Ans Pharmacology

Front 1

What is bethanecol used for?

Back 1

Used for postoperative and neurogenic ileus

Also used for urinary retention IN ABSENCE OF obstruction.

Bethanecol
1) Activates Bowel and Bladder
2) resistant to AChE.

Front 2

What is mechanism of action of bethanecol?

Back 2

Selectively stimulates muscarinic receptors without effect on nicotonic receptors.

Not hydrolyzed by acetolycholinesterase, so longer duration of action.

Front 3

What is carbachol and pilocarpine used for?

Back 3

Glaucoma

Front 4

What is mechanism of action of pilocarpine?

Back 4

It acts on a subtype of muscarinic receptor (M3) found on the iris sphincter muscle, causing the muscle to contract and produce miosis. This opens the trabecular meshwork through increased tension on the scleral spur. This action facilitates the rate that aqueous humor leaves the eye to decrease intraocular pressure.

Also activates ciliary muscle of eye (open angle) and causes pupillary sphincter contraction.

Produces miosis and decreases intraocular pressure in glaucoma.

Front 5

What is mechanism of action of neostigmine?

Back 5

Anticholinesterase, so increases ACh in the cleft.

Front 6

What is neostigmine used for?

Back 6

Drug of choice for myasthenia gravis because of the longer half life.

Used in postoperative and neurogenic ileus, urinary retention, Myasthenia, and reversal of neuromuscular junction blockage.

Front 7

What is pyridostgmine used for?

Back 7

Myasthenia Gravis

Front 8

What is edrophonium used for?

Back 8

1) AChE inhibitor
2) Diagnosis of myasthenia gravis (extremely short acting)
3) Tensilon strength test.
4) Strenght of patient should increase with edrophonium if they have Myasthenia gravis.

Front 9

What is physostigmine used for?

Back 9

1) IT CROSSES BBB
2) Used for glaucoma
3) Atropine overdose.
4) Uncharged lipophilic molecule

Front 10

What is echothiophate used for?

Back 10

1) ACHesterase inibitor2
2) Used for glaucoma.

Front 11

What are symptoms of acetylcholinesterase inhibitor poisoning?

Back 11

1) DUMBBELLS
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Excitation of Skeletal Muscle
Lacrimation
Sweating/Salivation

Front 12

How do you treat pyridostigmine overdose?

Back 12

Atropine: muscarinic receptor blocker!!

Pralidaxome: Regenerate Active cholinesterase.

Front 13

What can cause cholinesterase inhibitor poisoning?

Back 13

Parathion and other organophosphates!

Front 14

What do organophosphates do?

Back 14

Inhibit acetylcholinesterase in cells.

Front 15

What effect does atropine, homatropine, and tropicamide have on the eye?

Back 15

Produces mydriasis and cycloplegia.

Front 16

What is cycloplegia?

Back 16

Cycloplegia is the paralysis of the ciliary muscle, resulting in a loss of accommodation. The ciliary muscle has muscarinic (parasympathetic) innervation and controls the shape of the lens.

Front 17

What is mechanism of action of benzotropine?

Back 17

Block muscarinic receptors.

Used in Parkinson's disease.

Front 18

What is scopolamine used for?

Back 18

It is a muscarinic blocker and used for motion sickness.

Front 19

What is ipratropium used for?

Back 19

Blocks muscarinic receptors

1)Decreases bronchiolar secretions
2) Decreases bronchiolar constriction.
3) Used in asthma/COPD

Front 20

What is methscopolamine, oxybutin, and glycopyrrolate?

Back 20

1) Muscarinic blocker
2) Used to reduce urgency in mild cystitis
3) Reduce bladder spasms.

Front 21

What is the affect of atropine on the eyes?

Back 21

1) pupil dilation
2) Cycloplegia is the paralysis of the ciliary muscle, resulting in a loss of accommodation.

Front 22

What is the affect of atropine on the airway?

Back 22

Decreases airway secretions

Front 23

What is the effect of atropine on the stomach/gut?

Back 23

Decreases acid secretion
Decreases motility

Front 24

What is affect of atropine on bladder?

Back 24

Decreases urgency in cystitis.

Front 25

What is the toxicity of atropine?

Back 25

1) Increase body temperature
2) Rapid pulse
3) Dry mouth
3) Dry flushed skin
4) Cycloplegia
5) Constipation
6) Disorientation

**Hot as hell, Dry as a bone, Red as a beet, Blind as a Bat, Mad as a Hatter.

Front 26

What is the toxicity of atropine with respect to the ye?

Back 26

Acute-closure glaucoma in elderly; Urinary retention in men with prostatic hypertrophy, and hyperthermia in infants!

It increases body temperature!

Front 27

What is mechanism of action of hexamethonium?

Back 27

Blocks Nicotinic ACh receptor at autonomic ganglia, so it can block either sympathetic or parasympathetic response.
It is a ganglionic blocker

Front 28

What is hexamethonium used for?

Back 28

Mainly used for situations requiring a rapid rapid decrease in BP like pulmonary edema or dissecting aortic aneurysm.

Front 29

Why is epinephrine sometimes given with local anasthetics?

Back 29

Give epinephrine to vasoconstrict blood vessels near injection site increasing the duration of the anasthetic effect. BUT NEVER USE IN FINGERTIPS, NOSE, OR GENITALS!

Front 30

At what receptors does NE work on?

Back 30

Works on Alpha 1, alpha 2 at low doses

But with increasing concentrations it works on beta receptors.

Front 31

AT what receptors does NE work on?

Back 31

Alpha 1, alpha 2, > Beta 1, Beta2

Used in hypotension (but it decreases renal perfusion).

Front 32

At what receptors does epinephrine stimulate?

Back 32

At low doses, Beta effects predominate.

At high doses, stimulate alpha receptors causing vasoconstriction.

Front 33

What effect does epinephrine have on pulse pressure?

Back 33

Widens it.

Front 34

What effect does norepinephrine have on pulse pressure?

Back 34

narrows it.

Front 35

What are some clinical uses of epinephrine?

Back 35

Anaphylaxis, glaucoma (open angle), asthma, hypotension.

Front 36

What is effect of isoproterenol?

Back 36

B1= B2
Activates both beta receptors; non-selective.

Front 37

What is mechanism of action of amphetamine?

Back 37

Released stored catecholamines;
1) Narcolepsy
2) Suppresses appetite (obesity)
3) Attention deficit disorder!!

Front 38

What is mechanism of action of ephedrine?

Back 38

Releases stored catecholamines
1) Used for nasal decongestion
2) Used in urinary incontinence
3) Used in hypotension

Front 39

What is action of phenylephrine?

Back 39

Stimulates alpha 1. Stimulation causes vasoconstriction in mucous membranes and reduces secretion. It dilates the pupil because alpha 1 is one eye.
3) Vasoconstriction
4) Nasal decongestion.

Front 40

What is mechanism of action of albuterol and terbutaline?

Back 40

Acts on beta 2.

used for asthma

Terbulating is used to relax uterine smooth muscle and prevent premature contraction.

Front 41

What is mechanism of action of cocaine?

Back 41

Blcoks uptake of catecholamines in presynaptic neuron.

1) Causes vasoconstriction
2) used as local anasthesia by ENT docs.

Front 42

What is mechanism of action of dopamine?

Back 42

D1=D2 > B > alpha

Used in shock (increases renal perfusion) and used in heart failure.

Front 43

What is mechanism of action of dobutamine?

Back 43

B1 > B2

Increases HR and contractility

used in shock, heart failure; used in cardiac stress test because it increases CO WITHOUT elevating oxygen demand on myocardium!!

Front 44

What is mechanism of action of clonidine?

Back 44

Centrally acting alpha agonist; decreases central adrenergic outflow.

Used in HTN especially with renal disease becaue it doesnt decrease blood flow to kidney.

Front 45

What is NE effect on BP and HR?

Back 45

1) Increases blood pressure
2) Increases systolic and diastolic
3) Decreases pulse pressure
4) Causes reflex bradycardia so decreases HR.

Front 46

What is effect of Epi on BP and HR

Back 46

1) Increases BP
2) No effect on diastolic
3) Widens pulse pressure
4) Increases HR

Front 47

What is effect of isoproterenol on blood pressure and heart rate?

Back 47

Keep BP pretty steady
Increases heart rate enormous because sole effect on beta receptors!

Front 48

What is mechanism of action of phenoxybenzamine?

Back 48

It is a irreversible blocker at all alpha receptors (alpha 1 and 2).

Used for pheochromocytoma

Front 49

What is toxicity of phenoxybenzamine?

Back 49

Orthostatic hypotension
Reflex tachycardia.

Front 50

What is the mechanism of action of phentolamine?

Back 50

Reversible blocker at all alpha receptors.

Used in pheochromocytoma

Can cause orthostatic hypotension and reflex tachycardia!

Front 51

What are some alpha-1 blockers?

Back 51

Prazosin
Terazosin
Doxazosin

Front 52

What is prazosin and terazoin used for?

Back 52

1) Alpha-1- selective blocker
2) used for HTN, and urinary retention in BPH!!!

Front 53

what is toxicity of prazosin?

Back 53

1st dose orthostatic hypotension, dizziness, and headache.

Front 54

What is mirtazapine mechanism of action?

Back 54

Alpha-2 selective blocker

1) used for depression
2) causes sedation, increases serum cholesterol, and increases appetitie.

Front 55

What are some beta blockers?

Back 55

1) Propranolol
2) Metoprolol
3) Atenolol
4) Nadolol
5) Timolol
6) Pindolol
7) Esmolol
8) Labetolol

Front 56

What are the effects of beta-blockers on hypertension?

Back 56

1) Decrease cardiac output
2) Decrease renin secretion

Front 57

What are the effects of beta blockers on angina?

Back 57

1) Decrease HR and contractility causing decrease O2 consumption.

Front 58

What is the effect of beta-blockers in MI?

Back 58

Decrease mortality!

Front 59

What beta blockers can you use to treat supraventricular tachycardia?

Back 59

Propranolol and Esmolol

Decrease AV conduction velocity

Front 60

What is the effect of beta-blockers in CHF?

Back 60

Slows progression of chronic failure.

Front 61

What is effect of beta blockers on glaucoma?

Back 61

Timolol will decrease the secretion of aqueous humor.

Front 62

What is the toxicity of beta-blockers?

Back 62

1) Impotence
2) Exacerbation of asthma
3) Bradycardia, AV block, CHF
4) Sedation/sleep alteration

USE WITH CAUTION IN DIABETES.

Front 63

Which ones are Beta-1 selective blockers?

Back 63

Acebutolol (partial agonist), betaxolol, esmolol (short acting), atenolol, and metoprolol.

A BEAM of B1 blockers.

Atenolol
Betaxolol
Esmolol
Atenolol
Metoprolol.

Front 64

Which ones are nonselective beta blockers?

Back 64

propranolol
Timolol
Nadolol
Pindolol (partial agonist)
Labetolol (partial agonist)

Front 65

What effect does epinephrine have in glaucoma?

Back 65

1) alpha agonist
2) Increase outflow of humor

Side effects: mydriasis, stinging.

Front 66

What effect does brimonidine have in glaucoma?

Back 66

Alpha agonist
Decrease aqeous humor synthesis

Front 67

What effect do beta blockers such as timolol, betaxolol, and carteolol have on aqueous humor secretion?

Back 67

Decrease humor secretion.

No side effects.

Front 68

What effect does acetazolamide have on glaucoma?

Back 68

Decrease aqueous humor due to decreased bicarbonate.

Front 69

What effect does pilocarpine, carbachol, physostigmine, and echothiopate have on glaucoma?

They all act to increase muscarinic effects.

Back 69

Increase outflow of aqueous humor; contract ciliary muscle and open trabecular meshwork.

Side effect: miosis, cyclospasm.

Front 70

What effect does latanoprost have on glaucoma?

Back 70

PGF2: prostaglandin

Increases outflow of aqueous humor

Darkens color of iris (browning).