Clinical Pharmacology - Lecture 4

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Clinical Pharmacology - Lecture 4
2013-01-24 22:03:56
pharmacology chem360

These are the drugs and key words from lecture 4 from "Cholinergic Agonists" to "Prevention of Premature Parturition" for Quiz 3.
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  1. bethanecol (Urecholine)
    Cholinergic Agonist

    Stimulates bladder contraction, used to stimulate urination post-partum and post-op.
  2. cholinesterase inhibitors
    Increase ACh activity.

    Used in nerve gas to cause excessive urination/defecation/vomiting.
  3. atropine

    Used pre-op to decrease GI motility/secretions

    Increases HR (Tx for bradycardia)

    Antidote for poisons (insecticides, mushroom toxins) that do damage by inhibiting acetylcholinesterase

    Originally used to dilate pupils but had too long of a half life.
  4. tropicamide (Mydriacyl)

    Current eyedrop used to dilate eyes with a shorter half life than atropine.
  5. ipratropium bromide (Atrovent)

    Inhaler for emphysema and COPD

    15min onset lasts for 3-4 hours
  6. Combivent
    Combination of albuterol + Atrovent
  7. tiotropium bromide (Spiriva)

    New dry powder inhaler similar to Atrovent.

    15min onset last for 5-6 days

  8. oxybutynin (Ditropan and Ditropan XL)

    Antispasmodic used to tx nocturia and excessive urination.
  9. tolterodine (Detrol and Detrol LA)

    Newer bladder antispasmodic.
  10. Norepinephrine and epinephrine both have a common _______ structure and are rapidly metabolized by MAO and COMT in the _____.


    This is an example of the first pass effect.
  11. Drugs that have a catecholamine structure cannot be given ____.

    Noncatecholamines can be given orally and pass the BBB more efficiently.
  12. Epinephrine (OTC Primatene Mist)
    Catecholamine so must be IV, inhalation, or topical

    Stimulates all the adrenergic receptors (Alpha 1 +2 and Beta 1+2; agonist) to produce full fight or flight response.
  13. What are the clinical uses of epinephrine?
    • Asthma (Beta 2)
    • Anaphylactic shock (epi pen)
    • Adjunct to cardioversion (CLEAR!!) for cardiac arrest
    • Reduces bleeding topically
  14. Norepinephrine stimulate all adrenergic receptors except ___.
    Beta 2

    Tx for shock and hypotension
  15. pseudoephedrine (Sudafed - OTC) 
    Non-catecholamine nasal decongestant

    Causes nasal vasoconstriction

    Now behind the counter because it can be converted to meth.
  16. phenylephrine (Neo-synephrine, Sudafed PE)
    Replacement for pseudoephedrine in cold formulas yet has shown to be no more effective than placebo.
  17. ephedrine
    Same as pseudoephedrine

    Rarely prescribed, in dietary herbal supplements (herbal ecstasy) but has been pulled due to causing death.
  18. amphetamine (Benzedrine) and methylamphetamine
    Synthetic versions of epinephrine; catecholamine

    Originally used as nasal decongestant but pts build a tolerance too quickly

    Popular street drug either IV (crystal) or smoked in free base form (ice). Causes meth mouth and formication (hallucinations of bugs crawling on skin)
  19. MDA (methylenedioxyamphetamine)
    Similar to amphetamine, Love Drug

    Causes energy rush and increased self awareness while eliminating inhibitions and anxiety.
  20. MDMA (methylenedioxymethamphetamines)
    Ecstasy; noncatecholamine

    Similar to MDA with more dramatic stimulation of serotonin receptors. Widely popular street drug. 

    Can cause tachycardia and hyperthermia
  21. Quat (Khat)
    Arabian shrub that has active adrenergic agonists (Cathinone) that is chewed as a stimulant. 

    I think it is a catecholamine but am not positive
  22. Bath Salts
    Synthetic derivative of cathinon

    Got away with sale saying they weren't for human consumption but a ton of recent poison control calls about overdoses has raised awareness.
  23. methylphenidate (Ritalin, Concerta)
    Used to tx hyperactivity like ADHD

    Comes in extended release forms

    Inhibits reuptake of dopamine and norepinephrine in brain which helps some but not all ADHD people concentrate. 

    Widely abused and is Schedule II
  24. dexmethylphenydate (Focalin)
    Pure enantiomeric (right hand glove) form of methylphenidate. Was give a black box warning.
  25. amphetamine in the sustained release form Adderall XR
    Also used to tx ADHD

    Control II and causes euphoric high; "study drug"
  26. modafinil (Provigil)
    Officially approved for narcolepsy and obstructive sleep apnea; "cognitive enhancement

    Increase epinephrine and norepinephrine release.

    Off label use for ADHD 
  27. What 3 things to beta-2 agonists cause?

    Uterine relaxation

  28. How are asthma drugs typically administered?
    • Metered dose inhaler (MDI)
    • Dry powder inhaler (DPI)
  29. What is the most common asthma medicine?
  30. albuterol (salbuterol, ProAir, Proventil HFA, Ventolin HFA)
    Beta 2 agonist

    Used to stop asthma attack

    5-15min onset lasts for 3-6 hours
  31. salmeterol (Serevent)
    Long acting beta 2 agonist; administered using DPI

    45 min onset lasts 12 hours

    Prophylactic (preventative) use only, can't use it to stop asthma attack. 

    Should be added to anti-inflammatory, fluticason.