ANS pharmacology & pathophysiology 4 Flashcards by Hannah Garrison

Which is NOT a competitive inhibitor of acetylcholine?
a. atropine
b. nicotine
c. scopolamine
d. glycopyrrolate

b. nicotine

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Cholinergic agonists mimic the actions of

ACh but differ in their nicotinic and muscarinic activities

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Muscarinic antagonists like atropine are

competitive inhibitors of ACh at parasympathetic muscarinic receptors

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Side effects of muscarinic antagonists include

tachycardia
dry mouth
decreased GI motility
bronchodilation

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A common self-administered cholinergic agonist is

nicotine

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Ganglia of __________ are activated by nicotine

the SNS and PNS

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In the CV system, nicotine’s effects lead to

unopposed sympathomimetic activity causing the vascular tone to increase

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Other examples of cholinergic agonists include

methacholine
bethanachol
carbamychloline
pilocarpine

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Methacholine is used as a provocative agent to identify

reactive airway disease in those who do not have clinically apparent signs of asthma

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Methacholine evokes

bronchoconstriction
increases airway secretions
impairs peak expiratory flow rates via M3

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Bethanachol is relatively selective for

M3 receptors in the GI and urinary tracts and is used to treat nonobstructive urinary retention in the perioperative period

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Carbamylcholine and pilocarpine produce

miosis and have applications in treating glaucoma

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What is the specificity of atropine, glycopyrrolate, and scopolamine?

little to no muscarinic subtype specificity

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Low does atropine (<0.1 mg) may cause or worsen

bradycardia by blocking presynaptic M1 receptors

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Muscarinic antagonist effects of atropine dose 0.5-1.0 mg:

increased HR
dry mouth
lack of sweating
feeling thirsty
pupillary dilation

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Muscarinic antagonist effects of atropine dose 2-5 mg:

tachycardia
palpitations
mydriasis
cycloplegia
restlessness
confusion

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Muscarinic antagonist effects of atropine dose >5 mg:

profound tachycardia
mydriasis
cycloplegia
hot flushed skin
fever hallucinations
coma
death

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What should be given in the setting of atropine overdose?

physostigmine 1-2 mg IV b/c it will cross the BBB

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What effect does diltiazem have on the AV node?
a. sympathomimetic
b. negative inotropic
c. positive inotropic
d. negative dromotropic

d. negative dromotropic

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A dromotropic agents affects the

conduction speed in the AV node of the heart

What are the cardiac and vascular effects of calcium channel blockers?

vasodilation
negative chronotropic
negative inotropic
negative dromotropic effects
impact on baroreceptors

What are the three major classes of Ca2+ channel blockers?

dihydropyridines
benzothiazepines
phenylalkylamines

What are examples of dihydropyridines?

nifedipine
nimodipine
nicardipine
clevidipine

What are examples of benzothiazepines?

diltiazem

What are examples of phenylalkylamines?

verapamil

CCBs drugs produce __________ relaxation of arterial than venous smooth muscle

greater

Many of the CCBs induce

coronary artery vasodilation and inhibit coronary artery vasospasm

The CCBs reduce

myocardial oxygen consumption

Antiarrhythmics that depress electrical impulses in the SA and AV nodes include

verapamil and diltiazem

Calcium channel blockers are widely used to treat

hypertension arrhythmias PVD cerebral vasospasm angina

What CCBs should be used to control HR?

verapamil and diltiazem- good choices with tachycardia, atrial fibrillation, or aflutter

What CCBs should be used to control contractility?

highest to lowest that impair contractility: verapamil> nifedipine> diltiazem> nicardipine

What CCBs should be used to control vascular tone?

nifedipine and nicardipine are best used in the treatment of HTN from elevated SVR

____________ is the only CCB proven to reduce M & M from cerebral vasospasm.

Nimodipine

CCBs preserve _______ while reducing _________

preload; LV afterload

Describe Verapamil's effect on vasodilation, chronotropy, dromotropy, and inotropy.

not a potent vasodilator strong depressor of chronotropy, dromotropy, and inotropy

Use of verapamil in the presence of a B1 antagonists may cause

complete heart block or profound myocardial depression

What is the dosing of verapamil?

2.5-10 mg over 2 minutes

What is diltiazem's effect on vasodilation, chronotropy, and dromotropy?

produces arteriolar vasodilation potent negative chronotropic and dromotropic effects

Clevidipine is highly selective for

arterial smooth muscle without negative chronotropic or inotropic effects

________ may be seen with clevidipine

Reflex baroreceptor-mediated increases in HR

Nimodipine is useful in treating

cerebral vasospasm because it crosses the BBB producing cerebral arterial vasodilation

What is the effect on nifedipine on venous and arterial tone?

selective arterial vasodilator without effect on venous tone

Nifedipine is often combined with a

b1 antagonist to prevent reflex tachycardia

Nicardipine is similar to

nifedipine but has longer duration will see baroreceptor reflex tachycardia

Which calcium channel blocker is devoid of chronotropic effects and is ideally suited for IV infusion?

clevidipine

Which type of calcium channel do CCBs target?

L-type

Which calcium channel blocker is often prescribed for Raynaud's disease?

Nifedipine