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Cholinergic Drugs by Disease

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					                                                             Muscarinic Drugs
Name                   Class    Sub-Class            Use                                                                                   Additional Information
Acetylcholine chloride M Ag     Choline Ester        Induces miosis during surgery (Eye Drop - Salt)                                       M = N, quat

Bethanechol chloride M Ag       Choline Ester        Atonic bladder, post-op urinary retention and reflux esophagitis (IV - Salt)          M > N; quat

Carbachol Chloride    M Ag      Choline Ester        Induces miosis during surgery, ↓ IOP (Eye Drop - Salt)                                M = N; quat

Methacholine chloride M Ag      Choline Ester        Diagnosis of bronchial hyperactivity (inhale salt)                                    M > N; S form most potent, quat

Arecholine            M Ag      Naturally Occuring   Ophthalmic purposes                                                                   M > N; betel nuts; quat
Pilocarpine           M Ag      Naturally Occuring   Ophthalmic use; ↓ IOP, xeropthalmia in cancer pts, SS                                 M >> N, leaves; tertiary
Muscarine             M Ag      Naturally Occuring   Mushroom poisoning                                                                    M>N
Cevimiline            M Ag      Synthetic            Sjogren's syndrome                                                                    M > N, CYP2D6/3A4; tertiary
AF267B                M Ag      Synthetic            Alzheimer's Disease (AD) (under clinical trial)
Ambenonium            AChEI     Reversible           MG                                                                                    CYP
Edrophonium           AChEI     Reversible           Diagnosis of MG
Tacrine               AChEI     Reversible           AD                                                                                    CYP1A2; DI theophyline;
Donepezil             AChEI     Reversible           AD (used for severe)                                                                  hepatoxicity mixed elimination
                                                                                                                                           CYP2D6/3A4;
Galantamine           AChEI     Reversible           AD                                                                                    CYP2D6/3A4; renal only
Demecarium            AChEI     Semi-Reversible      Glaucoma, Accommodative estropia                                                      Esterase
Neostigmine           AChEI     Semi-Reversible      MG, post-op distention, paralytic illeus, urinary rentention, anti-dote for non-      Esterase, quat
                                                     depolarizing NMJBs
Pyridostigmine        AChEI     Semi-Reversible      MG, Military use against toxin induced toxicities                                     Esterase, quat
Physostigmine         AChEI     Semi-Reversible      Glaucoma, miotic agent, reverses cholinergic antagonist-induced toxicity              Esterase, tertiary, most sus
                                                                                                                                           hydrolysis
Rivastigmine          AChEI     Semi-Reversible      AD                                                                                    Esterase, tertiary
Echothiophate         AChEI     Irreversible         Glaucoma, Accommodative estropia
Isoflurophate         AChEI     Irreversible         Glaucoma
Organophosphates      AChEI     Irreversible         Insecticide and nerve gas                                                             2 PAM antidote to OP poisening

Malathion             AChEI     Irreversible         Insecticide and lice treatment                                                         S is bioactivated in insects
Echothiophate         AChEI     Irreversible         Glaucoma, Accommodative estropia
Atropine              M Antag   Tropane Alkaloid     OP and musc poisening, PD, EtOH w/d Sx, ↓ laughing and crying assoc with brain lesions, induces mydriasis and
                                                     cylcoplegia, ↓ resp secretions (b/f anesthesia), rhinorrhea, bronchitis, COPD, caridac ER, motion sickness, peptic ulcers,
Scopolamine           M Antag   Tropane Alkaloid     Postencephalitic PD, anesthetic, induces mydriasis, iridocylitis, motion sickness      Esterase

Tiotropium            M Antag   Tropane Alkaloid     Rhinorrhea, COPD, asthma                                                              Esterase
Ipratropium           M Antag   Tropane Alkaloid     Rhinorrhea, COPD, asthma                                                              Esterase
Homatropine           M Antag   Tropane Alkaloid     Induces mydriasis and cycloplegia symptomatic relief of cough                         Esterase
Pirenzepine           M Antag   M1                   Peptic ulcers, GI spasm
Telenzepine           M Antag   M1                   Peptic ulcers, GI spasm                                                               Tele > Pir M2 specificity
Methoctramine         M Antag   M2                   CVS failure (blocks parasympathetic function)
Darifenacin           M Antag   M3                   OAB                                                                                   CYP [O], Dar > Soli M3 specificity
Solifenacin       M Antag              M3                  OAB                                                                CYP [O]
Trihexyphenidyl   M Antag              Multiple Subtypes   PD, admin w/ other CNS drugs to control extrapyramidal disorders
Tolterodine       M Antag              Multiple Subtypes   OAB                                                                CYP [O]
Fesoterodine      M Antag              Multiple Subtypes   OAB
Benztropine       M Antag, Anti-Hist                       PD adjunct, DI tumor. CI: MAOI, anti-hist, anti-depres

Oxybutynin        M Antag              Multiple Subtypes   OAB, Peds w/ spina bifida, hyperhydrosis, anti-spasmodic
Trospium          M Antag              Multiple Subtypes   OAB                                                                Ester hydrolysis, OCTs
Cyclopentolate    M Antag              Multiple Subtypes   Induces mydriasis and paralysis of accommodation (cycloplegia)
Tropicamide       M Antag              Multiple Subtypes   Induces mydriasis and paralysis of accommodation (cycloplegia)
Propantheline     M Antag              Multiple Subtypes   Peptic ulcer, hyperhydrosis
                                                             Nicotinic Drugs and Others
Name                 Class             Sub-Class               Use                                                                          Additional Information
MCN-A-343            N Ag              Ganglionic              Determines muscarinic receptor subtypes
1,1- DPI             N Ag              Ganglionic              Determines muscarinic receptor subtypes
Tetramethylammoniu   N Ag              Ganglionic                                                                                           Experimental drug
m (TMA)
Epibatidine        N Ag                CNS                     Potent analgesic, neuropathic pain                                           Isolated from the skin of a frog
ABT-418            N Ag                CNS                     Exhibits some cognition enhancing properties, analgesic, neuropathic pain
SIB-1508Y          N Ag                CNS                     Potential for PD Tx
Varenicline        N Ag                CNS                     Smoking cessation                                                            Elim OCTS
Nicotine           N Ag (partial)      CNS                     Low dose gang stim (stimulation), high dose gang blocker (paralysis)         Partial antag
Mecamylamine       Nicotinic Antag     Ganglionic Blocker      Reduce nicotine cravings, severe HTN                                         Crosses BBB
                   (CNS)
Tetraethylammonium Nicotinic Antag     Ganglionic Blocker      Antihypertensive (no longer used)
(TEA)
Hexamethonium        Nicotinic Antag   Ganglionic Blocker      HTN                                                                          Depolarizes ganglionic N's, acts on
                                                                                                                                            ion channel
Trimethaphan         Nicotinic Antag   Ganglionic Blocker    Aortic aneurysm, induces hypotension during surgery                            Acts on receptor
D-Tubocurarine       Nicotinic Antag   Non-Depolarizing NMBA Hypertensive emergencies

Atracurium           Nicotinic Antag   Non-Depolarizing NMBA Hoffman elimination                                                            Benzylsioquinolone

Doxacurium           Nicotinic Antag   Non-Depolarizing NMBA Metabolism doesn't determine duration of action                                Benzylsioquinolone

Mivacurium           Nicotinic Antag   Non-Depolarizing NMBA Eliminated renally                                                             Benzylsioquinolone

Pancuronium          Nicotinic Antag   Non-Depolarizing NMBA Incr. HR, CO, BP                                                               Ammoniosteriods

Pipecuronium         Nicotinic Antag   Non-Depolarizing NMBA                                                                                Ammoniosteriods
Rocuronium           Nicotinic Antag   Non-Depolarizing NMBA                                                                                Ammoniosteriods

Rapacuronium         Nicotinic Antag   Non-Depolarizing NMBA                                                                                Ammoniosteriods

Vercuronium          Nicotinic Antag   Non-Depolarizing NMBA                                                                                Ammoniosteriods

Decamethonium        Nicotinic Antag   Depolarizing NMBA                                                                                    Flexible
Succinylcholine      Nicotinic Antag   Depolarizing NMBA       IV muscle relaxant, anesthetic adjunct                                       Flexible, soft drug
Botulinium Toxin     Spasmolytic                               Prevents the release of Ach in the NMJ
Procyclidine                                                   PD
Spider Venom                                                   Increases the release of Ach
Theophyline                                                    Incr. cAMP, incr. brochodialation
Memantidine          NMDA Antag                                AD                                                                           pH dependant and elim OCTS
Gallamine                                                      Co-admin with succinylcholine to prevent myalgia and intragastric pressure
Alpha Bungarotoxin                                             Blocks channel AND receptor
Hemicholinium           Blocks choline transport (presynap)
Vesamicol               Inhibits storage
Acetylcholine Mustard   Inhibits ChaT
      Alzheimer              PD-tremor           Dystonia           Tremor             Glaucoma              Asthma               OAB              Myasthenia          Sjogren’s
AChEIs                    Anticholinergics   Anticholinergics   Yoga              Cholinergic Ags      Anticholinergics    Anticholinergics   AChEIs               M Agonists
Rivastigmine              Benztropine        Diphenhydramine    DID- stop drug    Carbachol            Methacholine (D)    Oxybutynin         Physostigmine        Pilocarpine
Donepezil                 Diphenhydramine    Procyclidine       Surgery           Arecholine           Atropine            Tolterodine        Neostigmine          Cevimiline
Gallantamine              Procyclidine       Trihexyphenidyl    Thalamotomy       Pilocarpine          Ipratropium         Flavoxate          Ambenonium
Tacrine                   Trihexyphenidyl    Botulinium toxin   Psyc counseling                        Tiotropium          Darifenacin (M3)   Edrophoniumn(D)      NSAID
                                                                                  AChEIs                                   Solifenacin (M3)                        Hydroxychloroquine
NMDA Antagonist                              GABAnergic                           Physostigmine        Non-specific Symp                      Immunosuppressants   Immunosuppressants
Memantine                                    Diazepam                             Demacarium           Isoproterenol       Duloxetine         Azathioprine         Artificial tears
                                             Baclofen                             Echothiophate        Epinephrine         Trospium           Cyclosporine         Saliva substitute
Vitamin B1                                                                        Isoflurophate        Ephedrine           Estrogen           Cyclophosphamide
Vitamin B3                                   Anticonvulsants                                                               Interstim
Vitamin B12                                  Carbamazepine                        Alpha-2 agonist      SA B2 Agonist                          Plasmapheresis
                                                                                  Aproclonidine        Terbutaline                            IVIG
Anti-Ox/Apoptotic                            Dopaminergic                         Brimonidine          Albuterol                              Epinephrine
Melatonin                                    Bromocriptine                                                                                    Thymectomy
Ramelteon                                    Levodopa                             Non-specific Symp    LA B2 Agonist                          Corticosteroids
Coenzyme Q10                                 Reserpine                            Epinephrine          Salmeterol
Selegiline                                   Tetrabenazine                        Dipiverfin           Formeterol
                                             Surgery                              Phenyleprine
Recent Therapy                                                                                         PDE Inhibitor
1. Secretase inhibitors                                                           Beta Blockers        Theophylline
2. Immunotherapy                                                                  Betaxolol
3. Stem cells                                                                     Levobunolol          Rhinitis
4. Xaliproden                                                                                          Ipratropium
5. Anti-diabetic                                                                  Prostaglandins
6. Nicotinic agonist                                                              Latanoprost          Decongestant
7. AF267B                                                                         Bimatoprost          Ipratropium
Estrogen                                                                          Travoprost
Risk reducers                                                                     Unoprostone          COPD
                                                                                                       Atropine
Alternative                                                                       Carbonic Anhydrase   Ipratropium
(i) Selenium                                                                      Inhibitor
(ii) Essential Fas                                                                Dorzolamidee
(iii) Choline/Lecithin                                                            Brinzolamide
(iv) Magnesium                                                                    Acetazolamide
(v) Noni
(vi) Ginkgo                                                                       Marijuana
(vii) Huperazie-A
(viii) Coral calcium
(ix) Bacopa
(X) Centella
(xi) Care givers
                                                                                                                    Non-Selective Adrenergic Drugs
                                         Drug                        Mechanism                                PK                      Indications         Contraindications                 ADRs                           Interactions
                                   NE                Acts primarily on alphas to produce              IV and SQ only,     Acute hypotension,          hypotension secondary to   CNS stimulation, nausea,      Other sympathomimetics, MAOIs
                                   (Levophed)        vasoconstriction, incr systemic BP and           rapid onset and doa cardiogenic shock, septic   hypovolemia, pts under     diaphoresis, pallor, resp
                                                     coronary blood flow. Also acts on beta-1s        (1-2 min).          shock                       anesthesia, PMH of         weakness, myocardial
                                                     (less) which at low doses causes incr            Metabolized by                                  hyperthyroidism or HTN     ischemia, metabolic acidosis,
                                                     cardiac effects, and at high doses               MAO and COMT.                                                              cardiac arrhythmias
                                                     vasoconstriction, incr PR, incr BP. Also         Does not cross BBB.
                                                     glycogenolysis, inhibition of insulin release,
                                                     and lipolysis.
Nonselective Alpha/Beta Agonists




                                   Epinephrine       Potent Alpha and beta agonist.                   Poor oral BA,         Cardiac arrest, Acute     Same as NE                 Same as NE                   Same as NE
                                                     Stimulation of alpha 1s leads to arteriole       administered by IV, brochospasm, anaphylaxis,
                                                     vc. Stimulation of alpha 2s inhibits NE          IM, SQ, inhalation, glaucoma, homeostasis
                                                     release and can lead to arteriole vc.            or topically to the
                                                     Stimulation of beta 2s leads to arteriole vd.    eye. Crosses the
                                                                                                      placenta, but not the
                                                                                                      BBB

                                   Delivering        Hydrolysis to Epi results in decr production                             Open angled glaucoma
                                   (Propine)         and incr outflow of aq humor (decr IOP)


                                   Pseudoephedrine Acts directly on both alphas and to a lesser       Decongestion                                    Peds < 6 yoa               CNS stimulation, seizures,   Other sympathomimetics, MAOIs
                                   (Sudafed)       degree betas. Vc decr swollen nasal                occurs w/in 30 min                                                         HTN, MI, arrhythmias
                                                   mucosa, reduces hyperemia, relax                   of oral admin, doa 4-
                                                   bronchial smooth muscle                            6 hrs
                                                                                                          Alpha Adrenergic Drugs
                            Drug                         Mechanism                           PK                    Indications                  Contraindications                    ADRs                             Interactions
                      Phenylephrin      Constricts nasal mucosa                     Orally, intranasal,   Sinus and nasal decongestion; HTN, tachycardia, narrow         Pallor, paresthesia, HA,       MAOIs
                      (Neo-                                                         opthalmically, and    pupilarly dilation, post-surgical angle glaucoma               anxiety, rare arrhythmia
                      Synepherine)                                                  parenterally          hypotension, open angle
                                                                                                          glaucoma
    Alpha1 Agonists




                      Midodrine         Metabolized to active metabolite                                  Orthostatic hypotension (after
                      (ProAmatine)      desglymidodrine                                                   other nondrug therapies have
                                                                                                          failed)

                      Naphazoline       Vc of arterioles in conjunctiva and nasal
                      (Clear Eyes)      mucosa

                      Methyldopa                                                    Crosses BBB           HTN in pregnant women                                                                         B blockers, phenothiazine,
                      (Aldomet)                                                                                                                                                                         chlorpromazine, MAOIs,
                                                                                                                                                                                                        sympathomimemtics. Li+, Tolbutamind
                                                                                                                                                                                                        haloperidol, anethicetics, and levodopa
                                                                                                                                                                                                        toxicity

                      Clonodine                                                     Given epidural        HTN, nicotine w/d                 Preg risk C, close monitoring Abrupt d/c leads to rebound   MAOIs, anti-psycs and nitorprusside
                      (Catapres)                                                                                                            in diabetic pts               HTN, prevented by slowly      produce additive hypotension, B
                                                                                                                                                                          tapering off                  blockers, incr levels of cyclosporine, decr
                                                                                                                                                                                                        effect of levodopa



                      Dexmedetomidin Mainly selective for alpha 2 but at high                             Sedative and analgesic,           Use outside of ICU, Preg risk Hypo and HTN, nausea          MAOIs,
    Alpha2 Agonists




                      e (Precedex)   doses alpha 1s too                                                   (doesn't suppress respiratory     C
                                                                                                          center)

                      Brimonidine                                                                         Decr aq humor production,         Peds < 2 yoa                 Somnolence, HTN,               AntiHTNs, cardiac glycosides, MAOIs,
                      (Alphagan)                                                                          lowers IOP                                                     xerostomia                     Pilocarpine, tricyclic antidepressants


                      Apraclonidine                                                 Ophthalmic drops      Decr IOP post surgically                                       Hyperemia, puritis, ocular
                      (Iopidine)                                                                                                                                         discomfort, abnormal or
                                                                                                                                                                         blurry vision

                      Tizanidine        Acts centrally                                                    Skeletal muscle relaxant          hepatic impairment, preg risk Somnolence, hypotension,      Fluoxamine, Competes w/ CYP1A2 to
                      (Zanaflex)                                                                          centrally                         C                             xerostomia, weakness, incr    incr conc of Tizanidine
                                                                                                                                                                          liver enzymes, bradycardia,
                                                                                                                                                                          dizziness



                      Phentolamine      Blocks Alpha 1 for vd, blocks alpha 2 for                         HTN in pheochromcytoma                                                                        PDE inhibitors (Viagra) may lead to
Nonselective Alpha




                      (Regitine)        incr NE levels                                                    (and diagnosis), dermal                                                                       symptomatic hypotension
   Antagonists




                                                                                                          necrosis

                      Phenoxy-                                                      20-30% BA. Slow       Symptomatic Tx of
                      benzamine                                                     onset                 pheochromocytoma, HTN
                      (Dibenzyline)                                                                       crisis, frostbite

                      Alfuzosin         Competitively inhibits Alpha 1s which                             HTN alone or w/ ACE inhibitor                                  Orthostatic hypotension,       PDE inhibitors
                      (UroXatral)       results in vd and decr in PR and BP                               or combined w/ B blockers, Ca                                  dizziness, fatigue, dyspnea
                                                                                                          channel blockers, diuretics; Tx
                                                                                                          of urinary outflow in BPH
    st
                                    Competitively inhibits Alpha 1s which                      HTN alone or w/ ACE inhibitor     Orthostatic hypotension,      PDE inhibitors
                                    results in vd and decr in PR and BP                        or combined w/ B blockers, Ca     dizziness, fatigue, dyspnea
                      Doxazosin                                             Duration: 24 hrs   channel blockers, diuretics; Tx
                      (Cardura)                                                                of urinary outflow in BPH
  Alpha1 Antagonist




                      Prazosin                                              Duration: 24 hrs
                      (Minipress)
                      Tetrazosin
                      (Hytrin)
                      Tamsulosin                                            Duration: 14 hrs
                      (Flowmax)

                      Yohimbe                                                                  No clinical use, ingredient in
Antagonists




                      (Aphrodyne)                                                              herbal meds, marketed for Tx
  Alpha2




                                                                                               of impotence
                                                                                                              Beta Adrenergic Drugs
                              Drug                Mechanism                      PK                                 Indications                                          Contraindications                        ADRs               Interactions
                          Dobutamine direct acting sympathomimetic         IV infusion     Incr CO, tx of cardiac decompensation, cardiac arrest MI,      Preg risk C, idiopathic hypertrophic subarotic   Arrhythmias,           MAOIs,
  Beta1 Agonists



                          (Dobutrex)  (minor B2 and A1 stimulation).                       heart failure, mgmt of cardiogenic shock                       stenosis, pts with low CO secondary to           tachycardia (incr 5-   nonselective B
                                      Incr stroke vol w/ modest                                                                                           hypovolemia                                      15 bpm), angina,       blockers,
                                      chronotropic effects. Dose dep                                                                                                                                       palpitations,          guanethidine,
                                      ionotropic effects. Decr afterload                                                                                                                                   hypokalemia            methyldopa,
                                      and preload. Only systolic BP                                                                                                                                                               reserpine, and
                                      incr                                                                                                                                                                                        TCAs
                          Albuterol   SABA bronchodialator,                Onset: 7 min;   Acute bronchospasm assoc. w/ asthma, COPD, and                 Soybean and peanuts, preg risk C
                          (Proventil, moderate selectivity                 Duration: 2-6   exercise-induced bronchospasm
                          Ventolin)                                        hrs


                          Levalbuterol SABA bronchodialator,               Onset: 4-5 min; Mgmt and prevention of acute bronchospasms, Tx of
                          (Xopenex)    moderate selectivity                Duration: 3-6 hyperkalemia
                                                                                                                                                                                                                               Corticosteriods
                                                                           hrs
                                                                                                                                                                                                                               and Non-K+
                                                                                                                                                                                                                               sparing diuretics
                                                                                                                                                                                                                               cause
                          Terbutaline    SABA bronchodialator, high        Onset: 15 min; Reversible airway obstruction and asthma                                                                         HTN, angina, tachy,
                                                                                                                                                                                                                               hypokalemia.
                          (Breathaire)   selectivity                       Duration: 6 hrs                                                                                                                 palpitations,
                                                                                                                                                                                                                               MAOIs and TCAs
                                                                                                                                                                                                           possible perph vd
  Beta2 Agonists




                                                                                                                                                                                                                               potentiate NE
                                                                                                                                                                                                           fom stimulation of
                                                                                                                                                                                                                               release, incr. CV
                                                                                                                                                                                                           B2. More B2
                                                                                                                                                                                                                               effects. Thyroid
                          Formoterol     LABA bronchodialator, high        Onset: 15 min; Mgmt of asthma and prevention of acute bronchospasms            Preg risk C, not to be used to Tx acute          selectivity, less
                                                                                                                                                                                                                               hormones cause
                                         selectivity                       Duration: 12   assoc w/ COPD, nocturnal asthma                                 bronchospasm, asthamatic attack, status          ADRs on the heart,
                                                                                                                                                                                                                               lethargy and CV
                                                                           hrs                                                                            asthmaticus, acute respriatory insuffientcy,     but more vd (rarely
                                                                                                                                                                                                                               effects.
                                                                                                                                                          acutely deterorating COPD                        seen)
                                                                                                                                                                                                                               Potentiation w/
                                                                                                                                                                                                                               atomoxetine (NE
                          Salmeterol     LABA bronchodialator, high        Onset: 14 min; Mgmt of asthma and prevention of bronchospasm, COPD,                                                                                 repuptake
                          (Serevent)     selectivity                       Duration: 12   nocturnal asthma                                                                                                                     inhibitior)
                                                                           hrs


                          Metoproteren LABA or SABA (?)                    Onset: 1 hr;    Asthma, COPD                                                   Not for the assesment of respose to
                          ol (Atrovent) bronchodialator, moderate          Duration: 4 hrs                                                                bronchodialators
                                        selectivity

                          Isoproteronol Stimulates myocardial              Only IV,       Cardiac arrest secondary to Cardiac arrhythmia during      Preg risk C, cardiac arrhtymias associated with                              Sympathomimetic
Beta Agonist
Nonselective




                          (Isuprel)     peformance via Inotripic and       Duration of 30 ACLS resusciation, Ventricular arrhythmias, Cardiac shock, tachycardia(tachyarhythmias), extreme caution                                agents, xanthine
                                        Chronotropic effect, Improves      min - 2 hurs   temp. use in 3rd degree AV block, Diagnostic tool for      in pt with Pheochromocytoma                                                  derivatives
                                        Coronory outflow, Relaxes                         Vasovagal synchope, used Infrquently as bronchodilator
                                        bronchial, GI, Sk. Muscles
                          Atenolol      Competitvely Beta-1 selective                      HTN,angina, acute MI, suprvaentricular and ventricular         at high doses looses it beta-1 specificity
                          (Tenormin) antagonist                                            tacharrhytmias, mgmt of acute O w/d and Prophylaxis of
                                                                                           migraine

                          Betaxolol
                          (Betoptic)
                          Bisoprolol     Competitvely Beta-1 selective                     redution of resting and exercise HR, CO, systolic and          High dose (>20)-can block Beta-2 receptors and
                          (Zebeta)       antagonist                                        diastolic BP, reflex orthostatic hypotension, Inc sinus node   cause bronchospasm
                                                                                           recovery time, prolongs AV node refractory periods,
                                                                                           Prolongs AV node conduction
   tive Beta 1 Blockers
       Selective Beta 1 Bloc
                               Esmolol        Competitvely Beta-1 selective    IV only,Short    acute HTN, certain supraventrciular arrhythmias. Non-
                               (Brevibloc)    antagonist                       acting           approved Ind: short term control of perioperative HTN,
                                                                                                management of tahyarrhythmias complicating acute MI, min.
                                                                                                of acute myocardial ischemia secondary to acute MI or
                                                                                                unstable angina

                               Metoprolol     Competitvely Beta-1 selective                     HTN,angina,acute MI, supraventricular tachyarrhythmias,
                               (Lorpressor,   antagonist                                        CHF, Migraine HA
                               Toprol-XL)


                               Nebivolol      High affinity for beta-1 receptors lipophilic, lacks possesses vasodilatory properties due to NO modulation,
                               (Systolic)     at therapeutic doses               ISA               antioxidant properties, Dec. vascular PR, improves L
                                                                                                   ventricular peformance

                               Carvedilol                                      Oral             Hypertension reflex and Congestive heart failure,
Beta Blockers

  Blocking
  w/ Alpha




                               (Coreg)                                                          ventricular dysfunction
                                              Beta Blockers w/ Alpha Blocking
                               Labetalol      Activity                        Oral, IV and      Hypertension associated with angina or
                               (Trandate)                                      parenteral       pheochromocytoma and druring pregnancy
                               Acebutolol                                      Oral             Hypertentsion and ventricular arrhythmias. Management of     Unstable angina and non-Stsegment elevation
  Intrinsic Symp Activity




                               (Sectral)                                                        angina and myocardial infarction                             myocardial infarction
     Beta Blockers w/




                               Penbutolol     Beta Blockers w/ Intrinsic Symp Oral, High first Mild to moderate arterial hypertension                        Unstable angina and non-Stsegment elevation
                               (Levatol)      Activity                        pass                                                                           myocardial infarction
                               Pindolol                                        Oral             Exercise-induced tachycardian,                               Unstable angina and non-Stsegment elevation
                               (Visken)                                                                                                                      myocardial infarction
                                                      Enzyme             DA
DA Agonists             DA Antagonists
                                                     Inhibitors       Releasers

   Ergot                 Centrally Acting:
 Derivatives       Antipsychotics/Neuroleptics
                                                    MAO Inhibitors
 Bromocriptine
  Cabergoline
   Pergolide




 Non-ergot
 Derivatives

  Pramipexole
                                                    COMT Inhibitors
   Ropinirole

                                                    Tyrosine
                                                    Hydroxylase
                                                    Inhibitors
Partial Agonist
 (functional
 Antagonist)
                                                    Aromatic Amino
                                                    Acid
  Aripiprazole
                                                    Decarboxylase
                                                    Inhibitors
   Terguride




D2 specific
D2 and D3
Specific
D1 and D2 non-
specific


                  Peripherally Acting DA Blockers
DA Reuptake   Drugs Affecting DA Antimuscarinics
 inhibitors   Neurotransmission      for PD



              1) Lithium        Procyclidine
              2) Neurotoxins    Diphenhydramine
               - MPTP           Ethoproprazine
               - MPP+           Benzotropine
               - 6-OHDA         Biperiden
               - Pesticides     Trihexyphenidyl
               a) Paraquat
               b) Diquat         Parkinsons Disease
                                 Elements Blocking
                                    Body Tremor

				
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