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Anesthesia Pharm > Adrenergic Agonist Patho and Receptors > Flashcards

Adrenergic Agonist Patho and Receptors Flashcards

1
Q

The sympathetic outflow is also called ___

A

the thoracolumbar outflow

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2
Q

The sympathetic, or thoracolumbar, outflow arises from ____.

A

segments T1–L2 or segments T1–L3

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3
Q

Most sympathetic preganglionic neurons synapse with ____

A

postganglionic fibers in the paravertebral ganglia

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4
Q

Sympathetic cardiac accelerator fibers arise from ___.

A

T1–T4

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5
Q

The stellate ganglion is formed by ___.

A

the inferior cervical and first thoracic ganglia

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6
Q

The effects of the sympathetic nervous system on the body’s physiology are designed to ____.

A

facilitate the fight-or-flight response

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7
Q

The sympathetic nervous system is anatomically and functionally more ____.

A

systemic in its effects when compared to the PNS

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8
Q

A massive sympathetic response would lead to ____

A

tachycardia, dry mouth, bronchodilation and diaphoresis.

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9
Q

Effects of the Sympathetic Nervous System on organs in the body system

A

Eye - The pupil dilation (mydriasis)

Heart - Increased heart rate

Secretions - Decreased salivary and bronchial secretions

Smooth Muscle - Bronchodilation, and decreased motility and tone of the stomach and intestines and relaxation of the bladder (detrusor muscle)

Pancreas – Increased blood glucose

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10
Q

What are the main endogenous neurotransmitters for adrenergic receptors?

A

Norepinephrine and epinephrine

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11
Q

The major subtypes of adrenergic receptors are ___.

A

alpha-1, alpha-2, beta-1, and beta-2

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12
Q

Preganglionic SNS fibers are ____.

A

short, myelinated and release Acetylcholine

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13
Q

Postganglionic SNS fibers are ____.

A

long, unmyelinated, have nicotinic receptors at the ganglia and release either NE or Ach onto target adrenergic receptors

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14
Q

The adrenal medulla is directly stimulated by ___.

A

a preganglionic SNS fiber to release NE and Epi into systemic circulation

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15
Q

What is a ganglia?

A

a group of cell bodies in the periphery, and in the SNS, sympathetic ganglia are where many preganglionic dendrites synapse on postganglionic cell bodies

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16
Q

The preganglionic SNS fibers exit the spinal cord through ____.

A

the ventral nerve root

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17
Q

All preganglionic SNS fibers pass through the ___.

A

white ramus (myelinated) in route to the paravertebral ganglia

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18
Q

Where do some preganglionic SNS fibers synapse in?

A

the paravertebral ganglia

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19
Q

Where do the postganglionic SNS fibers pass through?

A

the grey ramus (unmyelinated), and travel to effector organ

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20
Q

some preganglionic fibers ascend or descend in the ___.

A

paravertebral ganglia before synapsing with postganglionic neurons

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21
Q

some preganglionic neurons pass through the paravertebral ganglia without _____.

A

synapsing; these fibers synapse with postganglionic neurons in peripheral ganglia

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22
Q

In addition to the collateral ganglion, another example of a peripheral ganglia is ____.

A

the stellate ganglion

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23
Q

A stellate ganglion block is ___.

A

an injection of medication into these nerves that can help relieve pain in the head, neck, upper arm and upper chest.

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24
Q

A stellate ganglion block is also an unintentional consequence of ___.

A

a brachial plexus block

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25
Q

Horner’s syndrome is common side effect of ____.

A

a stellate ganglion block

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26
Q

Signs and symptoms of Horner’s Syndrome

A

Ipsilateral miosis, ptosis, enophthalmos, flushing, increased skin temperature, anhydrosis, and nasal congestion (stuffiness)

Very Homely PAM: Vasodilation, Horner, Ptosis, Anhydrosis, Miosis

Ipsilateral miosis = lazy eye

Enophthalmos = posterior displacement of the eye

Anhydrosis = inability to sweat normally.

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27
Q

In the adrenal medulla, norepinephrine is converted to ___.

A

epinephrine, the catecholamine pool is comprised 20% NE and 80% epinephrine.

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28
Q

Describe the steps of the synthesis of norepinephrine

A
  1. Tyrosine transported into nerve terminal from bloodstream.
  2. Tyrosine converted to dopa.
  3. Dopa converted to dopamine.
  4. Dopamine transported into presynaptic vesicle.
  5. Dopamine converted to norepinephrine.
  6. Norepinephrine stored in presynaptic vesicles
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29
Q

Describe the steps of the release of norepinephrine

A
  1. An action potential travels along the axon of sympathetic postganglionic neuron.
  2. Depolarization opens voltage-gated Ca+ channels.
  3. Ca+ diffuses through channels into nerve terminal down electrochemical gradient
  4. Ca+ unites with calmodulin, and this second messenger system initiates a series of reactions leading to exocytosis.
  5. Norepinephrine spills into the synaptic cleft.
30
Q

First, norepinephrine combines with adrenergic receptors of postsynaptic membrane. Then what happens?

A

2.Norepinephrine-receptor complex causes:

  • ion channels to open, or
  • activation of adenylate cyclase and subsequent intracellular production of cAMP

3.The cell responds in a characteristic way to the opening of ion channels or the activation of adenylate cyclase (second messengers have tissue-specific actions).

•Ex: cAMP relaxes vascular smooth muscle but stimulates contraction of the myocardium

31
Q

Termination of norepinephrine

A

Diffusion of norepinephrine away from receptors is the first step in the termination of action of norepinephrine.

  1. Norepinephrine is actively transported back into the presynaptic nerve terminal; most (80%) of the released norepinephrine is returned to the nerve terminal by this reuptake mechanism.
  2. Small amounts of norepinephrine are metabolized in the synaptic cleft by monoamine oxidase (MAO); MAO is found on the surface of mitochondria; some MAO leaks from the nerve terminal into the synaptic cleft.
  3. Small amounts of norepinephrine diffuse into the bloodstream; once in the vascular compartment, norepinephrine is metabolized by catechol-O-methyl transferase (COMT).
32
Q

Indirect-acting sympathomimetics work in part by ___.

A

displacing norepinephrine from sympathetic nerve terminals.

Ephedrine is the most frequently used indirect-acting sympathomimetic. Ephedrine also stimulates adrenergic receptors directly, so it also is a direct-acting agent.

33
Q

What agents should be avoided in the patient taking an MAO inhibitor?

A

indirect-acting sympathomimetic agents (ephedrine) and meperidine; meperidine, like ephedrine, triggers the release of norepinephrine. When either ephedrine or meperidine is administered to a patient taking an MAO inhibitor, the release of excess amounts of norepinephrine may cause a hypertensive crisis. This hypertension is generally worse with meperidine.

34
Q

α1 (alpha 1) receptors are ___

A

postsynaptic adrenoceptors located in smooth muscle throughout the body (in the eyes, lungs, blood vessels, uterus, gut, and genitourinary system)

35
Q

α1(alpha 1) agonists are associated with ___.

A

mydriasis, bronchoconstriction, vasoconstriction, uterine contraction, constriction of GI/GU sphincters and inhibits insulin secretion.

mydriasis = pupils dilate

36
Q

The most important cardiovascular effect of α1 stimulation is ___.

A

vasoconstriction, which increases peripheral vascular resistance, left ventricular afterload, and arterial blood pressure.

37
Q

α2 (alpha 2) receptors are located primarily on ___.

A

the presynaptic nerve terminals, in addition to tissues on postsynaptic membranes in the brainstem and in peripheral tissues

38
Q

stimulation of alpha-2 receptors on sympathetic postganglionic, presynaptic nerves produces ____.

A

inhibition of norepinephrine synthesis and release

this is a negative feedback system.

39
Q

stimulation of postsynaptic alpha-2 receptors in the brainstem causes ____.

A

sedation and inhibits outflow of the sympathetic nervous system, which leads to peripheral vasodilation and lower blood pressure

40
Q

stimulation of alpha-2 receptors in the substantia gelatinosa of the spinal cord promotes ____.

A

analgesia

41
Q

Where are beta 1 receptors located?

A

heart and kidney

42
Q

Stimulation of beta 1 receptors is __ and produces ___.

A

excitatory and produces positive chronotropic (increased heart rate), dromotropic (increased conduction), inotropic (increased contractility) effects and increase renin release

43
Q

β2 (Beta 2) Receptors are primarily ___ and located ____.

A

primarily postsynaptic adrenoceptors located in smooth muscle and gland cells; but are also located in ventricular myocytes.

44
Q

β2 (Beta 2) stimulation causes ___.

A

smooth muscle relaxation, resulting in bronchodilation, vasodilation, and relaxation of the uterus (tocolysis), bladder, and gut.

45
Q

Glycogenolysis, lipolysis, gluconeogenesis, and insulin release are stimulated by ____.

A

β2-receptor activation.

46
Q

β3 (Beta 3) Receptors are found in ___.

A

adipose tissue and play a role in lipolysis and thermogenesis in brown fat.

47
Q

Stimulation of alpha 1 receptor on the pupil causes ___.

A

mydriasis (pupil dilates)

48
Q

Stimulation of beta 1 receptor on the SA Node causes ___.

A

increased heart rate

49
Q

Stimulation of beta 1 receptor on the AV Node causes ___.

A

increased conduction speed

50
Q

Stimulation of beta 1 receptor on muscle fibers causes ___.

A

increased contractility

51
Q

Stimulation of alpha 1 receptor on most arterial systemic vessels causes ___.

A

vasocontriction (increased SVR)

52
Q

Stimulation of beta 2 receptor on artieral skeletal muscle vessels causes ___.

A

vasodilation (decreased SVR)

53
Q

Stimulation of alpha 1 receptor on veins causes ___.

A

vasocontriction (increased preload)

54
Q

Stimulation of beta 2 receptor on the bronchiolar muscle of the lung causes ___.

A

bronchodilation

55
Q

Stimulation of beta 2 receptor on the secretory glands of the lung causes ___.

A

increased secretions

56
Q

Stimulation of alpha 1 receptor on the spleen causes ___.

A

release of RBCs

57
Q

Stimulation of beta 1 receptor on the kideny causes ___.

A

increased renin release

58
Q

Stimulation of alpha 1 receptor on the kidney causes ___.

A

decreased renin release

59
Q

Stimulation of beta 2 receptor on the liver causes ___.

A

Glycogenolysis & Gluconeogenesis

60
Q

Stimulation of beta 2 receptor on the gallbladder causes ___.

A

relaxation

61
Q

Stimulation of alpha 1 receptor on the stomach and intestines causes ___.

A

relaxation

62
Q

Stimulation of beta 2 receptor on the urinary bladder wall causes ___.

A

relaxation

63
Q

Stimulation of beta 2 receptor on the pancreas causes ___.

A

increased insulin secretion

64
Q

Stimulation of alpha 2 receptor on the pancreas causes ___.

A

decreased insulin secretion

65
Q

Stimulation of alpha 1 receptor on adipose tissue causes ___.

A

increased glucagon secretion

66
Q

Stimulation of beta 1 receptor on adipose tissue causes ___.

A

Lipolysis

67
Q

Stimulation of beta 2 receptor on the uterus causes ___.

A

relaxation

68
Q

Stimulation of alpha 1 receptor on the uterus causes ___.

A

contraction

69
Q

Stimulation of beta 2 receptor on the the sodium potassium pump causes ___.

A

the stimulation of the Na-K pump which causes decreased plasma potassium

70
Q

Dopamine (DA) receptors are ____.

A

a group of adrenergic receptors that are activated by dopamine; these receptors are classified as D1 and D2 receptors.

71
Q

Activation of D1 receptors ____.

A

mediates vasodilation in the kidney, intestine, and heart.

72
Q

D2 receptors are believed to play a role in ____.

A

antiemetic action

Anesthesia Pharm (18 decks)

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