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Autonomic Pharm Day1

QuestionAnswer
bethanechol direct cholinergic agonist
carbachol direct cholinergic agonist
pilocarpine direct cholinergic agonist
methacholine direct cholinergic agonist
atropine cholinergic antagonist
darifenacin cholinergic antagonist
scopolamine cholinergic antagonist
trospium cholinergic antagonist
solifenacin cholinergic antagonist
oxybutynin cholinergic antagonist
benzotropine cholinergic antagonist
ipratropium cholinergic antagonist
methoscopolamine cholinergic antagonist
glycopyrrolate cholinergic antagonist
tolteradine cholinergic antagonist
epinephrine a1, a2, b1, b2 agonist
norepinephrine a1, a2, b1 agonist
dopamine d1=d2 > b1 > a1 agonist
isoproteronol b1=b2 agonist
terbutaline b2 > b1 agonist
phenylephrine a1 > a2 agonist
neostigmine anti-AChE
pyridostigmine anti-AChE
edrophonium anti-AChE
physostigmine anti-AChE
echothiophate anti-AChE
donezepil anti-AChE
tacrine anti-AChE
hexamethonium nicotinic antagonist
pralidoxime AChE regenerator
phenoxybenzamine non-selective alpha blocker (irreversible; used as a prophylaxis in pheochromocytoma surgery)
prazosin alpha 1 blocker
phentolamine non-selective alpha blocker (reversible)
terazosin alpha 1 blocker
timolol non-selective beta blocker (b2=b1)
propranolol non-selective beta blocker (b2=b1)
labetalol non-selective alpha and beta blocker
metoprolol beta blocker (b1 selective)
atenolol beta blocker (b1 selective)
esmolol beta blocker (b1 selective)
a1 action vasoconstriction
a2 action decreased sympathetic outflow, decreased insulin release
b1 action increased hr, increased contractility, increased renin release
b2 action vasodilator, bronchodilation, increased HR, increased contractility, decreased uterine contraction
M1 action CNS, enteric nervous system
M2 action decreased HR and contractility of atria
M3 action increased exocrine gland secretions (gastric acid, sweat), increased gut peristalsis, increased bladder contraction, accommodation
D1 action relaxes renal vascular smooth muscle
D2 action modulates transmitter release, esp in the brain
H1 action increased nasal and bronchial mucus production, contraction of bronchioles, pruritus, and pain
H2 action increased gastric acid secretion
V1 action vascular smooth muscle contraction
V2 action increased H20 permeability and reabsorption in the collecting tubules of the kidney
What are the 5 classes of drugs used to treat glaucoma? alpha agonists, beta blockers, cholinomimetics, diuretics (mannitol and acetozolamide), and PGF2-alpha (lanaprost)
How does the BP response to phenlyephrine administration change if an alpha blocker is administered beforehand? Why is this different than the change seen when epinephrine is used rather than phenylephrine? Phenylephrine has pure alpha action. Epi (in small amts) has a greater B2 response. If phenylephrine is administered after an A blocker, there will be no change in BP (b/c the only R that could respond is silenced). With epi and an A blocker, BP decreases
What anticholinesterases are used to treat Alzheimer's? DONezepil, GALAntamine, and RIVastigmine. (DON't let grandma go GALAvanting into the RIVer now that she has alzheimer's)
What are 4 treatment options for myasthenia gravis? 1. AChE inhibitors (neostigmine, pyridostigmine) 2. Corticosteroids (autoimmune problem) 3. Thymectomy (thymus is source of Ab) 4. Plasmapheresis (cleans out autoantibodies)
What drug regenerates AChE after organophosphate poisoning? Pralidoxime
Which anticholinergic is one of the MCC of delirium in the elderly? Atropine
Which muscarininc antagonist is useful in improving FEV1 in a COPD patient? Ipratropium
A 30yo schizophrenic male has urinary retention due to his neuroleptic. What do you treat it with? Bethanechol
Which sympathomimetics are given as a nebulizer for asthma? Albuterol, levalbuterol (for patients with heart disease), and metaproterenol; epinephrine may be given as a 2nd line tx
Which sympathomimetic is the drug of choice for anaphylaxis? Epinephrine.
Which sympathomimetic is the MC first line agen for patients in cardiogenic shock? Dobutamine.
Which sympathomimetic is the MC first line agent for patients in septic shock? Norepinephrine.
Which sympathomimetic is given subQ for asthma? Terbutaline
Which sympathomimetic is used by ENT to vasoconstrict nasal vessels? Cocaine or phenylephrine
Which sympathomimetic is used to treat ADHD? Amphetamines
What cholinomimetic agent is used to treat glaucoma, relieves intraocular pressure, and causes pupillary contraction. Carbachol
What cholinomimetic agent is used to stimulate sweat, tears, and saliva? Pilocarpine (PILE on the sweat and tears; resistant to AChE)
What cholinomimetic agent is used for a challenge test to diagnose asthma? Methacholine
Which anticholinesterase is used to treat posteroperative and neurogenic ileus and urinary retention, myasthenia gravis, and reverse the neuromuscular junction blockade after surgery? Neostigmine
Which long-acting anticholinesterase is used to treat Myasthenia Gravis? PyRIDostigmine (gets RID of myasthenia)
Which anticholinesterase is used to diagnose Myasthenia Gravis? Edrophonium (Tensilon test)
Which anticholinesterase is used to treat glaucoma and atropine overdose? Physostigmine (PHYS is for EYES and PHYS PHYxes atropine overdose)
Which anticholinesterase is only used to treat glaucoma? Echothiophate
Which muscarininc antagonist is used to improve tremor and rigidity in Parkinson's disease? Benztropine
Which muscarininc antagonist is given as a patch to treat motion sickness? Scopolamine
Which muscarininc antagonist is used by anesthesiologists to reduce airway secretions during surgery? Glycopyrrolate
Which muscarininc antagonist is used to reduce urgency in mild cystitis and reduce bladder spasms? OxyBUtynIN (keeps your Bladder and Urine on the INside)
Which two muscarininc antagonist are used to treat peptic ulcers? Methscopolamine and propantheline
How is hexamethonium used? As an experimental ganglionic blocker that prevents vagal reflex responses to changes in BP.
Which sympathomimetic is used in cardiac stress testing? Dobutamine (also used to tx cardiogenic shock)
Which sympathomimetic is used to treat asthma long-term? Salmeterol
Name two sympathomimetics that reduce premature contractions? Terbutaline and ritodrine
What is the MOA of clonidine? In what patient population is it useful? What is problematic about it? A centrally acting alpha 2 agonist that decreases central adrenergic outflow. Useful in pts with renal failure. Problematic b/c it req's frequent dosage and missing a dose can cause rebound HTN.
What drug is commonly used to treat hypertension in pregnant women? Alpha-methyldopa (a centrally acting alpha-2 agonist)
Which alpha 2 anatagonist is used to treat depression in the elderly? Mirtazapine
How do beta blockers relieve angina? By decreasing HR and contractility which decreases oxygen demand
Which beta blockers have been shown to decrease mortality after an MI? Metoprolol (b1 blocker) and carvedilol (non-selective alpha and beta blocker)
How does timolol treat glaucoma? Decreases secretion of aqueous humor
Why should beta blockers be used with caution in diabetics? B/c it can mute symptoms of hypOglycemia.
Name 3 drugs that exhibit zero order elimination. Phenytoin, Ethanol, and Aspirin (PEA is round just like a zero)
How do you treat an overdose of weak acids (e.g., phenobarbital, methotrexate, and aspirin)? bicarbonate (traps acidic drug in basic urine)
How do you treat an overdose of weak bases (e.g., amphetamines)? ammonium chloride (traps basic drug in acidic urine)
Atropine, homatropine and tropicamide: category and application muscarinic antagonist that produces mydriasis and cycloplegia
Which beta blocker is a short-acting class II antiarrhythmic? Esmolol
Name 3 drugs that inhibit warfarin metabolism. Amiodarone, cimetidine, and TMP-SMX.
How do beta blockers affect the renin-angiotensin-aldosterone system? Inhibit renin release by blocking the B1 receptor mediated pathway: decrease angiotensin I, angiotensin II, and aldosterone. NO effect on ACE activity or bradykinin levels
Pt on NE venous drip develops blanching in v and cold, hard, pale tissues surrounding the v. What is the appropriate treatment? Phentolamine injections around the site (causes vasodilation which counteracts the vasoconstriction caused by the NE leaking into the tissue which can lead to tissue necrosis; must be given w/in 12hrs to be effective against tissue necrosis).
Created by: sarah3148