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Everyday drugs, and drugs used to treat PD and AD

Parasympathetic nervous system

The division of the autonomic nervous system known as the 'resting and digesting' system. It causes a general decrease in body activities such as heart rate, respiratory rate, and blood pressure, and an increase in blood flow to the GI tract and digestive function.

Sympathetic nervous system

"fight or flight" response, expends energy, increases heart rate, dilates pupils and bronchi, vasoconstriction, decreases secretions and GI and Intestinal motility

Sympathetic direct agonists exs

Epi, Norepi, Dopamine, Dobutamine, Terbutaline

Sympathetic indirect agonist exs

Amphetamines, Pseduophedrine

Alpha blocker exs

Tamsulosin (Flomax), Terazonsin

Beta blocker examples

Labetolol, Carvedilol(CoReg), Propanolol, Metoprolol, Atenolol

Parasympathetic Agonists exs

Bethadnechol, Pilocarpine, Physostigimine

Parasympathetic Antagonists exs

Atropine, Scopolamine, Tolteridine, Benztropine

Dopamine (DA)

direct sympathetic agonist, works on DA receptors; low doses : good renal blood flow, high doses: increase BP. USE: SHOCK

Terbutaline

direct sympathetic agonist, works on B2 receptors, cause bronchiolar and uterine relaxation, USE: prevent asthma, and premature L&D

Phenlyephrine

direct sympathetic agonist, works on alpha 1 receptors, vasoconstriction, increase HR, USE: in cold meds, dilate pupils

Pseudophedrine (Sudafed)

**indirect sympathetic agonist, works on alpha 1 receptors, vasoconstriction; USE: nasal decongestant, fewer CNS effects

Dobutamine(Dobutrex)

Direct sympathetic agonist, acts on B1 receptor, increase efficiency of heart beat, DOC for cardiac stimulation for adults, "chemical paddle"

Norepinephrine

Direct sympathetic agonist, works on alpha 1 receptors, vasoconstriction, increased reflex, decrease heart rate (reflex bradycardia) USE: SEPTIC SHOCK

Epinephrine

direct sympathetic agonist, works on alpha 1 &2, beta 1&2, vasoconstriction, bronchodilation, increase HR, increase glycolysis and lipolysis, GI relaxation; USE: peds cardiac stimulation, anaphylaxis, combined w/ local anasthetics

Amphetamines

indirect sympathetic agonist, works on alpha 1 receptors, heightened mood, decreased appetite. USE: ADD, Narcolepsy

Propanol

sympathetic antagonist, B1, B2 blocker(heart and lung effects!), decrease HR, BP, use w/ caution for asthmatics and diabetics(can mast signs of hypoglycemia, USE: HTN

Labetelol

HCZ, sympathetic antagonist, blocks alpha 1, beta 1 &2, decrease BP, HR, vasodilation; USE: Post-MI patients, HTN

Atenolol

sympathetic antagonist, B1 specific blocker, decrease HR and workload, used in CV diseases, avoids CNS effects **doesn't pass BBB

Metoprolol

sympathetic antagonist, B1 specific blocker, decrease HR and workload, USE: HTN, vtach, CHF **numb and cold extremeties SE

Tamulosin (Flomax)

sympathetic antagonist, alpha 1 blocker, vasodilation, USE: BPH +/- HTN, decreases size of prostate to allow better urinary flow

Bethanechol

muscarinic(parasympathetic) agonist --cholinergic, expulsion of urine, increase GI motility, USE: post-op patients, pts w/ urinary retention probs

Physostigmine

parasympathetic agonist -- cholinergic, enhances effect of Ach, increase GI motility, urination, secretions, bronchoconstriction USE: glaucoma(to reduce IOP), AD, delayed gastric emptying

Pilorcarpine

muscarinic(parasympathetic) agonist -- cholinergic, stimulates secrections, saliva, sweat, USE: glaucoma(to decrease IOP), antidote for scopolamine, atropine

Atropine

parasympathetic muscarinic antagonist, decrease secretions, USE: diarrhea, bronchospasm, anesthesia, ER codes, urinary incontinence

Scopolamine

parasympathetic muscarinc antagonist, decrease secretions, USE: motion sickness, pre-op patients as anticholinergic

Tolterodine(Detrol)

parasympathetic, muscarinic antagonist, anticholinergic, USE: overactive bladder

Benztropine (Cogentin)

atropine + diphenhydramine, parsympathetic antagonist, anitcholinergic/antihistamine, decrease imbalance b/w dopamine and ACh. USE: PD

Curare (Pancronium)

* non depolarizing muscle relaxant, nicotinic antagonist at the neuromuscular junction, USE: longer surgical procedures as adjuncts to anesthesia, work for 20-40 min, recovery = hour, *SE: Malignant hyperthermia

Succinylcholine (Anectine)

depolarizing muscle relaxant, nicotinic antagonist at the neuromuscular junction USE: quick onset w/i 30 secs for paralysis/muscle relaxant for purposes of intubation/endoscopy/removal of vent, inhibits gag reflex, works for about 5 min ** SE: Malignant hyperthermia

Baclofen (Lioresal)

muscle relaxer, * PO muscle relaxer for back spasms/aches

Carisoprodol (Soma)

PO muscle relaxer to treat back spasms/muscle aches

Cyclobenzaprine (Flexeril)

PO muscle relaxer to treat back spasms/muscle aches

Levodopa (L-dopa)

DA pre-cursor that crosses BBB, used to increase DA in the brain for PD patients,

Carbidopa

used in combination with L-dopa, inhibits breakdown of DA(inhibits decarboxlyase)

Sinemet

combo of L-Dopa and Carbidopa, reserved for more advanced PD patients

Selegiline

MAO-B inhibitor
Block degradation of Dopamine (no tyramine interactions).
Uses: atypical depression, Parkinson's disease (prevents dopamine breakdown).
Tox: GI distress, CNS stimulation, dyskinesias, serotonin syndrome if used with SSRI. CAUTION: RED FLAG DRUG

Ropinirole (Requip)

Parkinson's drug;D2 (some D3) agonist; sudden day time sleepiness; compulsive behavior; treatment for Restless Legs Syndrome (RLS)

Stalevo

New drug for treatment of Parkinson's disease that combines carbodopa, levodopa and entacapone for better results. Entacpone increases 1/2 life of L-Dopa

Donepezil (Aricept)

AchE inhibitor used in Alzheimer's to slow progressions. Causes peripheral cholinergic effects, N/V/diarrhea

Rivastigmine (Exelon)

AchE inhibitor. Used for Alzheimer's symptoms to increase Ach in frontal cortex.

Memantine

NMDA receptor antagonist; Helps prevent excitotoxicity (mediated by Ca).
Use: Alzheimers
Tox: Dizziness, confusion, hallucinations

alpha 1 receptor

vasoconstriction in areas that don't need it(GI), decrease secretions, pupil dilation, decreased GI motility, urinary retention

alpha 2 receptor

"turn off switch", decrease CNS sympathetic outflow, decreases NE release, decrease insulin release

beta 1 receptor

increased HR, CO, automaticity, contractitlity, renin secretion increased -- hold on to Na and H2O --> increase BP

beta 2 receptor

bronchial relaxation, uterine relaxation, vasodilation in areas needed - muscles, heart, lungs

nicotionic receptor

ACh receptor, found in CNS and PNS, stimulant, ganglia

muscarinic receptor

ACh receptor, smooth muscle contraction, increase secretions, decrease HR and contractility

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