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67 Cards in this Set
- Front
- Back
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Donezipil
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Achase (-)
Tx: Alzheimers (also Galantamine and Rivastigmine) |
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Galantimine
Rivastigmine |
also Donezapil
carbamate Achase (-) Tx: Alzheimers |
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Pseudocholinesterase and Ach analogs
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CAn't BE Metabolized
-Carbachol -Bethanechol -Methacholine -longer activity, slow metabolize in body |
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Methocholine
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-Dx asthma
-Ach analog -cannot be metabolized w/ pseudocholinesterase -only muscarinic effects |
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Muscarinic specific Choline esters
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-Methacholine- Dx asthma
-Bethanechol- Tx urinary retention |
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How to block hypoTN w/ i.v. choline ester admin:
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Atropine
-activate K+ channels to hyperpolarize cells -prevent Ach-like increase in cGMP/ NO |
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Pilocarpine
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Ach agonist
-miosis -fixate pupils at far distance -lower IOP -contraction of meridional fibers of ciliary muscle -align trabecular plates through canal of Schlem |
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Nicotine
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-tertiary amine
-not hydrolyzed by pseudocholinesterase -metabolized by liver -increase HR and BP--> vasodilation -increased GI Motility and respirations |
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Carbamates
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ACHase (-)--> phyostigmine, neostigmine, edrophonium
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Edrophonium
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4' amine ACHase (-)
-Dx myasthenia gravis -differentiate between MG and choinergic crisis Tx MG w/ neostigmine |
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Neostigmine
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3' amine ACHase (-)
Tx Myasthenia Gravis |
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Organophosphates
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-Malathion
-Parathion -Isoflophosphate (DFP) -toxins in home, agriculture and biochemistry labs -Sx: lacrimation, salivation, miosis, blurred vision, urination, sk. muscle fasciculations, pulm. edema, dyspnea Tx: atropine + pralidoxime |
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Phyostigmine
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indirect Ach agonist
Tx: anticholinergic toxicity (atropine OD) |
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Tx urge incontinence
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-Solifenacin
-Tolterodine Ach antagonist |
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Ach antagonists Tx Parkinsons
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-Diphenhydramine
-Trihexphenidyl -Benztropine |
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Tx Menier's Disease
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Meclazine
-Ach antagonist anti-emetic |
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DOC Fundoscopic exam
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Tropicamide
Ach antagonist |
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DOC determination refractive error
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Cyclopentolate
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Tx anterior uveitis pain, keratitis, choroiditid
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long-acting muscarinic antagonists
-Scopolamine -Atropine |
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Ganglionic blocking drugs
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-Trimethaphan
-Hexamethonium -antagonist N1 receptors in autonomic ganglia -(-) Epi release w/ hypoglycemia |
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Atropine w/ NE
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blocks baroreflex bradycardia
i.v. |
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Haloperidol + DA
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-DA nl. increase BF to kidneys and GI
-haloperidol blocks increase in BF -DA will still increase contractility (beta-1) -high dose DA will increase DBP |
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DA effects on body
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-increase contractility (beta-1)
-HIGH dose increase DBP -increase RBF and BF to GI (block w/ haloperidol) |
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EPI + halothane
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cardiac arrythmias
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EPI effects
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-vasodilation on skeletal muscle
-vasoconstriction to GI, kidneys, skin -increased HR, contractility, CO, SBP, PP -decrease PP |
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increase PP
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Epinephrine
-increase BF muscles -decrease BF to GI, kidneys, skin -increase SBP w/ no change in DBP |
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alpha blockers
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-prazosin
-phentolamine -phenoxybenzamine Epi + alpha block = lower BP, TPR, ERP, increase HR and RBF |
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Epi + alpha blocker
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-Prazosin
-Phenoxybenzamine -Phentolamine -lower TPR, BP, ERP -increase HR and RBF |
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Ritodrine
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beta2 agonist
-prevents premature labor |
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selective beta-2 agonists
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Albuterol
Tertbutaline -less incidence of tachycardia Isoproterenol= non-spec. beta agonist w/ increase HR |
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Isoproterenol
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non-specific beta-agonist
Tx: asthma -tachycardia prominent |
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Clonidine
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pre- and post-synaptic alpha agonist
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Methylphenidate
Amphetamines |
-dump catecholamines and DA (amphetamines)
-prevent reuptake |
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Ergotamine
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partial alpha agonist
Tx: migraines S/E: angina via vasospasm |
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Tx Pheo. to reverse effects of Epi
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Phentolamine
-alpha blocker -lowers the BP a/ EPI secretion |
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Beta-blockers specificity
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Propanolol, Isoproterenol, Timolol = nonspecific
Atenolol, Metopropolol = beta-1 (cardiac effects) Albuterol, Tertbutaline = beta=2 (respiratory effects) |
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beta-blockers and angina
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-lower O2 demand by lowering HR
-lower venous return |
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Reserpine
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-depletes NE stores
-poisons NE vesicles |
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S/E beta-blockers
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-hypoglycemia
-bronchospasm -AV block -CHF |
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Propanolol
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-non-specific beta blocker
-prevents peripheral conversion T4--> T3 -lowers HR and BP |
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MAO-A
MAO-B |
MAO-A= metab. NE and 5-HT
MAO-B= metab. 5-HT -Selegine MAO-B specific -Phenelezine, Tranylcypromide hits both MAO |
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Drugs that decrease plasma NE
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-Clonidine
-Reserpine -alpha-methyldopa -Guanethidine -ganglionic blockers |
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Drugs that increase plasma NE
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-alpha-blockers
-hydralazine, minodoxil, diazoxide -Nifedipine -nitroprusside -HCTZ -Cocaine |
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Arterial vasodilators
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-Hydralazine- SLE-like, edema
-Minodoxil- hirsituism, additive w/ finisteride -Diazoxide- inhibit insulin release -increase cGMP---> increase NO |
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DOC HTN emergency
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-Labetolol
-Diazoxide- activate K+ ATPase channel -Nitroprusside -Fenoldopam- agonist vascular D1-rec |
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Nitroprusside
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-balanced vasodilation- increase cGMP and NO
Tx: CHF, HTM emergency -not for G6PD def. -beware CN toxicity and thiocyanate toxicity |
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drugs which decrease contractility
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-beta-blockers
-calcium channel blockers |
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RAAS and the heart
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-aldosterone = increase fibrillar deposition in cardiac ECM
-AngII- increase BP via vasoconstriction |
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ACE(-) and Bradykinin
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ACE normally breaksdown Bradykinin
ACE(-) ---> increase Bradykinin -cough -facial edema -potentiate vasodilatory effects of Bradykinin -will see no change of Bradykinin w/ ARBs |
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Cough with ACE(-)
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Tx w/ aspirin
-due to increased Bradykinin and PGs -ARBs will not have cough associated |
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ACE (-) renal fxn
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-always give to diabetics
-preserves renal fxn -prevents proteinuria |
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Aliskiren
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renin inhibitor
Tx: HTN |
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Acetazolimide
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MOA (-) carbonic anhydrase in PT/ eye/ CSF
Tx: glaucoma, mild diuretic, clearance of acidic drugs, mild decrease gastric acid -altitude sickness S/E: hyperchloremic metabolic acidosis -loss of bicarb, K+, and Na+ |
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To make urine acidic
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ammonium chloride
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hyperchloremic metabolic acidosis and diuretics?
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acetazolimide
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hypochloremic metabolik alkalosis
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Loop diuretics (furosemide + ethacrynic acid)
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Diuretics and digoxin
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loss of K+ will potentiate digoxin
-loop diuretics -THiazides |
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bilateral hearing loss exacerbated w/ aminoglycosides (gentamycin)
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loop diuretics
-furosemide ethacrynic acids |
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diuretic with low GFR
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use a loop diuretic (furosemide/ ethacrynic acid)
thiazides will not work |
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S/E Loop diuretics
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-hypokalemic, hypochloremic metabolik alkalosis
-increase Hct due to loss plasma volume -ototoxicity worse w/ aminoglycosides -hyperuricemia -lithium toxicity -enhance digoxin (hypokalemia) |
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limitations of Thiazides
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-will not work w/ GFR <25 (use loop diuretic)
-will lower GFR in all pts. (does not apply to metolazone) |
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Metolazone
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thiazide diuretic works at low GFR
will not lower GFR like other thiazides |
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K+ sparing diuretics
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tASK
Triamterene Amilioride Spirinolactone -ALL contraindicated in renal insufficiency due to HYPERKALEMIA |
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Amilioride
Triamterene |
-block Na+ channels in principle cells of DCT
-increase Na+ excretion -decrease K+ excretion -make urine alkaline via (-) H+ secretion from intercalcated cells -K+ sparing--> contraindicated w/ renal insufficient pts. |
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Spirinolactone
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-antagonist aldosterone
-partial androgen/ estrogen agonist -increase excretion Na+ -reverse cardiac remodeling |
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Tx Conns syndrome
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Spirinolactone
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REMINDER
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GO OVER ELECTROLYTE AND FLOW ALGORYTHIM
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