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ANTI CHOLINERGIC drug, used in the Tx of COPD. It acts by blocking Muscarinic @ in the lungs and inhibiting bronchoconstriction and mucus secretion. A quaternary amine and does not cross BBB. A derivative of Atropine.
a short acting beta 2 agonist, used in condition of asthma and COPD
Beta 2 adrenergic receptor agonist
Smooth muscle relaxation, resulting in: *dilation of bronchial passages, *vasodilation in muscle and liver, *relaxation of uterine muscle and *release of insulin
What is the management of acute gouty attack?
naproxen, Indomethacin and other NSAIDs
If Pt has acute gout, but also has heart failure, PepticUlcerD, or NSAIDs allergy, what would you prescribe?
What are the side effects of Colchicine?
diarrhea, abdominal cramps, Nausea and Vomiting
Why Allopurinol should not be prescribed in acute gouty arthritis?
Allopurinol may worsen the acute attack. It is primarily used for prevention of recurrent gout.
Therapy of choice for PCP
Alternative regimen for PCP (besides TMP-SMX)
Pentamidine, TMP-Dapsone, Clindamycin-Primaquine, Trimetrexate Atovaquone
Empiric therapy of perforated duodenal ulcer: against Gram negative and anaerobes
Ampicillin + Metronidazole + Gentamicin or 3rd generation Cephalosporin
Therapy for DVT
Enoxaparin, subcutaneous, cont Warfarin, oral, continuous Percoced, oral, continuous Counseling
What antibiotics to order preoperatively to hemicolectomy for colon cancer?
Metronidazole, IV, one time Cefoxatime, IV, one time
What are the clinical uses of Bethanechol?
Rx: ileus (postop/neurogenic) Rx: urinary retention
What are the clinical uses of Methacholine?
In diagnosing bronchial hyperreactivity.
What is Pilocarpine?
a Direct-Acting Cholinomimetic a Muscarinic agonist, a Muscarinic receptor activator.
What are the clinical uses of Pilocarpine?
Rx-glaucoma, xerostomia.
What is the clinical use of Edrophonium?
Dx- Myasthenia; used to differentiate myasthenia from cholinergic crisis - the Tensilon test
What is Physostigmine?
an acetylcholinesterase inhibtor, an indirect acting cholinomimetic
What is the clinical use of Physostigmine?
Rx- glaucoma; Rx- antidote in Atropine overdose.
What are Neostigmine and Pyridostigmine?
Indirect-Acting Cholinomimetics; acetylcholinesterase inhibitors.
What are the clinical uses of Neostgmine and Pyridostigmine?
Rx: ileus, urinary retention, myasthenia; Rx: reversal of nondepolarizing NM blockers i.e. curare like; Neo and pyridostigmine are 4ternary - so remain in the periphery and increase ACh mainly for the PSNS.
What are Donepezil and Tacrine?
Acetylcholinesterase Inhibitors;
What are Donepezil and Tacrine used for?
Rx: Alzheimer disease
What are Organophosphates?
Acetylcholinesterase inhibitors; Indirect acting Cholinomimetics
What are the clinical uses of Organophosphates?
Malathion and Parathion are insecticides; Sarin is a nerve gas;
What is the TOC for a Group B streptococcal pneumonia in a 6 day old infant?
Ampicillin + Cefotaxime; you can add Gentamicin
Phenergan = Promethazine
a first generation H1 antagonist, anti-histamine and anti-emetic;
Muscarinic receptor antagonist
Atropine effects in order of increasing dose:
-Decreased secretions (salivary, bronchial, sweat) -mydriasis and cycloplegia -hyperthermia (w/ resulting vasodilation) -tachycardia -sedation -urinary retention and constipation -behavioral excitation and hallucinations
Other classes of drugs with antimuscarinic pharmacology
Antihistamines TCAs and antipsychotics Quinidine (antiarrhythmic) Amantadine (antiviral, also used in Parkinson) Meperidine (opioid analgesic in the CNS)
What are the three Cs of the TCAs and the Antipsychotics?
Coma Convulsions Cardiotoxicity (all are side effects in overdose, because of the muscarinic blockade)
What is the tx of acute Atropine intoxication?
Symptomatic +/- Physostigmine (Physostigmine is a tertiary amine, which blocks the AChesterase enzyme)
What are the clinical uses of Atropine?
Atispasmodic, antisecretory - used prior to intibation Antidiarrheal Management of AChE inhibitor OD
What is the clinical use of the M Blocker Tropicamide?
Ophthalmology (topical)
What is the clinical use of the M Blocker Ipratropium?
ASTHMA and COPD (inhalational) - no CNS entry, no change in mucus viscosity
What is the clinical use of the M Blocker Scopolamine?
Used in motion sickness, causes sedation and short term memory block
What are the clinical uses of the M blockers Benztropine and Trihexyphenidyl?
Lipid soluble (CNS entry) used in parkinsonism and in acute extrapyramidal symptoms induced by antipsychotics
The two types of Nicotinic receptor antagonists
Ganglionic Neuronal Type Skeletal muscle neuromuscular type
Ganglion Blocking Agents
Hexamethonium Mecamylamine
alpha 1 receptor in the eye:
located on the radial (dialtor) muscle and causes contraction - mydriasis
alpha 1 agonist vasoconstricts therefore used as a nasal decongestant and ophthalmologic use (mydriasis without cycloplegia)
used iv in hospitals to elicit reflex bradycardiadue to the hypotensive effect. Thereby rare and unusual use is to slow down the heart, but usually for tx of paroxysmal atrial tachycardia through vagal reflex
alpha 2 receptor agonist, direct-acting adrenoreceptor agonist in mild to moderate HTN
alpha 2 receptor agonist direct-acting adrenoreceptor agonist in mild to moderate HTN
direct-acting adrenoreceptor agonist beta 1 = beta 2 used to tx bronchospasm in asthma
Clinical uses of Isoproterenol
bronchospasm (asthma, beta2) heart block (beta 1 to increase the SAAV nodal conduction) bradyarrhythmias
Side effects of Isoproterenol
flushing, angina, arrhythmias
beta agonists [Direct-acting adrenoreceptor agonists]
Isoproterenol Dobutamine Salmeterol, Albuterol, Terbutaline Ritodrine
beta agonists with beta 1 = beta 2
beta agonists with beta 1 > beta 2
Dobutamine (used in congestive heart failure)
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