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