Usmle Step 1 Pharmacology-Autonomics

Front 1

G protein Gs
(a) receptors
(b) Effector
(c) Second Messenger response

Back 1

(a) beta1, beta2, D1, H2, V2
(b) Adenylyl cyclase
(c) increased cAMP

Front 2

G protein Gi
(a) receptors
(b) effector
(c) second messenger response

Back 2

(a) alpha2, M2, D2
(b) adenylyl cyclase
(c) decreased cAMP

Front 3

G protein Gq
(a) receptors
(b) effector
(c) second messenger response

Back 3

(a) alpha, M1, M3, H1,V1
(b) phospholipase
(c) increased IP3, increased IC Ca2+, DAG

Front 4

Bethanechol
(a) classification
(b) clinical application
(c) action

Back 4

(a) direct cholinergic agonist
(b) postop and neurogenic ileus and urinary retention
(c) activates bowel and bladder SM; resistant to AchE

Front 5

Carbachol
(a) classification
(b) clinical application

Back 5

(a) direct cholinergic agonist
(b) glaucoma, pupillary contraction, and release of intraocular pressure

Front 6

Pilocarpine
(a) classification
(b) clinical application
(c) action

Back 6

(a) direct cholinergic agonist
(b) potenti stimulator of sweat, tears, saliva
(c) contracts ciliary muscle of eye (open angle), pupillary sphincter (narrow angle); resistant to AChE

Front 7

Methacholine
(a) classification
(b) clinical application
(c) action

Back 7

(a) direct cholinergic agonist
(b) challenge test for diagnosis of asthma
(c) stimulates muscarinic receptors in airway when inhaled

Front 8

Neostigmine
(a) classification
(b) clinical application
(c) action

Back 8

(a) anticholinesterase
(b) postop and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular jct blockage (postop)
(c) increase endogenous Ach; no CNS penetration.

Front 9

Pyridostigmine
(a) classification
(b) clinical application
(c) action

Back 9

(a) anticholinesterase
(b) myasthenia gravis (long acting)
(c) increase enogenous Ach; increase strength; does not penetrate CNS

Front 10

Edrophonium
(a) classification
(b) clinical application
(c) action

Back 10

(a) anticholinesterase
(b) diagnosis of myasthenia gravis (extremely short acting)
(c) increase endogenous Ach

Front 11

Physostigmine
(a) classification
(b) clinical application
(c) action

Back 11

(a) anticholinesterase
(b) glaucoma (crosses BBB into CNS) and atropine overdose
(c) increase endogeous Ach

Front 12

Echothiophate
(a) classification
(b) clinical application
(c) action

Back 12

(a) anticholinesterase
(b) glaucoma
(c) increase endogenous Ach

Front 13

Describe treatment for the following toxicity:
Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, and Salivation (also abdominal cramp)

Back 13

Cholinesterase inhibitor poisoning
Antidote: atropine (muscarinic antagonist) plus pralidoxine (chemical antagonist used to regenerate active cholinesterase).

Front 14

Classification and Application of atropine in the eye

Back 14

Muscarinig antagonist
Produce mydriasis and cycloplegia

Front 15

Classification and Application of benzotropine

Back 15

Muscarinig antagonist
Parkinson's disease

Front 16

Classification and Application of Scopolopine

Back 16

Muscarinig antagonist
Motion sickness

Front 17

Classification and Application of oxybutynin, glycopyrrolate

Back 17

Muscarinig antagonist
Reduce urgency in mild cystitis and reduce bladder spasms

Front 18

Classification and Application of ipratropium

Back 18

Muscarinig antagonist
Asthma, COPD

Front 19

Classification and Application of Methscopolamine (also pirenzepine, propantheline)

Back 19

Muscarinig antagonist
Peptic ulcer treatment

Front 20

Atropine classification and effect

Back 20

Muscularinic antagonist
Increase pupil dilation (cycloplegia)
Decrease airway secretions
Decrease stomach acid secretions
Decrease GI motility

Front 21

Atropine toxicity

Back 21

Increase body temperature, rapid pulse
Dry mouth
Flushed skin
Cycloplegia
Constipation
Disorientation
Can cause acute angle glaucoma in elderly, urinary retention in men with BPH, and hyperthermia in infants

Front 22

Hexamethonium
(a) classification
(b) clinical use
(c) toxicity

Back 22

(a) nicotinic antagonist
(b) ganglionic blocker. Used in lab models to prevent vagal reflex response to changes in BP (prevents reflex bradycardia by NE)
(c) severe orthostatic hypotension, blurred vision, constipation, sexual dysfct

Front 23

Epinephrine
(a) classification
(b) mechanism/selectivity
(c) applications

Back 23

(a)drug direct sympathomimetic
(b) alpha1,2 and beta 1,2 (low dose selective for beta 1)
(c) anaphylaxis, glaucoma (open angle), asthma, hypotension

Front 24

Norepinephrine
(a) classification
(b) mechanism/selectivity
(c) applications

Back 24

(a)drug direct sympathomimetic
(b) alpha1, alpha2>beta 1
(c) hypotension, (but decreased renal perfusion)

Front 25

Isoprotenerenol
(a) classification
(b) mechanism/selectivity
(c) applications

Back 25

(a) direct sympathomimetics
(b) beta1=beta2
(c) AV block (rare)

Front 26

Dopamine
(a) classification
(b) mechanism/selectivity
(c) applications

Back 26

(a) direct sympathomimetics
(b) D1=D2>beta>alpha, inotropic and chronotropic
(c) shock (increased renal perfusion), heart failure

Front 27

Dobutamine
(a) classification
(b) mechanism/selectivity
(c) applications

Back 27

(a) direct sympathomimetics
(b) beta1>beta2 inotropic but not chronotropic
(c) shock, heart failure, cardiac stress testing

Front 28

Albuterol/Terbutaline
(a) classification
(b) mechanism/selectivity
(c) applications

Back 28

(a) direct sympathomimetics
(b) alpha1>alpha2
(c) albuterol for acute asthma; terbulatine reduces premature uterine contractions

Front 29

Ritodrine
(a) classification
(b) mechanism/selectivity
(c) applications

Back 29

(a) direct sympathomimetics
(b) beta 2
(c) reduces premature uterine contractions

Front 30

Amphetamine
(a) classification
(b) mechanism/selectivity
(c) applications

Back 30

(a) indirect sypmathomimetics
(b) indirect general agonist, released stored catecholamines
(c) narcolepsy, obesity, ADD

Front 31

Ephedrine
(a) classification
(b) mechanism/selectivity
(c) applications

Back 31

(a) indirect sympathomimetics
(b) indirect general agonist, releases stored catecholamines
(c) nasal decongestion, urinary incontinence, hypotension

Front 32

Cocaine
(a) classification
(b) mechanism/selectivity
(c) applications

Back 32

(a) indirect sympathomimetics
(b) indirect general agonist, uptake inhibitor
(c) causes vasoconstriction and local anesthesia

Front 33

Clonidine, alpha methyldopa
(a) classification
(b) mechanism/selectivity
(c) applications

Back 33

(a) sympathoplegics
(b) centrally acting alpha 2 agonist, decreased central adrenergic outflow
(c) HTN, esp w/renal disease (no decr in blood flow to kidney)

Front 34

Phenoxybenzamine
(a) classification
(b) applications
(c) toxicity

Back 34

(a) non selective alpha blocker
(b) pheochromocytoma (use phenoxybenzamine before removing tumor since high levels of released catecholamines will not be able to overcome blockage)
(c) orthostatic hypotension, reflex tachycardia

Front 35

Alpha 1 selective blockers

Back 35

Prazosin, terazosin, doxazosin

Front 36

Prazosin, terazosin, doxazosin
(a) classification
(b) applications
(c) toxicity

Back 36

(a) alpha 1 selective blocker
(b) HTN, urinary retention in BPH
(c) 1st dose orthostatic hypotension, dizziness, headache

Front 37

Mirtazapine
(a) classification
(b) application
(c) toxicity

Back 37

(a) alpha 2 selective blocker
(b) depression
(c) sedation, increased serum cholesterol, increased appetite

Front 38

Beta blocker: clinical applications

Back 38

HTN (decr CO and renin)
Angina pectoris (decrease HR, contractility, resulting in decr O2 consumption)
MI (beta blockers decrease mortality)
SVT-propranolol, esmolol (decr AV conduction velocity)
CHF (slows prgoression of chronic failure)
Glaucoma-timolol-decreases secretion of aqueous humor

Front 39

Nonselective antagonists

Back 39

Propranolol, timolol, nadolol, pindolol, and labetalol

Front 40

Beta 1 selective antagonists

Back 40

Acebutolol (partial agonist), betaxolol, esmolol (short acting), atenolol, metoprolol

Front 41

Non selective alpha and beta antagonists

Back 41

Carvediolol, labetalol

Front 42

Partial beta agonists

Back 42

Pindolol, acebutolol

Front 43

Toxicity of beta blockers

Back 43

Impotence, exacerbation of asthma, CV adverse effects (bradycardia, AV block, CHF), CNS adverse effects (sedation, sleep alterations); use with caution in diabetics.

Front 44

Synthesis of histamine

Back 44

Histidine converted to histamine by histadine decarboxylase

Front 45

Location of histamine

Back 45

Circulating basophils and mast cells

Front 46

H1 antagonists
(a) list common
(b) clinical use
(c) sedation, dry mucosa

Back 46

(a) diphenydramine, promethazine, chlorpheniramine, hydroxyzine, fexofenadine*, loratadine*, cetirizine *
*indicates no CNS entry
(b) allergic rxns, motion sickness, OTC (sleep aids and cold meds)
(c) sedation, dry mucosa

Front 47

H2 antagonists
(a) list common
(b) clinical use
(c) notes/toxicity

Back 47

(a) cimetidine, ranitidine, famotidine, nizatidine
(b) peptic ulcer disease, GERD, zollinger ellison syndrome
(c) cimetidine: P450 inhibition, antiandrogen effect

Front 48

Synthesis and degradation of serotonin

Back 48

Tryptophan converted to 5HT by tryptophan hydroxylase. MAO degrades serotonin into 5H1AA

Front 49

5HT1 (A-F)
(a) second messenger
(b) action

Back 49

(a) Gi, decr cAMP
(b) CNS, behavioral effects (sleep, feeding, thermoreg, anxiety), vasoconstriction

Front 50

5HT2(A-C)
(a) second messenger
(b) action

Back 50

(a) Gq; increase IP3, DAG
(b) CNS, behavioral effects, smooth muscle contraction, platelet aggregation

Front 51

5HT3
(a)second messenger
(b) action

Back 51

(a) ion channel
(b) CNS (area postrema), PNS, emesis, anxiety

Front 52

5HT4
(a) second messenger
(b) action

Back 52

(a) Gs; increase cAMP
(b) CNS: neuronal excitation, GI motility

Front 53

Sumatriptan, naratriptan
(a) mechanism of action
(b) clinical use
(c) notes/toxicity

Back 53

(a) 5HT1D agonist
(b) migraines
(c) n/a

Front 54

Buspirone
(a) mechanism of action
(b) clinical use
(c) notes/toxicity

Back 54

(a) 5HT1A partial agonist
(b) anxiety disorders
(c) lower addition potential than other drugs like benzos

Front 55

Ondasetron
(a) mechanism of action
(b) clinical use
(c) notes/toxicity

Back 55

(a) 5HT3 antagonist
(b) emesis
(c) mainly for postop or chemo induced n/v

Front 56

SSRI's
(a) mechanism
(b) clinical use
(c) notes/toxicity

Back 56

(a) selectively block 5HT reuptake
(b) anxiety disorders, depression
(c) sexual dysfct, interaction w/MAOI's can lead to serotonin syndrome

Front 57

Ergot alkyloids (ergonovine, ergotamine, methysergide, bromocriptin, pergolide, LSD)
(a) mechanism of action
(b) clinical use
(c) notes/toxicity

Back 57

(a) agonists, partial agonists, and antagonists at 5HT and alpha receptors; some are agonists or partial agonists at DA receptors
(b) postpartum hemorrhage (ergonavine, ergotamine)
-migraines (ergotamine for acute, methysergide for prophylaxis)
-parkinson's disease, hyperprolactinemia (bromo, pergolide)
-abuse (LSD)
(c) Ergotism (St. Anthony's fire)
-mental disorientation, convulsions, muscle cramps, hallucinations, dry gangrene of extremities

Front 58

MAOI's
(a) mechanism of action
(b) clinical use
(c) notes/tox

Back 58

(a) inhibit metabolism of 5HT, NE, and DA by MAO
(b) depression
(c) non selective MAO inhibitors
-tyramine ingestions can lead to hypertensive crisis