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Boards:Pharm, Autonomic

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bethanecol:
family
cholinomimetics, direct agonist
bethanecol:
clinical applications
Postoperative and neurogenic ileus and urinary retention
bethanecol:
Action
used to stimulate smooth muscle motor activity of urinary tract to prevent urine retention
activates bowel and bladder smooth muscle
Carbachol:
name and family
cholinomimetics, Pilocarpine
Carbachol:clinical application
glaucoma
Carbachol:Action
Activates cilliary muscle of eye (opens angle)

activates pupillary sphincter (narrow angle)
Neostigmine:
family, type,
cholinomimetic, anticholinesterase, indirect agonists
Neostigmine:clinical applications
Postoperative and neurogenic ileus and urinary retention

myasthenia gravis

reversal of NMJ blockade (postoperatively)
Neostigmine:
Action
increases endogenous Ach
Name the antocholinesterases
action?
Neostigmine, Pyridostigmine, Edrophonium, Physostigmine, echothiophate

indirect agonist, cholinomimetics
Pyridostigmine:
clinical applications
Myasthenia gravis
Pyridostigmine:Action
increases endogenous Ach
Pyridostigmine: family
anticholinesterases, indirect agonist
Edrophonium: clinical application
diagnosis of myasthenia gravis
extremely short acting
Edrophonium: action
increases endogenous Ach
Physostigmine: clinical application
Glaucoma: crosses BBB into CNS

atropine overdose
Physostigmine: Action
increases endogenous Ach
Echothiophate: clinical application
Glaucoma
Echothiophate: Action
Increases endogenous Ach
Cholinesterase inhibitors:
name them
sx for poisoning
DUMBBLESS
Diahrrea, Urination, Miosis, Bronchospasm, bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, Salivation
Cholinesterase inhibitors: Antidote for poisoning
Atropine (muscarinis antagonist) and pralidoxime (chemical antagonist used to regenerate active cholinesterase)
Muscarinic cholinoreceptor blockers: name them
atropine (homatropine, tropicamide), benztropine, scopolamine, Ipratropium
benzatropine
family
effects which organ system
application
muscarinic cholinoreceptor blocker
CNS
Parkinsons dz
Scopolamine
family
effects which organ system
application
muscarinic cholinoreceptor blocker
CNS
motion sickness
Ipratropium
family
effects which organ
application
muscarinic cholinoreceptor blocker
respiratory
Asthma, COPD
Atropine:
family
muscarinic cholinoreceptor blockers
Atropine:organ system that it effects
eye, airway, stomach, gut, bladder
Atropine:effects
eye
increases pupil dilation, cycloplegia
Atropine:effects airway
decreases secretions
Atropine:effects stomach
decreases acid secretions
Atropine:effects gut
motility
Atropine:effects bladder
decreased urgency in cystitis
Atropine: Toxicity
increased: body temp, rapid pulse, dry mouth, dry, flushed skin, cycloplegia, constipation, disorientation
Atropine: effects
blocks SLUD: Salivation, Lacrimation, Urination, Defecation
hexamethonium: what is it?
nicotinic Ach receptor antagonist
hexamethonium: mechanism
Nicotinic Ach nicotnic receptor antagonist
Hexamethonium: clinical use
Block ganglion
used in experimental models to prevent vagal reflex response to changes in blood pressure
ie) prevents reflex bradycardia caused by NE
Sympathomimetics: name them
Catecholamines (Epi, NE, Isoproteronol, dopamine, dobutamine)

Amphetamine, Ephedrine, Phenylephrine, Albuterol (terbutaline), Cocaine, Clonidine (a-methyldopa)
Epinephrine:
family
mechanism/selectivity
catecholamine/sympathomimetic
direct general agonist to A1, A2, B1, B2
epinephrine:
family
application
catecholamine/sympathomimetic
anaphylaxis, glaucoma (open angle), asthma, hypotension
Norepinephrine:
family
mechanism
sympathomimetic/catecholamine
direct general agonist against A1, A2, B1
Norepinephrine: Application
Hypotension with decreased renal perfusion
Isoproterenol: family
cats/sympathomimetics
Isoproterenol: mechanism/selectivity
B1=B2
Isoproterenol:Applications
AV block (rare)
Dopamine: family,
cats/sympathomimetics
Dopamine: Mechanism/selectivity
D1=D2>B>A
Dopamine: application
Shock (increased renal perfusion), heart failure
Dobutamine: family
cats/sympathomimetics
Dobutamine: mechanism/selectivity
B1>B2
Amphetamine:
family
mechanism/selectivity
cats/sympathomimetics
indirect general agonist
releases stored cats
Amphetamine: applications
Narcolepsy, obesity, ADD
Ephedrine: family
mechanism/selectivity
ctas/sympathomimetic
indirect general agonist
releases stored cats
ephedrine: application
nasal decongestion
urinary incontinence
hypotension
Phenylephrine:
family
mechanism/selectivity
cats/sympathomimetics
A1>A2
Phenylephrine: application
pupil dilator
vasoconstriction
nasal decongestion
Albuterol:
family
mechanism/sensitivity
terbutaline
cats/sympathomimetics
B2>B1
Albuterol: applications
asthma
cocaine
family
mechanism/selectivity
cats/sympathomimetics
indirect general agonist
uptake inhibitor
cocaine:
application
vasoconstriction and local anesthesia
Clonidine:
other name
family
mechanism
cats/sympathomimetics
a-methyldopa
cetrally acting A-agonist w/ decreased central adrenergic outflow
clonidine: application
hypertension esp. with renal dz (no decrease in blood flow to kidney)
A blockers:name them
nonselective:

A1 selective:


A2 selective--
NS: phenoxybenzamine (irreversible), phentolamine(reversible)
A1 selective-prazosin, terazosin, doxazosin

A2 selective--mirtzapine
Phenoxybenzamine, phentolamine
family
application
A blockers (irreversible, reversible)
pheochromocytoma
Phenoxybenzamine, phentolamine: toxicity
Orhtostatic hypotension
reflex tachycardia
Prazosin, terazosin, doxazosin
family
application
A1 selective blockers

Hypertension, urinary retention in BPH
Prazosin, terazosin, doxazosin:
Toxicity
1st dose orthostatic hypotension, dizziness, headache
Mirtzapine
family
clinical application
A2 selective blocker
Depression
Mirtzapine: toxicity
Sedation
increased serum cholesterol
increased appetite
B blockers; name them
Anything with -olol
propanolol, metoprolol, atenolol, nadolol, timolol, pindolol, esmolol, labetol
B blockers: effect
hypertension: decreased CO, renin secretion

Angina pectoris: dec. HR, contractility, resulting in decreased O2 consumption

MI: B blockers decreaed mortality

SVT: (propranolol,esmolol) dec AV conduction velocity

CHF: slows progression of heart failure

Glaucoma: (timolol) dec secretion of aqueous humor
B blockers: Toxicity
Impotence
Exacerbation of asthma
CV effects: bradycardia, AV block, CHF
CNS effects: sedation, sleep alterations

use with caution in diabetics
B blockers: selectivity
nonselective:

b1 selective
Nonselective (B1=B2)--propranolol, timolol, pindolol, nadolol, labetalol

Labetol-also blocks A1

B1 selective (B1>B2) "A BEAM" Acebutolol, Betaxolol, Esmolol (short acting) Atenolol, Metoprolol
Glaucoma drugs..
name drugs that are used and effect
Alpha agonist-epinephrine, brimonidine

beta-blocker--Timolol, betaxol, certelol

Diuretics--Acetazolamide

Cholinomimetics--Pilocarpine, carbachol, physostigmine, echothiophate

Prostaglandin--latanprost
Glaucoma--A agonists: names, MOA, SE
Epinephrine-increase outflow of aqueous humor, mydriasis and stinging
Do not use in closed-angle glaucoma

Brimonidine--decrease in aqueous humor synthesis,
SE-no pupillary or vision changes
Glaucoma--B blockers: name, MOA, SE
Timolol, betaxolol, carteolol
MOA: decrease aqueous humor secretion
SE: No pupillary or vision changes
Glaucoma: diuretics: Name, MOA, SE
Acetazolaminde
MOA-decrease aqueous humor secretion humor dt decreased HCO3 via inhibition of carbonic anhydrase

SE: No pupillary or vision changes
Glaucoma: cholinomimetics..Name, MOA, SE
Pilocarpine, carbachol, physostigmine, echothiophate

MOA: Increase outflow of aqueous humor; contract ciliary muscle; open trabecular meshwork

SE: Miosis, cyclospasm
Glaucoma: Prostaglandin
Name, MOA, SE
Latanoprost
MOA: increase outflow of Aqueous humor
SE: darkens color of iris (browning)

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