front 1 Drug: Hemicholinium (Cholinergic) | back 1 Class: Inhibitor of ACh synthesis (blocks choline uptake) Clinical Applications: Research tool; not used therapeutically Common Side Effects: Not clinically used Serious Adverse Effects: Experimental toxicity Contraindications: Not applicable (not for clinical use) Therapeutic Considerations: Blocks high-affinity choline transporter → ↓ ACh synthesis; important in experimental neuropharmacology |
front 2 Drug: Vesamicol (Cholinergic) | back 2 Class: Inhibitor of ACh storage Clinical Applications: Experimental use only Common Side Effects: Not used in humans Serious Adverse Effects: Not applicable Contraindications: N/A Therapeutic Considerations: Inhibits vesicular ACh transporter (VAChT), preventing ACh from entering synaptic vesicles |
front 3 Drug: Botulinum Toxin (Cholinergic) | back 3 Class: Neurotoxin; inhibits ACh release Clinical Applications: Dystonia, cosmetic reduction of wrinkles, chronic migraine, hyperhidrosis, strabismus Common Side Effects: Local muscle weakness, ptosis, flu-like symptoms Serious Adverse Effects: Dysphagia, respiratory depression if systemically absorbed Contraindications: Infection at injection site, hypersensitivity Therapeutic Considerations: Cleaves SNARE proteins needed for vesicle fusion, preventing ACh release; effects are long-lasting but reversible |
front 4 Drug: Scopolamine (Cholinergic) | back 4 Class: Muscarinic receptor antagonist Clinical Applications: Motion sickness (transdermal), postoperative nausea Common Side Effects: Dry mouth, drowsiness, blurred vision Serious Adverse Effects: Hallucinations, confusion (especially in elderly) Contraindications: Narrow-angle glaucoma Therapeutic Considerations: Crosses the blood-brain barrier; central effects dominate at therapeutic doses |
front 5 Drug: Atropine (Cholinergic) | back 5 Class: Muscarinic receptor antagonist Clinical Applications: Bradycardia, organophosphate poisoning, pre-op secretion reduction, pupil dilation for eye exams Common Side Effects: Dry mouth, tachycardia, photophobia Serious Adverse Effects: Hyperthermia, delirium, urinary retention Contraindications: Glaucoma, urinary tract obstruction Therapeutic Considerations: Non-selective M antagonist; dose-dependent tissue effects (low = salivary/gastric, high = heart and eyes) |
front 6 Drug: Ipratropium (Cholinergic) | back 6 Class: Muscarinic antagonist (inhaled) Clinical Applications: COPD, asthma (less effective for acute bronchospasm than β2 agonists) Common Side Effects: Dry mouth, cough Serious Adverse Effects: Rare systemic effects due to poor absorption Contraindications: Hypersensitivity to atropine derivatives or soy/peanut (formulation dependent) Therapeutic Considerations: Quaternary amine → minimal CNS effects; short-acting bronchodilator |
front 7 Drug: Tiotropium (Cholinergic) | back 7 Class: Long-acting muscarinic antagonist (LAMA) Clinical Applications: Maintenance therapy for COPD, sometimes used in asthma Common Side Effects: Dry mouth, constipation, urinary retention Serious Adverse Effects: Paradoxical bronchospasm, atrial fibrillation (rare) Contraindications: Hypersensitivity to tiotropium or lactose (inhaler formulation) Therapeutic Considerations: Longer duration than ipratropium; once-daily dosing improves adherence |
front 8 Drug: Solifenacin (Cholinergic) | back 8 Class: Muscarinic M3 receptor antagonist Clinical Applications: Overactive bladder, urinary urgency/incontinence Common Side Effects: Dry mouth, constipation, blurred vision Serious Adverse Effects: Urinary retention, QT prolongation (rare) Contraindications: Urinary retention, gastric retention, uncontrolled narrow-angle glaucoma Therapeutic Considerations: Higher selectivity for M3 → fewer CNS effects vs. older antimuscarinics |
front 9 Drug: Tolterodine (Cholinergic) | back 9 Class: Muscarinic antagonist (M3 receptor antagonist) Clinical Applications: Overactive bladder symptoms Common Side Effects: Dry mouth, constipation, headache Serious Adverse Effects: QT prolongation, confusion (especially in elderly) Contraindications: Urinary/gastric retention, narrow-angle glaucoma Therapeutic Considerations: Less M3 selectivity than solifenacin; caution in elderly patients |
front 10 Drug: Bethanechol (Cholinergic) | back 10 Class: Muscarinic receptor agonist Clinical Applications: Urinary retention, postoperative ileus Common Side Effects: Diarrhea, salivation, abdominal cramps Serious Adverse Effects: Bronchospasm, hypotension, bradycardia Contraindications: Asthma, GI obstruction, peptic ulcer, bradycardia Therapeutic Considerations: Selective for muscarinic receptors; does not cross BBB |
front 11 Drug: Nicotine (Cholinergic) | back 11 Class: Nicotinic receptor agonist Clinical Applications: Smoking cessation (patches, gums), experimental studies on ganglionic stimulation Common Side Effects: Nausea, dizziness, headache Serious Adverse Effects: Arrhythmias, seizures at high doses Contraindications: Hypersensitivity, caution in cardiovascular disease Therapeutic Considerations: Stimulates both sympathetic and parasympathetic ganglia; high doses cause receptor desensitization |
front 12 Drug: Edrophonium (Cholinergic) | back 12 Class: Short-acting acetylcholinesterase inhibitor Clinical Applications: Diagnosis of myasthenia gravis (Tensilon test) Common Side Effects: Increased salivation, GI cramping Serious Adverse Effects: Bradycardia, bronchospasm Contraindications: Intestinal or urinary obstruction Therapeutic Considerations: Rapid onset and short duration; does not cross Blood Brain Barrier |
front 13 Drug: Neostigmine (Cholinergic) | back 13 Class: Reversible acetylcholinesterase inhibitor Clinical Applications: Myasthenia gravis, reversal of neuromuscular blockade, urinary retention Common Side Effects: Nausea, diarrhea, bradycardia Serious Adverse Effects: Cholinergic crisis, bronchospasm Contraindications: Peritonitis, mechanical obstruction Therapeutic Considerations: Quaternary compound (does not cross BBB); longer duration than edrophonium |
front 14 Drug: Physostigmine (Cholinergic) | back 14 Class: Reversible acetylcholinesterase inhibitor Clinical Applications: Antidote for anticholinergic toxicity (e.g., atropine overdose) Common Side Effects: Sweating, nausea, bradycardia Serious Adverse Effects: Seizures, cholinergic crisis Contraindications: Asthma, cardiovascular disease Therapeutic Considerations: Tertiary amine; crosses BBB, unlike neostigmine |
front 15 Drug: Donepezil (Cholinergic) | back 15 Class: Centrally acting acetylcholinesterase inhibitor Clinical Applications: Alzheimer’s disease (mild to moderate) Common Side Effects: Nausea, diarrhea, insomnia Serious Adverse Effects: Bradycardia, syncope Contraindications: Hypersensitivity Therapeutic Considerations: Long half-life allows once-daily dosing; selectively enhances central cholinergic transmission |
front 16 Drug: Methacholine (Cholinergic) | back 16 Class: Muscarinic receptor agonist Clinical Applications: Diagnosis of bronchial hyperreactivity (asthma test) Common Side Effects: Coughing, chest tightness Serious Adverse Effects: Bronchospasm, hypotension Contraindications: Severe asthma, cardiovascular disease Therapeutic Considerations: Inhaled; used under medical supervision only; highly sensitive test for asthma diagnosis |
front 17 Drug: Succinylcholine (Cholinergic) | back 17 Class: Depolarizing neuromuscular blocker Clinical Applications: Muscle relaxation during intubation and surgery Common Side Effects: Muscle fasciculations, postoperative myalgia Serious Adverse Effects: Malignant hyperthermia, hyperkalemia, apnea Contraindications: History of malignant hyperthermia, burns, neuromuscular disease Therapeutic Considerations: Rapid onset, short duration; metabolized by plasma cholinesterases |
front 18 Drug: Pancuronium (Cholinergic) | back 18 Class: Non-depolarizing neuromuscular blocker Clinical Applications: Adjunct to anesthesia for muscle paralysis Common Side Effects: Tachycardia, hypotension Serious Adverse Effects: Prolonged paralysis, anaphylaxis Contraindications: Hypersensitivity, caution in renal/hepatic impairment Therapeutic Considerations: Long-acting agent; reversed by cholinesterase inhibitors (e.g., neostigmine) |
front 19 Drug: Tubocurarine (Cholinergic) | back 19 Class: Non-depolarizing neuromuscular blocker Clinical Applications: Historical use in anesthesia for muscle relaxation Common Side Effects: Hypotension (histamine release), prolonged weakness Serious Adverse Effects: Respiratory paralysis Contraindications: Asthma, hypotension, myasthenia gravis Therapeutic Considerations: Rarely used today; replaced by safer non-depolarizing agents |
front 20 Drug: Methyltyrosine (Adrenergic) | back 20 Class: Tyrosine hydroxylase inhibitor Clinical Applications: Treatment of pheochromocytoma (rare adrenal tumor) Common Side Effects: Sedation, diarrhea, anxiety Serious Adverse Effects: Extrapyramidal symptoms, hypotension Contraindications: Hypersensitivity, Parkinson’s disease Therapeutic Considerations: Depletes catecholamine synthesis; used adjunctively before surgery in pheochromocytoma |
front 21 Drug: Reserpine (Adrenergic) | back 21 Class: VMAT (vesicular monoamine transporter) inhibitor Clinical Applications: Rarely used now; previously used for hypertension Common Side Effects: Nasal congestion, GI upset, sedation Serious Adverse Effects: Depression, suicidal ideation (due to CNS catecholamine depletion) Contraindications: History of depression, peptic ulcer Therapeutic Considerations: Depletes NE, dopamine, serotonin in both CNS and PNS; long-lasting effects |
front 22 Drug: Guanethidine (Adrenergic) | back 22 Class: Adrenergic neuron blocker Clinical Applications: Rarely used antihypertensive Common Side Effects: Orthostatic hypotension, diarrhea, sexual dysfunction Serious Adverse Effects: Bradycardia, fluid retention Contraindications: MAOI therapy, pheochromocytoma Therapeutic Considerations: Replaces NE in nerve terminals and inhibits NE release; slow onset of action |
front 23 Drug: Midodrine (Adrenergic) | back 23 Class: Alpha-1 agonist (prodrug) Clinical Applications: Orthostatic hypotension Common Side Effects: Paresthesia, piloerection, urinary retention Serious Adverse Effects: Supine hypertension Contraindications: Severe heart disease, urinary retention Therapeutic Considerations: Converted to active form (desglymidodrine); avoid dosing near bedtime to prevent nocturnal hypertension |
front 24 Drug: Clonidine (Adrenergic) | back 24 Class: Alpha-2 adrenergic receptor agonist Clinical Applications: Hypertension, ADHD, withdrawal symptoms Common Side Effects: Dry mouth, sedation, dizziness Serious Adverse Effects: Rebound hypertension on sudden withdrawal Contraindications: Bradyarrhythmia, severe coronary insufficiency Therapeutic Considerations: Decreases sympathetic outflow from CNS; taper gradually to avoid rebound hypertension |
front 25 Drug: Dobutamine (Adrenergic) | back 25 Class: Beta-1 adrenergic receptor agonist Clinical Applications: Acute heart failure, cardiogenic shock Common Side Effects: Tachycardia, hypertension, palpitations Serious Adverse Effects: Arrhythmias Contraindications: Idiopathic hypertrophic subaortic stenosis Therapeutic Considerations: Increases contractility and output more than heart rate; short-term IV use only |
front 26 Drug: Albuterol (Adrenergic) | back 26 Class: Beta-2 adrenergic receptor agonist Clinical Applications: Acute bronchospasm (asthma, COPD), bronchodilator Common Side Effects: Tremor, nervousness, tachycardia Serious Adverse Effects: Paradoxical bronchospasm, arrhythmias Contraindications: Hypersensitivity to albuterol or excipients Therapeutic Considerations: Rapid onset, short-acting; overuse may cause receptor desensitization |
front 27 Drug: Amphetamine (Adrenergic) | back 27 Class: Indirect-acting sympathomimetic Clinical Applications: ADHD, narcolepsy Common Side Effects: Insomnia, anorexia, increased BP Serious Adverse Effects: Dependence, psychosis, cardiovascular events Contraindications: Cardiovascular disease, hypertension, hyperthyroidism Therapeutic Considerations: Increases release of NE and dopamine from nerve terminals; CNS stimulant |
front 28 Drug: Pseudoephedrine (Adrenergic) | back 28 Class: Mixed-acting sympathomimetic Clinical Applications: Nasal congestion Common Side Effects: Insomnia, anxiety, hypertension Serious Adverse Effects: Tachycardia, stroke (rare) Contraindications: Severe hypertension, MAOI use Therapeutic Considerations: Direct agonist at α and β receptors and promotes NE release; less CNS stimulation than amphetamines |
front 29 Drug: Phenylephrine (Adrenergic) | back 29 Class: Alpha-1 adrenergic receptor agonist Clinical Applications: Nasal congestion, hypotension, pupil dilation Common Side Effects: Hypertension, reflex bradycardia Serious Adverse Effects: Arrhythmias, rebound congestion (nasal) Contraindications: Severe hypertension, ventricular tachycardia Therapeutic Considerations: Used topically or IV; avoid prolonged use in nasal sprays to prevent rebound effect |
front 30 Drug: Tyramine (Adrenergic) | back 30 Class: Indirect sympathomimetic (naturally occurring amine) Clinical Applications: No therapeutic use; relevance in food-drug interactions Common Side Effects: None under normal metabolism Serious Adverse Effects: Hypertensive crisis (with MAOIs) Contraindications: Use with MAO inhibitors Therapeutic Considerations: Found in fermented foods; releases NE from adrenergic terminals; degraded by MAO under normal conditions |
front 31 Drug: Cocaine (Adrenergic) | back 31 Class: Monoamine reuptake inhibitor Clinical Applications: Local anesthesia (ENT procedures); vasoconstriction Common Side Effects: Euphoria, tachycardia, insomnia Serious Adverse Effects: Seizures, arrhythmias, myocardial infarction Contraindications: Cardiovascular disease, concurrent sympathomimetic use Therapeutic Considerations: Inhibits reuptake of NE, dopamine, serotonin; significant abuse potential and toxicity. It increases sympathetic activity |
front 32 Drug: Phentolamine (Adrenergic) | back 32 Class: Non-selective alpha-adrenergic receptor antagonist Clinical Applications: Pheochromocytoma (diagnosis and management), hypertensive emergencies due to catecholamines Common Side Effects: Hypotension, reflex tachycardia Serious Adverse Effects: Arrhythmias, myocardial ischemia Contraindications: Coronary artery disease Therapeutic Considerations: Short-acting; used in surgery or catecholamine excess |
front 33 Drug: Prazosin (Adrenergic) | back 33 Class: Selective alpha-1 adrenergic receptor antagonist Clinical Applications: Hypertension, benign prostatic hyperplasia (BPH) Common Side Effects: Dizziness, orthostatic hypotension, headache Serious Adverse Effects: Syncope (especially first dose) Contraindications: Hypersensitivity Therapeutic Considerations: “First-dose effect” — start with low dose at bedtime |
front 34 Drug: Tamsulosin (Adrenergic) | back 34 Class: Alpha-1A adrenergic receptor antagonist Clinical Applications: BPH (urinary retention) Common Side Effects: Dizziness, abnormal ejaculation Serious Adverse Effects: Hypotension (less than with prazosin) Contraindications: Known hypersensitivity Therapeutic Considerations: Selective for prostate/bladder neck; minimal BP effects |
front 35 Drug: Labetalol & Carvedilol (Adrenergic) | back 35 Class: Mixed alpha-1 and beta adrenergic receptor antagonists Clinical Applications: Hypertensive emergencies (labetalol), heart failure and hypertension (carvedilol) Common Side Effects: Fatigue, dizziness, orthostatic hypotension Serious Adverse Effects: Bradycardia, bronchospasm Contraindications: Asthma, AV block, bradycardia Therapeutic Considerations: Dual blockade reduces BP without reflex tachycardia; carvedilol has antioxidant properties |
front 36 Drug: Propranolol (Adrenergic) | back 36 Class: Non-selective beta adrenergic receptor antagonist Clinical Applications: Hypertension, angina, arrhythmias, migraine prophylaxis Common Side Effects: Fatigue, cold extremities, bradycardia Serious Adverse Effects: Bronchospasm, depression, heart block Contraindications: Asthma, severe bradycardia Therapeutic Considerations: Crosses BBB; not selective, affects β1 and β2 equally |
front 37 Drug: Atenolol (Adrenergic) | back 37 Class: Beta-1 selective adrenergic receptor antagonist Clinical Applications: Hypertension, angina, post-MI Common Side Effects: Fatigue, dizziness Serious Adverse Effects: Bradycardia, AV block Contraindications: Sinus bradycardia, AV block Therapeutic Considerations: Less CNS penetration than propranolol; preferred in patients with asthma or COPD |