therapy after which GC therapy will need to be tapered
5-7 days
Four main actions of NSAIDS
Anti-inflammatory, analgesia, antipyretic and antiplatelet activity
Irreversible, nonselective COX inhibitor
Aspirin (or other salicylates)
Difference between aspirin and other NSAIDS
Aspirin irreversibly inhibits cyclooxygenase
Long acting GC’s
Betamethasone, dexamethasone, and paramethasone
Drug that selectively inhibits COX 2
Celecoxib
Newer NSAIDs that selectively inhibit COX-2
Celecoxib
Short acting GC’s
Cortisone and hydrocortisone (equivalent to cortisol)
Difference between COX 1 and COX 2
COX 1 is constitutive while COX 2 may be induced during inflammation, although COX 2 is constitutive in some tissues
Mineralocorticoids
Fludrocortisone and deoxycorticosterone
COX 2 inhibitors may have reduced risk of
Gastric ulcers and GI Bleeding
Used for Addison’s disease, Congenital Adrenal Hyperplasia (CAH), inflammation, allergies, and asthma (as a local inhalation)
Glucocorticoids
SE of acetaminophen
Hepatotoxicity
NSAID used in gout
Indomethacin, ibuprofen
MOA of corticosteroids
Induce lipocortins to 1. inhibit phospholipase A2, 2. repress COX-2 gene and enzyme expression, 3. repress cytokines that activate COX-2
MOA of NSAIDS
inhibit prostaglandin synthesis by inhibiting cyclo-oxygenase (cox)
NSAID available orally, IM, IV, nasally, and ophthalmically
Ketoralac
NSAID that is used for acute condition, such as pre-op anesthesia and has limited duration (<5 days) of use due to nephrotoxicity
Ketoralac
Major SE of zileuton
Liver toxicity