Drugs Acting on ANS

summarize ver.

Q: What are the two divisions of the autonomic nervous system?

Sympathetic (fight or flight) and Parasympathetic (rest and digest)

Q: What neurotransmitter is used by the parasympathetic nervous system?

Acetylcholine (ACh)

Q: What neurotransmitters are used by the sympathetic nervous system?

Norepinephrine, Epinephrine, Dopamine

Q: What enzyme breaks down acetylcholine?

Acetylcholinesterase (AChE)

Q: Which drug class inhibits acetylcholinesterase?

Indirect-acting cholinergic agonists (AChE inhibitors)

Q: What receptors does acetylcholine act on?

Nicotinic and Muscarinic receptors

Q: What receptors does norepinephrine act on?

Alpha and Beta adrenergic receptors

Q: What are the two types of cholinergic receptors?

Nicotinic and Muscarinic

Q: What are the adrenergic receptor subtypes?

Alpha-1, Alpha-2, Beta-1, Beta-2, Beta-3

Q: Prototype direct cholinergic agonist used for urinary retention?

Bethanechol

Q: Direct cholinergic agonist used for glaucoma and xerostomia?

Pilocarpine

Q: Direct cholinergic agonist used in ophthalmology to induce miosis?

Carbachol

Q: Direct cholinergic agonist that stimulates bladder and GI tone?

Bethanechol

Q: Contraindications of direct cholinergic agonists?

Asthma, bradycardia, peptic ulcer, GI/GU obstruction, hypotension

Q: Adverse effects of direct cholinergic agonists?

Hypotension, bradycardia, bronchospasm, increased secretions, diarrhea

Q: Mechanism of indirect cholinergic agonists?

Inhibit acetylcholinesterase → increase ACh levels

Q: Indirect agonist used for diagnosis of myasthenia gravis?

Edrophonium

Q: Indirect agonist used for treatment of myasthenia gravis?

Neostigmine, Pyridostigmine

Q: Indirect agonist used for Alzheimer’s disease?

Donepezil, Rivastigmine, Galantamine

Q: Indirect agonist used as antidote for anticholinergic poisoning?

Physostigmine

Q: Adverse effects of indirect cholinergic agonists?

SLUDGE: salivation, acrimation, urination, diarrhea, GI upset, emesis

Q: Contraindications of indirect cholinergic agonists?

Asthma, bradycardia, intestinal/urinary obstruction

Q: Prototype anticholinergic drug?

Atropine

Q: Indications of atropine?

Bradycardia, cholinergic overdose, pre-op secretion reduction, pupil dilation

Q: Anticholinergic used for COPD/asthma?

Ipratropium, Tiotropium

Q: Anticholinergic used for overactive bladder?

Oxybutynin, Tolterodine

Q: Anticholinergic used for motion sickness?

Scopolamine

Q: Anticholinergic used for Parkinson’s tremors?

Benztropine

Q: Adverse effects of anticholinergics?

Dry mouth, blurred vision, constipation, urinary retention, tachycardia

Q: Classic anticholinergic mnemonic?

“Can’t see, can’t pee, can’t spit, can’t sh*t”

Q: Contraindications of anticholinergics?

Glaucoma, BPH, GI obstruction, tachyarrhythmias

Q: Nonselective adrenergic agonist used for anaphylaxis?

Epinephrine

Q: Adrenergic agonist that improves renal perfusion at low dose, increases BP at high dose?

Dopamine

Q: Beta-1 selective agonist used for acute heart failure?

Dobutamine

Q: Alpha-1 agonist used as decongestant and to increase BP?

Phenylephrine

Q: Alpha-2 agonist used for hypertension and withdrawal?

Clonidine

Q: Beta-2 selective agonist used for asthma/COPD?

Albuterol (Salbutamol), Terbutaline

Q: Adverse effects of adrenergic agonists?

Hypertension, tachycardia, arrhythmias, anxiety, tremors, headache

Q: Contraindications of adrenergic agonists?

Pheochromocytoma, tachyarrhythmias, hypovolemia, CAD

Q: Alpha-1 blocker used for hypertension and BPH?

Prazosin, Doxazosin, Terazosin

Q: Alpha-1 blocker used mainly for BPH?

Tamsulosin

Q: Nonselective alpha-blocker used for pheochromocytoma?

Phentolamine

Q: Nonselective alpha-blocker used for NE extravasation antidote?

Phentolamine

Q: Adverse effects of alpha-blockers?

Orthostatic hypotension, dizziness, reflex tachycardia, nasal congestion

Q: Prototype nonselective beta-blocker?

Propranolol

Q: Beta-1 selective blockers used in hypertension angina, post-MI?

Metoprolol, Atenolol, Bisoprolol

Q: Nonselective beta-blocker used in glaucoma?

Timolol

Q: Nonselective beta-blocker used for migraine prophylaxis and tremors?

Propranolol

Q: Mixed alpha & beta blocker used for CHF and hypertension?

Carvedilol, Labetalol

Q: Adverse effects of beta-blockers?

Bradycardia, hypotension, fatigue, bronchospasm, depression

Q: Danger of abrupt beta-blocker withdrawal?

Rebound hypertension, arrhythmias, MI

Q: Which adrenergic receptor increases heart rate and contractility?

Beta-1

Q: Which adrenergic receptor causes bronchodilation?

Beta-2

Q: Which adrenergic receptor causes vasoconstriction?

Alpha-1

Q: Which adrenergic receptor inhibits NE release (feedback)?

Alpha-2

Q: Which adrenergic receptor stimulates lipolysis and thermogenesis?

Beta-3

Q: Which beta-blockers are safer in asthma/COPD?

Beta-1 selective blockers (Metoprolol, Atenolol)

Q: Which anticholinergic is the antidote for organophosphate poisoning?

Atropine + Pralidoxime

Q: Drug used in hypertensive emergencies (alpha & beta blocker)?

Labetalol

Q: Adrenergic agonist used as tocolytic (prevent premature labor)?

Terbutaline

Q: Alpha-blocker used for Raynaud’s disease?

Prazosin

Q: Cholinergic agonist contraindicated in asthma due to bronchospasm risk?

Bethanechol