Parasympathetic Physiology and Anticholinergic Pharmacology

Anticholinergic drugs and the many, many more drugs with anticholinergic side effects are ubiquitous in medical practice. The presentation below will describe parasympathetic physiology as well as anticholinergic pharmacology.

Use the pause and play buttons to move through the flash animations below or download the powerpoint for free at the bottom of this page.

[wpfilebase tag=”file” id=6 /]

Dopamine and Acetylcholine in Schizophrenia, Delirium and Parkinson’s

Dopamine and Acetylcholine are key players in Psychiatric and Extrapyramidal Physiology and Pharmacology. The presentation below will help to clarify these affects and also help you to remember them.


Psychiatric neurotransitters are still a matter of theory and speculation. The actual mechanisms presented may , in the future, turn out to be completely bogus. For now they will help you in your clinical approach to patients.

Use the pause and play buttons to move through the flash animations below or download the powerpoint for free at the bottom of this page.

[wpfilebase tag=”file” id=5 /]

Clonidine and Beta Blocker Interaction

The interaction between clonidine and beta blockers (metoprolol, atenolol, carvedilol, nadolol, etc.) is often foggy in the mind of health care professionals. This confusion stems from the fact that the interaction is only relevant when the patient misses a dose or two and you have clonidine withdrawl.

Use the pause and play buttons to move through the flash animations below or scroll down to download the powerpoint for free.

[wpfilebase tag=”file” id=2 /]

Beta Blocker Pharmacology

Beta blockers are some of the most commonly used drugs. Understanding the pharmacology is foundational to good pharmacy and medical practice. You might want to start with the One Minute Genius on Sympathetic Drive first since this one is based on an understanding of Sympathetic Physiology. When you are ready, click on the beta blocker graphic.

If you can’t see the flash video in a few seconds then download the Beta Blocker Pharmacology Power Point

Use the play button to move through the powerpoint animations below.

Beta Blocker Pharmacology
Beta Blocker PDF

Insulin Dosing Rules

John and Albert in Bali Albert and I had to go into the beautiful mountains of the island of Bali to research these rules. Bali is one of many islands that make up the country of Indonesia. Somebody had to go.

Insulin Dosing Rules

Starting dose

0.5 to 1 unit / kg / day for Type 2 Diabetes
If they are already on Insulin Start with their current dose
Give 50% long acting and 50% short acting. Divide the short acting evenly for each meal.

Corrective Insulin (in addtion to meal insulin)

Estimated Blood sugar Decrease for Each Unit of Insulin

1700/ total daily insulin for Humalog and Novolog
1500/ total daily insulin for regular insulin

Insulin for Carb Counters

Number of grams of carbohydrate covered by each unit of insulin

450/ total daily insulin for Humalog and Novolog
500/ total daily insulin for regular insulin

Antibiotics Simplified

It might take a bit more than a minute, but we have created a powerpoint presentation that walks through most antibiotics and helps you see how one relates to another. This is a free resource for you called Antibiotics Oversimplified. This oversimplified approach is not good enough to make therapeutic decisions from, but what is does do, is organize these drugs according to class and type of antimicrobial activity. Of course, for patient care, you should use a local antibiogram or at very least, a Sanford or Johns Hopkins Antibiotic guide. The purpose of this one minute genius is to help you mentally structure your understanding of antibiotics, bacteria and therapeutic uses.

Warfarin Maintenance Dose Adjustments

Simple guidelines

Note: these are for maintenance doses only at steady state. Do NOT use these guidelines for starting someone on warfarin.

INR Dosage Adjustment
Less Than 1.3 Give them an extra dose and increase by 10% (always ask them if they “might” have missed a dose)
1.3 to 1.8 Increase weekly dose by 7 – 8% (always ask them if they “might” have missed a dose
1.8 – 2.0 Repeat the INR in one week, if still <2.0 than increase by 7%
2.0 t0 3.0 Smile
3.0 to 3.5 Check for patient errors in the dose first, then repeat the INR in 2 or 3 days. IF still elevated, decrease by 7% – 8%
3.5 to 4.5 Decrease by 7% – 8% (check for patient errors in the dose first)
Over 4.5 Hold the dose for one or two days and restart at a 10 – 20% lower weekly dose

Vitamin K

Often it is NOT necessary to give vitamin K. If you want to keep the patient anticoagulated, and you cannot stop yourself from giving vitamin K 🙂 … then give only 2.5 mg of phytonadione orally.

Do not give 10mg of vitamin K unless it is OK for the patient to NOT be anticoagulated for one or two weeks.

Obviously, you will usually give Vitamin K if the patient is bleeding.

Thyroid Pharmacotherapy

Normal Thyroid Physiology

Thyroid stimulation and feedback

Laboratory Tests for Thyroid

Total T4 Free T4 Total T3 TSH

4.5 – 12.5 mcg/dl

0.8 –  1.5 ng / dl

80 – 220 ng/dl

0.3 – µU /  mL



Thyroid Clinical Pearls

  • Normal levothyroxine dose is 1.6 mcg/kg/ day
  • Some people may benefit symptomatically from addition of 50mcg of T3 to levothyroxine
  • Normal TSH should probably not be above 3.5 Treated
  • Untreated TSH should be between 0.5 to 3.8 mU/L
  • 100 and 300 mcg tabs have yellow dye #5 and have allergic potential

Amidarone induced hypothyroidism: 2 mechanisms :

  • Thyroiditis: use a steroid
  • Iodine induced: use Synthroid

Subclinical hyperthyroidism consequences:

  • Osteoporosis mostly in post-menopausal women
  • A. Fib. 3 fold increase in risk
  • Increase LV mass (diastolic dysfunction)