Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

N550 Pharm > ANS > Flashcards

ANS Flashcards

0
Q

Where are preganglionic and postganglionic neurons of SNS located?

A

Preganglionic: T1-L2/L3, intermediolateral horn of grey matter
Postganglionic: Paravertebral chains, prevertebral ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
1
Q

Are preganglionic vs. postganglionic neurons myelinated or unmyelinated?

A

Preganglionic- myelinated

Postganglionic- unmyelinated

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Where are PSNS preganglionic neurons and postganglionic neurons located?

A

Preganglionic: Cranial (CN 3,7,9,10) Sacral (S2-4)
Postganglionic: target organs, also ganglia in head and neck

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Does SNS or PSNS have long preganglionic neurons and short postganglionic neurons?

A

PSNS

SNS has short pre and long post

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Most organs are innervated by SNS and PSNS.
What are the innervations for the exceptions? (sweat glands, ciliary muscle of the eye, bronchial smooth muscle, and blood vessels)

A

SNS: sweat glands and blood vessels (muscarinic receptors present)
PSNS: ciliary muscle of the eye and bronchial smooth muscle (B2 receptors present)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Ach binds to _____ receptors, what are the types?

Epi, NE, and dopamine bind to _______ receptors, what are the types?

A

ACh binds to cholinergic receptors, which are nicotinic (ligand gated) or muscarinic (g-protein coupled)
Epi, NE, and dopamine bind to adrenergic receptors, which are alpha 1-2 and beta 1-3 (**NE does NOT stimulate beta-2)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

The adrenal medulla releases ____% epi and _____% norepi

A

80% epi, 20% norepi

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

What receptors activate G-alpha-Q? What is the effect?

A

Alpha-1, M1, and M3

Increased calcium -> contraction/vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

What receptors activate G-alpha-I? What are the effects?

A

Alpha-2, M2
Inhibits adenylate cyclase which DECREASES cAMP (post synaptic) -> contraction!
Presynaptic increases K conductance

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What receptors activate G-alpha-S? What are the effects?

A

Beta 1,2,3
S=Stimulate the activation of adenylate cyclase increasing cAMP
Vasodilates, increases HR and contractility

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Alpha-1 effects?

A 
Vascular smooth muscle CONTRACTION
Iris contracts, pupil dilates
Pilomotor smooth muscle erects hair
Prostate/uterus contraction
Heart increases force of contraction (not as mjuch as beta-1)
Think of Phenylephrine!
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Alpha-2 effects?

A

Platelets aggregate
Presynaptic inhibition of adrenergic/cholinergic transmitter release (decrease BP/HR)
Presynaptic/CNS vasodilation, postsynaptic vasoconstriction
GI relaxation
CNS sedation and analgesia (via decreased SNS outflow from brain stem)
Think of Clonidine!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Beta-1 effects?

A

Heart- increase force and rate of contraction

Kidney- stimulate renin release (this will increase BP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Beta-2 effects?

A

Respiratory, uterine, vascular, GI, GU- relaxation
Mast cells- decrease histamine release
Skeletal muscle- dilation, uptake of K, increased speed of contraction
Liver- glycogenolysis
Pancreas- increase insulin secretion (so you can use the glucose)
Adrenergic nerve- increase release of NE

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Beta-3 effects?

A

Activates lipolysis, thermogenesis

worry about athrosclerosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

D-1 effects?

A

Smooth muscle- (postsynaptic) dilates renal, mesenteric, coronary, and cerebral blood vessels (decreased afterload)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

D-2 effects?

A

Nerve endings- (presynaptic) modulates transmitter release, increases N/V

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

All sympathomimetics are derivatives of what?

A

Beta-phenylethylamine
An amine side chain, hydroxyl group on 3,4 carbons of benzene ring (catechol)
Thus the name catecholamine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Sympathomimetics: MOA

A

Activation of G-protein couple receptor directly (drug binds to receptor) or indirectly (drug increase NE release from SNS nerves activating the receptor)
G-protein will have downstream effects, usually effecting the amount of intracellular Ca

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

How are catecholamines vs. non-catecholamines metabolized?

A

Catecholamines: Reuptake (neuronal, extraneuronal), MAO, COMT, lungs
Non-catecholamines: MAO, urinary excretion
**If someone is on MAOI’s, this will increase the availability of neurotransmitters in the CNS/PNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

What is the selectivity of Phenylephrine vs. Clonidine?

A

Phenylephrine α1>α2»»>β
Clonidine α2>α1»»>β
These are alpha agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

What is the selectivity of Norepinephrine vs. Epinephrine?

A

Norepinephrine* α1=α2; β1»»»>β2
*B2 not innervated
Epinephrine α1=α2; β1=β2
These are mixed alpha/beta agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

What is the selectivity of Dobutamine, Isoproterenol, and Terbutaline/albuterol?

A

Dobutamine β1>β2»»α
Isoproterenol β1=β2»»α
Terbutaline/albuterol β2»β1»»α
These are beta-agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

What is the selectivity of Dopamine vs. Fenoldopam?

A

Dopamine D1=D2»β»α
Fenoldopam D1»D2
These are dopamine agonists

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Epinephrine: route, onset, duration?
Route: subq or IV Onset: subq 5-10 min, IV 1-2 min Duration: 5-10 min
25
Epinephrine: indications?
``` Bronchial asthma Acute allergic reaction Electromechanical dissociation V fib unresponsive to defib Infusion to increase myocardial contractility (low dose) ```
26
Epinephrine dosing?
Resuscitation: bolus dose 10 mcg/kg IV (can start w 2-8 mcg/kg) Beta-2: 1-2 mcg/min IV Beta-1: 4-5 mcg/min IV Alpha and Beta: 10-20 mcg/min IV (over 20 is alpha)
27
CV effects of Epinephrine?
With moderate doses, SBP increases (B1, A1), DBP decreases (B2), MAP stays the same α1 - vasoconstriction - ↑ BP, ↑ CVP, ↑ Cardiac work α2 - negative feedback - ↓ BP β1 - increased contractility, HR, CO – ↑ BP β2 - peripheral vasodilation - ↓ BP
28
Cerebral effects of Epinephrine?
Minimal vasoconstriction of arterioles in cerebral vasculature (increase CBF), coronary vasculature, and pulmonary vasculature
29
Ocular effects of Epinephrine?
Alpha-1-mydriasis Alpha 1/2- increase humoral outflow Beta 1- increase production of aqueous humor (inc intraoccular pressure)
30
Respiratory effects of Epinephrine?
B2- dilate bronchial tree, decrease release of histamine A1- reduce mucosal secretion-decongestion (Note: beta blockers do the OPPOSITE which is why asthmatics can't handle them)
31
GI effects of Epinephrine?
A2- decreased secretions A/B2- decreased peristalsis A1- blood flow reduced even if BP normal
32
GU effects of Epinephrine?
A1- renal blood flow REDUCED, contract urethral sphincter B1-kidney increases renin release B2- decreases UO, inhibits labor The kidneys take a big hit! Consider giving a vasodilator
33
Metabolic effects of Epinephrine?
B2- Increased liver glycogenolysis and insulin release B3- lipolysis A2- minorly opposes B2, inhibits insulin release End result: BG goes up
34
Prep and dosage of norepinephrine (Levophed)?
For hypotension: 4-16 mcg/min | Mix in 5% glucose solution (to prevent oxidation)
35
What are the effects of norepinephrine?
Potent alpha and beta-1, but minimal beta-2, leading to intense vasoconstriction (increased BP/MAP), baroreceptors are activated decreasing HR/respiration Decreased venous return/CO/HR, preload is going up Bottom line: good for shock/hemorrhaging, but will do a lot of damage if the problem isn't fixed
36
How does dopamine work? What is the dose?
``` Works on all adrenergic receptors (a,b,d) D1 dominates ("renal dose" for peeing more, misleading) 1-3 mcg/kg/min B1 dominates 3-10 mcg/kg/min Alpha dominates over 10 mcg/kg/min ```
37
Why is dopamine not as useful with depleted catecholamine stores?
Increases endogenous norepinephrine release
38
If dopamine PIV infiltrates, dangerous Inhibitory at carotid bodies, pt may have altered response to hypoxia Increased intraocular pressure
Yup
39
Isoproterenol: what are the effects?
B1 and B2 agonists Increases HR and contractility, decreases SVR (inc SBP, dec DBP, dec MAP)
40
Who do you NOT give isoproterenol to?
Someone with a high HR, we decrease O2 delivery and increase demand, therefore setting them up for an MI
41
What is the dosage of isoproterenol?
1-5 mcg/min for heart block and bradydysrhythmias | Rapid metabolism by COMT so you need to give it as an infusion
42
Dobutamine is used for what? What is it?
Its a good coronary artery vasodilator, improves CO without increase HR/BP, good for CHF B1 selective drug (agonist)
43
Dobutamine dose?
2-10 mcg/kg/min B1 selective <5mcg/kg/min Weak A1 stimulation over 5
44
How does ephedrine work?
Indirect and direct agents of alpha and beta "weak epi", lasts 10x longer Used frequently in surgery to increase BP (increases HR too)
45
Ephedrine route and dosage?
PO, IM, IV | 10-25 mg IV, 10-50 mg IM
46
Ephedrine caution?
Tachyphylaxis with repeated dosing, NE depletion, receptor occupation long 1/2 life, CV compensation Excreted in urine, slowly metabolized by MAO, conjugated in the liver E1/2t 3 hours
47
How does phenylephrine (neo-synephrine) work?
Primarily A1 stimulant, direct acting VENOCONSTRICTION more than arterial constricts (improving preload) Less potent and longer lasting than norepinephrine Used in surgery to increase BP/SVR (decreases HR/CO)
48
Phenylephrine dosage?
50-200 mcg IV or infusion 20-50 mcg/min
49
If your pt gets an overdose of phenylephrine/epinephrine, what should you give?
Give an alpha-1 antagonist They have massive alpha 1 stimulation The absolute wrong answer here is a beta blocker, this will kill them because nothing will be left to balance out the alpha
50
What effects do Beta-2 agonists have?
Relax bronchiole and uterine smooth muscle Sustained duration of action Useful in premature labor, asthma, COPD Side effects: tremor (B2 in skeletal muscle), reflex tachycardia (vasodilation and B2 in heart)
51
What is the preferred choice for bronchospasm due to asthma?
Albuterol - B2 agonist | To prevent, have them use this before surgery
52
Albuterol dose? Side effects?
MDI: 100 ug/puff, 2 puffs q4-6h, max 16-20 puffs Neb: 15 mg/h for 2 hours Side effects: large doses can cause tachycardia and hypokalemia
53
What are terutaline and salmeterol used for?
These are B2 agonists Terbutaline for asthma/premature labor Salmeterol has longer DOA than albuterol (clinically similar to albuterol)
54
What is Ritordine used for? What are side effects?
Premature labor Has some B1 so increase HR/CO Can cause pulmonary edema
55
What are these drugs? Midodrine (ProAmatine), oxymetazoline, tetrahydrozoline, xylometazoline?
A1 agonists Midodrine for postural hypotension Oxymetazoline, tetrahydrozoline, xylometazoline for nasal/ocular decongestants
56
What are clonidine, dexmedetomidine, and methyldopa?
A2 agonists Decreased SNS output from CNS, decreases BP and causes sedation and analgesia Clonidine- partial agonist Dexmedetomidine- full agonist
57
How does amphetamine and methamphetamine work? | Note: methylphenidate (ritalin) and pemoline (cylert) are for ADHD and are amphetamine variants
Amphetamine increases release of NE, 5HT, and dopamine, blocks repute and vesicular transport and inhibits MAO Methamphetamine is similar but has more CNS effects These drugs are impossible to predict how a pt will react
58
How do reserpine and cocaine work? | *Note that Cocaine can be used as a LA by working on Na channels to provide analgesia to the area
These are inhibitors of catecholamine storage and reuptake Reserpine- vesicles lose ability to store NE, 5HT, and dopamine and MAO breaks down excess, causes hypotension and depression Cocaine- prevents reuptake of catecholamines (NE,5HT,DA) and interferes with transport
59
What are the selectivity of these drugs? What is the class? Prazosin, terazosin, doxazosin, phentolamine, yohimbine, tolazoline?
Prazosin, terazosin, doxazosin α1>>>>α2 Phentolamine α2=α1 Yohimbine, tolazoline α2>>α1 These are alpha antagonists
60
What are the selectivity of these drugs? What is the class? Labetalol and carvedilol?
Labetalol, carvedilol β1=β2>α1>α2 | These are mixed alpha and beta antagonists
61
What are the selectivity of these drugs? What is the class? Metoprolol, atenolol, esmolol, propranolol, nodal, timolol, butoxamine?
Metoprolol, atenolol, esmolol β1>>>β2 Propanolol, nadolol, timolol β1=β2 Butoxamine β2>>>β1 These are beta-antagonists
62
What happens when we block alpha-1?
If we block alpha-1 we get rebound tachycardia because we will have vasodilation, decreased BP/PVR, then the baroreceptors kick in to increase HR (we also get postural hypotension)
63
What happens when we block alpha-2?
If we block alpha-2 we are blocking the negative feedback so we will have more NE available (alpha-2 inhibits neurotransmitter release, so when we block, it is not being inhibited anymore)
64
What are general alpha-antagonist effects with GU, eyes, and nasal?
Blockade in prostate/bladder causes muscle relaxation, eases micturation Miosis (constricted pupil) Increased nasal congestion (secretions)
65
What is phentolamine?
Nonselective alpha blocker | Causes dec BP and inc HR/CO
66
What doses are given for phentolamine for hypertensive emergencies vs. local infiltration (ex. dopamine)?
``` Hypertensive emergency (pheochromocytoma or autonomic dysreflexia): 30-70 mcg/kg IV, onset 2 min, DOA 10-15 min (works fast, stops working fast) Local infiltration dose: 2.5-5 mg in 10ml ```
67
What is phenoxybenzamine used for? How long is the onset and E1/2t?
``` Binds covalently meaning it will have a long acting drug Onset: 1 hr, E1/2t: 24 hours!! Works on alpha-1 more than alpha-2 Decreases SVR, vasodilation Used for pheochromocytoma and raynaud's ```
68
Why might your patients be taking prazosin or yohimibine?
Prazosin for pheochromocytoma, blocks A1, has less reflexive tachycardia Yohimibine is a A2 blocker, increases NE release, used for orthostatic hypotension and impotence
69
Why might your patients be taking tarazosin and tamulosin?
Long acting A1-agonist effective in prostatic smooth muscle relaxation Helpful for BPH
70
Why would we avoid Beta (b2 specifically) blockers in asthma patients?
If we block b2 they will be more likely to have a bronchospasm, asthma pt need the b2 for bronchodilation effects Note, when giving beta-1 antagonists, the drug can lose selectivity and still cause bronchospasm, so be careful!
71
Beta antagonist effects?
Heart: improve oxygen supply and demand balance Lungs: provokes bronchospasm Vessels: vasoconstriction in skeletal muscle, PVD worsen symptoms Kidney: decrease renin release, decreasing BP Pancreas: B2 release insulin, B1 mask symptoms of hypoglycemia
72
Beta agonist MOA?
Selective binding to beta receptors, competitive and REVERSIBLE inhibition (large doses of agents will overcome antagonists) Chronic use will upregulate receptors
73
What happens intra-op if the pt doesn't get their beta-blocker?
Higher incidence of intra-op MI if they don't get their beta blocker
74
What is propranolol?
Pure antagonist, equally blocking B1 and B2 (nonselective)
75
CV effects of propranolol?
Decrease HR, contractility, CO (especially during exercise and SNS outflow) B2-Increase PVR, increase coronary vasc resistance Sodium retention (bc renal is responding to CO drop)
76
Propranolol pharmacokinetics? (Protein bound? E1/2t? Clearance?)
``` Highly protein bound Significant first pass effect (need large po dose compared to IV dose) Metabolized in liver, E1/2t 2-3h Can decrease clearance of LAs Decreases first pass effect of fentanyl ```
77
Timolol uses?
Non selective b-blocker Tx glaucoma, decreases intraocular pressure by decreasing production of aqueous humor Eye drops can cause systemic absorption, decreases BP/HR and increasing airway resistance
78
What is nadolol's E1/2t?
Non selective b-blocker with no significant metabolism (renal/biliary elimination) E1/2t 20-40 hours!
79
Metoprolol uses? Dose? E1/2t?
Selective B1 blocker, prevents inotropy and chronotropy PO 50-400 mg (60% first pass effect) IV 1-15 mg E1/2t 3-4h
80
Atenolol uses? E1/2t?
Most selective b1-blocker. Has least CNS effects, doesn't cross BBB, so useful with people that have trouble with CNS side effects, also useful for CAD (prevents MI intra-op). NOT good for someone with renal disease bc it is not metabolized in the liver, excreted renal E1/2t 6-7h (longer in renal disease)
81
Why might someone be on betaxolol?
Selective b1 blocker. E1/2t 11-22h Taken for HTN Taken topical for glaucoma, especially asthmatics (less risk of bronchospasm)
82
Esmolol uses and dose? DOA?
``` B1 antagonist Rapid onset, short acting, used for dec HR without significant BP drop, can be used at the end of a case IV 0.5 mg/kg (10-180mg) Infusion 50-300 mcg/kg/min DOA less than 15 min ```
83
Esmolol E1/2t? metabolism?
E1/2t 9 min! | Rapidly hydrolyzed by plasma esterase's (not the same as sux, no effect on that)
84
B-blocker side effects?
CV: dec HR/contractility/BP, exacerbate PVD Lungs: bronchospasm, airway resistance Metabolism: alter and mask hypoglycemia symptoms (the HR will not increase like usual) Inhibit uptake of K into skeletal muscle CNS: fatigue, lethargy GI: N/V/D
85
RELATIVE contraindications of B-blockers?
Pre-existing AV heart block or heart failure Asthma DM Hypovolemia
86
B-blocker use?
hypertension treatment, angina management, decrease mortality in tx of post-MI, suppress tachyarrythmias, prevent SNS activity
87
What is labetalol used for? What are the cautions and side effects?
Selective A1,B1,B2 blocker (more B, 7:1) Decrease BP, SVR, HR (CO unaffected) Caution in renal pt, metabolize glucuronic acid, in urine Side effects orthostatic hypotension, bronchospasm, heart block, CHF, bradycardia
88
Labetalol dose and E1/2t?
Dose 0.1-0.5 mg/kg Give 5mg at a time for HTN, wait to redose, BP will drop in 5-10 after IV administration E1/2t 5-8h, prolonged in liver disease
89
Why should we call anticholinergics the name "antimuscarinics" instead?
These drugs don't work on Ach, they work on the muscarinic receptors. The name is misleading. They competitively antagonize Ach at the muscarinic receptors only. This is REVERSIBLE. This allows SNS response to dominate (blocks PSNS)
90
Atropine effects
Sedation, nausea + Inc HR +++ Relax smooth muscle ++ Anti-sialagogue +
91
Scopalamine effects
Sedation, nausea +++ Inc HR + Relax smooth muscle + Anti-sialagogue +++
92
Glycopyrrolate
Sedation, nausea 0! (Doesn't cross BBB) Inc HR ++ Relax smooth muscle ++ Anti-sialagogue ++
93
Which antimuscarinics are tertiary amines (alkaloids of belladonna plants)? Which are quaternary ammonium derivatives?
Tertiary amines: Atropine and scopalamine | Quaternary ammonium derivative: glycopyrrolate (robinal)
94
Compare onsets, duration of action and E1/2t of IV atropine and IV glycopyrrolate
Atropine onset 1 min, DOA 30-60 min, E1/2t 2h (18% unchanged in urine) Glycopyrrolate onset 2-3 min, DOA 30-60 min, E1/2t 1.25h (80% unchanged in urine) Scopolamine extensively metabolized with only 1% unchanged in urine
95
Why do CRNAs use antimuscarinics?
Pre-op: antisialagogue, sedation, nausea prevention Anytime: treat bradycardia (esp vagal, note: young have high tone= more tacky; old have less tone= less tacky), bronchodilation, mydriasis and cycloplegia for ophtho cases (don't give for glaucoma bc it increases IOP), reduce biliary and ureteral spasm with opioids ALWAYS give with anticholinesterase drugs to antagonize NMB
96
Ipratropium uses and dose?
Use: bronchodilation, given in asthmatics, COPD, and smokers before surgery MDI 40-80 mcg/2 puffs 0.25-0.5 mg neb Onset 30-90 min
97
Dose of scopolamine?
Preop IM: 0.3-0.5 mg or 5mcg/kg | Transdermal 1.5 mg (5mcg/h x 72h)
98
Dose of atropine?
IV pre-op: 0.2-0.4 mg IV brady: 0.4-1 mg Neb: 2 mg in 5 mL NS (bronchodilate)
99
Dose of glycopyrrolate?
0.1-0.2 mg IV for pre-op or bradycardia
100
What is central anticholinergic syndrome? How is it treated?
Caused by scopalamine or atropine (unlikely with glycopyrrolate as it doesn't cross BBB) Restlessness, hallucination, somnolence, unconscousness, delayed recovery in PACU Treat with physostigmine 15-60 mcg/kg IV repeat q1-2h prn
101
Why might your patient be on ipratropium (atrovent) or tiotropium (spiriva)
Muscarinic antagonist that has bronchodilator effects for COPD
102
Why might your patient be on oxybutynin (ditropan), tolterodine (detrol), darifenacin (enablex), or solifenacin (vesicare)?
Muscarinic antagonists good for overactive bladder Oxybutynin and tolterodine are nonspecific muscarinic antagonists Darifenacin and solifenacin are M3 specific
103
Where are M1-5 receptors, where are Nm and Nn receptors?
M1: CNS stomach M2: cardiac, CNS, airway smooth muscle M3: airway smooth muscle, glandular tissues M4/5: CNS Nm: skeletal muscle at NMJ Nn: autonomic ganglia, adrenal medulla, CNS

N550 Pharm (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions