Pharm Flashcards
Norepinephrine
Alpha1>Alpha2>B1
APPLICATIONS: hypotension (but decreased renal perfusion)
Epinephrine
B>alpha
APPLICATIONS: anaphylaxis, open angle glaucoma, asthma, hypotension. Alpha effects predominate at high doses
Isoproterenol
Direct sympathomimetic. B1=B2
APPLICATIONS: electrophysiologic evaluation of tachyarrhythmias. Can worsen ischemia.
Dopamine
D1=D2>B>alpha
APPLICATIONS: unstable bradycardia, heart failure, shock; ionotropic and chronotropic alpha effects predominate at higher doses.
Dobutamine
Direct sympathomimetic. B1>B2, alpha
APPLICATIONS: heart failure (inotropic>chronotropic), cardiac stress testing
Phenylephrine
Direct sympathomimetic. alpha1>alpha2
APPLICATIONS: hypotension (vasoconstriction), ocular procedures (mydriatic), rhinitis (decongestant)
Albuterol, salmeterol, terbutaline
B2>B1
APPLICATIONS: albuterol for acute asthma; salmeterol for long-term asthma or COPD control; terbutaline to reduce premature uterine contractions
Amphetamine
Indirect sympathomimetic.
EFFECT: indirect general agonist, reuptake inhibitor, also releases stored catecholamines.
APPLICATIONS: narcolepsy, obesity, ADD
Ephedrine
Indirect sympathomimetic
EFFECT: indirect general agonist, releases stored catecholamines
APPLICATIONS: nasal decongestant, urinary incontinence, hypotension
Cocaine
Indirect sympathomimetic
EFFECT: indirect general agonist, reuptake inhibitor
APPLICATIONS: causes vasoconstriction and local anesthesia; never give B blockers if cocaine intoxication is suspected (can lead to unopposed alpha 1 activation and extreme hypertension)
Clonidine
Sympatholytic (alpha2 agonist)
APPLICATIONS: 1. hypertensive urgency (limited situations); does not decrease renal blood flow 2. ADHD, severe pain, and a variety of off-label indications (e.g. Ethanol and opioid withdrawal)
TOXICITY: CNS depression, bradycardia, hypotension, respiratory depression, and small pupil size
Alpha-methyldopa
Sympatholytic (alpha2 agonist)
APPLICATIONS: hypertension in pregnancy (safe in pregnancy)
TOXICITY: direct Coombs positive hemolytic anemia, SLE-like syndrome
Phenoxybenzamine
Nonselective alpha blocker (IRREVERSIBLE)
APPLICATIONS: pheochromocytoma (used preoperatively) to prevent catecholamine (hypertensive) crisis
TOXICITY: orthostatic hypotension, reflex tachycardia
Phentolamine
Reversible non selective alpha blocker
APPLICATIONS: give to patients on MAO inhibitors who eat tyramine-containing foods (tyrosine and MAOis will increase availability of NE, DA, and serotonin)
Prazosin
Alpha1 selective alpha blocker
APPLICATIONS: urinary symptoms of BPH, PTSD, hypertension
Terazosin
Alpha1 selective alpha blocker
APPLICATIONS: urinary symptoms of BPH, hypertension
Doxazosin
Alpha1 selective alpha blocker
APPLICATIONS: urinary symptoms of BPH, hypertension
Tamsulosin
Alpha1 selective alpha blocker
APPLICATIONS: urinary symptoms of BPH
Mirtazapine
Alpha 2 selective blocker
APPLICATIONS: depression
TOXICITY: sedation, increased serum cholesterol, increased appetite
Metoprolol
B1 selective antagonist
EFFECTS: 1. Angina-decreases heart rate and contractility, resulting in decreased oxygen consumption 2. MI-decreases mortality 3. SVT-decreases AV conductance velocity (class II antiarrhythmic) 4. Hypertension- decreases CO, decreases renin secretion (due to B1 receptor blockade on JGA cells) 5. CHF- slows progression of chronic failure
TOXICITY: impotence, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (seizures, sedation, sleep alterations), dyslipidemia, may cause exacerbation of people with COPD or asthma
Bethanechol
Cholinergic agonist
APPLICATIONS: postoperative ileus, neurogenic ileus, and urinary retention
ACTIONS: activates bowel and bladder smooth muscle; resistant to AChE
Carbachol
Cholinergic agonist
APPLICATIONS: glaucoma, pupillary constriction, and relief of intraocular pressure
ACTION: Carbon copy of acetylcholine
Pilocarpine
Cholinergic agonist
APPLICATIONS: potent stimulator of sweat, tears, and saliva; open angle and closed angle glaucoma
ACTION: contracts ciliary muscle of eye (open angle glaucoma), pupillary sphincter (closed angle glaucoma); resistant to AChE
Methacholine
Cholinergic agonist
APPLICATIONS: challenge test for diagnosis of asthma
ACTIONS: stimulates muscarinic receptors in irritates when inhaled
Neostigmine
Anticholinesterase
APPLICATIONS: postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of NMJ blockade (postoperative)
ACTION: increases endogenous ACh; NO CNS penetration
Pyridostigmine
Anticholinesterase
APPLICATIONS: myasthenia gravis (long acting); does not penetrate CNS
ACTION: increases endogenous ACh; increases strength
Physostigmine
Anticholinesterase
APPLICATIONS: anticholinergic toxicity (crosses BBB)–atropine overdose
ACTION: increases endogenous ACh
Donepezil
Anticholinesterase
APPLICATIONS: Alzheimer’s disease
ACTION: increases endogenous ACh
Rivastigmine
Anticholinesterase
APPLICATIONS: Alzheimer’s disease
ACTION: increases endogenous ACh
Galantamine
Anticholinesterase
APPLICATIONS: Alzheimer’s disease
ACTION: increases endogenous ACh
Edrophonium
anticholinesterase
APPLICATIONS: historical, diagnosis of myasthenia gravis (extremely short acting). Myasthenia now diagnosed by anti-AChR antibodies
ACTION: increases endogenous ACh
Antidote to organophosphate poisoning
Atropine + pralidoxime (regenerates AChE if given early)
Atropine
Muscarinic antagonist in EYE
APPLICATIONS: produce mydriasis and cycloplegia
Homatropine
Muscarinic antagonist in EYE
APPLICATIONS: produce mydriasis and cycloplegia
Tropicamide
Muscarinic antagonist in EYE
APPLICATIONS: produce mydriasis and cycloplegia
Benzotropine
Muscarinic antagonist in CNS
APPLICATIONS: Parkinson’s disease
Scopolamine
Muscarinic antagonist in CNS
APPLICATIONS: motion sickness
Ipratropium
Muscarinic antagonist in RESPIRATORY system
APPLICATIONS: COPD, asthma
Tiotropium
Muscarinic antagonist in RESPIRATORY system
APPLICATIONS: COPD, asthma
Oxybutynin
Muscarinic antagonist in GU system
APPLICATIONS: reduce urgency in mild cystitis and reduce bladder spasms
Solifenacin
Muscarinic antagonist in GU system
APPLICATIONS: reduce urgency in mild cystitis and reduce bladder spasms
Glycopyrrolate
Muscarinic antagonist in GI and RESPIRATORY systems
APPLICATIONS: parenteral- preoperative use to reduce airway secretions. Oral- drooling, peptic ulcer
Atropine
Muscarinic antagonist. Used to treat bradycardia and for ophthalmic applications
EYE: increases pupil dilation, cycloplegia AIRWAY: decreases secretions STOMACH: decreases acid secretion GUT: decreases motility BLADDER: decreases urgency in cystitis
TOXICITY: increased body temp (due to decreased sweating), rapid pulse, dry mouth, dry flushed skin, cycloplegia, constipation, disorientation
Acebutolol
B1 selective antagonist
EFFECTS: 1. Angina-decreases heart rate and contractility, resulting in decreased oxygen consumption 2.Hypertension- decreases CO, decreases renin secretion (due to B1 receptor blockade on JGA cells) 3. CHF- slows progression of chronic failure
TOXICITY: impotence, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (seizures, sedation, sleep alterations), may cause exacerbation of people with COPD or asthma
Betaxolol
B1 selective antagonist
EFFECTS: 1. Angina-decreases heart rate and contractility, resulting in decreased oxygen consumption 2. SVT-decreases AV conductance velocity (class II antiarrhythmic) 3. Hypertension- decreases CO, decreases renin secretion (due to B1 receptor blockade on JGA cells) 4. CHF- slows progression of chronic failure
TOXICITY: impotence, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (seizures, sedation, sleep alterations), may cause exacerbation of people with COPD or asthma
Carvedilol
Nonselective alpha and beta antagonist
EFFECTS: 1. Angina-decreases heart rate and contractility, resulting in decreased oxygen consumption 2. MI-decreases mortality 3. SVT-decreases AV conductance velocity (class II antiarrhythmic) 4. Hypertension- decreases CO, decreases renin secretion (due to B1 receptor blockade on JGA cells) 5. CHF- slows progression of chronic failure
TOXICITY: impotence, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (seizures, sedation, sleep alterations), may cause exacerbation of people with COPD or asthma
Esmolol
B1 selective antagonist
EFFECTS: 1. Angina-decreases heart rate and contractility, resulting in decreased oxygen consumption 2. SVT-decreases AV conductance velocity (class II antiarrhythmic) 4. Hypertension- decreases CO, decreases renin secretion (due to B1 receptor blockade on JGA cells) 5. CHF- slows progression of chronic failure
TOXICITY: impotence, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (seizures, sedation, sleep alterations), may cause exacerbation of people with COPD or asthma
Atenolol
B1 selective antagonist
EFFECTS: 1. Angina-decreases heart rate and contractility, resulting in decreased oxygen consumption 2. SVT-decreases AV conductance velocity (class II antiarrhythmic) 3.Hypertension- decreases CO, decreases renin secretion (due to B1 receptor blockade on JGA cells) 4. CHF- slows progression of chronic failure
TOXICITY: impotence, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (seizures, sedation, sleep alterations), may cause exacerbation of people with COPD or asthma
Nadolol
Nonselective B1=B2 antagonist
EFFECTS: 1. Angina-decreases heart rate and contractility, resulting in decreased oxygen consumption 2. SVT-decreases AV conductance velocity (class II antiarrhythmic) 3. Hypertension- decreases CO, decreases renin secretion (due to B1 receptor blockade on JGA cells) 4. CHF- slows progression of chronic failure
TOXICITY: impotence, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (seizures, sedation, sleep alterations), may cause exacerbation of people with COPD or asthma
Timolol
Nonselective B1=B2 antagonist
EFFECTS: 1. Angina-decreases heart rate and contractility, resulting in decreased oxygen consumption 2. SVT-decreases AV conductance velocity (class II antiarrhythmic) 3. Hypertension- decreases CO, decreases renin secretion (due to B1 receptor blockade on JGA cells) 4. CHF- slows progression of chronic failure 5. Glaucoma-decreases secretion of aqueous humor
TOXICITY: impotence, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (seizures, sedation, sleep alterations), may cause exacerbation of people with COPD or asthma
Pindolol
Nonselective B1=B2 antagonist–partial agonist
EFFECTS: 1. Angina-decreases heart rate and contractility, resulting in decreased oxygen consumption 2. SVT-decreases AV conductance velocity (class II antiarrhythmic) 3. Hypertension- decreases CO, decreases renin secretion (due to B1 receptor blockade on JGA cells) 4. CHF- slows progression of chronic failure
TOXICITY: impotence, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (seizures, sedation, sleep alterations), may cause exacerbation of people with COPD or asthma
Labetalol
Nonselective Alpha and B antagonist
EFFECTS: 1. Angina-decreases heart rate and contractility, resulting in decreased oxygen consumption 2. SVT-decreases AV conductance velocity (class II antiarrhythmic) 3. Hypertension- decreases CO, decreases renin secretion (due to B1 receptor blockade on JGA cells) 4. CHF- slows progression of chronic failure
TOXICITY: impotence, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (seizures, sedation, sleep alterations), may cause exacerbation of people with COPD or asthma
Acetaminophen antidote
N-acetylcysteine (replenishes glutathione)
AChE inhibitors, organophosphate antidote
Atropine + pralidoxime
Amphetamine antidote
NH4Cl-ammonium chloride–acidify urine to trap the weak base
Antimuscarinic, anticholinergic agent antidote
Physostigmine salicylate, control hyperthermia
Benzodiazepine antidote
Flumazenil (competitive antagonist at GABA benzodiazepine receptor)
B blocker antidote
Glucagon
Carbon monoxide antidote
100% oxygen, hyperbaric oxygen
Copper, arsenic, gold antidote
Penicillamine
Cyanide antidote
Nitrite + thiosulfate, hydroxocobalamin
Digitalis antidote
Anti-dig Fab fragments
Heparin antidote
Protamine sulfate
Iron antidote
Deferoxamine, deferasirox
Lead antidote
EDTA, dimercaprol, succimer, penicillamine
Mercury, arsenic, gold antidote
Dimercaprol, succimer
Methanol, ethylene glycol (antifreeze)
Fomepizole>ethanol, dialysis
Fomepizole inhibits alcohol dehydrogenase
Methemoglobin antidote
Methylene blue, vitamin c
Opioid antidote
Naloxone
Salicylate antidote
NaHCO3 (alkalinize urine), dialysis
TCA antidote
NaHCO3 (plasma alkilinization)
TPA, streptokinase, urokinase antidote
Aminocaproic acid
Warfarin antidote
Vitamin K, plasma (if active bleeding)
Hyoscyamine
Muscarinic antagonist targeting GI system
Antispasmodic for IBS
Dicyclomine
Muscarinic antagonist targeting GI system
Antispasmodic for IBS
Tetrodotoxin
Highly potent toxin that binds fast voltage-gated Na+ channels in cardiac and nerve tissue, preventing depolarization (blocks action potential without changing resting potential). Causes nausea, diarrhea, parasthesias, weakness, dizziness, loss of reflexes. Treatment is supportive. Poison can result from ingestion of poorly prepared pufferfish, a delicacy in japan
Ciguatoxin
Causes ciguatera fish poisoning. Opens Na+ channels causing depolarization. Symptoms easily confused with cholinergic poisoning. Temperature related dysesthesia (e.g. Cold feels hot, hot feels cold) is regarded as a specific finding here. Treatment is supportive. Dissed by consumption of reef fish (e.g, barracuda, snapper, moray eel)
Scombroid poisoning
Acute onset burning sensation of the mouth, flushing of a face, erythema, urticaria pruritis, headache. May cause anaphylaxis-like presentation. Treat supportively with antihistamines; if needed, antianaphylactics. Caused by consumption of dark meat fish (elf. Bonito, mackerel, mahi-mahi, tuna) improperly stored a warm temp. Bacterial histidine decarboxylase converts histidine to histamine. Histamine is not degraded by cooking. Frequently misdiagnosed as allergy to fish!
Nebivolol
MOA: B blocker; combines cardiac-selective B1 adrenergic blockade with stimulation of B3 receptors, which activate NO synthase in the vasculature
Parathion
Organophosphate that irreversibly inhibits AChE leading to cholinergic toxicity. Often seen in farmers. Antidote is atropine + pralidoxime
Tolterodine
Muscarinic antagonist in GU system
APPLICATIONS: reduce urgency in mild cystitis and reduce bladder spasms
