Autonomic Pharmacology

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lazzsant
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172646
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Autonomic Pharmacology
Updated:
2012-09-26 19:52:56
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Autonomic Pharm
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Autonomic Pharm
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  1. Bethanechol
    Cholinomimetic agonist

    • FOR:
    • postop and neurogenic ileus and urinary retention
  2. Carbachol
    Cholinomimetic

    FOR: Glaucoma, pupillary contraction, and relief of intraocular pressure
  3. Pilocarpine
    Cholinomimetic

    Potent stimulator of sweat, tears, saliva.

    Contracts ciliary muscle of eye, pupillary sphincter, resistant to ACHE
  4. Metacholine
    Cholinomimetic

    Challenge test for asthma

    Stimulates muscarinic receptors in airway when inhaled
  5. Neostigmine
    Anticholinesterase

    Postoperative and neurogenic ileus and urinary retention, myasthenia gravis, reversal of neuromuscular junction blockade (postop)

    inc endogenous ACh; no CNS penetration
  6. Pyridostigmine
    Anticholinesterase

    Myasthenia gravis(long acting), no CNS penetration

    inc endogenous ACh, inc strength
  7. Edrophonium
    Anticholinesterase

    Diagnosis of myasthenia gravis(short acting)

    inc endogenous ACh
  8. Physostigmine
    Anticholinesterase

    Glaucoma (crosses blood-brain barrier -> CNS) and atropine overdose

    inc endogenous ACh
  9. Echothiophate
    Anticholinesterase

    Glaucoma

    inc endogenous ACh
  10. Organophosphate
    Cholinesterase inhibitor

    • Diarrhea
    • Urination
    • Miosis
    • Bronchospasm
    • Bradycardia
    • Excitation of skeletal muscle & CNS
    • Lacrimation
    • Sweating
    • Salivation
  11. Atropine
    Muscarinic antagonists

    • EYE- produce mydriasis and cycloplegia.
    • Block dumbbelss

    Hot, dry, red, cycloplegia, delirium, bloated
  12. Homatropine
    Muscarinic antagonist

    EYE- produce mydriasis and cycloplegia
  13. tropicamide
    Muscarinic antagonist

    EYE- produce mydriasis and cycloplegia
  14. Benztropine
    Muscarinic antagonist

    CNS- Parkinsons disease
  15. Scopolamine
    Muscarinic antagonist

    CNS- Motion sickness
  16. Ipratropium
    Muscarinic antagonist

    Respiratory- Asthma, COPD
  17. Oxybutynin
    Muscarinic antagonist

    Genitourinary- reduce urgency in mild cystitis and reduce bladder spasms
  18. glycopyrrolate
    Muscarinic antagonist

    • Genitourinary- reduce urgency in mild cystitis and reudce bladder spasms
    • decrease airway secretion
  19. Methoscopolamine
    Muscarinic antagonist

    Gastro- peptic ulcer treatment
  20. propantheline
    Muscarinic antagonist

    Gastrointestinal- peptic ulcer treatment
  21. 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
  22. Drugs for urge type incontinence
    • oxybutynin
    • tolterodine
    • Darifenacin & solifenacin
    • Trospium
  23. Epinephrine
    Direct sympathomimetic

    a1,a2,B1,B2 (low dose = B1)

    • For:
    • Anaphylaxis
    • open angle glaucoma
    • asthma
    • hypotensive shock
  24. Norepinephrine
    Direct sympathomimetic

    a1, a2 > B1

    • For:
    • Septic shock
    • hypotension (but decreases renal perfusion)
  25. Isoproterenol
    Direct sympathomimetic

    B1= B2

    • FOR: AV block
    • decrease vascular resistance/ increase contraction
  26. Dopamine
    Direcrt sympathomimetic

    • D1=D2 >B > a
    • inotropic and chronotropic

    • FOR: Shock ( increase renal perfusion)
    • heart failure
  27. Dobutamine
    Direct sympathomimetic

    B1 > B2

    • FOR:
    • Heart failure (cardiogenic shock)
    • cardiac stress testing
  28. Phenylephrine
    Direct sympathomimetic

    a1 > a2

    • For:
    • Pupillary dilation
    • vasoconstriction
    • nasal decongestion
  29. Metaprotereonol
    • Selective B2- agonists
    • For: acute asthma
  30. albuterol
    Selective B2 agonists

    FOR: acute asthma
  31. salmeterol
    Selective B2 agonists

    For: Long term treatment of asthma
  32. Terbutaline
    Selective B2 agonists

    FOR: reducing premature uterine contractions
  33. Ritodrine
    Direct sympathomimetic

    FOR: Reducing premature uterine contractions
  34. Amphetamine
    Indirect sympathomimetic

    Indirect general agonist, releases stored catecholamines

    • FOR:
    • Narcolepsy
    • obesity
    • ADHD
  35. Ephedrine
    Indirect sympathomimetic

    Indirect general agonsit, releases stored catecholamines

    • FOR:
    • Nasal decongestion
    • urinary incontinence
    • hypotension
  36. Cocaine
    Indirect sympathomimetic

    Uptake inhibitor

    • Causes:
    • vasoconstriction and local anesthesia
  37. Clonidine
    Sympathoplegics

    Centrally acting a2-agonist -> decrease central adrenergic outflow

    • FOR:
    • Hypertension, especially with renal disease)
  38. a-methyldopa
    Sympathoplegic

    Centrally acting a2- agonists -> decrease central adrenergic outflow

    FOR: Hypertension, especially with renal disease
  39. Phenoxybenzamine
    Nonselective a-blocker (irreversible)

    Pheochromocytoma

    • Toxicity:
    • Orthostatic hypotension, relfex tachycardia
  40. Phentolamine
    Non-selective a-blocker (reversible)

    Pheochromocytoma

    • Toxicity:
    • Orthostatic hypotension, reflex tachycardia
  41. Prazosin
    a1- selective blocker

    FOR: Hypertension, urinary retention in BPH

    • Toxicity:
    • 1st dose orthostatic hypotension, dizziness, headache
  42. Terazosin
    a1- selective blocker

    FOR: Hypertension, urinary retention in BPH

    • Toxicity:
    • 1st dose orthostatic hypotension, dizziness, headache
  43. doxazosin
    a1-selective blocker

    FOR: Hypertension, unrinary retention in BPH

    • Toxicity:
    • 1st dose orthostatic hypotension, dizziness, headache
  44. Mirtazapine
    a2- selective blocker

    FOR: Depression

    • Toxicity:
    • sedation, increase serum cholesterol, increse appetite
  45. 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
  46. Toxicities of B-blockers
    • Impotence
    • exacerbation of asthma
    • cardiovascular adverse effects(bradycardia, AV block, CHF)
    • CNS adverse (sedation, sleep alterations)
  47. Nonselective B blockers
    Propanolol, timolol, nadolol, and pindolol
  48. B1- selective antagonists
    • Acebutolol (partial agonist)
    • Betaxolol
    • Esmolol
    • Atenolol
    • Metoprolol
  49. Nonselective a and B antagonists
    • carvedilol
    • labetalol
  50. Partial B agonists
    Pindolol, Acebutolol

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