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Pharm Fundamental Drugs
Pharm - Fundamentals
41
Medical
Graduate
08/24/2012

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Term
Acetylcholine
Definition
Agonist at all AChRs (duh.) Limited clinical use: used intraocularly to produce miosis, intracoronary use causes vasodilation, can be used to diagnose vasospastic angina.
Term
Methacholine
Definition
Can be used to diagnose asthma through a challenge test. Inhalation of this drug causes bronchoconstriction by acting at muscarinics. Must be used very carefully.
Term
Carbachol
Definition
Treatment for wide-angle glaucome when other cholinomimetics have failed. Causes pupillary contraction and relief and relief of intraocular pressure.
Term
Bethanechol
Definition
Used postoperatively to reduce bladder/bowel distension (BBB). Can be used as an alternative to pilocarpine for treatment of xerostomia.
Term
Pilocarpine
Definition
Potent stimulator of sweat, tears and saliva. Used for wide-angle glaucoma and to treat xerostomia. Also used for emergency treatment of narrow-angle glaucoma with an AChE inhibitor (although this condition requires immediate surgical attention). Prolonged use can cause reduced night vision and difficulty in focusing on far objects.
Term
Edrophonium
Definition
Quaternary amine with brief duration (1-5 mins). Used to test for myasthenia gravis where IV administration causes a brief improvement of strength. Also used to judge correct dosage: if brief improvement is seen with use that patient may benefit from a higher dose of carbamate.
Term
Physostigmine
Definition
Crosses BBB into CNS, used for treatment of wide-angle glaucoma, often with pilocarpine. Used to treat atropine overdose ('PHYxes' atropine overdose). Can adversely facilitate formation of cataracts.
Term
Neostigmine
Definition
Short lasting (0.5 - 2hr). Used to treat loss of tone in GI tract and bladder (urinary retention) either from disease or from postoperative recovery from anesthesia. Also used for myasthenia gravis. No CNS penetration ('NEO' CNS penetration).
Term
Pyridostigmine
Definition
Used to treat myasthenia gravis, longer duration (3-6hr) than neostigmine.
Term
Ambenonium
Definition
Similar to pyridostigmine but even longer acting (4-8hr).
Term
Echothiophate
Definition
Used to treat glaucoma, only clinically useful organophosphate.
Term
Malathion
Parathion
Definition
Insecticides responsible for many cases of farm poisonings. Converted to malaoxon and paraoxon, respectively, which are more toxic compounds. Detoxified in mammals and birds via plasmaesterases.
Term
Sarin/Soman
Definition
'Nerve gases' that are potent inhibitors of AChE, among the most toxic agents known.
Term
Donepezil
Definition
Used in treatment of Alzheimer's. Long acting (once-a-day dosing), CNS penetrant, good oral absorption.
Term
Rivastigmine
Definition
Carbamate similar to physostigmine used to treat Alzheimer's. Requires twice-a-day dosing.
Term
Galantamine
Definition
Long-acting drug for Alzheimer's. Not only a AChE-I but also a potent allosteric enhancer of CNS nicotinic receptors.
Term
Atropine
Definition
Anti-muscarinic. Uses: mydriasis for eye exam (outdated); induce cycloplegia (ciliary muscle paralysis) in children for determination of refractive error; sinus bradycardia and AV block; reduction of salivary and resp. secretions and to prevent airway obstruction in patients under anesthesia (outdated); reduce intestinal spasms and pain; reduce gastric acid secretion (outdated); reverse muscarine or AChE-I poisoning; prevent muscarinic side effects in patients receiving neostigmine or AChE-I; as an antidiarrheal
Term
Scopolamine
Definition
Anti-muscarinic. Used for motion sickness, sedative. Applied as a patch.
Term
Tropicamide
Definition
Fast but short-acting mydriatic agent.
Term
Cyclopentolate
Definition
Fast but short-acting mydriatic agent.
Term
Homatropine
Definition
Fast but short-acting mydriatic agent.
Term
Ipratropium
Definition
Quaternary amine anti-muscarinic. Taken by inhalation, causes bronchodilation, used in COPD.
Term
Tiotropium
Definition
Quaternary amine anti-muscarinic. Taken by inhalation, causes bronchodilation, used in COPD. Similar to Ipratropium but longer-acting.
Term
Tolterodine
Definition
Anti-muscarinic. Used to manage overactive bladder, relaxes detrusor to allow for more filling. Contraindicated for patients with narrow-angle glaucoma.
Term
Dicyclomine
Definition
Anti-muscarinic. Relaxes intestinal smooth muscle. Used for irritable bowel.
Term
Glycopyrrolate
Definition
Anti-muscarinic. Low doses used to inhibit secretions (e.g. to make intubation easier). Used to prevent excessive generalized sweating and to prevent muscarinic side effects in patients receiving neostigmine (used preferentially over atropine for this use).
Term
Benztropine
Definition
Anti-muscarinic. Used to relieve extrapyramidal symptoms in Parkinson's patients or patients taking antipsychotics.
Term
Hexamethonium
Definition
Non-depolarizing ganglionic blocker. Was used as an anti-hypertensive.
Term
Trimethaphan
Definition
Non-depolarizing ganglionic blocker. Was used for aortic dissection as it lowers BP and prevents the sympathetic reflex.
Term
Mecamylamine
Definition
Non-depolarizing ganglionic blocker. Was used for hypertension, can be used to improve GI absorption. Recent interest for use in Tourette Syndrome.
Term
Succinylcholine
Definition
Depolarizing competitive AChR agonist. Phase I: fasiculations; Phase II: desensitization.
Term
Mivacurium
Definition
Short-acting, rapid-onset.
Autonomic ganglia: No effect
Histamine release: Low
Cardiac mAChR: None
Metabolism: plasmaChE
Term
Rocuronium
Definition
Medium-acting, rapid-onset.
Autonomic ganglia: no effect
Histamine release: none
Cardiac mAChR: slight
Metabolism: Liver
Term
Vecuronium
Definition
Medium-acting, slow-onset.
Autonomic ganglia: no effect
Histamine release: none
Cardiac mAChR: none
Metabolism: Liver (and kidney) deacetylation
Term
Atracurium
Definition
Medium-acting, slow-onset.
Autonomic ganglia: no effect
Histamine release: low
Cardiac mAChR: none
Metabolism: spontaneous hydrolysis
Term
Cisatracurium
Definition
Medium-acting, slow-onset.
Autonomic ganglia: no effect
Histamine release: slight
Cardiac mAChR: none
Metabolism: Spontaneous hydrolysis
Term
Tubocurarine
Definition
Long-acting, slow-onset.
Autonomic ganglia: blockade
Histamine release: high
Cardiac mAChR: none
Metabolism: Kidney excretion
Term
Metocurine
Definition
Long-acting, slow-onset.
Autonomic ganglia: blockade
Histamine release: moderate
Cardiac mAChR: none
Metabolism: Kidney excretion
Term
Pancuronium
Definition
Long-acting, slow-onset.
Autonomic ganglia: no effect
Histamine release: none
Cardiac mAChR: moderate block (also called 'vagolytic effect': tachycardia)
Metabolism: Kidney deacetylation
Term
Pipecuronium
Definition
Long-acting, slow-onset.
Autonomic ganglia: no effect
Histamine release: none
Cardiac mAChR: none
Metabolism: Kidney deacetylation
Term
Doxacurium
Definition
Long-acting, slow-onset.
Autonomic ganglia: no effect
Histamine release: none
Cardiac mAChR: no effect
Metabolism: Kidney excretion
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