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STEP 1 > Autonomic Drugs > Flashcards

Autonomic Drugs Flashcards

1
Q

Name the direct cholinomimetic agonists

A

Bethanechol, carbachol, methacholine, pilocarpine

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2
Q

Use of bethanechol

A

postoperative ileus, neurogenic ileus, urinary retention

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3
Q

Action of bethanechol

A

Activate bowel and bladder smooth muscle

resistant to AChE

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4
Q

Use of cabachol

A

constricts pupil and relieves intraocular pressure in glaucoma

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5
Q

Use of methacholine

A

challenge test for diagnosing asthma

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6
Q

Mech of methacholine

A

stimulates muscarinic receptors in airway when inhaled –> bronchoconstriction

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7
Q

Use of pilocarpine

A

potent stimulator of sweat, tears and saliva

open-angle and closed-angle glaucoma

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8
Q

Action of pilocarpine

A

constricts the ciliary muscle of the eye (good for open-angle glaucoma)
constricts the pupillary sphincter (good for closed-angle glaucoma)

resistant to AChE

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9
Q

Name the indirect cholinergic agonists

A

donepezil, galantamine, rivastigmine, edrophonium, neostigmine, physostigmine, pyridostigmine

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10
Q

Use of donepezil, galantamine and rivastigmine

A

alzheimers disease –> increase in ACh

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11
Q

Use of edrophonium

A

historically to dx myasthenia gravis

now dx MG via anti-AChR antibody test

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12
Q

Use of neostigmine

A

postoperative and nuerogenic ileus and urinary retention
myasthenia gravis
reversal of neuromuscular junction blockade (postoperative)

DOES NOT CROSS BBB

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13
Q

Use of physostigmine

A

anticholinergic toxicity

CROSS BBB

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14
Q

Use of pyridostigmine

A

myastenia gravis (long-acting)

DOES NOT CROSS BBB

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15
Q

Caution with cholinomimetic agents in who?

A

Asthmatics and pts with COPD to avoid exacerbation of disease

also peptic ulcers

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16
Q

Cholinesterase inhibitor poisoning

A

often due to organophosphates (irreversibly inhibit AChE)

DUMBBELSS
diarrhea, urination, miosis, bradycardia, bronchoconstriction, excitation of muscle, lacrimation, sweating, salivation

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17
Q

Antidote to organophosphate poisoning

A

atropine (competitive inhibitor) + pralidoxime (regenerates AChE if given early)

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18
Q

Name the muscarinic antagonists

A

atropine, homatropine, tropicamide, benztropine, glycopyrrolate, hyoscyamine, dicyclomine, ipratropium, tiotropium, oxybutynin, solifenacin, tolterodine, scopolamine

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19
Q

Organ system affected by atropine, homatropine, and tropicamide

A

eye

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20
Q

Action of atropine, homatropine, and tropicamide

A

produce mydriasis and cycloplegia

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21
Q

Organ system action of benztropine

A

CNS

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22
Q

Action of benztropine

A

Parkinson disease

Acute dystonia

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23
Q

Organ system action of glycopyrrolate

A

GI and respiratory

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24
Q

Action of glycopyrrolate

A

parenteral: preoperative use to reduce airway secretions
oral: drooling, peptic ulcers

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25
Q

Organ system for hyoscyamine, dicyclomine

A

GI

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26
Q

Action of hyoscyamine, dicyclomine

A

antispasmodics for irritable bowel syndrome

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27
Q

Organ system for ipratropium and tiotropium

A

respiratory

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28
Q

Action of ipratropium and tiotropium

A

inhibit bronchoconstriction so good for asthmatics and pts with COPD

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29
Q

Organ system for oxybutynin, solifenacin, tolterodine

A

Genitourinary

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30
Q

Action of oxybutynin, solifenacin, tolterodine

A

use to tx patients with urinary incontinence/overactive bladder

reduce bladder spasms

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31
Q

Organ system for scopolamine

A

CNS

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32
Q

Action of scopolamine

A

motion sickness

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33
Q

Multiple effects of atropine

A 
Eye - pupil dilation and cycloplegia
Airway - decrease secretions
Stomach - decrease acid secretion
Gut - decrease motility
Bladder - decrease urgency in cystitis

blocks DUMBBeLLS (excitation is nicotinic receptors)

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34
Q

Toxicity of atropine

A

HOT (due to decreased sweating), DRY (no secretions), RED (flushed), BLIND (cycloplegia), MAD (disoriented)

can cause acute angle-closure glaucoma in elderly due to mydriasis, urinary retention in men with BPH, and hypertermia in infants

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35
Q

Jimson weed (Datura)

A

causes gardener’s pupil (mydriasis due to plant alkaloids)

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36
Q

Mech of tetrodotoxin

A

binds fast voltage-gated Na+ channels in cardiac and nerve tissue, preventing depolarization (blocks AP without changing resting potential)

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37
Q

Effects of tetrodotoxin

A

nausea, diarrhea, paresthesias, weakness, dizziness, loss of reflexes

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38
Q

Tx of tetrodotoxin poisoning

A

supportive

39
Q

How acquire tetrodotoxin

A

eating improperly prepared pufferfish (Japan)

40
Q

Mech of ciguatoxin

A

opens Na+ channels causing depolarization (symptoms often confused with colinergic poisoning)

41
Q

Effects of ciguatoxin

A

DUMBBELS PLUS

temperature-related dysesthesia (cold feels hot, hot feels cold)

42
Q

How acquire ciguatoxin

A

consumption of reef fish (ciguatera fish, barracuda, snapper, moray eel)

43
Q

Treatment of ciguatoxin

A

supportive

44
Q

Effects of scombroid poisoning

A

acute-onset burning sensation of the mouth, flushing of the face, erythema, urticaria, pruritis, headache

may be anaphylaxis-like presentation (brhoncospasms, angioedema, hypotension)

45
Q

Mech of scombroid poisoning

A

bacterial histidine decarboxylase converts histidine –> histamine
histamine not degraded by cooking (misdiagnosed as allergy to fish)

46
Q

How acquire scombroid poisoning

A

caused by consumption of dark-meat fish (bonito, mackerel, mahi-mahi, tuna) improperly stored at warm temperature

47
Q

Treatment of scombroid poisoning

A

antihistamines

if needed give antianaphylactics (epi)

48
Q

Albuterol, salmeterol receptors

A

B2 > B1

49
Q

Use of albuterol and salmeterol

A

albuterol for acute asthma; salmeterol for long-term asthma or COPD control

50
Q

Dobutamine receptors

A

B1 > B2, alpha

51
Q

Use of dobutamine

A

heart failure (HF) (inotropic > chronotropic), cardiac stress testing

52
Q

Dopamine receptors

A

D1 = D2 > beta > alpha

53
Q

Use of dopamine

A

unstable bradycardia, HF, shock; inotropic and chronotropic alpha effects predominate at high doses

54
Q

Epinephrine receptors

A

beta > alpha

55
Q

Use of epi

A

anaphylaxis, asthma, open-angle glaucoma

alpha effects predominate at high doses

significantly stronger effects at beta2 receptors than norepinephrine

56
Q

Isoproterenol receptors

A

B1 = B2 with NO alpha effects

57
Q

Use of isoproterenol

A

electrophysiologic evaluation of tachyarrhythmias

can worsen ischemia

58
Q

Norepinephrine receptors

A

alpha 1 > alpha 2 > beta 1

NO beta2 effects

59
Q

Use of norepinephrine

A

hypotension (but decreases renal perfusion)

60
Q

Phenylephrine receptors

A

alpha 1 > alpha 2

61
Q

Use of phenylephrine

A

hypotension (vasoconstrictor), ocular procedures (mydriatic), rhinitis (decongestant)

62
Q

Effect of amphetamine

A

indirect general agonist, reuptake inhibitors, also releases stored catecholamines

63
Q

Use of amphetamine

A

Narcolepsy, obesity, ADHD

64
Q

Effect of cocaine

A

indirect general agonist, reuptake inhibitor (NET)

65
Q

Use of cocaine

A

causes vasoconstriction and local anesthesia

never give beta blockers if cocaine intox is suspected because can cause unopposed alpha activation and extreme hypertension

66
Q

Effect of ephedrine

A

indirect general agonist, releases stored catecholamines

67
Q

Use of ephedrine

A

nasal decongestion, urinary incontinence, hypotension

68
Q

Clonidine receptor

A

alpha2- agonist

69
Q

Use of clonidine

A

hypertensive urgency
does not decrease renal blood flow
ADHD and Tourette syndrome

70
Q

Toxicity of clonidine

A

CNS depression, bradycardia, hypotension, respiratory depression, miosis

71
Q

alpha-methyldopa receptor

A

alpha-2 agonist

72
Q

Use of alpha-methyldopa

A

used for hypertension in pregnancy

73
Q

Toxicity of alpha-methyldopa

A

direct Coombs positive hemolysis

SLE-like syndrome (also seen with procainamide and hydralazine)

74
Q

Name the non-selective alpha blockers

A

phenoxybenzamine (irreversible)

phentolamine (reversible)

75
Q

Toxicity of the non-selective alpha blockers

A

orthostatic hypotension, reflex tachycardia

76
Q

Use of phenoxybenzamine

A

pheochromocytoma (used preoperatively) to prevent catecholamine (hypertensive) crisis

77
Q

Use of phentolamine

A

give to patients on MAO-inhibitors who eat tyramine-containing foods (to prevent the vasoconstriction and hypertensive crisis)

78
Q

Name the alpha1 selective antagonist

A

(-osin ending)

prazosin, terazosin, doxazosin, tamsulosin

79
Q

Use of alpha 1 selective antagonist

A

urinary symptoms of BPH

Prazosin - PTSD
All BUT TAMSULOSIN - hypertension

80
Q

Toxicity of alpha1 selective antagonist

A

1st dose orthostatic hypotension, dizziness, headache

81
Q

Name the alpha2 selective antagonist

A

mirtazapine

82
Q

Use of mirtazapine

A

depression

83
Q

Toxicity of mirtazapine

A

sedation, increased serum cholesterol, increased appetite

84
Q

Name the B1 selective antagonists

A

acebutolol (partial agonist), atenolol, betaxolol, esmolol, metoprolol

85
Q

Name the non-selective beta antagonists

A

nadolol, pindolol (partial agonist), propranolol, timolol

86
Q

Name the non-selective alpha and beta antagonists

A

carvedilol and labetalol

87
Q

What is special about nebivolol?

A

cardiac selective B1 blockade with stimulation of B3 receptors, which activate NO synthase in the vasculature

88
Q

Use of beta-blockers in angina pectoris

A

decrease heart rate and contractility, resulting in decreased O2 consumption

89
Q

Use of beta-blockers in MI

A

beta-blockres (metoprolol, carvedilol and bispropolol) decrease mortality

90
Q

Use in SVT of metoprolol and esmolol

A 
short acting
Decrease AV conduction velocity (class II antiarrhythmics)
91
Q

Use of beta-blockers in hypertension

A

decrease cardiac output, decrease renin secretion (due to B1-receptor blockade on JGA cells)

92
Q

Use of beta-blockers in HF

A

decrease mortality in chronic HF

93
Q

Use of beta-blockers in glaucoma (timolol)

A

decrease secretion of aqueous humor)

94
Q

Toxicity of beta-blockers

A

impotence, CV adverse effects (bradycardia, AV block, HR), CNS adverse effects (seizures, sedation, sleep alterations), asthma/COPD exacerbations

dyslipidemia specifically in metoprolol use

STEP 1 (26 decks)

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