-
Direct acting cholinomimetics
- Beth and Meth Piled Directly into the Chold Car
- Bethanechol
- Carbachol
- Pilocarpine
- Methacholine
-
Indirect acting cholinomimetics (anticholinesterases)
- The "stigma" of being anticholine
- Neostigmine
- Pyridostigmine
- Edrophonium
- Physostigmine
-
Bethanechol
- Direct acting cholinomimetic
- Neurogenic ileus and urinary retention (activates bowel and bladder)
-
Carbachol
- Direct acting cholinomimetic
- Glaucoma, pupillary constriction
-
Pilocarpine
- Direct acting cholinomimetic
- Open and closed angle glaucoma
-
Methacholine
- Direct acting cholinomimetic
- Challenge test for asthma diagnosis
-
Neostigmine
- Anticholinesterase
- Postoperative/neurogenic ileus and urinary retention
- Myasthenia gravis
- Reversal of NM junction blockade
-
Pyridostigmine
- Anticholinesterase
- Myasethenia gravis (long acting)
-
Edrophonium
- Anticholinesterase
- Diagnosis of myasthenia gravis
-
Physostigmine
- Anticholinesterase
- Glaucoma (crosses BBB) and atropine overdose
-
Organophosphate poisoning
- Anticholinesterase
- DUMBBELSS
- Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, Excitation of skeletal muscle and CNS, Lacrimation, Sweating, Salivation
- Antidote: atropine and pralidoxime
-
Muscarininc antagonists
- Oppose parasympathetic activity
- Atropine, homatropine, tropicamaide
- Benztropine
- Scopolamine
- Ipratropium
-
Atropine overdose
- Hot as a hare
- Dry as a bone
- Red as a beet
- Blind as a bat
- Mad as a hatter
- Reverse with physostigmine
-
Benztropine
- Muscarinic antagnoist
- Parkinson's disease
-
Scopolamine
- Muscarinic antagonist
- Motion sickness
-
Ipratropium
- Muscarinic antagonist
- Asthma, COPD
-
Hexamethonium
- Nicotinic antagonist
- Ganglionic blocker
-
Direct acting sympathomimetics
- Epinephrine
- NE
- Isoproterenol
- Dopamine
- Dobutamine
- Phenylephrine
- Metaproterenol
- Albuterol
- Salmeterol
- Terbutaline
-
Indirect acting sympathomimetics
- Amphetamine (narcolepsy, obesity, ADD)
- Ephedrine (nasal decongestion, urinary incontinence, hypotension)
- Cocaine (vasoconstriction and local anesthesia)
-
Epinephrine
- Direct acting sympathomimetic
- Equal alpha and beta activity
- B1 selective at low dose
- For anaphylaxis, open angle glaucoma, asthma, hypotension
-
NE
- Direct acting sympathomimetic
- Alpha activity > B1
- Hypotension (causes decreased renal perfusion)
-
Isoproterenol
- Direct acting sympathomimetic
- Equal B activity
- AV block
-
Dopamine
- Direct acting sympathomimetic
- D1 = D2
- Shock (increased renal perfusion), heart failure
-
Dolbutamine
- Direct acting sympathomimetic
- B1>B2 (inotropic, not chronotropic)
- Shock, HF, cardiac stress testing
-
Phenylephrine
- Direct acting sympathomimetic
- A1>A2
- Pupillary dilation, casoconstriction, nasal decongestion
-
Metaproterenol
- Direct acting sympathomimetic
- Selective B2
- Acute asthma
-
Albuterol
- Direct acting sympathomimetic
- B2 selective
- Acute asthma
-
Salmeterol
- Direct acting sympathomimetic
- B2 selective
- Long-term asthma treatment
-
Terbutaline
- Direct acting sympathomimetic
- B2 selective
- Reduce premature uterine contractions
-
Clonidine
- Sympathoplegic centrally acting alpha 2 agonist
- Decreases central adrenergic outflow
- Hypertension (esp in renal disease)
-
Alpha-methyldopa
- Sympathoplegic centrally acting alpha 2 agonist
- Decreases central agrenergic outflow
- Hypertension (esp in pregnancy)
-
Non-selective alpha blockers
- Phenoxybenzamine (irreversible)
- Phentolamine (reversible)
- Pheochromocytoma (before surgery)
-
Prazosin, terazosin, doxazosin
- A1 selective antagonists
- HTN, urinary retention in BPH
- 1st dose hypotension
-
Mirtazapine
- A2 selective antagonist
- Depression
-
Beta blockers
- -olol
- HTN, angina, MI, SVT, glaucoma
- Impotence, exacerbation of asthma, bradicardia
-
Propranolol
- Non selective B blocker
- Also timolol, nadolol, pindolol
-
Atenolol
B1 selective antagonist
-
Esmolol
Short acting B1 selective antagonist
-
Metoprolol
- B1 selective antagonist
- Can cause HLD
-
Carvedilol
Nonselective alpha and beta antagonist
-
Labetalol
Nonselective alpha and beta antagonist
-
Pindolol
Partial beta agonist
-
Acebutolol
Partial beta agonist
-
Hydralazine
- Increase cGMP --> smooth muscle relaxtion (arterioles > veins)
- Reduces afterload
- Usind in severe HTN, CHF, HTN in pregnancy (with methyldopa)
- Reflex tachycardia (give with B blocker), SLE-like syndrome
-
Minoxidil
- Minoksidil
- K channel opener - relaxes smooth muscle
- Severe HTN
- Hypertrichosis, reflex tachycardia
-
Calcium channel blockers
- Amlodipine, nifedipine, verapimil, diltiazem
- Block voltage-dependent calcium channels --> reduce contractility of smooth muscle (first two) and cardiac muscle (second two)
- HTN, angina, arrythmias (varapimil, diltiazem), Raynaud's
-
Nitroglycerin
- Release NO in smooth muscle --> increase cGMP --> smooth muscle relaxation (dilate veins >> arterioles)
- Angina, pulmonary edema
- Reflex tacycardia, hypotension, flushing
-
Nitroprusside
- Increase cGMP by release of NO
- Malignant HTN
- Can cause cyanide toxicity
- Fenoldopan (D1 agonist) and diazoxide (K channel opener - can cause hyperglycemia) also used for malignant HTN
-
Digoxin
- Cardiac glycoside
- Directly inhibits Na/K ATPase --> inhibits Na/Ca exchanger --> increased intracellular Ca --> positive inotropy
- CHF, atrial fibrillation; don't give in WPW or other reentrant tachycardia
- Cholinergic side effects, increased PR, decreased QT, can cause paroxysmal SVT at high doses
-
Class IA antiarrythmics
- Na channel blockers
- The Queen Proclains Diso's Pyramid
- Quinidine, procainamide, disopyramide
- Decrease slope of phase 4 depolarization
- Increase ERF, increase QT interval
- Reentrant and ectopic SVT, V-tac
- Torsades from quinidine, SLE-like syndrome from procainamide
-
Class IB antiarrythmics
- Na channel blockers
- Lidocaine, Mexiletine, Tocainide
- I'd Buy Lidy's Mexican Tacos
- Decrease slope of phase 4 depolarization
- Acute ventricular arrythmias (post-MI), digitalis-induced arrythmias
-
Class IC antiarrythmics
- Na channel blockers
- Flecainide, Encainide, Propafenone
- Contraindicated post-MI
- V-tach, V-fib, intractable SVT
-
Class II antiarrythmics
- Beta blockers
- Decrease slope of phase 4, increase PR interval
- V-tach, SVT, atrial fib, atrial flutter
- Treat overdose with glucagon
-
Class III antiarrythmics
- K channel blockers
- Sotalol, ibutilide, amiodarone
- Increase AP duration and ERP
- Ibutilide can cause torsades
- Amiodarone: blue, blind, and coughing up your liver and thyroide
-
Class IV antiarrythmics
- Ca channel blockers
- Verapimil and diltiazem
- Increase PR intercal and ERP
- Prevention of nodal arrythmias (SVT)
-
Adenosine
- 1st line for diagnosing/abolishing SVT
- Very short acting (15 seconds)
- Effects blocked by theophylline
-
Potassium
Depresses extopic pacemakers in hypokalemia
-
Mg
Effective in torsades and digoxin toxicity
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