Drug Exam 1

• Muscarinic Antagonists: an anticholinergic agent that blocks the activity of acetylcholine
• Indications for muscarinic antagonists?

  • preoperatively to decrease secretions 
  • prevent vagal-induced bradycardia/restore cardiac rate
  • hyperactive bowel
  • asthma preparations
• Major contraindications for muscarinic antagonists: BEERS criteria,

  Glaucoma (mydriasis can increase pressure in eye), Pre-existing tachycardia, Chronic constipation or opioid use with constipation, Some drugs used to treat Parkinson’s work by blocking cholinergic receptors (additive effect)
• Adverse Effects of muscarinic antagonists: Ventricular fibrillation, Delirium, and Coma
• atropine (Atropen):

  (P)muscarinic antagonist and anticholinergic

  (T)antiarrhythmic
• atropine (Atropen):

  Indications: decrease oral and respiratory secretions, bradycardia, and heart block
• atropine (Atropen):

  MOA: inhibits the action of acetylcholine at postganglionic sites
• atropine (Atropen):

  Contraindications: hypersensitivity, angle-closure glaucoma, and acute hemorrhage
• atropine (Atropen):

  Adverse effects: arrhythmias, seizures, prolonged QT interval
• bethanechol (Duvoid, Urecholine):

  (P)Direct cholinergic/muscarinic agonist, parasympathomimetic

  (T)prokinetic and urinary stimulant
• bethanechol (Duvoid, Urecholine):

  MOA: directly stimulates muscarinic cholinergic receptors, mimicking acetylcholine action, increasing GI tract tone and peristalsis and contraction of the detrusor muscle of the urinary bladder.
• bethanechol (Duvoid, Urecholine):

  Indications: urinary retention, conditions causing dry mouth, glaucoma, eye surgeries
• bethanechol (Duvoid, Urecholine):

  contraindications: Suspected bowel obstruction, Recent G I surgery, Active ulcer, Inflammatory disease, Suspected urinary obstruction, Severe bradycardia, hypotension, OR hypertension, Hyperthyroidism, Peritonitis, epilepsy, Parkinson’s disease
• bethanechol (Duvoid, Urecholine):

  adverse effects: Orthostatic hypotension, syncope (passing out), bradycardia, Reflex tachycardia, Complete heart block, Acute bronchospasm
• epinephrine (Epi-Pen, Auvi-Q, Twinject):

  (P)nonselective adrenergic agonist

  (T)sympathomimetic, antishock, antianaphylaxis
• epinephrine (Epi-Pen, Auvi-Q, Twinject):

  Indications: anaphylaxis, hypotension, cardiac resuscitation, asthma
• epinephrine (Epi-Pen, Auvi-Q, Twinject):

  MOA: stimulates both alpha- and beta-adrenergic receptors through the body. Actions typical of fight or flight. Bronchodilator and vasoconstrictor.
• epinephrine (Epi-Pen, Auvi-Q, Twinject):

  contraindications: hypersensitivity to sympathomimetic amines, angle-closure glaucoma, bisulfites, Non anaphylactic shock
• epinephrine (Adrenalin):

  adverse effects: Hypertensive crisis, dysrhythmias, bronchospasm, angina pectoris, and hyperglycemia
• prazosin (Minipress):

  (P) selective alpha 1 adrenergic antagonist

  (T)antihypertensive
• prazosin (Minipress):

  Indications: mild to moderate hypertension
• prazosin (Minipress):

  MOA: Dilates both arteries and veins by blocking postsynaptic alpha-1 adrenergic receptors. Decreases contractions in smooth muscle.
• prazosin (Minipress):

  Adverse effects: Orthostatic Hypotension, Reflex tachycardia, Arrhythmias, angina, edema, CHF
• prazosin (Minipress):

  Contraindications: hypersensitivity to quinazolines or alpha blockers, cautious with using other antihypertensives.
• metoprolol tartrate, metoprolol succinate (Lopressor, Toprol XL):

  (P)selective beta blocker and calcium channel blocker

  (T)antianginal and antihypertensive
• metoprolol tartrate, metoprolol succinate (Lopressor, Toprol XL):

  Indications: hypertension, angina pectoris, prevention of MI, and decreased mortality in pt with MI.
• metoprolol tartrate, metoprolol succinate (Lopressor, Toprol XL):

  MOA: Blocks stimulation of beta-1 adrenergic receptors. Does not usually affect beta-2 adrenergic receptor sites.
• metoprolol tartrate, metoprolol succinate (Lopressor, Toprol XL):

  Adverse Effects: bradycardia, HF, and pulmonary edema
•  metoprolol tartrate, metoprolol succinate (Lopressor, Toprol XL):

  Contraindications: uncompensated HF, pulmonary edema, cardiogenic shock, bradycardia, heart block, or sick-sinus syndrome.
• carbidopa- levodopa (Sinemet):

  (P) dopamine replacement therapy 

  (T) Dystonias/Parkinson disease, parasomnias, sleep-related movement disorders
• carbidopa- levodopa (Sinemet):

  Indications: Parkinson's disease
• carbidopa- levodopa (Sinemet):

  MOA: Levodopa is converted to dopamine in the CNS (it passes the BBB), where it serves as a neurotransmitter. Carbidopa, a decarboxylase inhibitor, prevents peripheral destruction of levodopa.
• carbidopa- levodopa (Sinemet):

  Adverse Effects: Agranulocytosis, leukopenia, hemolytic anemia, psychosis, blood dyscrasias
•  carbidopa- levodopa (Sinemet):

  Contraindications: closed-angle glaucoma, use within 2 weeks of MAOIs, MI (heart attack) with dysrhythmias, seizure disorder, lactation
• benztropine (Cogentin):

  (P) Anticholinergic 

  (T) Dystonia/Parkinson drug
• benztropine (Cogentin):

  Indications: Parkinson’s disease, Drug-induced EPS
• benztropine (Cogentin):

  Major Contraindications: Closed-angle glaucoma, myasthenia gravis, tardive dyskinesia, GI urinary obstruction, prostatic hypertrophy
• benztropine (Cogentin):

  Serious Adverse Effects: paralytic ileus
• benztropine (Cogentin):

  MOA: Reduces excess cholinergic effect associated with dopamine deficiency
•  donepezil (Aricept):

  (P) Cholinesterase inhibitor 

  (T)Anti-Alzheimers agents