Pharmacology exam 2 - New notes

Alpha 1 vs. Alpha 2

Alpha 1 (A1) = “blood vessels & eyes”

• Location: blood vessels, iris, bladder

• Effect: vasoconstriction → ↑ BP

• Other:

  • pupil dilation (mydriasis)

  • contracts bladder sphincter → urinary retention

Alpha 2 (A2) = “turn OFF SNS”

• Location: presynaptic nerve terminals

• Effect:

  • ↓ norepinephrine release

  • ↓ sympathetic outflow → ↓ BP, ↓ HR

Beta 1 vs. Beta 2

Beta 1 = “Heart”

• ↑ HR

• ↑ contractility

• ↑ cardiac output

Beta 2 = “Lungs + vessels + uterus”

• bronchodilation

• vasodilation (some vessels)

• uterine relaxation

• ↑ glucose release

Phenylephrine (A1 agonist)

• What does it do: A1 stimulation → vasoconstriction

• Uses: hypotension, shock, nasal congestion

• Side effects:

  • HTN

  • reflex bradycardia

  • caution: narrow-angle glaucoma

Clonidine (A2 agonist)

• MOA: ↓ sympathetic outflow → ↓ NE

• Uses: hypertension

• Side effects:

  • sedation, drowsiness

  • hypotension, bradycardia

  • rebound HTN if stopped suddenly

Albuterol (B2 agonist)

• MOA: bronchodilation (wider)

• Uses: Acute asthmatic attacks (rescue inhaler)

• Side effects:

  • tremor

  • tachycardia

  • nervousness

Isoproterenol (beta-agonist)

• MOA: ↑ HR + bronchodilation

• Uses: severe bradycardia, bronchospasm during surgery

• Side effects:

  • tachycardia, arrhythmias

  • angina risk

Dopamine (A1 + B1)

• Low dose: kidney perfusion

• Moderate: ↑ HR/contractility

• High: vasoconstriction → ↑ BP

• Uses: shock

• Side effects:

  • arrhythmias (big one)

  • tachycardia

• ❗ Not for Parkinson’s

Epinephrine (A1 + B1 + B2)

• MOA:

  • ↑ HR + contractility

  • bronchodilation

  • vasoconstriction

• Uses:

  • anaphylaxis (KEY)

  • cardiac arrest

• Side effects:

  • tachycardia

  • HTN

  • anxiety, tremor

Labetalol (alpha + beta blocker)

• MOA: ↓ BP + ↓ HR

• Uses: hypertension (no reflex tachycardia)

• Side effects:

  • hypotension

  • fatigue

  • bradycardia

Tamsulosin (A1 blocker)

• MOA: relaxes prostate + bladder (urine flow ↑)

• Uses: BPH

• Side effects:

  • orthostatic hypotension

  • dizziness

  • Tachycardia

• ⚠ “first dose syncope” + Give at night

Metoprolol (B1 selective blocker)

• MOA: ↓ HR, ↓ contractility

• Uses:

  • HTN

  • post-MI

• Side effects:

  • bradycardia

  • fatigue

  • hypotension

• ⚠ watch for SOB (even though B1 selective)

Bethanechol (direct ACh agonist)

• MOA: ↑ bladder tone, ↑ GI secretions, ↑ urinary excretion

  Uses:

  • urinary retention

  • post-op bladder atony

• Side effects:

  • sweating

  • diarrhea

  • bronchoconstriction

Pyridostigmine (indirect ACh agonist)

• MOA: ↑ ACh (blocks breakdown)

• Uses: Myasthenia gravis

• Side effects:

  • bradycardia

  • cramps, diarrhea

• ⚠ Too much = cholinergic crisis use Atropine fixes overdose

Donepezil (Indirect ACh agonist)

• MOA: ↑ ACh in brain

• Uses: Alzheimer’s disease

• Side effects:

  • nausea, diarrhea

  • bradycardia

Atropine (anticholinergic antidote)

• MOA: blocks ACh receptors

• Uses:

  • bradycardia

  • cholinergic overdose

  • pre-op drying secretions

• Side effects:

  • dry mouth

  • urinary retention

  • constipation

  • blurred vision

Phenytoin (Hydantoins)

• MOA: Blocks sodium channels

• Uses: Generalized seizures

• Therapeutic range: 10–20 mcg/mL

• Side effects:

  • gingival hyperplasia

  • Ataxia

  • CNS depression

  • Liver toxicity (LFT)

  • Bone marrow suppression (CBC)

• ⚠ oral care important + Risk for Pregnant women +

Phenobarbital (Barbiturates)

• MOA: CNS depression = decreasing GABA

• Uses: Generalized seizures

• Side effects:

  • sedation

  • CNS depression

  • dependence (Schedule 4)

Diazepam (Benzo)

• MOA: ↑ GABA

• Uses: seizures (emergency)

• Side effects:

  • CNS depression

  • dependence (Schedule 4)

  • paradoxical effects (Opposite)

Valproic acid

• MOA: Increase GABA activity

• Uses: absence seizures

• Side effects:

  • liver toxicity ⚠

• Monitor LFTs

Carbamazepine

• MOA: Alters sodium and calcium channels = Increasing GABA

• Uses: seizures, bipolar

• Side effects:

  • Bone marrow suppression (CBC)

  • BBW: serious dermatological reactions (Skin)

  • CNS depression

  • Suicidal ideation

  • ⚠ taper slowly + Take regularly, same time each day

Levodopa/Carbidopa (Dopaminergic Agents)

• MOA:

  • Levodopa → dopamine in brain

  • Carbidopa → prevents breakdown

• Uses: Parkinson’s

• Side effects:

  • dyskinesia

  • confusion

  • GI upset

  • On-Off Syndrome: wears off

• ⚠ avoid protein + vitamin B6 + BBW: melanoma risk

Amantadine (Dopaminergic Agents)

• MOA: ↑ dopamine release levels (Prevents it from returning)

• Uses: early Parkinson’s

• Side effects:

  • confusion

  • Dyskinesia

  • urinary retention

  • Hypotension

Benztropine (Anticholinergic)

• MOA: blocks ACh

• Uses: Symptom control for Parkinson’s (Useful when levodopa no longer effective)

• Side effects:

  • dry mouth

  • urinary retention

  • Hypotension

  • heat intolerance (Decrease sweating)

Avoid hot days → Heat stroke

Ipratropium (anticholinergic)

• MOA: Blocks ACh = bronchodilation

• Uses: COPD (Prevention NOT rescue)

• Side effects:

  • dry mouth

  • Dizziness

  • HA

  • urinary retention

Allergy to soy products or peanuts

Fluticasone (Nasal Steroid Decongestants)

• MOA: ↓ inflammation

• Uses: asthma (Prevention)

• Side effects:

  • Local burning

  • Dryness of mucosa

  • Irritation

• ⚠ Rinse mouth (fungal infection → candida albicans)

Montelukast (Leukotriene Receptor Antagonists )

• MOA: blocks leukotrienes

• Uses: chronic asthma prevention

• Side effects

  • HA

  • N/V/D

  • Elevated LFTs

  • Generalized myalgia

NOT for acute attacks + fetal toxicity in animal studies

Theophylline (Xanthines)

• MOA: bronchodilation + decreasing swelling

• Uses: Asthma; Bronchospasms

• Narrow therapeutic range (10–20mcg)

• Side effects:

  • tachycardia

  • GI upset

  • irritability

Nicotine causes an increase in metabolism -> Need a higher dose

Guaifenesin (Expectorants)

• MOA: loosens mucus, increase productive cough

• Uses: Remove secretions, induce cough

• Side effects

  • nausea

Dextromethorphan (Antitussives)

• MOA: cough suppressant

• Side effects:

  • drowsiness

  • thick secretions