01 Autonomics
- NE acts as NT (e.g. BP); E acts as hormone (e.g. stress induced)
- fight or flight Sympathetic mime: sympathomimetic
- QISS: alpha-1, alpha-2, beta-1, beta-2 receptors are coupled to Gq, Gi, Gs, Gs respectively
- Alpha scouts: alpha receptor agonists
- Single lit alpha candle: alpha-1 agonist
- 3 "dags": alpha-1 receptor coupled to Gq -> IP3-DAG cascade
- "Dag" with bone: IP3-DAG cascade-> increased intracellular calcium (smooth muscle cell in vasculature/sphincters)
- Alpha-1 scout pulling red leashes: alpha-1 activation increases peripheral arterial resistance (vasoconstriction at small arteries, arterioles, precapillary sphincters)
- Alpha-1 scout elevating MAP: alpha-1 activation increases mean arterial pressure (MAP)
- Alpha-1 scout pulling blue leashes: alpha-1 activation increases venous return (venoconstriction) (good for increase CO)
- Alpha-1 scout binoculars: alpha-1 activation at pupillary dilator muscle causes mydriasis (pupillary dilation)
- Alpha-1 scout pulling pants string: alpha-1 activation causes urethral sphincter and prostatic smooth muscle contraction
- Full bladder canteen: alpha-1 activation causes urinary retention
- Two lit alpha candles: alpha-2 agonist
- "No sympathy": alpha-2 agonists are sympatholytics (act centrally to decrease sympathetic tone)
- Packed up alpha-2 camp tent: alpha-2 receptor coupled to Gi -> decreased cAMP
- Alpha-2 scout packing up presynaptic wire: presynaptic alpha-2 receptors cause inhibition of neurotransmitter release
- Welcome INSIDE mat: insulin
- Rolled up welcome INSIDE mat: alpha-2 activation at pancreatic islet cells decreases insulin release
- Alpha-2 scout dousing roasting pig: alpha-2 activation inhibits lipolysis and release of fatty acids
- Alpha-2 scout emptying water from eyeball hat: activation of alpha-2 at ciliary body decreases aqueous humor production (glaucoma meds)
- Brim of eyeball hat: brimonidine is an alpha-2 agonist used to treat chronic open angle glaucoma (decreases aqueous humor production)
- βand cAMP: beta receptor agonists increase cyclic AMP (cAMP)
- Beta-1 horn: beta-1 agonist
- "I heart βand cAMP": beta-1 receptors are found on cardiac myocytes (including SA and AV nodes)
- "I heart βand cAMP": beta-1 activation causes increased cyclic AMP -> increased intracellular calcium
- Elevated heart clock: beta-1 activation increases heart rate (SA node)
- Buff contracted bicep: beta-1 activation increases cardiac contractility
- Heart hydrant: beta-1 activation results in increased cardiac output
- Open rain umbrella: beta-1 activation increases renin release (JGA cells), increase BP/volume
- Beta-2 tuba: beta-2 activity
- "ROL" call sheet: beta-2 agonists used for bronchodilation have -"rol" suffix (albuterol, formoterol, salmeterol)
- Beta-2 camper taking big breath: beta-2 activation leads to bronchoDILATION (increased cyclic AMP -> activates PKA)
- Beta-2 camper with dilated sleeves: beta-2 activation causes coronary and skeletal muscle vasoDILATION -> decreases systemic vascular resistance (SVR)
- Beta-2 camper roasting pig: beta-2 activation stimulates lipolysis and release of free fatty acids
- Beta-2 camper producing marshmallows from liver-shaped bag: beta-2 receptor activation at the liver promotes gluconeogenesis
- Beta-2 camper carrying s'mores INSIDE tent: beta-2 activation at pancreatic islet cells stimulates insulin release-> moves glucose into cells
- Banana peels: beta-2 activation can cause hypokalemia (due to increased insulin activity)
- Beta-2 camper filling eyeball balloon: beta-2 activation at ciliary body increases aqueous humor production (β antagonist for glaucoma)
- Sleeping beta-2 camp counselor: beta-2 agonists relax uterine smooth muscle
Drugs
- Flannel friends: phenylephrine (alpha-1 agonist)
- Flannel friend holding single alpha candle: phenylephrine is an alpha-1 agonist
- Flannel friend's nasal spray: phenylephrine treats nasal congestion (alpha-1 mediated local vasoconstriction reducing edema)
- Flannel friend's binoculars: phenylephrine causes mydriasis (activates alpha-1 at pupillary dilator muscle)
- map: Phenylephrine increases MAP (alpha-1 increase in SVR)
- 1st line: Phenylephrine increases systolic pressure (alpha-1 arteriolar constriction)
- 2nd line: Phenylephrine increases diastolic pressure (alpha-1 venous constriction)
- Flannel friend's low dangling heart watch: phenylephrine causes reflex bradycardia (response to alpha-1 increase in MAP)
- Pts with reduced autonomic function (diabetic neuropathy) can't have baroreceptor reflex = very high pressure in response
- North compass: NORepinephrine (alpha>beta1 agonist) - a1, a2
- North scout blowing beta-1 bugle: norepinephrine has some beta-1 activity (primarily an ALPHA AGONIST)
- Norepinephrine increases MAP (alpha-1 increase in SVR)
- Norepinephrine increases systolic pressure (alpha-1 arteriolar constriction)
- Norepinephrine increases diastolic pressure (alpha-1 venous constriction)
- North scout's low dangling heart watch: norepinephrine causes reflex bradycardia (response to alpha-1 increase in MAP)
- North scout's buff contracted bicep: norepinephrine increases cardiac contractility (activates beta-1), although bradycarida
- Norepinephrine increases pulse pressure (b2 activity)
- Norepinephrine increases PULSE PRESSURE, difference between systolic and diastolic (beta-1 increase in contractility)
- Septic tank: septic shock (phenylephrine and norepinephrine increase SVR and venous return to treat distributive/hypovolemic shock)
- "Just DO BUgling": DOBUtamine (beta-1>beta-2 agonist)
- Beta-1 bugle: dobutamine is primarily a beta-1 agonist
- "Just DO BUgling" friend's beta-2 tuba: dobutamine has some beta-2 activity (primarily a BETA-1 AGONIST)
- "Just DO BUgling" winding up heart flashlight: dobutamine increases heart rate, contractility, and cardiac output (beta-1 effects)
- "Just DO BUgling" friend's dilated sleeves: dobutamine causes vasodilation -> decreases SVR (effects mild due to minimal beta-2 activity)
- Dobutamine increases PULSE PRESSURE, difference between systolic and diastolic (beta-1 increase in contractility)
- Dobutamine increases systolic pressure (beta-1 increase in CO)
- Dobutamine can decrease diastolic pressure (beta-2 arteriolar dilation)
- Batteries fallen out of heart flashlight: dobutamine can be used in cardiogenic shock
- Dead heart batteries: cardiogenic shock (dobutamine increases contractility and CO to treat cardiogenic shock)
- Dobutamine used for stress test (make heart work more without exercise )
- "Iso-pro-tunnel" between beta-1 and beta-2 camps: isoproterenol (beta-1=beta-2 agonist)
- Tunnel camper's elevated heart watch and contracted bicep: isoproterenol increases heart rate and contractility (beta-1 effects)
- Tunnel camper's dilated sleeves: isoproterenol causes vasodilation -> decreases SVR (beta-2 effects)
- Tunnel camper's dangling DIAmond earrings: isoproterenol decreases DIAstolic pressure (beta-2 vasodilation and decreased SVR)
- Isoproterenol increases PULSE PRESSURE, difference between systolic and diastolic (beta-1 increase in contractility)
- Isoproterenol decreases MAP (beta-2 decrease in SVR)
- Isoproterenol decreases diastolic pressure (beta-2 arteriolar dilation)
- dangling DIAmond earrings: decreased DIAstolic pressure (beta-2 vasodilation and decreased SVR)
- "Do not disTURB": TERButaline prevents premature labor (beta-2 relaxes the uterus)
- "I DREAM of band camp": ritoDRINE prevents premature labor (beta-2 relaxes the uterus)
- EPIC kiss between alpha and beta camps: EPInephrine (beta>alpha agonist)
- Low side of EPIC raft: at LOW doses, epinephrine's BETA AGONIST effects predominate
- EPIC DIAmond falling off LOW side of raft: at LOW doses, epinephrine decreases DIAstolic pressure (beta-2 vasodilation and decreased SVR)
- EPIC elevated heart watch and buff contracted bicep: epinephrine increased heart rate and cardiac contractility (beta-1 effects)
- High side of epic raft: at HIGH doses, epinephrine's ALPHA AGONIST effects predominate
- Epinephrine increases MAP (alpha-1 increase in SVR)
- Epinephrine increases systolic pressure (alpha-1 arteriolar constriction)
- Epinephrine can decrease diastolic pressure (beta-2 arteriolar dilation)
- Epinephrine increases PULSE PRESSURE, difference between systolic and diastolic (beta-1 increase in contractility)
- Beta-2 tuba girl's EPIC inhaler: epinephrine causes bronchodilation (beta-2 effects)
- "Anna + Phil": anaphylactic shock (epinephrine increases SVR and bronchodilates to treat anaphylactic shock) a1 for vasoconstriction, b1 for blood flow to tissues, b2 for bronchodilation
Indirect Sympathomimetics
- Indirect view of sympathetic mime: Indirect sympathomimetics
- Catfish: catecholamines (epinephrine, norepinephrine, dopamine)
- Dock: adrenergic nerve terminal (site of action of indirect sympathomimetics)
- Retrieving tire: tyrosine (the amino acid precursor to catecholamines) is transported to nerve terminal
- L-shaped rope handle: tyrosine is converted to L-DOPA
- Dope rope: L-dopa is converted to dopamine
- Sea vessel: vesicle containing neurotransmitters in the presynaptic neuron
- "V" mat: vesicular monoamine transporter (VMAT)
- Catfish transported to sea vessel: catecholamines are transported by VMAT into presynaptic vesicle
- North-facing compass on sea vessel: dopamine is converted to norepinephrine in the vesicle
- Hauled in catfish NET: norepinephrine transporter (NET) transports norepinephrine (and dopamine) back into the presynaptic neuron
- NET DAT catfish: dopamine transporter (DAT) transports dopamine back to the presynaptic neuron
- "My tire!": metyrosine (a tyrosine analog) prevents conversion of tyrosine to L-DOPA
- Hot cocoa: cocaine
- Hot cocoa scout ignoring catfish net: cocaine inhibits the norepinephrine transporter (NET and dopamine transporter (DAT)
- Stimulated hot cocoa scout: cocaine can cause agitation, pupillary dilation, hypertension and tachycardia
- Bloody nose: cocaine can cause nasal mucosal atrophy or septal perforation to due vasoconstriction
- Constricted red crown: cocaine can cause coronary vasospasm and myocardial ischemia
- Constricted net on anvil: cocaine induced coronary vasospasm can cause angina
- High pressure blocked bugle: beta-blockers can cause severe hypertension in cocaine intoxication (unopposed alpha-1 stimulation)
- Atom next to empty net: atomoxetine (NET inhibitor)
- Distracting HD TV: atomoxetine treats attention deficit and hyperactivity disorder (ADHD)
- Serpent blocking "V" mat: reserpine inhibits VMAT, depleting neurotransmitter stores
- A FRIEND of MINE releasing catfish: amphetamines displace catecholamines (norepinephrine, dopamine) into synapse; good for attention to tasks
- Distracted by HDTV while catfish are released: amphetamines can be used to treat ADHD
- Friend Date on HDTV: methylphenidate (an amphetamine derivative) treats ADHD
- Untouched dinner: stimulants (e.g. amphetamines, methylphenidate, modafinil) suppress appetite
- Sleeping scout hitting "sleep mode": modafinil is a stimulant used to treat narcolepsy
- Untouched dinner: stimulants (e.g. amphetamines, methylphenidate, modafinil) suppress appetite
- Untouched dinner: stimulants (e.g. amphetamines, methylphenidate, modafinil) suppress appetite
- Single rope swing: D1 receptor
- Double rope swing: D2 receptor
- Dope rope SwIng: D1 and D2 are coupled to Gs and Gi, respectively
- Low kidney tied to single rope: low doses of dopamine act on D1 receptors to increases renal blood flow
- Beta bugler in the middle: medium doses of dopamine activate beta-1 receptors (cardiac activation)
- Alpha scout up high: high doses of dopamine activate alpha-1 receptors (pressor effects)
- Brain helmet on double rope swing: D2 receptors are found in the CNS
Alpha drugs
- Claw weapon: clonidine (alpha-2 agonist)
- 2 lit alpha candles: alpha-2 receptor agonist
- Brain-shaped platform: alpha-2 agonists given systemically affect the CNS (inhibition of sympathetic tone -> reduced blood pressure)
- Crossed out "sympathy": alpha-2 agonists (e.g. clonidine) are sympatholytics
- High pressure pipes: clonidine treats hypertension (reduced sympathetic tone)
- Urgent pressure: clonidine is useful in the treatment of hypertensive urgency
- Distracting mirror: clonidine can be used to treat ADHD
- Tourette's marionette: alpha-2 agonists (e.g. clonidine) are useful in the management Tourette's syndrome
- Alpha shaped rope: a-methyldopa (alpha-2 agonist)
- 2 lit alpha candles: alpha-2 receptor agonist
- Brain-shaped platform: alpha-2 agonists given systemically affect the CNS (inhibition of sympathetic tone -> reduced blood pressure)
- High pressure pipes: a-methyldopa treats hypertension (reduced sympathetic tone)
- Pregnant: a-methyldopa is primarily used to treat gestational hypertension
- Lupus wolf: a-methyldopa can cause a lupus-like syndrome
- To X-tine: tizanidine (alpha-2 agonist)
- 2 lit alpha candles: alpha-2 receptor agonist
- Relaxing chair: tizanidine (alpha-2 agonist) is a muscle relaxant
- Phantom: phentolamine (reversible alpha-1 and alpha-2 receptor antagonist)
- Extinguished single and double alpha candles: alpha-1 and alpha-2 antagonist
- Dilated sleeves: phentolamine causes vasodilation (alpha-1 antagonist effect)
- Hot cocoa: alpha antagonists (e.g. phentolamine) can be used to treat cocaine toxicity (avoid beta blockers due to unopposed alpha vasoconstriction)
- Mousetrap protecting wine and cheese: MAO inhibitors can prevent the metabolism of tyramine -> hypertensive crisis (treat with alpha blockers e.g. phentolamine)
- Irreversible phoenix tattoo: phenoxybenzamine (irreversible alpha-1 and alpha-2 receptor antagonist)
- Hot cocoa: alpha antagonists (e.g. phentolamine) can be used to treat cocaine toxicity (avoid beta blockers due to unopposed alpha vasoconstriction)
- Wine and aged cheese contain the sympathomimetic tyramine (metabolized by monoamine oxidase-A (MAO-A))
- Mousetrap protecting wine and cheese: MAO inhibitors can prevent the metabolism of tyramine -> hypertensive crisis (treat with alpha blockers e.g. phentolamine)
- Frozen colorful dessert: pheochromocytoma (catecholamine secreting tumor of the adrenal medulla)
- Brain freeze: catecholamine excess in pheochromocytoma causes headaches, hypertension, palpitations, sweating (use alpha blockers (e.g. phentolamine) preoperatively to control blood pressure)
- Tiltable: alpha receptor antagonists can cause orthostatic hypotension (alpha-1 antagonist effect)
- Heart shaped reflex hammer: alpha blocker induced hypotension causes reflex tachycardia
- Dilated sleeves: alpha-1 antagonists "-osins" cause vasodilation
- Opera singer: "-osin" suffix of alpha-1 selective antagonists (e.g. prazosin, terazosin, doxazosin, tamsulosin)
- Extinguished single alpha candle: alpha-1 receptor antagonist
- Banister compressing prostate: alpha-1 antagonists (e.g. terazosin) treat symptoms of BPH (relax smooth muscle in the urethra and prostate)
- Praying opera singer: prazosin (alpha-1 antagonist)
- PTSD dog tags: prazosin can be used to treat PTSD
- 2 extinguished alpha candles: alpha-2 receptor antagonist
- Mirth and Misery: mirtazapine (atypical antidepressant with antagonist effects at alpha-2 and other a receptors)
- Happy face: mirtazapine enhances serotonin release and treats depression
Beta drugs
- Muted beta-1 bugle and beta-2 tuba: beta adrenergic receptor antagonists (beta blockers)
- Brahm's LOLlaby : "-lol" suffix of beta blockers (e.g. propranolol, metoprolol, atenolol)
- Weak arm: beta blockers decrease cardiac contractility (by antagonizing beta-1 receptors in the myocardium) (ionotropy)
- Music notes: beta blockers suppress activity at the SA and AV nodes (by antagonizing beta-1 receptors) (chronotropy)
- Low dangling heart watch: inhibition of SA node activity can cause bradycardia
- A-BEAM spotlight on beta-1 bugler: beta-1 selective antagonists (e.g. Atenolol, Betaxolol, Esmolol, Acebutolol, Metoprolol) A through M
- Nebivolol
- A-BEAM spotlight on heart: the beta-1 selective antagonists primarily suppress adrenergic stimulation of the heart (cardioselective)
- Broken heart strings under A-BEAM spotlight: cardioselective beta blockers are useful in the acute treatment of MI and other acute coronary syndromes (ACS)
- Failing heart balloon in the A-BEAM spotlight: cardioselective beta blockers are useful in the management of chronic heart failure
- Extinguished alpha candle on CARVED candleholder: carvedilol is a nonselective beta blocker and alpha-1 blocker
- CARVED candleholder next to failing heart: carvedilol (in addition to cardioselective beta blockers) is useful in the management of chronic heart failure.
- Angina anvil: beta blockers are useful in the management of chronic stable angina. Slow Hr, increase diastolic time, decrease contractility
- Discarded oxygen line: beta blockers treat angina by reducing myocardial oxygen demand (decreased heart rate and contractility)
- Angel: beta blockers (e.g. carvedilol and cardioselective agents) reduce mortality in chronic heart failure and post-MI
- Remodeling: beta blockers reduce cardiac remodeling by protecting the heart from excess circulating catecholamines
- Big obstructed heart bag: beta blockers are useful in the management of hypertrophic obstructive cardiomyopathy. Slow down heart, allow more filling
- Rhythm inducing record: beta blockers have antiarrhythmic properties
- High pressure pipes: beta blockers are useful in the treatment of hypertension (especially in patients with heart failure or post-MI). Decrease CO
- Closed rain umbrella with blocked beta-1 bugle: beta blockers inhibit production of renin (antagonize beta-1 receptors at the JGA)
- Alpha and beta organ stops with extinguished alpha candle: labetalol ("alpha-beta-lol") is a nonselective beta blocker and alpha-1 blocker
- Dilated sleeves: labetalol antagonizes alpha-1 receptors causing vasodilation
- Pregnant organist: labetalol treats hypertension in pregnancy
- Emergency stop: labetalol is useful in hypertensive emergency (due to combined alpha and beta blocking effects)
- Dissected organ pipe with ivy: IV beta blockers (e.g. labetalol, propranolol, esmolol) are useful in the acute management of aortic dissection
- Ivy: IV beta blockers (e.g. labetalol, esmolol) treat hypertensive emergency
- Dissected organ pipe with ivy: IV beta blockers (e.g. labetalol, propranolol, esmolol) are useful in the acute management of aortic dissection
- Pounding head bell: beta blockers can be used for migraine prophylaxis
- Big stormy bowtie: beta blockers are useful for the symptomatic treatment of thyroid storm (blocks increased sympathetic activity) (treat with propanolol, propylthiouracil, prednisolone)
- Shaking baton: beta blockers treat essential tremor
- Draining the muted beta-2 tuba: topical nonselective beta blockers (e.g. timolol) treat glaucoma (antagonize beta-2 receptors on the ciliary epithelium -> decreased aqueous humor production)
- Droopy trombone: beta blockers can cause impotence in men
- Remain un-blocked: beta blockers can cause or exacerbate heart block (due to excessive suppression of AV node conduction)
- Wheezing beta-2 tuba player: nonselective beta blockers can exacerbate asthma and COPD (antagonize beta-2 mediated bronchodilation). Block b1 and b2 causing vasoconstriction
- Agonizing plastic bugle: acebutolol (a selective beta-1 antagonist with partial agonist activity)
- Agonizing pin: pindolol (a nonselective beta blocker with partial agonist activity)
- Popping failing heart: beta blockers with partial agonist activity (e.g. pindolol, acebutolol) should be avoided in patients with heart failure or a history of MI
- Glucagon packets: glucagon treats beta blocker toxicity (stimulates heart via glucagon receptors)
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