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58 Cards in this Set
- Front
- Back
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How do the SANS and PANS affect the heart?
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SANS = ↑HR, ↑Contractility
- ß1 (Gs) - ß2 (Gs) PANS = ↓HR, ↓Contractility - M2 (Gi) |
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How do the SANS and PANS affect the eye?
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SANS = Mydriasis (dilate - pupillary dilator)
- α1 (Gq) PANS = Miosis (contraction - pupillary sphincter) & Accomodation (ciliary muscle contraction) - M3 (Gq) |
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How do the SANS and PANS affect the salivary glands?
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SANS = Viscous secretions
- α2 (Gi) PANS = Watery secretions - M3 (Gq) |
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How do the SANS and PANS affect the bronchiolar smooth muscle?
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SANS = Bronchodilation
- ß2 (Gs) PANS = Bronchoconstriction - M3 (Gq) |
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How do the SANS and PANS affect the bladder?
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SANS = Sphincter contraction (retention)
- α1 (Gq) PANS = Bladder contraction (urination) - M3 (Gq) |
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How do the SANS and PANS affect the male GU?
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SANS = S-hoot (Ejaculation)
- α1 (Gq) PANS = P-oint (Erection) - M3 (Gq) |
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How do the SANS and PANS affect the GI tract?
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SANS = Slows the gut ~ Ileus (sphincters contract, smooth muscle relaxes, ↓secretions)
- α1 (Gq) PANS = Gets gut moving (Tx Ileus; relax sphincters, peristalsis, ↑secretions) - M1 (Gq) → Enteric NS - M3 (Gq) |
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What are the symptoms of excess PANS activity?
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Makes you "Leaky"
DUMBELSS: D-iarrhea U-rinatino M-iosis B-ronchospasm B-radycardia E-xcitation L-acrimation S-weating S-aliva (Seen in organophosphate poisoning - ACh-E inhibition) |
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What drugs can cause excess PANS activity?
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ACh-E Inhibitors
Muscarinic agonists |
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What are the thymus conditions a/w Myasthenia Gravis?
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50% have Thymic HYPERplasia
20% have Thymic ATROPHY 15% have a Thymoma |
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What drug regenerates AChE after organophophate poisoning?
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Pralidoxime
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What are the symptoms of inhibited PANS activity?
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Opposite of DUMBELSS:
- Hyperthermia (Hot as a Hare) - Dry mouth/skin (Dry as a Bone) - Flushing (Red as a beet) - Cycloplegia (Blind as a bat) - Delirium (Mad as a hatter) - Constipation/Urinary retention (Bloated as a toad) |
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What are the muscarinic antagonists used in the eye?
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Cyclops wearing a H-A-T:
- H-omaTROPine - A-TROPine - T-ROPicamide Cause CYCLOplegia & mydriasis (dilation) |
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What are the muscarinic antagonists used in the CNS? What for?
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Benztropine = Parkinsons
Scopolamine = Nausea (motion sickness & end of life care) |
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What are the muscarinic antagonists used in the respiratory tract?
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Ipratropium (ATROVENT)
used for Asthma / COPD |
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What are the muscarinic antagonists used in the GU tract?
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gotta G-O, TO the D-amned/S-tinking T-oilet!!
G-lycopyrrolate O-xybutynin TO-lterodine D-arifenacin/S-olifenacin T-rospium Reduce urgency (mild cystitis); reduce bladder spasms |
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What are the muscarinic antagonists used in the GI tract?
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Methscopolamine
Propantheline |
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In what patient populations is Atropine contraindicated?
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1) Glaucoma patients
2) Infants w/ a fever (→ Hyperthermia) 3) BPH (→ urinary retention) 4) Ileus (already not moving) 5) Elderly (dementia) |
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A gardener presents with SOB, salivation, miosis, and diarrhea. What caused this? What's the MOA?
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Organophosphate poisoning (parathion)
Irreversibly inhibits ACh-Esterase |
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Atropine is not effective in reversal of organophosphate poisoning; what Rx would best help?
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Pralidoxime
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Which drug would help improve FEV1 in a patient with COPD?
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Ipratropium
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A 30 y/o schizophrenic male now has urinary retention d/t his neuroleptic. What do you treat him with?
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Bethanechol
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If a drug is administered to one eye, and in the dark both pupils are dilated, what is the drug if the other pupil constricts in the light?
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Muscarinic Antagonist:
- Atropine - Homatropine - Tropicamide Or Sympathetic agonist |
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How does hexamethonium affect blood pressure?
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Dominant tone = SANS
Anti-EPI effects → ↓BP Hexamethonium = N-ACh-R blocker (therefore blocks BOTH PANS and SANS) |
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How does hexamethonium affect heart rate?
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Dominant tone = PANS
Anti-Vagus → ↑HR Hexamethonium = N-ACh-R blocker (therefore blocks BOTH PANS and SANS) |
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How does hexamethonium affect cardiac output?
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Dominant tone = PANS
Anti-Vagus → ↓CO Hexamethonium = N-ACh-R blocker (therefore blocks BOTH PANS and SANS) |
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How does hexamethonium affect urine output?
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Dominant tone = PANS
Anti-M3 effect → retention Hexamethonium = N-ACh-R blocker (therefore blocks BOTH PANS and SANS) |
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How does hexamethonium affect GI motility?
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Dominant tone = PANS
Anti-M1/M3 effect → ↓motility Hexamethonium = N-ACh-R blocker (therefore blocks BOTH PANS and SANS) |
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How does hexamethonium affect pupil of the eye?
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Dominant tone = PANS
Anti-M3 effect → Midriasis (dilated) Hexamethonium = N-ACh-R blocker (therefore blocks BOTH PANS and SANS) |
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What is the general byproduct of Phase I metabolism? of Phase II?
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1) slightly more polar chemicals
2) very polar, conjugated chemicals, inactivated, |
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What reactions take place in Phase I? Phase II?
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1) Reduction, Oxidation, Hydrolyzation
2) GAS = Glucuronidation, Acetylation, Sulfation |
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What question is asked in each of the 4 clinical phases of drug development?
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Phase I - Is it safe?
Phase II - Does it work? Phase III - Does it work better? Phase IV - Post-market surveillance |
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Name 5 drugs that inhibit ACh-Esterase and their clinical application.
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1) Edrophonium = MG Dx
2) Neostigmine = MG Tx; reverse paralytics 3) Pyridostigmine = MG Tx (long acting; no CNS) 4) Physostigmine = Glaucoma, Atropine O/D 5) Echothiophate = Glaucoma Others: - Alzheimer rx = Donepezil, Rivastigmine, Galantamine - Organophosphates (Parathion) |
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What are the various clinical applications for atropine?
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- Anesthesia - ↓ airway secretions
- GI - ↓ gastric acid secretion; ↓ gut mobility - GU - ↓ bladder spasm - Eyes - Dilation & Cycloplegia ALSO: Organophosphate poisoning |
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What G-protein is stimulated by the α1-receptor?
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Gq
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What G-protein is stimulated by the α2-receptor?
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Gi
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What G-protein is stimulated by the ß1-receptor?
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Gs
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What G-protein is stimulated by the ß2-receptor?
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Gs
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What G-protein is stimulated by the M1-receptor?
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Gq
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What G-protein is stimulated by the M2-receptor?
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Gi
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What G-protein is stimulated by the M3-receptor?
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Gq
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What G-protein is stimulated by the D2-receptor?
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Gi
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How many half lives does it take for a drug to reach 94% steady state? What variables determine t1/2?
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4 half-lives
Variables: - Vd - CL |
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Which receptor(s) is stimulated by Clonidine?
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α2 agonist (central)
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Which receptor(s) is stimulated by Dopamine?
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D1/D2 > ß > α
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Which receptor(s) is stimulated by Phenylephrine?
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α1 > α2
useful for epistaxis |
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Which receptor(s) is stimulated by Albuterol?
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ß2 >> ß1 (SE's)
note: LEV-albuterol doesn't have the ß1 SE's |
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Which receptor(s) is stimulated by Norepinephrine?
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α1 & α2 > ß1 >> ß2
Go-to agent for Septic Shock |
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Which receptor(s) is stimulated by Isoproterenol?
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Only ß
ß1 = ß2 |
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Which receptor(s) is stimulated by Epinephrine?
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ALL (ß>α)
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Which receptor(s) is stimulated by Dobutamine?
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ß1 >> ß2
Go-to drug for Cardiogenic shock |
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Which receptor(s) is stimulated by Terbutaline?
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ß2 > ß1
used as a tocolytic (stopping premature uterine contractions) |
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Which sympathomimetic is given as a nebulizer for asthma?
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Albuterol
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Which sympathomimetic is given SQ for asthma?
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Terbutaline
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Which sympathomimetic is used by ENT to vasoconstric nasal vessels?
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Phenylephrine
Cocaine |
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Which sympathomimetic is used to treat ADHD?
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Amphetamine (stimulates the release of stored catecholamines)
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When would you give Levalbuterol instead of Albuterol?
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Someone w/ CHF & COPD (don't want to elevate the HR)
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Which drugs would be most appropriate in a pt in shock b/c they maintain renal blood flow?
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Dopamine
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