Autonomic Drugs

Front 1

What receptors are associated with the sympathetic nervous system?

Back 1

alpha1, alpha 2, beta1, beta2

Front 2

What is the main role of alpha1 receptor?

Back 2

alpha1: vasoconstriction, contract pupillary dilator m. (dilation), contract intestine/bladder sphincter m. (stop both)

Front 3

What is the main role of alpha 2 receptor?

Back 3

Inhibits sympathetics (vasodilator)
decreases insulin release

Front 4

What is the role of beta1 and beta2 receptors?

Back 4

beta1 (on the heart) - increases HR, contractilty
(on the kidney) increase renin release

beta2: vasodilation, bronchodilation, decreases uterine tone (tocolysis)

Front 5

What receptor decrease BP, dilates the broncospasm and can be used to stop premature labor?

Back 5

beta2

Front 6

Which receptor increases BP, can be used in optho to dilate eye, and stop unwanted urination?

Back 6

alpha1

Front 7

What is the main function of M1?

Back 7

CNS and enteric nervous system

(anti-emetic drugs?)

Front 8

What is the role of M2 receptors?

Back 8

They are on the heart.

Decrease heart rate and contracilty of the atria?

Front 9

What two important receptors (both PSN and SNS) on the heart?

Back 9

Beta1 and M2

Front 10

What is the role of M3 receptors?

Back 10

Increase bladder contraction, bronchoconstriction, and mostly everything else related to PSN

(eg. gland secretion, gut peristalsis, accomodation--ciliary m. contraction, contract pupillary sphincter m.---miosis)

Front 11

What is the role of D1 and D2 receptors?

Back 11

D1: relaxes renal vascular smooth muscle (KIDNEY STUFF)

D2: brain stuff

Front 12

What is the role of H1 and H2?

Back 12

H1: increases nasal and bronchial mucus production, contraction of bronchioles, pruritus, and pain
-Think of an allergic rxn.

H2: increase gastric acid secretion (think of H2 blockers in GI)

Front 13

What is the role of V1 and V2 receptors

(vasopression = ADH)

Back 13

V1: increase vascular smooth muscle contraction (ACLS)

V2: Increase H20 permeability and reabosprtion in the collecting tubules of the kidney (V2 = 2 kidneys!)

Front 14

How does Gq protein work?

Back 14

Activates Phospholipase C which cleaves lipids into PIP2.

PIP2 can either be turned into DAG (to activate PKC) or IP3 (to increase [Ca])

Front 15

How do GI and Gs proteins work?

Back 15

Via Adenylyl Cyclase which converts ATP to cAMP. cAMP stimulates PKC.

(Gi would just inhibit this process)

Front 16

What receptors work through Gq? Gi? Gs?

Back 16

Gq = H1, alpha1, V1, M1, M3
(mnemonic= HAVe 1M%M)

Gi = M2, alpha2, D2
(mnemonic = 2MAD

Gs = rest of them (beta1,2 D1, H2, V2)

Front 17

Epi and Norepi bind alpha and beta receptors

Ach binds M receptors and N receptors

Back 17

DUH!

Front 18

Where are Nicotonic receptors located?
MOA?

Back 18

Presyaptic for both PSN and ANS.
They are ligand gated Na/K channels

(bind to Ach)
p230 FA

Front 19

Adrenal Medulla are sweat glands are considered part of the sympathetic nervous system.

However there is something weird about them. What is it?

Back 19

They are innervated by cholinergic fibers (Ach)

Sweat glands have M receptors
Medulla has Nicotonic receptors

Front 20

What kind of receptors are at the neuromuscular junction?

Back 20

Nicotonic (Nm) which bind to Ach

Front 21

Bethanechol
Carbachol
Pilocarpine
Methacholine

What kind of drugs are these?

Back 21

Direct Cholinergic agonists (M receptors --- Ach)

Front 22

Bethanechol

Clinical use?

Back 22

Activates bladder and bowels!

Front 23

Carbachol

clinical use

Back 23

Glaucoma

Pupillary contraction

Front 24

Pilocarpine

Clinical use

Back 24

Open and closed angle glaucoma

Xerostomia (this drug helps sweat, makes tears and sweat)

(hint: PILO = you drool, cry and sweat on your PILLOW)

Front 25

Methacholine

clinical use

Back 25

Challenge test for diagnosis of asthma (it will constrict bronchioles and make pt. go crazy; really fast so its okay)

Not used much anymore

Front 26

Neostigmine
Pyridostigmine
Edrophonium
Physostigmine
Donepezil
Echothiophate

What kind of drugs are these?

Back 26

Indirect M agonist (they inhibit cholinesterase)

Front 27

Neostigmine

clinical use

Back 27

Reverse neuromuscular junction blockade (post anestesia)
Myasathenis gravis
Help pee and poop

Mainly all things Ach does.

Doesn't go into CNS

Front 28

Pyridostigmine

Clinical use

Back 28

Myasthenia gravis (long acting!)

Doesn't go into CNS

Front 29

Edrophonium

clinical use

Back 29

Diagnosis of myasthenia gravis (extremely short acting)

Front 30

Physostigmine

clinical use

Back 30

Anticholinergic toxicity (eg. Atrophine overdose)

Crosses INTO CNS!!!!

Front 31

Donepezil

clinical use

Back 31

Alzheimer's disease

Front 32

With all cholinomimetic agents, watch for exacerbation of COPD, asthma and PUD

Back 32

:)

Front 33

what do Organophosphates in Insectisides to do your body that causes DUMBBELS?

Back 33

These irreversibly inhibit cholinesterase. Thus you have too much Ach!

Front 34

DUMBBELSS?

Back 34

Diarrhea, Urination
Miosis, bronchospasm
bradycardia, excitation of skeletal m. and CNS, Lacrimation, sweating, and salivation

Front 35

How do you treat Cholinesterase inhibitor poisoning?

Back 35

Atropine + Pralidoxime (2PAM)

2PAM - regenerates AchE
Atropine - inhibits Ach

Front 36

Atropine, homatropine, tropicamide
Benzotropine
Scopolamine
Iptratropium, tiotropium
Oxybutynin
Glycopyrrolate

What kinds of drugs are these?

Back 36

Muscarinic Antagonist

Front 37

Benzotropine

clinical use

Back 37

Works in CNS

Parkinson's Dz.

(hint: Park my BENZ)

Front 38

Scopolamine

clinical use

Back 38

works in CNS

MOTION sickness

Front 39

Ipratropium, triotropium

(hint: drugs you inhale)

Back 39

COPD and Asthma

Front 40

Oxybutynin

Back 40

Works in GU

Reduce bladder spasms (prevent peeing!)

Front 41

Glycopyrrolate

Back 41

Preop to reduce airway secretions

and

help stop drooling and PUD (GI)

Front 42

What can be used for mydriasis and cycloplegia (eye dilation + loss of accomidation)

Back 42

Atropine, homatropine, tropicamide

Front 43

What are some effects of Atropine?

(classic M blocker)

Back 43

Pupil dilation, decrease secretions, decrease acid secretion, decrease pooping and peeing

Front 44

Side effects of Atropine?

Back 44

Hot as hare
Dry as bone
Red as beet
Blind as a bat
Mad as a hatter

They block DUMBBELSS

Front 45

Jimson weed

Back 45

Has atropine like stuff in it

Front 46

Hexamethonium

Back 46

Blocks Nicotonic receptor (thus blocks both PNS and SNS)

Decreased BP, decreased pooping, decreased urinary output, tachycardia

Front 47

Epinephrine

What receptors does it like to bind to?

Back 47

binds all 4 (alpha1, alpha2, beta1, and beta2).

Slightly higher affinity for beta1 and 2.

Front 48

What does low dose epi do to BP?

Back 48

No effect on BP (b/c doesn't effect alpha receptors).
It will increase HR and contractility (B1 receptor)

Front 49

What is Epi used for?

Back 49

Anapylaxis, asthma, hypotension

(increased BP and HR)

Front 50

Norepinephrine

What receptors does it bind it to?

Back 50

Mainly Alpha1 and alpha 2. Some beta1 (no beta2).

Thus mainly used for BP management (NOT heart stuff)

Front 51

Norepi

clinical use?

Back 51

Hypotension

(septic shock --- aka when BP is going down the water!)

(increases BP but will have decreased HR as reflex)

Front 52

Isoprosterenol

What receptors does it bind?

Back 52

Binds only betas. Beta 1 and 2 equally (ISO)

Front 53

Isoproterenol

Clinical use

Back 53

bradycardia + bradyarrhtymias

(increases HR, contractilty; decreased BP due to reflex)

Front 54

Low dose Dopamine binds what receptors? what result?
Medium dose?
High dose?

Back 54

Low dose binds D1: increases kidney perfusion
Medium dose binds betas
High dose binds alphas

Front 55

Dopamine

Clinical use

Back 55

Shock (renal perfusion), heart failure

(this drug, unlike others, makes sure kidney gets blood)

Front 56

What receptors does Dobutamine bind?

Back 56

Mainly B1.

Front 57

Dobutamine

Clinical use

Back 57

Heart failure, cardiac stress testing, cardiogenic shock

(since it only works on heart, it helps with heart stuff :) )

Front 58

Phenylephrine

clinical use

(hint: mainly works at alpha1; some alpha2)

Back 58

Hypothension

ocular procedures (dilation)

rhinitis* (decongestant)

Front 59

Albuterol, salmeterol, terbutaline, ritodrine

What receptors do they bind?

Back 59

Mainly bind Beta2

Front 60

Clinical use of albuterol and salmeterol?

Back 60

Acute asthma = albuterol
chronic asthma = salmeterol

Front 61

Clinical use of Ritodrine and TERBUTALINE*

Back 61

Reduce premature uterine contractions

(STOP LABOR)

Front 62

Amphetamine
Ephedrine
Cocaine
Tyramine

What kinds of drugs are these?

Back 62

Indirect sympathomimetics

They increase NE/E in synaptic cleft

Front 63

Amphetamine

Clinical use

Back 63

Narcolepsiy,

ADD (aderall)

Front 64

Ephedrine

Back 64

Nasal decongestion*, urinary incontinence, hypotension

Front 65

Cocaine

Back 65

Local anesthesia (ENT + optho)

Front 66

Cocaine

What is special about this compared to other anesthetics?

Back 66

Only vasoconstrictive anesthetic!!!

Front 67

Clonidine
alpha-methyldopa
Guanfacine

What kinds of drugs are those?

Back 67

Centrally acting Alpha2 agonists (thus decrease sympathetics)

Front 68

Clonidine and alpha-methyldopa

clinical use

Back 68

Can treat hypertension, especially for pt. with renal disease (won't decrease blood flood to kidney)

Front 69

What is special about alpha-methyldopa?

Back 69

Can be used to treat hypertension in PREGNANCY*

Front 70

Prazosin, Terazosin, Doxazosin, tamsulosin

What kinds of drugs are these? Clinical use?

Back 70

alpha1 selective antagonist

Hypertension, BPH (will help you pee better)

Front 71

What is the DOC for BPH?

Back 71

Tamsulosin

alpha1-agonis
(VERY specific to prostate; will help you pee afterwards :) )

Front 72

Mirtazapine

What kind of drug? clinical use?

Back 72

Alpha2 antagonist.

Can treat Depression

Front 73

1st-dose orthostatic hypotension is a worry in these drugs. Thus you usually start low and at night (then can change)

Back 73

alpha1 selective agonist (-osin)

Front 74

Phentolamine vs. Phenoxybenzamine

Back 74

Phentolamine: reversible nonselective alpha-blocker

Phenoxybenzamine: irreversible nonselective alpha blocker

Front 75

DOC for Pheochromocytoma

Back 75

Phenoxybenzamine mainly

(maybe phentolamine)

Front 76

What happens to BP if you give Epi with an alpha blocker?

Back 76

Blood pressure would decrease. B/c alpha is blocked. Thus epi will only stimulate Betas (b2 is a vasodilator)

Front 77

What happens to BP if you give phenylephrine and alpha1 blocker together?

Back 77

no change

Front 78

Acebutolol, betaxolol, esmolol, atenolol, metoprolol, propranolol, timolol, pindolol, labetalol

What class?

Back 78

beta-blockers

Front 79

What can beta blockers be used for?

Back 79

Angina, decrease MI mortality, SVT, Hypertension, CHF (chronic)

Front 80

What drugs can reduce mortlity in MI pt? (name 2 specific beta blockers)

Back 80

Carvedilol and Metoprolol

Front 81

Nonselective alpha-beta blockers

name 2

Back 81

Carvedilol and labetalol

(hint: they don't end in -olol)

Front 82

B1 slective blockers

Back 82

BEAM

(Betaxolol, Esmolol, Atenolol, Acebutolol, Metoprolol)

The rest are nonselective (like beta1 and 2)

Front 83

Partial Beta agonists

Back 83

Pindolol and Acebutolol

(hint: PAPA)

Front 84

Should you use beta blockers for chronic or acute CHF?

Back 84

CHRONIC ONLY!!!

(you don't want to start the heart, when it is already stopped in acute situations!)

Front 85

Which beta blocker for Glaucoma?

Back 85

Timolol

Front 86

Adverse effects of beta blockers

Back 86

Impotence, asthma problems, bradycardia, AV block, CHF

Use with caution in diabetics (beta2 increase insulin release)