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220 Cards in this Set

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28 year old chemist presents with MPTP exposure

What NT is depleted?
Dopamine
Woman taking tetracycline exhibits photosensitivity

What are the clinical manifestations?
Rash on sun-exposed regions of body
Nondiabetic patient presents with hypoglycemia but low levels of C peptide

What is the diagnosis
Surreptitious insulin injection
African American male who goes to Africa develops hemolytic anemia after taking malaria prophylaxis

What is the enzyme defficiency
Glucose 6 phosphate dehydrogenase
27 year old female with history of psychiatric illness now has urinary retention due to neuroleptic

What do you treat it with?
Bethanechol
Farmer presents with dyspnea, salivation, miosis, diarrhea, cramping and blurry vision

What caused this and what is the mechanism
Insecticide poisoning, inhibition of acetylcholinesterase
Patient with recent kidney transplant is on cyclosporine for immunosuppresion, he requires antifungal agent for candidiasis

What antifungal drug would result in cyclosporine toxicity?
Ketoconazole
Man on several medications including antidepressants and antihypertensives, has mydriasis and becomes constipated

What is the cause of symptoms?
TCA
55 year old postmenopausal woman on tamoxifen therapy

What is she at increased risk of acquiring?
Endometrial carcinoma
Woman on MAO inhibitor has hypertensive crisis after meal

What did she ingest?
Tyramine (wine or cheese)
After taking clindamycin, patient develops toxic megacolon and diarrhea

What is the mechanism of diarrhea?
Clostridium difficile overgrowth
Man starts a medication for hyperlipidemia. He then develops rash, pruritus and GI upset

What drug was it?
Niacin
Patient is on carbamazepine

What routine workup should be done?
LFT's
23 year old female who is on rifampin for TB prophylaxis and on birth control (estrogen) gets pregnant

Why?
Rifampin augments estrogen metabolism in liver rendering it less effective
Patient develops cough and must discontinue captopril

WHat is a good replacement drug and why doesnt it have the same side effects?
Losartan - an angiotensin II receptor antagonist, does not increase bradykinin as captopril does
Relates the amount of drug in the body to plasma concentration
Vd - volume of distribution
Formule for volume of distribution
Vd = amount of drug in the body/plasma drug concentration
Vd of plasma protein-bound drugs can be altered by what disease?
Liver and kidney
Relates the rate of elimination to plasma concentration
CLEARANCE
Formula for clearance
Cl = rate of elimination of drug/plasma drug concentration
The time required to change the amount of drug in the body by 1/2 during elimination (or during constant infusion) is called _
Half life T1/2
After 1 half life concentration of drug equals _ %
50%
After 2 half lifes concentration of drug equals_
75%
A drug infused at constant rate reaches about _ % of steady state after 4 T1/2
94
Formula for T1/2
T1/2 = 0.7 * Vd/CL
Loading dose formula
Loading dose = Cp * Vd/F

Cp= target plasma concentration

F = bioavailibility
Formula for maintenance dose
Cp * CL / F

Cp = target plasma concentration

F = bioavailibility
In patients with impaired renal or hepatic function, the loading dose decreases, increases or remains unchanged?

Maintenance dose?
Loading dose remains unchanged

Maintenance dose decreases
Rate of elimination is constant (constant amount of drug is eliminated per unit time) - what order elimination?

What happens to target plasma concentration?
Zero order elimination

Target plasma concentration decreases linearly with time
Rate of elimination is proportional to drug concentration (constant fraction of drug eliminated per unit time) - what order elimination?

What happens to target plasma concentration?
First order elimination

Cp decreases exponentially with time
Give examples of drugs with zero order elimination
Ethanol

Phenytoin

Aspirin (at high or toxic concentration)
Phase I metabolism (reduction, oxidation, hydrolysis) yields _ metabolites (often still active)
Slightly polar, water soluble
What phase of metabolism associated with cytochrome P450
Phase I
What phase of metabolism associated with conjugation
Phase iI
Phase II metabolism (acetylation, glucoronidation, sulfation) yields _ metanolites (renally excreted)
Very polar, inactive
Geriatric patients lose which phase of metabolism first?
Phase I
Is it safe? Pharmacokinetics? - which phase of clinical testing of the drug
Phase I
Does it work in patients?- which phase of clinical testing of the drug
Phase II
Does it work? Double blind - which phase of clinical testing of the drug
Phase III
What happens in phase IV of clinical testing of the drug
Postmarketing surveillance
A competitive antagonist shifts agonist curve where?
To the right
A noncompetitive antagonist (irreversible) shifts agonist curve where?
Downward
Name antibiotics that block cell wall synthesis by inhibition of peptidoglycan cross linking
Penicillin

Ampicillin

Ticarcillin

Pipercarcillin

Imipenem

Aztreonam

Cephalosporins
Name antibiotics that block peptidoglycan synthesis
Bacitracin

Vancomycin

Cycloserine
Name antibiotics that block protein synthesis at 50S ribosomal unit
Chloramphenicol

Erythromycin/macrolides

Lincomycin

Clindamycin

Streptogramins (quinupristin, dalfopristin)

Linezolid
Name antibiotics that block protein synthesis at 30S ribosomal unit
Aminoglycosides

Tetracyclines
Name antibiotics that block nucleotide synthesis
Sulfonamides

Trimethoprim
Name antibiotics that block DNA topoisomerase
Quinolones
Name antibiotic that blocks mRNA synthesis
Rifampin
Name bactericidal antibiotics
Penicillin

Cephalosporins

Vancomycin

Aminoglycosides

Fluoroquinolones

Metronidazole
Name drugs that disrupt bacterial/fungal cell membrane
Polymyxins
Name drugs that disrupt fungal cell membranes
Amphotericin B

Nystatin

Flucoconazole/azoles
Oral form of penicillin is called _

IV form?
Penicillin V

Penicillin G
Mechanism of penicillin
- Binds penicillin binding proteins

- Blocks transpeptidase cross linking of cell walls

- Activates autolytic enzymes
This antibiotic is bactericidal for gram positive cocci, gram positive rods, gram negative cocci and spirochetes. Not penicillinase resistant
PENICILLIN
Toxicity of penicillin
Hypersensitivity reactions

Hemolytic anemia
Methicillin, nafcillin, dicloxacillin - mechanism of action?

Narrow or broad action?

Penicillinase resistant or not?
Same as penicillin

Narrow action

Penicillinase resistant because of bulkier R groups
Methcillin, nafcillin and dicloxacillin are clinically used for treatment of what bug?
S. aureus
Methicillin toxicity
Interstitial nephritis
Methcillin, nafcillin, dicloxacillin toxicity
Hypersensitivity reactions
Ampicillin, Amoxicillin- mechanism of action

Penicillinase sensitive or resistant?

Spectrum narrow or wide?
SAME AS PENICILLIN

Wide spectrum

Penicillinase sensitive
Ampicillin, amoxicillin can be combined with _ to enhance spectrum
Clavulinic acid
Which has greater oral bioavailibility - amoxicillin or ampicillin
AmOxicillin has greater Oral bioavailibility
Name antibiotics that are extended-spectrum penicillins - against certain gram positive and gram negative rods

Name rods
HELPS kill enterococci - H influenzae, E.coli, Listeria monocytogenes, Proteus mirabilis, Salmonella, enterococci

Ampicillin, amoxicillin
Toxicity for ampicillin and amoxicillin
Hypersensitivity reactions, ampicillin rash, pseudomembranous colitis
Mechanism for carbenicillin, pipercillin, ticarcillin
Spectrum?
Same as penicillin, extended spectrum
Name penicillins used for treatment of Pseudomonas, and gram negative rods

Is it penicillinase resistant or sensitive

Can it be used with clavulinic acid
Carbencillin, Piperacillin, Ticarcillin

Penicillinase sensitive

Use with clavulinic acid
Toxicity for carbencillin, piperacillin, ticarcillin
Hypersensitivity reactions
Beta lactam drugs that inhibit cell wall synthesis but are less susceptible to penicillinases, bactericidal
CEPHALOSPORINS
Which cephalosporins target gram positive cocci + Proteus , E. coli,Klebsiella
1st generation
Which cephalosporins target gram positive cocci + H. flu, Enterobacter, Neisseria, Proteus, E coli Klebsiella, Serratia
2nd generation
Which cephalosporins target serious gram negative infections resitant to other beta lactams, meningitis (most penetrate BBB) - give examples
3d generation - ceftazidime, ceftriaxone
3d generation cephalosporin used for treatment of Pseudomonas
Ceftazidime
3d generation cephalosporin used for treatment of gonorrhea
Ceftriaxone
Which cephalosporins have increased activity agains Psedudomonas and gram positive organisms
4th generation
Is there cross hypersensitivity between cephalosporins and penicillin
Yes, 5-10%
Toxicity for cephalosporins
Hypersensitivity reactions

Increase nephrotoxicity of aminoglycosides

Disulfiram like reaction with ethanol (in cephalosporins with methylthiotetrazole group) - cefamandole
A monobactam resistant to beta lactamases. Inhibits cell wall synthesis (binds to PBP3), synergistic with aminoglycosides, no cross allerginicity with penicillins
AZTREONAM
This antibiotic is used for Gram negative rods (Klebsiella, Pseudomonas, Serratia), no activity agains gram positives or anaerobes, for penicillin allergic patients and those with renal insufficiency who cannot tolerate aminoglycosides
AZTREONAM
Is there any toxicity associated with AZTREONAM
Usually nontoxic, occasional GI upset
Broad spectrum beta lactamase resistant carbapenem
Imipenem
Imipenem is ALWAYS administered with _

WHY?
CILASTATIN

Inhibitor of renal dihydropeptidase I - to decrease inactivation of the drug in renal tubules
Drug of choice for Enterobacter, also active against gram positive cocci, gram negative rods and anaerobes
Imipenem + cilastatin
Toxicity associated with Imipenem/cilastatin
GI distress, skin rash, CNS toxicity (seizures) at high plasma levels
Inhibits cell wall mucopeptide formation by binding D ala D ala portion of cell wall precursors. Resistance occurs with amino acid change of D ala D ala to D ala D lac
VANCOMYCIN
This antibiotic is used for serious gram positive multi drug resistant organisms, including S aureus, and Clostridium difficile (pseudomembranous colitis)
VANCOMYCIN
Diffuse flushing ("red man syndrome") associated with vancomycin can be largely prevented by?
Pretreatment with antihistamines and slow infusion rate
Toxicity for Vancomycin
Nephrotoxicity
Ototoxicity
Thrombophlebitis

Well tolerated in general - does NOT have many problems
Gentamicin, neomycin, amikacin, tobramycin, streptomycin - what class of antibiotics?
Aminoglycosides
Bactericidal, inhibit formation of initiation complex and cause misreading of mRNA. Require O2 for uptake, therefore ineffective against anaerobes
AMINOGLYCOSIDES
Which aminoglycoside is used for bowel surgery
Neomycin
Aminoglycosides are _ with beta lactams
Synergistic
Aminoglycosides are clinically used for treatment of _
Severe gram negative rod infections
Toxicity of aminoglycosides
Nephrotoxicity (especially with cephalosporins)
Ototoxicity (especially with loop diuretics)
Doxycycline, demeclocycline, minocycline - name class of antibiotics
Tetracyclines
Bacteriostatic, bind to 30S and prevent attachment of aminoacyl-tRNA, limited CNS penetration
Tetracyclines
Which tetracycline is fecally eliminated and can be used in patients with renal failure
Doxycycline
Must NOT take tetracyclines with _

Why?
Milk

Antacids

Iron containing preparations

Divalent cations inhibit its absorption in gut
Clinical use of tetracyclines
Vibrio cholerae
Acne
Chlamydia
Ureaplasma
Urealyticum
Mycoplasma pneumonia
Borelia burgdorferi
Riccketsia
Tularemia

VACUUM your BedRoom Tonight
Toxicity of tetracyclines
GI distress, discoloration of teeth and inhibition of bone growh in children, photosensitivity
Erythromycin, azithromycin, clarithromycin- name class of antibiotics
Macrolides
Inhibit protein synthesis by blocking translocation - bind to 23S rRNA of 50S ribosomall subunit, bacteriostatic
Macrolides
Clinical use macrolides
URI
Pneumonia
STD
gram positive cocci (streptococcal infections in patients allergic to penicillin), Mycoplasma, Legionella, Chlamydia, Neisseria
Toxicity macrolids
GI discomfort, acute cholestatic hepatitis, eosinophilia, skin rashes
Patient on antibiotic therapy develops acute cholestatic hepatitis - which clas of drug?
Macrolides
Most common cause of non compliance with macrolides
GI discomfort
Inhibits 50S peptidyltransferase, bacteriostatic
Chloramphenicol
This drug is used for treatment of meningitis (H flu, N meningitidis, Strep pneumoniae) but conservatively used due to toxicities
Chloramphenicol
Toxicities with chloramphenicol
Anemia (dose dependent)

Aplastic anemia (dose independent)

Gray baby syndrome
Which drug causes gray baby syndrome and why
Chloramphenicol - premature infants because they lack liver UDP-glucuronyl transferase)
Blocks peptide bond formation at 50S ribosomal subunit, bacteriostatic
Clindamycin
Which antibiotic is used to treat anaerobic infections (Bacteroides fragilis, Clostridium perfringens)
CLindamycin
Toxicity associated with clindamycin
Pseudomembranous colitis (C. difficile overgrowth), fever, diarrhea
PABA antimetabolites inhibit dehydropteorate synthase, bacteriostatic
Sulfonamides
Which sulfonamides are used for treatment of simple UTI
Triple sulfas or SMX
Clinical use of sulfonamides
Gram positive
Gram negative
Nocardia
Chlamydia
Toxicity with sulfonamides
Hypersensitivity reactions
Hemolysis if G6PD deficient
Nephrotoxicity (tubulointerstitial nephritis)
Kernicterus in infants
Displace other drugs from albumin (warfarin)
Antibiotic inhibits dihydropteorate synthase
Sulfonamides
Antibiotic inhibits dihydrofolate reductase
Trimethoprim, pyrimethamine
Inhibits bacterial dihydrofolate reductse, bacteriostatic
Trimethoprim
This drug is used in combination with sulfonamides causing sequential block of folate synthesis
Trimethoprim
This drug is used for recurrent UTI's, Shigella, Salmonella, Pneumocystis carinii pneumonia
TMP-SMX
Toxicity of trimethoprim
Megaloblastic anemia
Leukopenia
Granulocytopenia

TMP - Treats Marrow Poorly
Toxicity connected with trimethoprim can be alleviated by _
Supplemental folinic acid
Ciprofloxacin, norfloxacin, ofloxacin, sparfloxacin, moxifloxacin, gatifloxacin, enoxacin - name class
Fluoroquinolones
Antibiotics inhibit DNA gyrase (topoisomerase II), bactericidal
Fluoroquinolones
Used clinically for treatment of gram negative rods of urinary and GI tracts (including Pseudomonas), Neisseria, some gram positive organisms
Fluoroquinolones
Are fluoroquinolones safe in pregnant women
Contraindicated in pregnant women and in children because animal studies show damage to cartilage.
Fluoroquinolones toxicity
Tendonitis and tendon rupture in adults
GI upset
Superinfections
Skin rashes
Headache
Dizziness

FluoroquinoLONES hurt attachments to your BONES
Forms toxic metabolites in bacterial cells, bactericidal
Metronidazole
Antiprotozoal, Giardia, Entamoeba, Trichomonas, Gardenrella vaginalis, anearobes (bacteroides, clostridium) - name drug
Metronidazole
This drug is used with bismuth and amoxicillin (or tetracycline) for "triple therapy" against H pylori
Metronidazole
Anaerobic infections above diaphragm - ?

Anaerobic infections below diaphragm?
Above - clindamycin

Below - metronidazole
Toxicity of metronidazole
Disulfiram like reaction with alcohol, headache
Bind to cell membranes of bacteria and disrupt their osmotic properties, cationic, basic proteins that act like detergents - treat resistant gram negativ infections
Polymyxins
Toxicity for polymyxins
Neurotoxicity
Acute renal tubular necrosis
Name anti TB drugs
RESPIre
Rifampin
Ethambutol
Streptomycin
Pyrazinamide
Isoniazid
2nd line therapy for TB
Cycloserine
All anti TB drugs have same toxicity - name it
liver toxicity
Anti TB drug - decreases synthesis of mycolic acids
Isoniazid
The only agent used as solo prophylaxis against TB
Isoniazid
Toxicity for INH (Isoniazid)
Hemolysis if G6PD defficient
Neurotoxicity
Hepatoxocitiy
SLE like syndrome

INH - Injures Neurons and Hepatocytes
_ can prevent neurotoxicity caused by isoniazid
Pyridoxine (B6)
Which anti TB drug has different half lifes in fast vs slow acetylators
Isoniazid
Anti TB drug - inhibits DNA dependent RNA polymerase
Rifampin
Delays resistance to dapsone when used for leprosy
Rifampin
Used for meningococcal prophylaxis and chemoprophylaxis in contacts of children with H influenzae type B
Rifampin
Rifampin toxicity
Minor hepatoxicity and drug interactions (increases P450)
Rifampin 4 R's
RNA polymerase inhibitos
Revs up P450
Red/orange body fluids
Rapid resistance if used alone
Beta lactamase cleavage of beta lactam drug is a resistance mechanism against which drugs
Penicillins and cephalosporins
Modification via acetylation, adenylation, or phosphorylation is resistance mechanism against which drugs
Aminoglycosides
Terminal D ala component of cell wall replaced with D lac, decreases affinity - resistance mechanism against which drug
Vancomycin
Modification via acetylation - resistance mechanism against which drug
Chloramphenicol
Decreased uptake or increased transport out of cell is resistance mechanism against which drugs
Tetracyclines
Altered enzyme (bacterial dihdropteorate synthetase), decreased uptake or increased PABA synthesis is resistance against which drugs
Sulfonamides
Drug of choice for prophylaxis of meningococcal infections

Alternative?
Rifampin

Minocyclin
Prophylaxis of gonorrhea
Ceftriaxone
Prophylaxis of syphillis
Benzathine penicillin G
Prophylaxis in patients with history of recurrent UTI
TMP-SMX
Drug of choice for prophylaxis for pneumocystic carinii pneumonia

Alternative
TMP-SMX

Aerosolized pentamidine
Binds ergosterol (unique to fungi), forms membrane pores that allow leakage of electrolytes and disrupt homeostasis
Amphotericin B
Used for wide spectrum of systemic mycoses (Cryptococcus, Blastomyces, Coccidioides, Aspergillus, Histoplasma, Candida, Mucor). Intrathecally for fungal meningitis, does NOT cross BBB
Amphotericin B
Toxicity of Amphotericin B
NEPHROTOXICITY
Arrhythmias (amphoterrible)
Fever/chills (shake and bake)
Hypotension
Binds to ergosterol, disrupting fungal membranes, used as "swish and swallow" for oral candidiasis (thrush)
NYSTATIN
Inhibit fungal steroid (ergosterol) synthesis
AZOLES
Drug of choice for cryptococcal meningitis in AIDS patients and candidal infections of all types (i.e yeast infections)
FLuconazole
Drug of choice for Blastomyces, Coccidioides, Histoplasma, Candida albicans, hypercortisolism
Ketoconazole
Toxicity of azoles
Hormone synthesis inhibition (gynecomastia)
Liver dysfuntion (inhibits cytochrome P450)
Fever, chills
Inhibits DNA synthesis by conversion to fluorouracil which competes with uracil, used in systemic fungal infections (Candida, Cryptococcus), causes bone marrow suppression, n/v/d
FLUCYTOSINE
Antifungal medication, inhibits cell wall synthesis, clinically used for invasive aspergillosis, can cause GI upset and flushing
CASPOFUNGIN
Antifungal, inhibits fungal enzyme squalene epoxidase, used to treat dermatophytoses (especially onychomycosis)
TERBINAFINE
Anti fungal, interferes with microtubule function, disrupts mitosis, deposits in keratin containing tissues (nails) - oral treatment of superficial infections, inhibits growth of dermatophytes (tinea, ringworm)
GRISEOFULVIN
Toxicity Griseofulvin
Teratogenic
Carcinogenic
Confusion'
Headache
Increased warfarin metabolism
Antiviral drug used for prophylaxis for influenza A and treatment of Parkinsons
Amantadine
Derivative of Amantadine with fewer CNS side effects
Rimantidine
Anti viral medication, blocks biral penetration/uncoating, may buffer pH of endosome, also causes release of dopamine from intact nerve terminals
Amantadien
Toxicity of amantadine
Ataxia + dizziness+ slurred speech

Amantadine causes problems with cerebellA
Two antiviral medications that inhibits influenza neuraminidase, both used for influenza A and B
Zanamivir
Oseltamivir
Antiviral - inhibits synthesis of guanine nucleotides by competitively inhibiting IMP dehydrogenase, used for treatment of RSV and chronic hep C
Ribavirin
Toxicity for Ribavirin
Severe teratogen
Hemolytic anemia
THis antiviral medication preferentially inhibits viral DNA polymerase when phosphorylated by viral thymidine kinase
Acyclovir
Antiviral medication used for treatment of VZV, HSV, EBV, mucocutaneous and genital herpes lesions, prophylaxis in immunocompromised patients
Acyclovir
Toxicity for acyclovir
Delirium
Tremor
Nephrotoxicity
Antiviral drug - works by phosphorylation viral kinase, preferentially inhibits CMV DNA polymerase, drug of choice for CMV especialy in immunocopromised patients
Ganciclovir
Which drug is more toxic - acyclovir or ganciclovir to host enzymes
Ganciclovir
Ganciclovir toxicity
Leukopenia
Neutropenia
Thrombocytopenia
Renal toxicity
Viral DNA polymerase inhibitor that binds to the pyrophosphate binding site of the enzyme. Does not require activation by viral kinase
FOSCARNET = pyroFOSphate analog
Antiviral drug used for treatment of CMV retinitis in immunocompromised patients when ganciclovir fails
FOSCARNET
Patient is on foscarnet for CMV retinitis, which toxicity could be suspected?
Nephrotoxicity
Saquinavir, ritonavir, indinavir, nelfinavir, aprenavir - class of drugs
HIV therapy, protease inhibitors - inhibit assembly of new virus by blocking protease enzyme
HIV patient is taking anti HIV drugs, develops GI intolerance - nausea, diarrhea, hyperglycemia, lipid abnormalities, thrombocytopenia - which drugs was he taking
PROTEASE INHIBITORS
Zidovudine (AZT), didanosine, zalcitobine, stavudine, lamivudine, abacavir - what class of drugs
Reverse transcriptase inhibitors, nucleosides
Name non-nucleosides reverse transcriptase inhibitors
Nevirapine

Delavirdine

Efavirenz
Toxicity associated with reverse transcriptase inhibitors
Bone marrow suppression (neutropenia, anemia)
Peripheral neuropathy
Lactic acidosis (nucleosides)
Megaloblastic anemia
Rash (non-nucleosides)
Highly active antiretroviral therapy (HAART) generally entails combination of?
Protease inhibitors + reverse transcriptase inhibitors
Which antiretroviral drug is used during pregnancy to reduce risk of fetal transmission
AZT
Patient on anti HIV therapy develops megaloblastic anemia - which drug most likely caused it
AZT
When is HAART initiated?
When patients have low CD4 counts (<500 cell/mm3) or high viral load
Glycoproteins from human leukocytes that block various stages of viral RNA and DNA synthesis, used for treatment of chronic hep B and C, Kaposis sarcoma

Name drug and what toxicity associated with it
Interferons

Neutropenia
Antiparasitic drug from onchocerciasis
Ivermectin (rIVER blindness treated with IVERmectin)
Antiparasitic drug used to treat nematode/roundworm (pinworm, whipworm) infections
Mebendazole/thiabendazole
Antiparasitic drugs used to treat gian roundowrm (ascaris), hookworm (Necator/Ancylostoma) and pinworm (Enterobius)
Pyrantel pamoate
Antiparasitic used to treat trematode/fluke (shistosomes, Paragonimus, Clonorchis) and cysticercosis
Praziquantel
Niclosamide is used to treat?
Cestode/tapeworm infections except cysticercosis
Drug of choice for leishmaniasis
Pentavalent antimony
Name anti malaria drugs
Chloroquine
Quinine
Mefloquine
Atovaquone
Proguanil
Name drug used for treatment of latent hypnozoite (liver) forms of malaria (Plasmodium vivax, P.ovale)
Primaquine
Drug of choice agains giardiasis, amebic dysentery, bacteria vaginitis, Trichomonas
Metronidazole
Drug of choice for Chagas disease, American trypanosomiasis (trypanosoma cruzi)
Nifurtimox
Drug of choice for African trypanosomiasis (sleeping sickness)
Suramin
Cholinomimetic used for postoperative and neurogenic ileus and urinary retention - activates bowel and bladder smooth muscle
BETHANECHOL
Direct agonist, cholinomimetic used for treatment of glaucoma, activates ciliary muscle of eye (open angle), pupillary sphincter (narrow angle)
Carbachol, pilocarpine
Anticholinesterase, used in treatment of postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular junction blockade (postoperative), increases endogenous Ach
Neostigmine
Anticholinesterase used in treatment of myasthenia gravis - increases endogenous Ach, increases strength
Pyridostigmine
This anticholinesterase is used for diagnosis of myasthenia gravis (extremely short acting), increases endogenous Ach
Edrophonium
Anticholinesterase, used in treatment of glaucoma (crosses BBB to CNS) and atropine overdose, increases endogenous Ach
Physostigmine
Anticholinergic, used for treatment of glaucoma, increases endogenous Ach
Echothiophate
Name symptoms of cholinesterase inhibitor poisoning
DUMBBELSS
Diarrhea
Urination
Miosis
Bronchospasm
Bradycardia
Excitation of skeletal muscle
Lacrimation
Sweating
Salivation (also abdominal cramping)
Name substances that can lead to cholinesterase inhibitor poisoning
Parathion and other organophosphates
Antidote used in treatment of organophosphate poisoning
Atropine (muscarinic antagonist) plus pralidoxime (chemical antagonist used to regenerate active cholinesterase)