Autonomic Pharmacology

Article Author:
Derek Clar

Article Editor:
Sandeep Sharma

Editors In Chief:
Melissa Max
Danyae Lee
Manouchkathe Cassagnol

Managing Editors:
Avais Raja
Orawan Chaigasame
Carrie Smith
Abdul Waheed
Khalid Alsayouri
Kyle Blair
Trevor Nezwek
Radia Jamil
Erin Hughes
Patrick Le
Anoosh Zafar Gondal
Saad Nazir
William Gossman
Hassam Zulfiqar
Navid Mahabadi
Hussain Sajjad
Steve Bhimji
Muhammad Hashmi
John Shell
Matthew Varacallo
Heba Mahdy
Ahmad Malik
Sarosh Vaqar
Mark Pellegrini
James Hughes
Beata Beatty
Daniyal Ameen
Altif Muneeb
Beenish Sohail
Nazia Sadiq
Hajira Basit
Phillip Hynes
Komal Shaheen
Sandeep Sekhon

9/27/2019 1:53:29 PM


The basis of autonomic pharmacology reflects the physiology of the sympathetic nervous system (SNS) and the parasympathetic nervous system (PSNS) to regulate involuntary reactions to stresses on multiorgan systems within the body. When a pathologic process is present that affects the homeostasis achieved between the SNS and PSNS in this process, either of these branches can become overactive while the other is excessively inhibited.[1] This break in homeostasis results in various clinical manifestations that can range in severity from simply presenting rhinorrhea symptomology to fatal presentations like cardiovascular collapse.[2] For a wide range of presentations and severity of pathologies, the agents classified in autonomic pharmacology are indicated to re-establish the homeostasis that the human body attempts to produce via the autonomic nervous system (ANS).[3]

Within autonomic pharmacology, there are four specific categories of drugs based on how they affect the ANS:

  1. Cholinomimetics/Cholinesterase antagonists
  2. Anticholinergics
  3. Adrenoreceptor agonists/sympathomimetics
  4. Adrenoreceptor antagonists

The clinical indications of drugs from each of the four categories are listed below. Important to note is that this is not a complete list due to the vastness of this topic; drugs included are representative of each category.

 FDA-labeled indications:

Cholinomimetics/Cholinesterase antagonists[4][5][6][7]:

  • Bethanechol - postoperative and neurogenic ileus and urinary retention
  • Pilocarpine - glaucoma and alleviating the symptoms of Sjogren’s syndrome
  • Nicotine - found in smoking cessation regimens
  • Cholinesterase inhibitors (neostigmine, edrophonium, pyridostigmine, physostigmine) - the diagnosis and treatment of myasthenia gravis, maintenance treatment of Alzheimer’s disease, and specifically neostigmine used commonly with glycopyrrolate to reverse neuromuscular blockade in postoperative anesthesia practice


  • Atropine - used in ACLS guidelines to correct bradyarrhythmias and in ophthalmic surgery as a retinal dilator
  • Ipratropium and tiotropium - correct acute exacerbations of bronchospasm (asthma, COPD), as well as exacerbation prophylaxis for those conditions
  • Scopolamine - prevents motion sickness and postoperative nausea/vomiting
  • Oxybutynin - urge incontinence and postoperative bladder spasm
  • Dicyclomine, glycopyrrolate - can be used for reducing diarrhea output in irritable bowel syndrome; glycopyrrolate can also be added to cholinesterase reversal of neuromuscular blockades in postoperative anesthesia care to prevent bronchospasm and is currently undergoing investigation as an adjunct treatment in COPD

Adrenoreceptor agonists/Sympathomimetics[15][16][17][18][19][20][21]:

  • Clonidine - used as an antihypertensive
  • Dobutamine, phenylephrine, epinephrine - used to correct severe hypotension in cardiogenic shock and acute heart failure exacerbation; epinephrine specifically also used in ACLS guidelines for non-shockable heart rhythms in cardiac arrest and rapid reversal of fatal anaphylactic reactions
  • Albuterol - fast-acting bronchodilator used in acute asthma exacerbations
  • Fenoldopam - corrects hypertension
  • Bromocriptine - involved in the maintenance of Parkinson disease and conditions involving prolactinoma

Adrenoreceptor antagonists[22][23][24]:

  • Phenoxybenzamine, phentolamine - used to correct high catecholamine states
  • Prazosin, doxazosin, terazosin, tamsulosin - indicated to correct urinary retention in benign prostatic hyperplasia
  • Beta-blockers (propranolol, metoprolol, labetalol, etc.) - indicated for many cardiovascular conditions since they are in the classification of class II antiarrhythmics; these agents are used to manage tachyarrhythmias, hypertension, angina, heart failure, and migraine prophylaxis            

Mechanism of Action

As with the homeostasis established via processes performed by the SNS and PSNS, drugs from each of the four categories listed above also work inversely of each other. The primary mechanism of action for most of these agents are to serve as either agonists or antagonists of specific receptors within these systems.[2] The receptors with their locations and physiologic actions are listed below.  

For adrenoreceptors stimulated by norepinephrine (synapses) and epinephrine (endocrine), involved in SNS processes[25][26]:

  • Alpha-1 (A1) – located mostly in postsynaptic effector cells found in smooth muscle; effects mediated by IP3/DAG path, include mydriasis due to contraction of radial muscles, constriction of arteries and veins, urinary retention due to internal/external urethral sphincter contraction, and a decrease in renin release from renal juxtaglomerular cells   
  • Alpha-2 (A2) – located in presynaptic adrenergic terminals found in lipocytes and smooth muscle; effects mediated by decreasing cAMP, including a decrease in norepinephrine release, stimulates platelet aggregation and decreases insulin secretion 
  • Beta-1 (B1) – located in postsynaptic effector cells in the SA node of the heart, lipocytes, brain, juxtaglomerular apparatus of renal tubules, and the ciliary body epithelium; effects mediated by increasing cAMP, including increased heart rate and the conduction velocity through the cardiac nodes, also increases renin release from renal juxtaglomerular cells
  • Beta-2 (B2) – located in postsynaptic effector cells in smooth muscle and cardiac myocytes; effects mediated by increasing cAMP, include vasodilation, bronchiole dilation, increased insulin secretion, and uterine relaxation
  • Beta-3 (B3) – located in postsynaptic effector cells in lipocytes and myocardium; similar effects to beta-1 receptors mediated by increasing cAMP

For cholinoreceptors stimulated by acetylcholine, most involved in PSNS processes[27]:

  • Muscarinic-1 (M1) – important to note is the only cholinoreceptor involved in an SNS process, located in sweat glands of the skin; effects mediated by IP3/DAG path, include glandular contraction and increased secretion  
  • Muscarinic-2 (M2) – located in SA and AV nodes and myocardium; effects mediated by decreasing cAMP, include decreasing heart rate and myocardial conduction velocity 
  • Muscarinic-3 (M3) – located in the smooth muscle of various organ systems; effects mediated by IP3/DAG path, include contraction of the ciliary muscle causing miosis, contraction of bronchioles, increased bronchiole secretions, increased GI motility, detrusor muscle contraction and internal/external urethral sphincter relaxation  
  • Nicotinic-N (NN) – located in postsynaptic dendrites of both sympathetic and parasympathetic postganglionic neurons; effects mediated by Na+/K+ depolarization, include increased neurotransmission   
  • Nicotinic-M (NM) – located in neuromuscular endplates of skeletal muscle; effects mediated by Na+/K+ depolarization, include skeletal muscle contraction

For dopamine receptors, most involved in both SNS and PSNS processes[28]:

  • Dopamine 1-5 (D1-5) – located in the CNS, except for Dopamine-1 receptors, which also appear in renal vasculature; effects mediated by cAMP path, include renal artery vasodilation, increased renal blood flow, and modulation of neuroendocrine signaling

 In terms of the four categories mentioned, each is an agonist and/or antagonist of the receptors listed. Cholinomimetics have agonist activity at muscarinic receptors augmenting PSNS activity to achieve the desired effects of increasing GI motility and decreasing intraocular pressure.[4][5] Whereas the other agents mentioned work directly on receptors as agonists/antagonists, the subcategory of drugs that also achieve similar effects to cholinomimetics are the cholinesterase antagonists. These agents inhibit acetylcholinesterase enzymes within the synaptic cleft to increase the concentration of acetylcholine, resulting in increased PSNS neurotransmission and facilitating skeletal muscle contraction.[7] Inversely, the anticholinergic agents work to inhibit PSNS activity; the main mechanism of action involving antagonism of muscarinic receptors resulting in increased heart rate and conduction velocity and stimulate bronchodilation.[8][9]

Within the SNS system, adrenoreceptor agonists/sympathomimetics work at alpha and beta receptors to potentiate SNS activity to achieve higher cardiac output and fast bronchodilation.[16][18] Inversely, adrenoreceptor antagonists are also active at alpha and beta receptors in decreasing SNS neurotransmission to reduce heart rate, dampen high catecholamine states, and increase urinary smooth muscle relaxation.[24][22][23]


Most agents are available as IV, IM, SC, PO formulations.[29][30][31] Some agents can also be given topically as eye drops, specific to ophthalmologic surgery requiring extended pupillary dilation and the medical treatment of open-angle and closed-angle glaucoma.[32][33]

Adverse Effects

Due to the various effects of the ANS on cardiovascular, pulmonary, gastrointestinal, and genitourinary systems, the general theme of reactions to these medications involves effects on these organ systems. The various reactions to each of the categories of agents include[16][18][24][22][23]:

  • Cholinomimetics/cholinesterase inhibitors – nausea, vomiting, diarrhea, urinary urgency, excessive salivation, sweating, cutaneous vasodilation, bronchial constriction
  • Anticholinergics – tachycardia, urinary retention, xerostomia (dry mouth), constipation, increased intra-ocular pressure
  • Adrenoreceptor agonists/sympathomimetics – tremor, tachycardia, hypertension, urinary retention, piloerection
  • Adrenoreceptor antagonists – bradycardia, bronchospasm, hypotension 


Based on the adverse reaction profiles of each category, several significant contraindications can be elucidated[34][35][31]:

  • Cholinomimetics/Cholinesterase inhibitors – relative contraindications in asthma/COPD, bradycardia, volume-depleted/hypotension, cardiogenic shock, sepsis, reduced ejection fraction heart failure
  • Anticholinergics – relative contraindications in glaucoma especially angle-closure, older males with benign prostatic hyperplasia, and peptic ulcer disease; atropine specifically not recommended for children, especially infants who are sensitive to its hyperthermic effects
  • Adrenoreceptor agonists/Sympathomimetics – relative contraindications in patients with a previous/current history of tachycardia or hypokalemia, hypertension, urinary retention, gastroparesis; for clonidine specifically in elderly who are more prone to fall from orthostatic hypotension, and epinephrine in those with angle-closure glaucoma
  • Adrenoreceptor antagonists – relative contraindications for alpha-blockers in orthostatic hypotension, tachycardia, myocardial ischemia; for beta-blockers asthma/COPD for the nonselective agents, bradycardia, hypotension 


Toxic profiles of the four categories described are mostly involved in overdose, exhibiting the same effects that are augmented so that the benefits no longer outweigh the risks. The main reversal strategy for these situations typically is to discontinue the offending agent and treat the resultant symptoms.[1] Several agents of each category have toxic effects which require more specific reversal methods as listed[7][36][37][38]:

  • Cholinesterase inhibitors (neostigmine, pyridostigmine, physostigmine) – formerly, high doses of these agents were used in chemical warfare would present as miosis, bronchial constriction, vomiting and diarrhea, and progress to convulsions, coma, and finally death; this toxicity profile remains the same and can be reversed with pralidoxime with adjunctive parenteral atropine and benzodiazepines for possible seizure activity
  • Atropine – can cause vision disturbances when in excess resulting in prolonged mydriasis and cycloplegia, can also exacerbate closed-angle glaucoma by increasing intra-ocular pressure; reversal generally is to discontinue; however, physostigmine has utility in extreme cases such as severe elevation of body temperature and rapid supraventricular tachycardia
  • Clonidine – can cause xerostomia and sedation; though currently there is no approved reversal, studies are currently investigating the use of naloxone as a reversal agent
  • Beta-blockers – besides severe hypotension and bradycardia, tremors and bronchospasm are worrisome in the event of overdose; glucagon serves as the reversal

Enhancing Healthcare Team Outcomes

Healthcare workers who prescribe agents that work on the autonomic system must be fully aware of the side effects of these agents. Requisite close monitoring of vital signs, including blood pressure, heart rate, respiratory rate, oxygen saturation, and the temperature is strongly recommended when attempting to reestablish autonomic homeostasis with ANS agents.[2] Several common conditions which require autonomic pharmacological correction need specific monitoring[39][40][41][42]:

  • Glaucoma – ocular telemetry sensors can be used to continuously monitor intraocular pressures.
  • Shock – requires several monitoring functions as listed:
    • Maintaining a MAP of 65 and above
    • MAP measurements via an arterial line
    • Pulse pressure variation to guide fluid therapy
    • Bedside echocardiography to assess chambers of the heart and looking for cardiogenic shock vs. obstructive shock (massive PE) and calculate cardiac output/ejection fraction
    • Pulse index continuous cardiac output (PiCCO) device which can be used for continuous cardiac output monitoring and assessment of fluid response
  • Asthma/COPD – pulmonary function testing is the standard to diagnose and monitor the severity of pulmonary obstruction; can also assess the effectiveness of inhaled autonomic agents in reversing obstructive processes
  • Arrhythmias – for acute monitoring 4-lead ECG and 12-lead EKG are standard for monitoring tachycardias or bradycardias; if extended monitoring is required extended continuous ambulatory rhythm monitors (ECAM) is the monitoring modality of choice 

Interested in Participating?

We are looking for contributors to author, edit, and peer review our vast library of review articles and multiple choice questions. In as little as 2-3 hours you can make a significant contribution to your specialty. In return for a small amount of your time, you will receive free access to all content and you will be published as an author or editor in eBooks, apps, online CME/CE activities, and an online Learning Management System for students, teachers, and program directors that allows access to review materials in over 500 specialties.

Improve Content - Become an Author or Editor

This is an academic project designed to provide inexpensive peer-reviewed Apps, eBooks, and very soon an online CME/CE system to help students identify weaknesses and improve knowledge. We would like you to consider being an author or editor. Please click here to learn more. Thank you for you for your interest, the StatPearls Publishing Editorial Team.

Autonomic Pharmacology - Questions

Take a quiz of the questions on this article.

Take Quiz
A 45-year-old male presents with an unsteady gait. The patient is having difficulty speaking, so his wife recounts that the patient has been exhibiting the unsteady gait and impaired speech, as well as blurred vision and shortness of breath over the past 3 months. It all started around the time when he began a new job. His vitals assessed at the clinic are: BP 110/50 HR 56 RR 22 Temp 99.1F. On physical exam, the patient has excessive tearing and salivation, bradycardia with no murmurs, rubs or gallops, and generalized muscle weakness in all extremities. What job did the patient most likely start 3 months ago and what is the next best step in management?

Click Your Answer Below

Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.

Sign Up
An ophthalmologist is performing a cataract repair on a 67-year-old female. Prior to the procedure when gaining consent from the patient, the clinician places a few drops of atropine-based solution in the patient’s eye being operated on to keep the pupil dilated during the procedure. What is the mechanism of action of atropine in this case?

Click Your Answer Below

Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.

Sign Up
A 65-year-old male is currently being treated on the step-down floor after experiencing a massive STEMI 5 days ago. Suddenly, while a nurse is attempting to help him ambulate to a chair, the patient slumps forward with the loss of mentation. Vitals assessed are BP 85/45, HR 105, and RR 25. On physical exam, the patient appears diaphoretic with cold, pale skin. Bed-side ultrasound performed does not show any blood in pericardium. What is the next best step in management?

Click Your Answer Below

Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.

Sign Up
A 58-year-old female presents to her clinician's office for a return visit after being prescribed propranolol for one month. The patient’s past medical history is remarkable for hypertension and asthma, the latter managed by an albuterol inhaler and low dose corticosteroids. The patient informs the clinician that her hypertension is currently under control; however, she has been noticing that she is having more difficulty in catching her breath while on her daily walks and requires more use of her albuterol inhaler to correct. Her clinician informs her that this is most likely due to her propranolol prescription and decides to change it to metoprolol. Why is the prescription change necessary?

Click Your Answer Below

Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.

Sign Up
A 50-year-old farmer presents to the emergency department with continuous vomiting and diarrhea for the past 1 hour. He was involved in spraying insecticide over his agricultural land. A 2nd-year medical student, present during this encounter recalls basic autonomic pharmacology. Which autonomic receptor is correctly matched to its signaling cascade?

Click Your Answer Below

Would you like to access teaching points and more information on this topic?

Improve Content - Become an Author or Editor and get free access to the entire database, free eBooks, as well as free CME/CE as it becomes available. If interested, please click on "Sign Up" to register.

Purchase- Want immediate access to questions, answers, and teaching points? They can be purchased above at Apps and eBooks.

Sign Up

Autonomic Pharmacology - References


Ibrahim MS,Samuel B,Mohamed W,Suchdev K, Cardiac Dysfunction in Neurocritical Care: An Autonomic Perspective. Neurocritical care. 2018 Nov 27;     [PubMed]
La Rovere MT,Christensen JH, The autonomic nervous system and cardiovascular disease: role of n-3 PUFAs. Vascular pharmacology. 2015 Aug;     [PubMed]
Patel HC,Rosen SD,Lindsay A,Hayward C,Lyon AR,di Mario C, Targeting the autonomic nervous system: measuring autonomic function and novel devices for heart failure management. International journal of cardiology. 2013 Dec 10;     [PubMed]
Gaitonde S,Malik RD,Christie AL,Zimmern PE, Bethanechol: Is it still being prescribed for bladder dysfunction in women? International journal of clinical practice. 2018 Aug 15;     [PubMed]
Mogil RS,Khezri N,Ren R,Adleyba O,Abumasmah R,Ghassibi MP,Chien JL,Pearlstein A,Patthanathamrongkasem T,Liebmann JM,Ritch R,Park SC, Changes in Iridocorneal Angle and Anterior Chamber Structure in Eyes With Anatomically Narrow Angles: Laser Iridotomy Versus Pilocarpine. Journal of glaucoma. 2018 Dec;     [PubMed]
Watkins SL,Thrul J,Max W,Ling P, Cold Turkey and Hot Vapes? A national study of young adult cigarette cessation strategies. Nicotine     [PubMed]
Kumar A,Mehta V,Raj U,Varadwaj PK,Udayabanu M,Yennamalli RM,Singh TR, Computational and in-vitro validation of natural molecules as potential Acetylcholinesterase inhibitors and neuroprotective agents. Current Alzheimer research. 2018 Dec 12;     [PubMed]
Kusumoto FM,Schoenfeld MH,Barrett C,Edgerton JR,Ellenbogen KA,Gold MR,Goldschlager NF,Hamilton RM,Joglar JA,Kim RJ,Lee R,Marine JE,McLeod CJ,Oken KR,Patton KK,Pellegrini CN,Selzman KA,Thompson A,Varosy PD, 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay. Circulation. 2018 Nov 6;     [PubMed]
Aziz MIA,Tan LE,Wu DB,Pearce F,Chua GSW,Lin L,Tan PT,Ng K, Comparative efficacy of inhaled medications (ICS/LABA, LAMA, LAMA/LABA and SAMA) for COPD: a systematic review and network meta-analysis. International journal of chronic obstructive pulmonary disease. 2018;     [PubMed]
Dohar JE, Sialorrhea     [PubMed]
Herbison P,McKenzie JE, Which anticholinergic is best for people with overactive bladders? A network meta-analysis. Neurourology and urodynamics. 2018 Dec 21;     [PubMed]
Alammar N,Stein E, Irritable Bowel Syndrome: What Treatments Really Work. The Medical clinics of North America. 2019 Jan;     [PubMed]
Bulka CM,Terekhov MA,Martin BJ,Dmochowski RR,Hayes RM,Ehrenfeld JM, Nondepolarizing Neuromuscular Blocking Agents, Reversal, and Risk of Postoperative Pneumonia. Anesthesiology. 2016 Oct;     [PubMed]
Ohar J,Tosiello R,Goodin T,Sanjar S, Efficacy and safety of a novel, nebulized glycopyrrolate for the treatment of COPD: effect of baseline disease severity and age; pooled analysis of GOLDEN 3 and GOLDEN 4. International journal of chronic obstructive pulmonary disease. 2019;     [PubMed]
Schuster Bruce C,Rull G,Sotiris A,Lobo MD, Novel stratified medicines approach to manage uncontrolled hypertension due to multiple drug intolerances. BMJ case reports. 2018 Dec 13;     [PubMed]
Kislitsina ON,Rich JD,Wilcox JE,Pham DT,Churyla A,Vorovich EB,Ghafourian K,Yancy CW, Shock - Classification and Pathophysiological Principles of Therapeutics. Current cardiology reviews. 2018 Dec 12;     [PubMed]
Beavers CJ,Pandya KA, Pharmacotherapy Considerations for the Management of Advanced Cardiac Life Support. The Nursing clinics of North America. 2016 Mar;     [PubMed]
Gardiner MA,Wilkinson MH, Randomized Clinical Trial Comparing Breath-Enhanced to Conventional Nebulizers in the Treatment of Children with Acute Asthma. The Journal of pediatrics. 2019 Jan;     [PubMed]
Szymanski MW,Bhimji SS, Fenoldopam 2018 Jan;     [PubMed]
Sahney A,Sharma BC,Jindal A,Anand L,Arora V,Vijayaraghavan R,Dhamija RM,Kumar G,Bhardwaj A,Sarin SK, A double blind randomized controlled trial to assess efficacy of bromocriptine in cirrhotic patients with hepatic parkinsonism. Liver international : official journal of the International Association for the Study of the Liver. 2018 Dec 16;     [PubMed]
Wu YP,Wang YB,Wu ZB, Bromocriptine-responsive supersellar germinoma with the expression of dopamine receptors: A case report. Clinical neurology and neurosurgery. 2019 Jan;     [PubMed]
Falhammar H,Kjellman M,Calissendorff J, Treatment and outcomes in pheochromocytomas and paragangliomas: a study of 110 cases from a single center. Endocrine. 2018 Dec;     [PubMed]
Zabkowski T,Saracyn M, Drug adherence and drug-related problems in pharmacotherapy for lower urinary tract symptoms related to benign prostatic hyperplasia. Journal of physiology and pharmacology : an official journal of the Polish Physiological Society. 2018 Aug;     [PubMed]
Parch J,Powell C, No longer failing to treat heart failure: A guideline update review. JAAPA : official journal of the American Academy of Physician Assistants. 2019 Jan;     [PubMed]
Philipp M,Brede M,Hein L, Physiological significance of alpha(2)-adrenergic receptor subtype diversity: one receptor is not enough. American journal of physiology. Regulatory, integrative and comparative physiology. 2002 Aug;     [PubMed]
do Vale GT,Ceron CS,Gonzaga NA,Simplicio JA,Padovan JC, Three generations of β-blockers: history, class differences and clinical applicability. Current hypertension reviews. 2018 Sep 17;     [PubMed]
Bradley SJ,Tobin AB,Prihandoko R, The use of chemogenetic approaches to study the physiological roles of muscarinic acetylcholine receptors in the central nervous system. Neuropharmacology. 2018 Jul 1;     [PubMed]
Beaulieu JM,Espinoza S,Gainetdinov RR, Dopamine receptors - IUPHAR Review 13. British journal of pharmacology. 2015 Jan;     [PubMed]
Carlson AB,Kraus GP, Physiology, Cholinergic Receptors 2018 Jan;     [PubMed]
Broderick ED,Crosby B, Anticholinergic Toxicity 2018 Jan;     [PubMed]
Farzam K,Lakhkar AD, Adrenergic Drugs 2018 Jan;     [PubMed]
Moustafa GA,Borkar DS,McKay KM,Eton EA,Koulisis N,Lorch AC,Kloek CE, Outcomes in resident-performed cataract surgeries with iris challenges: Results from the Perioperative Care for Intraocular Lens study. Journal of cataract and refractive surgery. 2018 Dec;     [PubMed]
Adams CM,Stacy R,Rangaswamy N,Bigelow C,Grosskreutz CL,Prasanna G, Glaucoma - Next Generation Therapeutics: Impossible to Possible. Pharmaceutical research. 2018 Dec 13;     [PubMed]
Pecikoza U,Micov A,Tomić M,Stepanović-Petrović R, Eslicarbazepine acetate reduces trigeminal nociception: Possible role of adrenergic, cholinergic and opioid receptors. Life sciences. 2018 Dec 1;     [PubMed]
Araklitis G,Thiagamoorthy G,Hunter J,Rantell A,Robinson D,Cardozo L, Anticholinergic prescription: are healthcare professionals the real burden? International urogynecology journal. 2017 Aug;     [PubMed]
Bozkurt B,Okudan N,Belviranli M,Oflaz AB, The evaluation of intraocular pressure fluctuation in glaucoma subjects during submaximal exercise using an ocular telemetry sensor. Indian journal of ophthalmology. 2019 Jan;     [PubMed]
Simmons J,Ventetuolo CE, Cardiopulmonary monitoring of shock. Current opinion in critical care. 2017 Jun;     [PubMed]
Bokov P,Delclaux C, [Interpretation and use of routine pulmonary function tests: Spirometry, static lung volumes, lung diffusion, arterial blood gas, methacholine challenge test and 6-minute walk test]. La Revue de medecine interne. 2016 Feb;     [PubMed]
Schultz KE,Lui GK,McElhinney DB,Long J,Balasubramanian V,Sakarovitch C,Fernandes SM,Dubin AM,Rogers IS,Romfh AW,Motonaga KS,Viswanathan MN,Ceresnak SR, Extended cardiac ambulatory rhythm monitoring in adults with congenital heart disease: Arrhythmia detection and impact of extended monitoring. Congenital heart disease. 2019 Jan 3;     [PubMed]
Cole JB,Orozco BS,Arens AM, Physostigmine Reversal of Dysarthria and Delirium After Iatrogenic Atropine Overdose From a Dental Procedure. The Journal of emergency medicine. 2018 Jun;     [PubMed]
Seger DL,Loden JK, Naloxone reversal of clonidine toxicity: dose, dose, dose. Clinical toxicology (Philadelphia, Pa.). 2018 Oct;     [PubMed]
Lafarge L,Bourguignon L,Bernard N,Vial T,Dehan-Moya MJ,De La Gastine B,Goutelle S, [Pharmacokinetic risk factors of beta-blockers overdose in the elderly: Case report and pharmacology approach]. Annales de cardiologie et d'angeiologie. 2018 Apr;     [PubMed]


The intent of StatPearls is to provide practice questions and explanations to assist you in identifying and resolving knowledge deficits. These questions and explanations are not intended to be a source of the knowledge base of all of medicine, nor is it intended to be a board or certification review of Pharmacy-Pharmacotherapy. The authors or editors do not warrant the information is complete or accurate. The reader is encouraged to verify each answer and explanation in several references. All drug indications and dosages should be verified before administration.

StatPearls offers the most comprehensive database of free multiple-choice questions with explanations and short review chapters ever developed. This system helps physicians, medical students, dentists, nurses, pharmacists, and allied health professionals identify education deficits and learn new concepts. StatPearls is not a board or certification review system for Pharmacy-Pharmacotherapy, it is a learning system that you can use to help improve your knowledge base of medicine for life-long learning. StatPearls will help you identify your weaknesses so that when you are ready to study for a board or certification exam in Pharmacy-Pharmacotherapy, you will already be prepared.

Our content is updated continuously through a multi-step peer review process that will help you be prepared and review for a thorough knowledge of Pharmacy-Pharmacotherapy. When it is time for the Pharmacy-Pharmacotherapy board and certification exam, you will already be ready. Besides online study quizzes, we also publish our peer-reviewed content in eBooks and mobile Apps. We also offer inexpensive CME/CE, so our content can be used to attain education credits while you study Pharmacy-Pharmacotherapy.