Pharmacology: Autonomic drugs Flashcards
Bethanechol
Direct cholinergic agonist
Carbachol
Direct cholinergic agonist
Pilocarpine
Direct cholinergic agonist
Methacholine
Direct cholinergic agonist
Neostigmine
Indirect cholinergic agonist (AChEI)
- No CNS penetration!
- For reversal of NMJ junction blockade (post-op)
Pyridostigmine
Indirect cholinergic agonist (AChEI)
- Myasthenia gravis
Edrophonium
Indirect cholinergic agonist (AChEI)
Physostigmine
Indirect cholinergic agonist (AChEI)
- Atropine OD
Echothiophate
Indirect cholinergic agonist (AChEI)
- Glaucoma (contricts pupil)
Donepezil
Indirect cholinergic agonist (AChEI)
- AD
Pralidoxime
Reactivates inhibited AchE
- Use with atropine for organophosphate poisoning
Atropine
Muscarinic antagonist - eye, airway, stomach, gut, bladder
Homatropine
Muscarinic antagonist - eye
Tropicamide
Muscarinic antagonist - eye
Benztropine
Muscarinic antagonist - CNS
- Dystonia
- Parkinson’s (2nd line, improves tremor, not rigidity and bradycardia)
Scopolamine
Muscarinic antagonist - CNS
Ipratropium
Muscarinic antagonist - lung
Oxybutynin
Muscarinic antagonist - GU
Glycopurrolate
Muscarinic antagonist - GU
- Reduce urgency in mild cystitis and reduce bladder spasms
Methscoplolamine
Muscarinic antagonist - GI
- PUD
Pirenzepine
Muscarinic antagonist - GI
- PUD
Propantheline
Muscarinic antagonist - GI
- PUD
Toxicity of anticholinergics
Hot, dry, red, blind, mad
- Hyperthemia
- Urinary retention
- Constipation
- Flushed skin (decr vasoconstriction)
- Cycloplegia
- Acute angle closer glaucoma
- Disorientation
Epinephrine
Non-selective Alpha1/2, Beta1/2
Low dose: Beta2 > Alpha1 (vasodilatatory)
High dose: Alpha1 > Beta2 (vasocontrictive)
Norepinephrine
Alpha1/2 > Beta1
Isoproterenol
Beta1/2 selective
- B1: tachycardia
- B2: relaxes bronchial smooth muscle
Dobutamine
Beta1 selective, minor Beta2 and Alpha1/2 effects
- Cardiac stress testing
Phenylephrine
Alpha1>2 selective
- Pupillary dilation
- Vascocontriction
- Decongestant (2/2 vasoconstriction)
- Cardiac stress testing
Dopamine
Low: D1
Med: Beta1/2
High: Alpha1/2
Metaproterenol
Beta2 agonist (some Beta1) - Acute asthma (MAST)
Albuterol
Beta2 agonist (some Beta1) - Acute asthma (MAST)
Salmeterol
Beta2 agonist (some Beta1) - Long-term asthma management (MAST)
Terbutaline
Beta2 agonist (some Beta1) - For premature uterine contractions (MAST)
Ritodrine
Beta2 agonist (pure) - Decr premature uterine contractions
Amphetamine
Indirect sympathomimetic (release stored catecholamines)
Ephedrine
Indirect sympathomimetic (release stored catecholamines)
Cocaine
Indirect sympathomimetic (uptake inhibitor)
NorE vs. Isoproterenol vs. Phenelephrine?
NorE: alpha > beta1 (no beta2)
Isoproterenol: beta1/2 only
Phenelephrine: alpha only
Clonidine
Central apha2-agonist, sympathoplegic
Alpha-methyldopa
Central apha2-agonist, sympathoplegic
Phenoxybenzamine
Irreversible alpha-blocker
- Before pheochromocytoma removal
Phentolamine
Reversible alpha-blocker
- Reverse MAOI tyramine-food OD
Prazosin
Alpha1-selective blocker
- HTN, BPH,
- First dose orthostatic hypotension
Terazosin
Alpha1-selective blocker
- HTN, BPH,
- First dose orthostatic hypotension
Doxazosin
Alpha1-selective blocker
- HTN, BPH,
- First dose orthostatic hypotension
Mirtazapine
Alpha2-selective blocker
Acebutolol
Beta1-selective blocker with partial Beta-AGonist activity
Betaxolol
Beta1-selective blocker
Esmolol
Beta1-selective blocker
Atenolol
Beta1-selective blocker
Metoprolol
Beta1-selective blocker
Propanolol
Beta1/2-nonselective blocker
Timolol
Beta1/2-nonselective blocker
Nadolol
Beta1/2-nonselective blocker
Pindolol
Beta1/2-nonselective blocker with partial Beta-AGonist activity
Cavedilol
Alpha and Beta-nonselective blocker
- CHF
Labetalol
Alpha and Beta-nonselective blocker
- HTN
The two beta blockers with partial beta-agonist activity
Pindolol
Acebutolol