Pharmacology Step 1

Front 1

Name some direct cholinergic agonists (cholinomimetic agents).

Back 1

Bethanechol

carbachol

pilocarpine

methacholine

Make you ooze from every orifice!

Front 2

What is bethanechol used for?

Back 2

Used for activating bowel and bladder smooth muscles.

Clinical uses: post-operative ileus, and non-obstructive urinary retention.

Front 3

What is carbachol used for?

Back 3

Clinical applications: glaucoma, pupillary contraction, and relief of IOP.

'Carbon copy of ACh'

Front 4

What is pilocarpine used for?

Back 4

Pilocarpine contracts ciliary muscles (open-angle glaucoma), pupillary sphincter (closed-angle glaucoma).

'You cry, drool, and sweat on your pillow'

Clinical applications: glaucoma. Potent stimulator of sweat, tears, and saliva.

Front 5

Name some indirect cholinergic agonists (anticholinesterases).

Back 5

Neostigmine

Pyridostigmine

Edrophonium

Physostigmine

Donepezil

Front 6

What is neostigmine used for? Does it cross the CNS?

Back 6

Used for myasthenia gravis, reversal of neuromuscular blockade (postoperative), urinary retention, and ileus.

NEOstigmine = NO CNS penetration.

Front 7

What is pyridostigmine used for?

Back 7

Used for myasthenia gravis (long acting).

Also no CNS penetration.

Front 8

What is edrophonium used for?

Back 8

Dx of myasthenia gravis, since it is extremely short acting.

Front 9

What is physostigmine used for?

Back 9

Used in anticholinergic toxicity, since it crosses BBB.

"Physostigmine 'phyxes' atropine overdose"

Front 10

What is donepezil used for?

Back 10

Used in Alzheimer's disease.

Front 11

What do you need to watch out for when giving a cholinomimetic drug?

Back 11

Watch for exacerbation of COPD, asthma, and peptic ulcers disease in susceptible pts.

Remember, cholinomimetic agents make pts ooze from every orifice.

Front 12

How can someone get AChE inhibitor poisoning? Name an example.

Back 12

Organophosphate insecticides can cause AChE inhibitor poisoning, usually seen in farmers.

Example: parathion, which is an irreversible inibitor of AChE.

Front 13

What are the sx of organophosphate poisoning?

Back 13

Diarrhea, urination, lacrimation, sweating, and salivation.

Miosis, bronchospasm, excitation of skeletal muscle and CNS.

Bradycardia.

Use mnemonic DUMBBELSS.

Remember, excitation of skeletal muscle and CNS is mediated via nicotinic receptors.

Front 14

What is the antidote for organophosphate poisoning?

Back 14

Atropine + pralidoxime (regenerates AChE)

Front 15

Name some muscarinic antagonists.

Back 15

Atropine, homatropine, tropicamide.
Benztropine.
Scopolamine.
Ipratropium, tiotropium.
Oxybutynin.
Glycopyrrolate.

Front 16

Which muscarinic antagonists are used for the eye? What effects do they cause?

Back 16

Atropine, homatropine, tropicamide.

Application: produce mydriasis and cycloplegia.

Front 17

Which muscarinic antagonist is used in Parkinson's?

Back 17

Benztropine.

Remember, Park my Benz!

Front 18

Which muscarinic antagonist is used in motion sickness?

Back 18

Scopolamine.

Front 19

Which muscarinic antagonists are used in COPD?

Back 19

Ipratropium and tiotropium.

I pray I can breathe.

Front 20

Which muscarinic antagonist is used for the genitourinary system? What effects does it have?

Back 20

Oxybutynin.

Reduce urgency in mild cystitis and reduce bladder spasms.

Front 21

Which muscarinic antagonist is used preoperatively to reduce airway secretions?

Back 21

Glycopyrrolate.

Front 22

What is atropine used for? What is its effects on the eye, airway, stomach, gut, and bladder?

Back 22

Atropine is used to tx bradycardia and ophthalmic disorders.

Eye: increases pupil dilation, cycloplegia.
Airway: decreases secretions.
Stomach: decreases acid secretion.
Gut: decreases motility.
Bladder: decreases urgency in cystitis.

Remember, it blocks DUMBBeLSS (skeletal muscle and CNS excitation is mediated by nicotinic receptors, not muscarinic).

Front 23

What are the toxicities of atropine? What mnemonic is used?

Back 23

Hot as a hare, dry as a bone, red as a beet, blind as a bat, mad as a hatter.

Increased temp (decreased sweating).
Dry mouth/skin (decreased secretions).
Flushed skin.
Cycloplegia.
Disorientation.

Also, rapid pulse and constipation.

Front 24

Order the following sympathomimetic drugs from the most alpha agonist to the most beta agonist:

Epi, NE, phenylephrine, isoproterenol.

Back 24

From more alpha agonist to more beta agonist:

Phenylephrine, NE, epi, isoproterenol.

Remember, NE: alpha + beta1

Epi: alpha + beta1 + beta2 + dose dependent.

high dose = alpha. Low dose = beta.