Bone and skin disorders, then the autonomic nervous system — the adrenergic and cholinergic drugs.
Treatment steps up with severity. Mild: topical benzoyl peroxide and a topical retinoid (tretinoin, adapalene, tazarotene). Mild to moderate inflammatory: add a topical antibiotic (clindamycin, erythromycin) or azelaic acid. Moderate: oral antibiotics (doxycycline, minocycline) plus hormonal therapy (combined oral contraceptives, spironolactone). Severe nodulocystic or refractory: oral ISOTRETINOIN.
Isotretinoin = 'iso-TERATOGEN': two contraceptives, two pregnancy tests, iPLEDGE.
Topical first: high-potency corticosteroids, vitamin D analogs (calcipotriene), topical retinoids (tazarotene), coal tar, calcineurin inhibitors, and salicylic acid. Then phototherapy (UVB, PUVA). For moderate to severe disease or joint involvement: systemic methotrexate, cyclosporine, acitretin, apremilast, or BIOLOGICS.
Methotrexate is WEEKLY, not daily. That mix-up is the classic fatal medication error.
ACUTE flare: NSAIDs (indomethacin, naproxen), colchicine, or corticosteroids (oral, IV, or intra-articular). PROPHYLAXIS: urate-lowering therapy with allopurinol or febuxostat (xanthine oxidase inhibitors) or probenecid (uricosuric), plus low-dose colchicine or an NSAID as cover for the first 3 to 6 months.
| Acute attack | Prophylaxis / chronic |
|---|---|
| Goal: stop the pain and inflammation NOW | Goal: lower serum uric acid (target under 6 mg/dL) to prevent future attacks |
| NSAIDs: indomethacin, naproxen (avoid in CKD, GI bleed, heart failure) | Allopurinol: first-line xanthine oxidase inhibitor |
| Colchicine: most effective within 24 to 36 hours of onset; causes nausea, vomiting, diarrhea | Febuxostat: for allopurinol intolerance; carries a cardiovascular boxed warning |
| Corticosteroids: prednisone or an intra-articular injection when NSAIDs and colchicine are contraindicated | Probenecid: uricosuric; needs decent renal function and 2 to 3 L of fluid daily |
| Do NOT start allopurinol during an acute flare | Do NOT stop allopurinol during a flare if the patient is already taking it |
Allopurinol PREVENTS, colchicine and NSAIDs RELIEVE. Never start the preventer mid-attack.
Corticosteroids produce a Cushingoid picture: hyperglycemia, weight gain with moon face and buffalo hump, hypertension and fluid retention, osteoporosis, immunosuppression with masked infection, GI ulceration, mood changes, cataracts and glaucoma, thin skin with poor wound healing, and muscle wasting. Because they cause adrenal suppression they must be TAPERED, never stopped abruptly.
Steroids give you Cushing's on purpose: high sugar, high pressure, high infection risk, low bone, low potassium. And taper, always taper.
Bone-resorption inhibitor, Bisphosphonate
Treatment and prevention of osteoporosis in postmenopausal women, treatment of osteoporosis in men, Paget’s disease, treatment of corticosteroidinduced osteoporosis in postmenopausal women not receiving estrogen and in men who are on continuing corticosteroid …
Decreases rate of bone resorption and may directly block dissolution of hydroxyapatite crystals of bone; inhibits osteoclast activity
RESP: Asthma exacerbation CV: Atrial fibrillation INTEG: Rash, photosensitivity CNS: Headache GI: Abdominal pain, constipation, nausea, vomiting, esophageal ulceration, acid reflux, dyspepsia, esophageal perforation, diarrhea, esophageal cancer META: Hypophosphatemia, hypocalcemia MS: Bone pain …
Antigout drug, antihyperuricemic, Xanthine oxidase inhibitor
Chronic gout, hyperuricemia associated with malignancies, recurrent calcium oxalate calculi, uric acid calculi
Inhibits the enzyme xanthine oxidase, reducing uric acid synthesis
GI: Nausea, vomiting, malaise, diarrhea, hepatitis INTEG: Rash CV: Hypo- and hypertension, HF (IV use) CNS: Drowsiness GU: Renal failure MISC: Hypersensitivity, bone marrow depression MS: Acute gouty attack
Parathyroid agent (calcium regulator), Polypeptide hormone
Paget’s disease, postmenopausal osteoporosis, hypercalcemia
Decreases bone resorption, blood calcium levels; increases deposits of calcium in bones; opposes parathyroid hormone
CNS: Headache (nasal) EENT: Eye pain (nasal) GI: Nausea, diarrhea, vomiting, anorexia, (IM/SUBCUT) GU: Nocturia, frequency INTEG: Rash, flushing, reaction at injection site MS: Backache, myalgia, arthralgia RESP: Dyspnea, flulike symptoms, bronchospasm SYST: Anaphylaxis, infection
Parathyroid agent (calcium regulator), Vitamin D hormone
Hypocalcemia with chronic renal disease, hyperparathyroidism, pseudohypoparathyroidism, renal osteodystrophy; plaque psoriasis (TOP)
Increases intestinal absorption of calcium; provides calcium for bones; increases renal tubular reabsorption of phosphate
CNS: Drowsiness, headache, vertigo CV: Hypertension, dysrhythmias, edema EENT: Blurred vision, photophobia, rhinorrhea ENDO: Hypercalcemia GI: Nausea, vomiting, jaundice, anorexia, dry mouth, constipation, cramps, metallic taste, pancreatitis GU: Polyuria MS: Myalgia, arthralgia …
Antidote / reversal: 1
🔗 Full card in the drug guideAntigout agent, Alkaloid
Gout, gouty arthritis (prevention, treatment); to arrest the progression of neurologic disability in those with MS, Mediterranean fever Unlabeled: Bechet syndrome with arthritis, cutaneous lesions or mucocutaneous ulcers …
Inhibits microtubule formation of lactic acid in leukocytes, which decreases phagocytosis and inflammation in joints
GI: Nausea, vomiting, anorexia, cramps HEMA: Agranulocytosis, thrombocytopenia, aplastic anemia, pancytopenia MISC: Alopecia, peripheral neuritis
Antidote / reversal: 1
🔗 Full card in the drug guideAntirheumatic agent (disease modifying) (DMARD), Anti-TNF agent
Acute, chronic rheumatoid arthritis that has not responded to other disease-modifying agents, polyarticular course of juvenile rheumatoid arthritis (JRA), ankylosing spondylitis, plaque psoriasis, psoriatic arthritis Unlabeled: Crohn’s disease …
Binds tumor necrosis factor (TNF), which is involved in immune and inflammatory reactions
CNS: Headache, asthenia, dizziness, seizures CV: Heart failure GI: Abdominal pain, dyspepsia, vomiting, hepatitis, diarrhea HEMA: Pancytopenia, anemia, thrombocytopenia, leukopenia, neutropenia INTEG: Rash, injection site reaction, keratoderma blenorrhagicum RESP: Pharyngitis, cough, URI, non-URI …
Antimalarial, antirheumatic (DMARDs), 4-Aminoquinoline derivative
Malaria caused by susceptible strains of Plasmodium vivax, P. malariae, P. ovale, P. falciparum (some strains); SLE, rheumatoid arthritis Unlabeled: Lupus nephritis, polymorphous-light eruptions
Impairs complement-dependent antigen–antibody reactions
CNS: Headache, fatigue, irritability, seizures, bad dreams, dizziness, confusion, psychosis, anxiety, suicidal ideation CV: HF, torsades de pointes, QT prolongation, asystole with syncope EENT: Blurred vision, corneal changes, tinnitus, vertigo, nystagmus, corneal deposits GI: Nausea, vomiting …
Antidote / reversal: 1
🔗 Full card in the drug guideAntineoplastic-antimetabolite (vesicant), Folic acid antagonist
Acute lymphocytic leukemia; in combination for breast, lung, head, neck carcinoma; lymphoma, sarcoma, gestational choriocarcinoma, hydatidiform mole, psoriasis, RA, mycosis fungoides, osteosarcoma Unlabeled: Active Crohn’s disease, SLE, psoriatic arthritis
Inhibits an enzyme that reduces folic acid, which is needed for nucleic acid synthesis in all cells; specific to S phase of cell cycle; immunosuppressive
CNS: Dizziness, seizures, leukoencephalopathy, headache, confusion, encephalopathy, hemiparesis, malaise, fatigue, chills, fever; arachnoiditis (intrathecal) EENT: Blurred vision, optic neuropathy GI: Nausea, vomiting, anorexia, diarrhea, ulcerative stomatitis, hepatotoxicity, cramps, ulcer …
Corticosteroid, Intermediate-acting glucocorticoid
Severe inflammation, neoplasms, multiple sclerosis, collagen disorders, dermatologic disorders, pulmonary fibrosis, asthma
Decreases inflammation by increasing capillary permeability and lysosomal stabilization, minimal mineralocorticoid activity
CNS: Depression, flushing, sweating, headache, mood changes CV: Hypertension, thrombophlebitis, embolism, tachycardia, fluid retention EENT: Fungal infections, increased intraocular pressure, blurred vision GI: Diarrhea, nausea, abdominal distention, GI hemorrhage, increased appetite …
Bone resorption inhibitor, Hormone modifier, selective estrogen receptor modulator (SERM)
Prevention, treatment of osteoporosis in postmenopausal women; breast cancer prophylaxis in postmenopausal women with osteoporosis or in postmenopausal women at high risk for developing the disease; invasive breast cancer risk reduction
Tissue-selective estrogen agonist/antagonist; agonist activity in bone and on lipid metabolism; antagonist activity on breast and uterus; reduces resorption of bone and decreases bone turnover
CNS: Insomnia, depression, migraines CV: Hot flashes, peripheral edema, thromboembolism, stroke, fever, chest pain EENT: Pharyngitis, sinusitis, laryngitis GI: Nausea, vomiting, diarrhea, dyspepsia, abdominal pain, gastroenteritis GU: Vaginitis, leukorrhea, cystitis, UTI …
🔗 Full card in the drug guideGI antiinflammatory, antirheumatic (DMARD), Sulfonamide
Ulcerative colitis; RA; juvenile RA (Azulfidine EN-tabs)
Prodrug to deliver sulfapyridine and 5-aminosalicylic acid to colon; antiinflammatory in connective tissue also
CNS: Headache, neuropathy GI: Nausea, vomiting, abdominal pain, stomatitis, hepatitis, glossitis, pancreatitis, diarrhea GU: Orange-colored urine HEMA: Leukopenia, neutropenia, thrombocytopenia, agranulocytosis, hemolytic anemia INTEG: Rash, dermatitis, urticaria, Stevens-Johnson syndrome …
Antiviral, Purine nucleoside/nucleotide analog
Mucocutaneous herpes simplex virus, herpes genitalis (HSV-1, HSV-2), varicella infections, herpes zoster, herpes simplex encephalitis, herpes labialis
Converted to acyclovir monophosphate by virus-specific thymidine kinase then further converted to acyclovir triphosphate by other cellular enzymes, inhibits viral DNA synthesis
CNS: Tremors, confusion, lethargy, hallucinations, seizures, dizziness, headache, encephalopathic changes EENT: Gingival hyperplasia GI: Nausea, vomiting, diarrhea, increased ALT/AST, abdominal pain, colitis GU: Hematuria, acute renal failure …
Antidote / reversal: 1
🔗 Full card in the drug guideBenzoyl peroxide is a topical antibacterial and keratolytic for acne. It kills Cutibacterium acnes, dries and unplugs the follicle, and prevents antibiotic resistance when paired with a topical antibiotic.
Benzoyl peroxide bleaches everything but your patience. White towels only.
Corticosteroid, topical
Inflammation/itching corticosteroid-responsive dermatoses on the skin/scalp
Crosses cell membrane to attach to receptors to decrease inflammation, itching; inhibits multiple inflammatory cytokines
INTEG: Burning, folliculitis, pruritus, dermatitis, maceration, erythema MISC: Hyperglycemia, glycosuria, Cushing’s syndrome, HPA axis suppression
Calcipotriene (Dovonex) is a topical VITAMIN D ANALOG for plaque psoriasis. It slows the excessive proliferation of keratinocytes and normalizes skin cell differentiation.
Calcipotriene = calcium plus psoriasis. Too much cream means too much calcium.
Topical antifungal, Imidazole derivative
Vulvovaginal, oropharyngeal candidiasis; topical fungal infections, prevention of oropharyngeal candidiasis in immunocompromised
Antifungal activity results from altering cell wall permeability
GI: Nausea, vomiting GU: Vaginal burning, irritation INTEG: Burning, peeling, rash, pruritus
Hormone, androgen inhibitor, hair stimulant, 5-α-Reductase inhibitor
Symptomatic benign prostatic hyperplasia (Proscar); male-pattern baldness (Propecia)
Inhibits 5-α-reductase and reduction in DHT; DHT induces androgenic effects by binding to androgen receptors in the cell nuclei of the prostate gland, liver, skin; prevents development of BPH
GU: Impotence, decreased libido, decreased volume of ejaculate, sexual dysfunction, gynecomastia INTEG: Rash MISC: Breast tenderness, secondary malignancy, angiedema
Antiacne agent, retinoid
Severe recalcitrant nodulocystic acne
🔗 Full card in the drug guideAntifungal, Imidazole derivative
Chronic mucocandidiasis, oral thrush, candiduria, coccidioidomycosis, histoplasmosis, chromomycosis, paracoccidioidomycosis, blastomycosis; tinea cruris, tinea corporis, tinea versicolor …
🔗 Full card in the drug guideantiinfective, Tetracycline
Acinetobacter sp., Actinomyces israelii, Actinomyces sp., Bacillus anthracis, Bartonella bacilliformis, Bordetella pertussis, Borrelia burgdorferi, Borrelia recurrentis, Brucella sp., Burkholderia mallei, Burkholderia pseudomallei, Campylobacter fetus …
Inhibits protein synthesis, phosphorylation in microorganisms by binding to ribosomal subunits, reversibly binding to ribosomal subunits; bacteriostatic
CNS: Dizziness, fever, light-headedness, vertigo, seizures, increased intracranial pressure, headache CV: Pericarditis, thrombophlebitis EENT: Permanent discoloration of teeth, oral candidiasis, tinnitus GI: Nausea, vomiting, diarrhea, anorexia, hepatotoxicity …
Antihypertensive, Vasodilator, peripheral
Topically to treat alopecia
🔗 Full card in the drug guideTopical antiinfective
Impetigo, skin lesions (Staphylococcus aureus/Streptococcus pyogenes)
Antibacterial activity results from inhibition of protein synthesis; bacteriostatic at low concentration, bactericidal at high concentration
CNS: Headache GI: Taste change, nausea INTEG: Burning, rash, pruritus
Permethrin is a topical scabicide and pediculicide that is neurotoxic to the parasite. For SCABIES use 5% cream: apply to the entire body from the NECK DOWN, leave on 8 to 14 hours, wash off, and repeat in 7 days. For HEAD LICE use the 1% cream rinse on clean, towel-dried hair for 10 minutes.
Neck down, 8 to 14 hours, repeat in a week, and the itch outlives the mite.
Immunosuppressant, calcineurin inhibitor, Macrolide, calcineurin inhibitor
Organ transplants to prevent rejection; topical: atopic dermatitis
Produces immunosuppression by inhibiting T-lymphocytes
CNS: Tremors, headache, insomnia, paresthesia, chills, fever, seizures, BK virus–associated nephropathy, coma, posttransplant lymphoproliferative disorder (PTLD) CV: Hypertension, myocardial hypertrophy, prolonged QTc, cardiomyopathy EENT: Blurred vision, photophobia GI: Nausea, vomiting, diarrhea …
Tazarotene (Tazorac) is a topical RETINOID used for psoriasis and acne. It normalizes keratinocyte turnover and reduces inflammation. It is PREGNANCY CATEGORY X and is absolutely contraindicated in pregnancy.
Every retinoid: night, sunscreen, and NOT in pregnancy.
Bradycardia and hypotension are the big ones. Also fatigue, dizziness, bronchospasm (non-selective agents in asthma or COPD), MASKED HYPOGLYCEMIA symptoms, erectile dysfunction, depression and vivid dreams, and worsening of acute decompensated heart failure. NEVER stop a beta blocker abruptly: rebound tachycardia, hypertension, angina, and MI.
Beta blockers SLOW the heart, MASK the low sugar, TIGHTEN the airway, and are never stopped cold.
Vasopressors and inotropes: norepinephrine (first-line in septic shock), epinephrine, phenylephrine, dopamine, vasopressin, dobutamine (an inotrope), and oral midodrine for chronic orthostatic hypotension.
| Drug | Main action | Best use |
|---|---|---|
| Norepinephrine (Levophed) | Strong alpha-1 vasoconstriction plus some beta-1 | First-line for septic and most distributive shock |
| Epinephrine | Alpha-1, beta-1, and beta-2 | Anaphylaxis, cardiac arrest, refractory shock |
| Phenylephrine | Pure alpha-1 vasoconstriction | Raises BP without increasing heart rate; useful with tachyarrhythmia |
| Dopamine | Dose-dependent: dopaminergic, then beta-1, then alpha-1 | Bradycardia with hypotension; causes more arrhythmias than norepinephrine |
| Vasopressin | V1 receptor, non-adrenergic vasoconstriction | Add-on to norepinephrine in septic shock |
| Dobutamine | Beta-1 inotrope; can LOWER blood pressure | Cardiogenic shock and low cardiac output: increases contractility |
Fluids first, then squeeze. Norepinephrine is first-line in septic shock.
Cholinergic crisis is an excess of acetylcholine. Think SLUDGE plus the killer B's: Salivation, Lacrimation, Urination, Defecation and diarrhea, GI cramping, Emesis, plus Bradycardia, Bronchorrhea, and Bronchospasm. The secretions and respiratory muscle weakness are what kill.
SLUDGE plus the killer B's. Everything that can leak, leaks.
ATROPINE is the antidote: an anticholinergic that dries secretions and reverses bradycardia. For organophosphate or nerve-agent poisoning, add PRALIDOXIME (2-PAM) to reactivate acetylcholinesterase, plus benzodiazepines for seizures and aggressive airway support.
Atropine DRIES the flood; pralidoxime UNSTICKS the enzyme.
Anticholinergics block acetylcholine at muscarinic receptors, producing dry mouth, blurred vision and photophobia from mydriasis, constipation, urinary retention, tachycardia, decreased sweating with hyperthermia, and confusion or delirium, especially in older adults.
Blind as a bat, dry as a bone, red as a beet, hot as a hare, mad as a hatter, and full as a flask.
Malignant hyperthermia is a genetic (autosomal dominant, usually an RYR1 ryanodine receptor mutation) hypermetabolic reaction triggered by VOLATILE INHALED ANESTHETICS (halothane, sevoflurane, desflurane, isoflurane) and the depolarizing paralytic SUCCINYLCHOLINE. Uncontrolled calcium release from the sarcoplasmic reticulum causes sustained muscle contraction.
Dantrolene DAMPENS the calcium. Fever is the LAST sign; the CO2 rises first.
Depolarizing blockers (succinylcholine) act as acetylcholine AGONISTS: they depolarize the motor end plate, cause fasciculations, then sustained paralysis, and there is NO reversal agent. Non-depolarizing blockers (the -curium and -uronium drugs) are competitive ACh ANTAGONISTS: no fasciculations, longer acting, and reversible with neostigmine or sugammadex.
| Depolarizing (succinylcholine) | Non-depolarizing (rocuronium, vecuronium, cisatracurium) |
|---|---|
| Agonist that persistently depolarizes the end plate | Competitive antagonist that blocks ACh from binding |
| Muscle fasciculations first, then paralysis | No fasciculations, smooth onset of paralysis |
| Ultra-short, about 5 to 10 minutes; broken down by plasma pseudocholinesterase | Intermediate to long acting; renal and hepatic elimination |
| NO reversal agent, you must wait it out | Reversed by neostigmine with glycopyrrolate, or sugammadex for rocuronium and vecuronium |
| Used for rapid sequence intubation | Used for maintenance of surgical paralysis and in ventilated patients |
| Risks: malignant hyperthermia, HYPERKALEMIA, bradycardia, raised ICP and IOP, postop myalgias | Risks: prolonged paralysis, histamine release with older agents, residual weakness |
SUX = short, sudden, no antidote. The '-uroniums' you can reverse.
First-line is a cholinesterase inhibitor, PYRIDOSTIGMINE (Mestinon), which increases available acetylcholine at the neuromuscular junction. Add immunosuppression (corticosteroids, azathioprine, mycophenolate); for crisis use PLASMAPHERESIS or IVIG; thymectomy is used in selected patients.
Pyridostigmine 30 to 60 minutes before meals: strength for the fork.
Bronchodilator, Adrenergic β2-agonist, sympathomimetic, bronchodilator
Prevention of exercise-induced asthma, acute bronchospasm, bronchitis, emphysema, bronchiectasis, or other reversible airway obstruction Unlabeled: Hyperkalemia in dialysis patients, COPD, emphysema
Causes bronchodilation by action on β2 (pulmonary) receptors by increasing levels of cAMP
CNS: Tremors, anxiety, insomnia, headache, stimulation, restlessness CV: Angina, hypo/hypertension, dysrhythmias, chest pain EENT: Dry nose, irritation of nose and throat GI: Nausea, vomiting MISC: Hyperglycemia RESP: Paradoxical bronchospasm
Antihypertensive, Central alpha-adrenergic agonist
Mild to moderate hypertension, used alone or in combination; severe pain in cancer patients (epidural), attention-deficit/hyperactivity disorder (ADHD)
Inhibits sympathetic vasomotor center in CNS, which reduces impulses in sympathetic nervous system; B/P, pulse rate, cardiac output are decreased …
CNS: Drowsiness, nightmares, anxiety, depression, hallucinations, syncope, dizziness CV: Orthostatic hypotension, HF, ECG abnormalities, sinus tachycardia EENT: Taste change, dry eyes ENDO: Hyperglycemia GI: Nausea, vomiting, constipation, dry mouth GU: Impotence, urinary retention …
Antidote / reversal: 1
🔗 Full card in the drug guideBronchodilator nonselective adrenergic agonist, vasopressor, Catecholamine
Acute asthmatic attacks, hemostasis, bronchospasm, anaphylaxis, allergic reactions, cardiac arrest, adjunct in anesthesia, shock
β1- and β2-agonist causing increased levels of cAMP, thereby producing bronchodilation, cardiac, and CNS stimulation; high doses cause vasoconstriction via alpha-receptors; low doses can cause vasodilation via β2-vascular receptors
CNS: Tremors, anxiety, insomnia, headache, dizziness, confusion, hallucinations, weakness, drowsiness CV: Palpitations, tachycardia, hypertension, dysrhythmias, increased T wave GI: Anorexia, nausea, vomiting MISC: Sweating, dry eyes RESP: Dyspnea …
Antihypertensive, antianginal, β1-Blocker
Mild to moderate hypertension, acute MI to reduce cardiovascular mortality, angina pectoris, NYHA class II, III heart failure, cardiomyopathy
Lowers B/P by β-blocking effects; reduces elevated renin plasma levels; blocks β2-adrenergic receptors in bronchial, vascular smooth muscle only at high doses; negative chronotropic effect
CNS: Insomnia, dizziness, mental changes, hallucinations, depression, anxiety, headaches, nightmares, confusion, fatigue, weakness CV: Hypotension, bradycardia, HF, palpitations, dysrhythmias, cardiac arrest, AV block, pulmonary/peripheral edema, chest pain EENT: Blurred vision GI: Nausea …
Antidote / reversal: 1
🔗 Full card in the drug guideVasopressor, α/ β-agonist
Acute hypotension, shock
Causes increased contractility and heart rate by acting on β-receptors in heart; also acts on α-receptors, thereby causing vasoconstriction in blood vessels; B/P is elevated, coronary blood flow improves, and cardiac output increases
CNS: Headache, anxiety, dizziness, insomnia, restlessness, tremor, cerebral hemorrhage CV: Palpitations, tachycardia, hypertension, ectopic beats, angina GI: Nausea, vomiting GU: Decreased urine output INTEG: Necrosis, tissue sloughing with extravasation, gangrene RESP: Dyspnea SYST: Anaphylaxis
Vasopressor, nasal decongestant, mydriatic, Alpha-1 adrenergic agonist
Clinically important hypotension from vasodilation, especially under anesthesia (IV); nasal congestion (spray); pupil dilation for eye exams (ophthalmic); hemorrhoids (topical). The oral form is sold for congestion but FDA has proposed removing it as ineffective.
An alpha-1 agonist with minimal to no beta activity. It squeezes blood vessels; it does not directly drive the heart. Pressure rises because the vessels tighten, and the vagus answers that rise by SLOWING the heart.
CV: Reflex BRADYCARDIA, hypertension, reduced cardiac output, reduced blood flow to kidney and gut, arrhythmias. CNS: Headache, restlessness, tremor, insomnia. EENT: Rebound congestion after more than three days of spray;
Antidote / reversal: 1
🔗 Full card in the drug guideAntihypertensive, α1-Adrenergic blocker, peripheral
Hypertension, benign prostatic hypertrophy to decrease urine outflow obstruction
Blocks α-mediated vasoconstriction of adrenergic receptors, thereby inducing peripheral vasodilation
CNS: Dizziness, headache, drowsiness, anxiety, depression, vertigo, weakness, fatigue, syncope CV: Palpitations, orthostatic hypotension, tachycardia, edema, rebound hypertension EENT: Blurred vision, epistaxis, tinnitus, dry mouth, red sclera GI: Nausea, vomiting, diarrhea, constipation …
Selective β2-agonist; bronchodilator, Catecholamine
Bronchospasm Unlabeled: Premature labor
Relaxes bronchial smooth muscle by direct action on β2-adrenergic receptors through the accumulation of cAMP at β-adrenergic receptor sites; bronchodilation, diuresis, CNS, cardiac stimulation occur; relaxes uterine smooth muscle
CNS: Tremors, anxiety, insomnia, headache, dizziness, stimulation, restlessness CV: Palpitations, tachycardia, hypertension, dysrhythmias, cardiac arrest, QT prolongation GI: Nausea, vomiting META: Hypokalemia, hyperglycemia RESP: Paradoxical bronchospasm …
Antidysrhythmic, anticholinergic parasympatholytic, antimuscarinic, Belladonna alkaloid
Bradycardia <40-50 bpm, bradydysrhythmia, reversal of anticholinesterase agents, insecticide poisoning, blocking cardiac vagal reflexes, decreasing secretions before surgery, antispasmodic with GU, biliary surgery, bronchodilator …
Blocks acetylcholine at parasympathetic neuroeffector sites; increases cardiac output, heart rate by blocking vagal stimulation in heart; dries secretions by blocking vagus
CNS: Headache, dizziness, involuntary movement, confusion, flushing, drowsiness CV: Tachycardia, bradycardia EENT: Blurred vision, photophobia, dry eyes GI: Dry mouth, constipation RESP: Tachypnea, pulmonary edema GU: Retention, hesitancy, impotence INTEG: Flushing, decreased sweating
Antidote / reversal: 1
🔗 Full card in the drug guideUrinary tract stimulant, cholinergic, Synthetic choline ester
Urinary retention (postoperative, postpartum), neurogenic atony of bladder with retention Unlabeled: Ileus, GERD, anticholinergic syndrome
Stimulates muscarinic ACH receptors directly; mimics effects of parasympathetic nervous system stimulation; stimulates gastric motility, micturition; increases lower esophageal sphincter pressure
CNS: Dizziness, headache, malaise CV: Hypotension, bradycardia, reflex tachycardia, cardiac arrest, circulatory collapse EENT: Miosis, increased salivation, lacrimation, blurred vision GI: Nausea, bloody diarrhea, belching, vomiting, cramps, fecal incontinence GU: Urgency INTEG: Rash, urticaria …
Edrophonium (Tensilon) is an ultra-SHORT-acting cholinesterase inhibitor used diagnostically, in the 'Tensilon test,' to distinguish myasthenic crisis from cholinergic crisis. Strength IMPROVES = myasthenic crisis (too little ACh). Weakness WORSENS with SLUDGE symptoms = cholinergic crisis (too much ACh).
Edrophonium is the QUESTION, not the treatment: better means myasthenic, worse means cholinergic. Atropine at the bedside.
Anticholinergic, urinary antispasmodic, Synthetic tertiary amine
Antispasmodic for neurogenic bladder, overactive bladder in females (OTC)
Relaxes smooth muscles in urinary tract by inhibiting acetylcholine at postganglionic sites
CNS: Anxiety, restlessness, dizziness, somnolence, insomnia, nervousness, seizures, headache, drowsiness, confusion CV: Palpitations, sinus tachycardia, hypertension, peripheral edema, QT prolongation EENT: Blurred vision, dry eyes, increased intraocular tension, dry mouth, dry throat GI: Nausea …
Neuromuscular blocker (depolarizing, ultra short)
Facilitation of endotracheal intubation, skeletal muscle relaxation during orthopedic manipulations
Inhibits transmission of nerve impulses by binding with cholinergic receptor sites, thus antagonizing action of acetylcholine; causes release of histamine
CV: Bradycardia, tachycardia; increased, decreased B/P; sinus arrest, dysrhythmias, edema EENT: Increased secretions, intraocular pressure HEMA: Myoglobulinemia INTEG: Rash, flushing, pruritus, urticaria MS: Weakness, muscle pain, fasciculations, prolonged relaxation, myalgia …