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157 Cards in this Set

  • Front
  • Back
The adrenal medulla has ___ ACh receptors that respond to sympathetic/parasympathetic stimulation.
nicotinic; sympathetic
Renal vascular smooth muscle has ___ receptors that respond to sympathetic/parasympathetic stimulation by constricting/relaxing.
D1; sympathetic; relaxing
Hemicholinium is an anticholinergic that works by:
inhibiting transport of choline into presynaptic nerve --> no ACh can be made
Vesamicol is an anticholinergic that inhibits transport of:
Acetyl-CoA + choline into a packaging vesicle
How does botulinum work?
inhibit ACh release from presynaptic nerve terminal --> flaccid muscle paralysis
Influx of what ion is needed for ACh vesicles to be released from the presynaptic terminal?
Acetylcholinesterase breaks ACh to:
acetate + choline
Which amino acid is needed to make NE?
Tyrosine (--> dopa --> dopamine --> NE)
What does reserpine do at the noradrenergic presynaptic nerve terminal?
blocks transport of dopamine into vesicle to be made into NE (for HTN, causes sedation/depression/nasal stuffiness/diarrhea)
What does guanethidine do at the noradrenergic presynaptic nerve terminal?
blocks release of NE from presynaptic nerve (for HTN, causes orthostatic and exercise hypotension/sexual dysfunction/diarrhea)
What do amphetamines do at the noradrenergic presynaptic nerve terminal?
enhances release of stored catecholamines like NE
What do cocaine and TCAs do at the noradrenergic presynaptic nerve terminal?
inhibit reuptake of NE --> release more NE
Angiotensin II acts on its receptor at the sympathetic noradrenergic nerve terminal to enhance/decrease NE release.
Bethanechol =
direct ACh agonist - for postoperative and neurogenic ileus and urinary retention
Carbachol =
direct ACh agonist - glaucoma (activate ciliary muscle, pupillary sphincter)
Pilocarpine =
direct ACh agonist - glaucoma (activates ciliary muscle, pupillary sphincter)
Neostigmine =
anticholinesterase - postop and neurogenic ileus and urinary retention, myasthenia gravis, reverse nmj blockade
Pyridostigmine =
anticholinesterase - myasthenia gravis (also increases strength)
Edrophonium =
anticholinesterase - Dx myasthenia gravis, very short acting
Physostigmine =
anticholinesterase - glaucoma (crosses BB barrier) and atropine overdose
Echothiophate =
anticholinesterase - glaucoma
What are the clinical manifestations of cholinesterase poisoning?
too much ACh!
1) diarrhea, urination
2) sweating, tearing, drooling
3) miosis
4) bradycardia
5) excitation of sk. muscle
6) bronchospasm
7) abdominal cramping
What do you give in cholinesterase poisoning?
atropine (muscarinic antagonist) + pralidoxime (regenerate AChE)
Which cholinoreceptor blockers act on the EYE?
atropine, homatropine, tropicamide --> mydriasis, cycloplegia
Which cholinoreceptor blocker is used for Parkinson's disease?
BENZTROPINE!! --> reduces rigidity and tremor
Which cholinoreceptor blocker is used for motion sickness?
Which cholinoreceptor blocker is used for asthma and COPD?
ipratropium --> prevents bronchoconstriction
Which cholinoreceptor blockers act on the GU system to reduce urgency and bladder spasms?
Methscopolamine, oxybutin, glycopyrrolate
How does atropine affect:
- eye
- airway
- stomach
- gut
- bladder
- mydriasis, cycloplegia
- dec. secretions
- dec. acid secretion
- dec. motility
- dec. urgency in cystitis
What are toxicities of atropine? (laundry list of anticholinergic effects)
raise body Temp, rapid pulse, dry mouth, dry flushed skin, cycloplegia, constipation, disorientation, acute angle-closure glaucoma in old ppl, urinary retention w/BPH, hyperthermia in babies
Hexamethonium =
Nicotinic ACh receptor antagonist --> ganglion blocker to prevent reflex bradycardia caused by NE
Epinephrine =
direct agonist (a1, a2, b1, b2) - for anaphylaxis, open angle glaucoma, asthma, hypotension
NE =
direct agonist of a1, a2, b1 - for hypotension but decreases renal perfusion
Isoproterenol =
b1 = b2 agonist - for asthma, AV block
Dopamine =
D1 = D2 > b > a - for shock and increases renal perfusion (recall: D1 relaxes renal vasculature)
Dobutamine =
b1 > b2 - for shock, heart failure
Amphetamine mechanism; is used to treat:
releases stored catecholamines - for narcolepsy, obesity, ADD
Ephedrine =
releases stored catecholamines - for nasal decongestion, urinary incontinence, hypotension
Phenylephrine =
a1 > a2 agonist - vasoconstriction, nasal decongestion, pupil dilator
Albuterol =
b2 > b1 agonist - asthma
Terbutaline =
b2 > b1 agonist - asthma
Cocaine =
catecholamine reuptake inhibitor - causes vasoconstriction, local anesthesia
Clonidine =
centrally acting a2 agonist decreases sympathetic outflow - for HTN w/renal disease
a-methyl dopa =
centrally acting a2 agonist decreases sympathetic outflow - for HTN w/renal disease
Giving someone NE will raise BP overall but causes a reflex ___.
bradycardia (recall: give hexamethonium to prevent this)
Giving epinephrine will do what to the systolic P, diastolic P, mean BP, and heart rate?
raise systolic, lower diastolic, mean BP unchanged, raise HR
Giving isoproterenol will cause mean BP to ___ and heart rate to ___.
decrease, increase
Phenoxybenzamine =
irreversible a1 & a2 blocker - pheochromocytoma
Phentolamine =
reversible a1 & a2 blocker - pheochromocytoma
Prazosin/terazosin/doxazosin =
a1 blocker - HTN, BPH
Mirtazapine =
a2 blocker - atypical depression (causes side effects like dry mouth, inc. appetite, wt. gain)
Beta blockers are used for:
1) HTN
2) angina
3) MI - decreases mortality!!
4) SVT - esmolol, propranolol
5) CHF - slows progression!
6) glaucoma - timolol, betaxolol, carteolol dec. secretion of aqueous humor
Toxicities of beta-blockers:
1) impotence!!
2) worsen asthma
3) bradycardia
4) AV block
5) CHF
6) sedation
7) mask hypoglycemic sxs in diabetics!!!
NONselective beta-blockers = (LNPPT)
1) propranolol
2) timolol
3) nadolol
4) pindolol
5) labetolol
Beta-1 selective blockers = (A BEAM)
1) acebutolol
2) atenolol
3) betaxolol
4) metoprolol
5) esmolol (short acting)
Latanoprost =
PGF2 - inc. outflow of aqueous humor for glaucoma
Which cholinomimetics are used for glaucoma? (4)
1) pilocarpine & carbachol - ACh agonists
2) physostigmine & echothiophate - anticholinesterases
How does acetazolamide work for glaucoma?
decrease aqueous humor secretion due to decreased synthesis of HCO3
Which beta-blockers work for glaucoma? (3)
1) timolol (non specific)
2) betaxolol (b1)
3) carteolol
* dec. aqueous secretion
Which alpha-agonists work for glaucoma?
1) epinephrine - not for closed angle, inc. outflow
2) brimonidine - dec. aqueous synthesis
antidote for acetaminophen =
antidote for salicylates =
alkalinize pee (acetazolamide), dialysis
antidote for anticholinesterates & organophosphates (too much ACh) =
atropine & pralidoxime (which regenerates cholinesterASE)
antidote for antimuscarinic/anticholinergic agents (too little ACh) =
physostigmine (anticholinesterase, for atropine overdose & glaucoma)
antidote for beta-blockers =
antidote for digitalis =
1) stop digitalis
2) normalize K+
3) lidocaine
4) anti-dig Fab fragments
5) magnesium
antidote for iron =
antidote for lead =
dimercaprol, EDTA, succimer, penicillamine
antidote for MERCURY, arsenic, gold =
dimercaprol, succimer
antidote for COPPER, arsenic, gold =
antidote for cyanide =
nitrites (to turn Hb into metHb which has high affinity for CN-), hydroxocobalamin, thiosulfate
antidote for methemoglobin =
methylene blue
antidote for CO =
100% O2, hyperbaric O2
antidote for methanol poisoning =
FOMEPIZOLE, ethanol, dialysis
antidote for ethylene glycol poisoning =
FOMEPIZOLE, ethanol, dialysis
antidote for opioids =
naloxone, naltrexone
antidote for benzodiazepines =
antidote for TCA's =
sodium bicarbonate (nonspecific)
antidote for heparin =
protamine sulfate
antidote for warfarin =
IV vitamin K, fresh frozen plasma
antidote for tPA & streptokinase =
aminocaproic acid
Lead poisoning si/sx =
1) x-ray --> lead lines on gums and epiphyses of long bones
2) encephalopathy, erythrocyte basophilic stippling
3) abdominal pain, sideroblastic anemia
4) wrist & foot drop
1st line treatment for lead poisoning =
dimercaprol, EDTA, succimer for kids
How to pee out drugs like phenobarbital, MTX, aspirin:
these are weak acids - want to alkalinize urine with bicarb to increase their clearance
How to pee out something like amphetamines:
amphetamines are weak bases - need to acidify urine with ammonium chloride to increase clearance
What drugs can have atropine-like (anticholinergic) reactions?
a lot...but in this section they wanted "TCAs" especially amitriptyline
Drug reaction causing cardio toxicity?
doxorubicin (Adriamycin), daunorubicin
Drug reaction causing coronary vasospasm?
Drug reaction causing cutaneous flushing? ("V CAN")
- vancomycin (red man)
- calcium channel blockers
- adenosine
- niacin
Drug reaction causing torsades de pointes?
sotalol, quinidine, cisapride
Drug reaction causing agranulocytosis? (3 C's)
clozapine, carbamazepine, colchicine
Drug reaction causing aplastic anemia?
chloramphenicol, benzene, NSAIDs
Drug reaction causing Gray Baby syndrome?
Drug reaction causing hemolysis in G6PD deficient patients?
- sulfonamides
- aspirin
- ibuprofen
- primaquine (antimalarial)
- nitrofurantoin (UTI)
Drug reaction causing thrombosis?
oral contraceptives
Drug reaction causing cough?
ACE inhibitors (give losartan instead)
Drug reaction causing pulmonary fibrosis?
busulfan (CML), bleomycin (testicular cancer), amiodarone
Drug reaction causing Acute Cholestatic Hepatitis???
Drug reaction causing hepatic necrosis? (4)
halothane (inhaled anesthetic), valproic acid (epilepsy), acetaminophen overdose, amanita phalloides (mushroom)
Drug reaction causing hepatitis? (this is a TB drug)
Drug reaction causing pseudomembranous colitis due to C.dificile overgrowth?
ampicillin, clindamycin - treat with vancomycin!
Drug reaction causing adrenal insufficiency?
steroid WITHDRAWAL - adrenal gland was suppressed and now suddenly needs to make its own steroids
Drugs causing gynectomastia (Inna, this is all you):
- spironolactone
- digitalis
- cimetidine
- chronic alcohol use
- ketoconazole
- estrogens (durr)
Drug reaction causing hot flashes?
tamoxifen - selective estrogen receptor modulator, for E/P receptor positive breast cancers
Drug reaction causing gum hyperplasia?
Drug reaction causing osteoporosis?
corticosteroids, heparin
Drug reaction causing photosensitivity? (SAT)
- sulfonamides
- amiodarone
- tetracyclines
Drug reaction causing lupus-like sxs? (HIPP)
- hydralazine
- procainamide
- phenytoin
Drug reaction causing tendonitis, tendon rupture, cartilage damage in kids?
Drug reaction causing Fanconi's syndrome? (dehydration, polyuria, osteomalacia, proteinuria, hypokalemia, acidosis)
expired tetracycline (weird)
Drug reaction causing interstitial nephritis?
methicillin (for S.aureus)
Drug reaction causing hemorrhagic cystitis?
cyclophosphamide, ifosfamide (NHL, breast, ovarian)
Quinidine and quinine can -->
cinchonism (tinnitus, headache, deafness)
Lithium and demeclocycline -->
diabetes insipidus
Bupropion, imepenem/cilastatin -->
Disulfiram-like reaction can be due to which drugs?
- metronidazole
- cephalosporins w/methylthiotetrazole group
- procarbazine (Hodgekin's)
- sulfonylureas (insulin release for type 1 diabetes)
What is a disulfiram-like reaction like?
flushing, vasodilation, nausea, hypotension, respiratory difficulty
Polymyxins can lead to:
nephro and neurotoxicity
Aminoglycosides, loop diuretics, cisplatin can lead to:
ototoxicity, nephrotoxicity
Inducers of P450: (5)
- barbiturates
- phenytoin
- rifampin
- griseofulvin
- carbamazepine
Inhibitors of P450: (9)
- sulfonamide
- cimetidine
- ketoconazole
- St. John's wort
- erythromycin
- grapefruit juice
- quinidine
- (norfloxacin)
ethylene glycol -->
oxalic acid: acidosis and nephrotoxicity (crystals)
methanol -->
formic acid: severe acidosis, retinal damage!!!
ethanol + disulfiram -->
accumulate acetaldehyde: nausea, vomiting, hypotension
Which enzyme does disulfiram inhibit?
acetaldehyde dehydrogenase
Which enzyme is first in the breakdown of ethylene glycol, methanol, and ethanol?
alcohol dehydrogenase
common cold
(GI distress, dizzy, headache)
like ephedrine releases stored catecholamines, for nasal decongestion, urinary incontinence, hypotension
(arrhythmia, stroke, seizure)
(GI distress, mouth ulcers, antiplatelet actions)
intermittent claudication
(GI distress, anxiety, insomnia, headache, antiplatelet actions)
chronic anxiety
(GI distress, sedation, ataxia, liver tox, photo tox, dermato tox)
milk thistle
viral hepatitis
(loose stools)
saw palmetto
(GI distress, dec. libido, HTN)
St. John's wort
(GI distress, photo tox, serotonin syndrome with SSRI's, inhibits P450)
symptomatic improvement in women with lupus of AIDS
(androgenization in premenopause, estrogenic effects postmenopause, feminization of young men)
jet lag
(sedation, suppresses midcycle LH, hypoprolactinemia)
erectile dysfunction (sildenafil)
inhaled anesthetic (halothane)
benzodiazepine (diazepam)
neuroleptic, antiemetic (chlorpromazine)
antifungal (ketoconazole)
barbituate (phenobarbital)
local anesthetic (lidocaine)
penicillin (methicillin)
antibiotic protein synthesis inhibitor (tetracycline)
TCA (imipramine
protease inhibitor for HIV (saquinavir)
beta blocker (propranolol)
butyrophenone neuroleptic (haloperidol)
cardiac glycoside inotropic agent (digoxin)
methylxanthine (theophylline)
ACE inhibitor
beta 2 agonist (albuterol, salmeterol)
H2 blocker (cimetidine)
TCA (amitriptyline)
pituitary hormone
alpha 1 blocker (terazosin)