-
Bethanechol
Cholinomimetic agonist
- FOR:
- postop and neurogenic ileus and urinary retention
-
Carbachol
Cholinomimetic
FOR: Glaucoma, pupillary contraction, and relief of intraocular pressure
-
Pilocarpine
Cholinomimetic
Potent stimulator of sweat, tears, saliva.
Contracts ciliary muscle of eye, pupillary sphincter, resistant to ACHE
-
Metacholine
Cholinomimetic
Challenge test for asthma
Stimulates muscarinic receptors in airway when inhaled
-
Neostigmine
Anticholinesterase
Postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular junction blockade (postop)
inc endogenous ACh; no CNS penetration
-
Pyridostigmine
Anticholinesterase
Myasthenia gravis(long acting), no CNS penetration
inc endogenous ACh, inc strength
-
Edrophonium
Anticholinesterase
Diagnosis of myasthenia gravis(short acting)
inc endogenous ACh
-
Physostigmine
Anticholinesterase
Glaucoma (crosses blood-brain barrier -> CNS) and atropine overdose
inc endogenous ACh
-
Echothiophate
Anticholinesterase
Glaucoma
inc endogenous ACh
-
Organophosphate
Cholinesterase inhibitor
- Diarrhea
- Urination
- Miosis
- Bronchospasm
- Bradycardia
- Excitation of skeletal muscle & CNS
- Lacrimation
- Sweating
- Salivation
-
Atropine
Muscarinic antagonists
- EYE- produce mydriasis and cycloplegia.
- Block dumbbelss
Hot, dry, red, cycloplegia, delirium, bloated
-
Homatropine
Muscarinic antagonist
EYE- produce mydriasis and cycloplegia
-
tropicamide
Muscarinic antagonist
EYE- produce mydriasis and cycloplegia
-
Benztropine
Muscarinic antagonist
CNS- Parkinsons disease
-
Scopolamine
Muscarinic antagonist
CNS- Motion sickness
-
Ipratropium
Muscarinic antagonist
Respiratory- Asthma, COPD
-
Oxybutynin
Muscarinic antagonist
Genitourinary- reduce urgency in mild cystitis and reduce bladder spasms
-
glycopyrrolate
Muscarinic antagonist
- Genitourinary- reduce urgency in mild cystitis and reudce bladder spasms
- decrease airway secretion
-
Methoscopolamine
Muscarinic antagonist
Gastro- peptic ulcer treatment
-
propantheline
Muscarinic antagonist
Gastrointestinal- peptic ulcer treatment
-
Hexamethonium
Nicotinic antagonist
Ganglionic blocker- used to prevent vagal reflexes responses to changes in blood pressure
Toxicity: Severe orthostatic hypotension, blurred vision, constipation, sexual dysfunction
-
Drugs for urge type incontinence
- oxybutynin
- tolterodine
- Darifenacin & solifenacin
- Trospium
-
Epinephrine
Direct sympathomimetic
a1,a2,B1,B2 (low dose = B1)
- For:
- Anaphylaxis
- open angle glaucoma
- asthma
- hypotensive shock
-
Norepinephrine
Direct sympathomimetic
a1, a2 > B1
- For:
- Septic shock
- hypotension (but decreases renal perfusion)
-
Isoproterenol
Direct sympathomimetic
B1= B2
- FOR: AV block
- decrease vascular resistance/ increase contraction
-
Dopamine
Direcrt sympathomimetic
- D1=D2 >B > a
- inotropic and chronotropic
- FOR: Shock ( increase renal perfusion)
- heart failure
-
Dobutamine
Direct sympathomimetic
B1 > B2
- FOR:
- Heart failure (cardiogenic shock)
- cardiac stress testing
-
Phenylephrine
Direct sympathomimetic
a1 > a2
- For:
- Pupillary dilation
- vasoconstriction
- nasal decongestion
-
Metaprotereonol
- Selective B2- agonists
- For: acute asthma
-
albuterol
Selective B2 agonists
FOR: acute asthma
-
salmeterol
Selective B2 agonists
For: Long term treatment of asthma
-
Terbutaline
Selective B2 agonists
FOR: reducing premature uterine contractions
-
Ritodrine
Direct sympathomimetic
FOR: Reducing premature uterine contractions
-
Amphetamine
Indirect sympathomimetic
Indirect general agonist, releases stored catecholamines
- FOR:
- Narcolepsy
- obesity
- ADHD
-
Ephedrine
Indirect sympathomimetic
Indirect general agonsit, releases stored catecholamines
- FOR:
- Nasal decongestion
- urinary incontinence
- hypotension
-
Cocaine
Indirect sympathomimetic
Uptake inhibitor
- Causes:
- vasoconstriction and local anesthesia
-
Clonidine
Sympathoplegics
Centrally acting a2-agonist -> decrease central adrenergic outflow
- FOR:
- Hypertension, especially with renal disease)
-
a-methyldopa
Sympathoplegic
Centrally acting a2- agonists -> decrease central adrenergic outflow
FOR: Hypertension, especially with renal disease
-
Phenoxybenzamine
Nonselective a-blocker (irreversible)
Pheochromocytoma
- Toxicity:
- Orthostatic hypotension, relfex tachycardia
-
Phentolamine
Non-selective a-blocker (reversible)
Pheochromocytoma
- Toxicity:
- Orthostatic hypotension, reflex tachycardia
-
Prazosin
a1- selective blocker
FOR: Hypertension, urinary retention in BPH
- Toxicity:
- 1st dose orthostatic hypotension, dizziness, headache
-
Terazosin
a1- selective blocker
FOR: Hypertension, urinary retention in BPH
- Toxicity:
- 1st dose orthostatic hypotension, dizziness, headache
-
doxazosin
a1-selective blocker
FOR: Hypertension, unrinary retention in BPH
- Toxicity:
- 1st dose orthostatic hypotension, dizziness, headache
-
Mirtazapine
a2- selective blocker
FOR: Depression
- Toxicity:
- sedation, increase serum cholesterol, increse appetite
-
Applications of B-blockers
HTN: dec CO, dec renin secretion
Angina Pectoris: dec HR & contractility -> dec O2 consumption
MI:
SVT(propanolol, esmolol): dec AV conduction speed
CHF: slows progression of chronic failure
Glaucoma(timolol): dec secretion of aqueous humor
-
Toxicities of B-blockers
- Impotence
- exacerbation of asthma
- cardiovascular adverse effects(bradycardia, AV block, CHF)
- CNS adverse (sedation, sleep alterations)
-
Nonselective B blockers
Propanolol, timolol, nadolol, and pindolol
-
B1- selective antagonists
- Acebutolol (partial agonist)
- Betaxolol
- Esmolol
- Atenolol
- Metoprolol
-
Nonselective a and B antagonists
-
Partial B agonists
Pindolol, Acebutolol
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