Pharmacology: Autonomics

Front 1

What is used to diagnose myasthenia gravis?

Back 1

EDROPHONIUM - short acting (5-15mins) AChE inhib

+ test shows sudden brief inc musc strength

Front 2

EDROPHONIUM: What does it mean when the weakness improves vs. worsens?

Back 2

improves: weakness due to MG, Eaton-Lambert synd, or AChR antag

worsens: weakness due to depolarizing block (e.g. from overmedication)

Front 3

EDROPHONIUM vs PYRIDOSTIGMINE?

Back 3

EDROPHONIUM: dx MG

PYRIDOSTIGMINE: tx MG (longer half life)

Front 4

tx for EDROPHONIUM O.D.?

Back 4

ATROPINE

Front 5

meds to treat myasthenia gravis?

Back 5

AChE inhib: PYRIDOSTIGMINE, NEOSTIGMINE, AMBENOMIUM

Front 6

CARBAMATE ESTERS?

Back 6

NEOSTIGMINE, PHYSOSTIGMINE, PYRIDOSTIGMINE

Front 7

mech of action of CARBAMATE ESTERS?

Back 7

inhib AChE by carbamylating it (more stable bond)--.5-6hrs

also have weak cholinomimetic properties

Front 8

what is used to reverse a non-depolarizing block?

Back 8

AChE inhib: NEOSTIGMINE, PYRIDOSTIGMINE

(e.g. reverse surgical anesth induced by nicotinic AChR antag)

Front 9

tx for anticholinergic drug poisoning, w/CNS toxicity present?

Back 9

PHYSOSTIGMINE--can cross BBB

Front 10

Which AChE inhib can be used to treat glaucoma?

Back 10

PHYSOSTIGMINE

Front 11

What drugs are used to inc GI motility and reduce urinary retention in p/o pts?

Back 11

NEOSTIGMINE (AChE inhib)
BETHANCHOL (M2,M3 musc ag)

Front 12

What AChE inhibitors are used to delay sx of Alzheimers?

Back 12

TACRINE, DONEPEZIL, RIVASTIGMINE, GALANTAMINE

Front 13

mech of organophosphate AChE inhibitors?

Back 13

bind to and is hydrolyzed by AChE to form stable bond, undergoes "aging", becomes irreversible

Front 14

what are the long-lasting AChE inhibitors?

Back 14

DIISOPROPYL FLUOROPHOSPHATE (DFP), ECHOTHIOPHATE, MALATHION, PARATHIONa

Front 15

antidote to organophosphate AChE inhibitors?

Back 15

PRALIDOXIME--cholinesterase regenerator, must be give before again occurs
ATROPINE--to block musc effects of ACh to avoid fatal bradycardia

Front 16

Sx of AChE inhibitor toxicity?

Back 16

musc effects: bronchoconstriction, bradycardia, secretions, miosis, diarrhea, vasodil, urinary incont

nic effects: fascic, depol block of skel musc (diaphragm)

CNS effects: convulsions, resp and CV collapse

Front 17

Where are nicotinic receptors found?

Back 17

Nn subtype: autonomic (SNS) gang, adrenal medulla

Nm subtype: motor endplate

Front 18

what are the effects of nicotinic stimulation on: adrenal medulla, cardiac, vascular, GI, carotid bodies, emetic chemoreceptors, NM endplate.

Back 18

epineph release
inc hr
periph vasoconstric
inc GI motility
inc RR
nausea and vomiting
fasiculations/spasms, depol blockage (high doses)

Front 19

what can cause depolarizing block?

Back 19

SUCCINYLCHOLINE, NICOTINE, DECAMETHONIUM (nic recep agonists)

Front 20

what are phase I and phase II of depolarizing block?

Back 20

I: continuous depol
II: inactivation of voltage gated Na channels (desensitization)

Front 21

clinical uses of SUCCINYLCHOLINE?

Back 21

skel musc relax for surg

Front 22

hypotens, bradycard, resp depres, musc weak, unresponsive to ATROPINE and NEOSTIGMINE. cause?

Back 22

depolarizing blockade (NICOTINE, SUCCINYLCHOLINE, DECAMETHONIUM)

Front 23

what are the major effects of beta-2 receptor stimulation?

Back 23

vasodil, bronchodil, relax uterus, relax bladder wall

Front 24

what are the selective beta-2 agonists?

Back 24

ALBUTEROL, METAPROTERENOL, TERBUTALINE, RITODRINE, SALMETEROL

Front 25

main drugs to treat bronchospasm, asthma, bronchitis, COPD?

Back 25

ALBUTEROL, METAPROTERENOL, TERBUTALINE (beta-2 agonists)

Front 26

what drugs are used in tx of premature labor?

Back 26

RITADRINE, TERBUTALINE (selective beta-2 agonists -> relax uterine smooth musc)

Front 27

what drug is selective agonist for beta-1 receptors?

Back 27

DOBUTAMINE

Front 28

clinical effects of DOBUTAMINE?

Back 28

pos inotropy w/o inc myocard O2 demand (b/c also dec' SVR). used for short term mgmt of CHF

Front 29

what drug is a non-selective beta-agonist?

Back 29

ISOPROTERENOL

Front 30

clinical effects/uses of ISOPROTERENOL?

Back 30

inc inotropy, h.r.
relaxes bronchial, vascular SM

used to stim hr in pts w/bradycardia or heart block

Front 31

what drug is used for tx of glaucoma that does not exert its effects on the cholinergic system?

Back 31

TIMOLOL--non-selective beta antag; decreases aqueous humor production, given as eye drops

Front 32

What are the muscarinic agonists?

Back 32

METHACHOLINE, BETHANECHOL, CARBACHOL, PILOCARPINE

Front 33

which one of these 4 is not like the others: METHACHOLINE, BETHANECHOL, CARBACHOL, PILOCARPINE

Back 33

BETHANECHOL is BETter--used to treat p/o abdominal distension and gastric atony

others are topical for glaucoma

Front 34

clinical uses of ATROPINE?

Back 34

bradycardia, AChE inhib overdose, cycloplegia and mydriasis, tx for cramping and urgent bladder in mild cystitis

Front 35

which muscarinic antagonist is used by inhalation for tx of bronchial asthma? why?

Back 35

IPRATROPIUM, is a quaternary amine, cant cross lipid bilayers, thus acts locally

Front 36

what are the classic sx of atropine overdose?

Back 36

"red as a beets, blind as a bat, dry as a bone, hot as a hare, mad as a hatter"

Front 37

what classes of agents could be used to treat asthma?

Back 37

beta-2 agonists (ALBUTEROL, TERBUTALINE, METAPROTERENOL, SALMETEROL), muscarinic antag (IPRATROPIUM)

Front 38

what are the common side effects of beta-2 agonists?

Back 38

skeletal muscle tremors, tachycardia

Front 39

what class is used as a nasal decongestant? examples?

Back 39

alpha agonists. PHENYLEPHRINE, XYLOMETAZOLINE, OXYMETAZOLINE

Front 40

tx for ADHD?

Back 40

AMPHETAMINE, METHYLPHENIDATE, PEMOLINE

Front 41

which bronchodilator (beta-agonist) is most likely to cause tachycardia and arrhythmias?

Back 41

ISOPROTERENOL