Autonomic Drugs

Question 1

What is the nerve fiber type and primary neurotransmitter of the sympathetic nervous system?

Answer 1

Nerve Fibers: Adrenergic

NT: Norepinephrine

Question 2

What is the nerve fiber type and primary neurotransmitter of the parasympathetic nervous system?

Answer 2

Nerve Fibers: Cholinergic

NT: Acetylcholine

Question 3

What receptor types respond primarily to Acetylcholine

Answer 3

Muscarinic and Nicotinic

Question 4

What receptor types respond primarily to norepinephrine

Answer 4

Alpha and Beta

Question 5

If you wanted to treat asthma using drugs that affect the ANS what drugs could you use, what are their mechanisms of action?

Answer 5

Ipratropium or Tiotropium (Anticholinergics via muscarinic receptors)

Albuterol
(Beta2 agonist)

Question 6

If you wanted to slow down heart rate, what drugs could you use, what are their MOA?

Answer 6

Clonidine (sympathomimetic)

Doxazosin, Prazosin, Tamsulosin, Terazosin, (Alpha blockers)
Atenolol Metoprolol, Propranolol (Beta Blockers)

Question 7

If a person had an overactive bladder, what medications would slow it down and what are their MOA?

Answer 7

Oxybutynin (Ditropan)
Tolterodine (Detrol)
Anticholinergics

Question 8

What are two possible ways cholinomimetics could exert their effect.

Answer 8

Direct Acting: Agonizing cholinergic receptors (muscarinic or nicotinic)

Indirect Acting:
Inhibiting acetylcholinesterase

Question 9

Briefly summarize the general physiological effects exerted by cholinomimetics.

Answer 9

Pupil contraction
Decreased HR/Contractile Force
Bronchial contraction
Increased GI motility
Increased bladder contraction

Question 10

What are the clinical uses for cholinomimetics?

Answer 10

Glaucoma
(pilocarpine, methacholine, carbachol, physostigmine, demecarium, echothiophate)

Myasthenia Gravis
(pyridostigmine, neostigmine) 

Alzheimers
(donepazil;Aricept, galantamine;Razadyne, rivastigmine;Exelon)

Smoking cessation
(varencicline;Chantix)

Question 11

Briefly summarize the general physiological effects exerted by anticholinergics.

Answer 11

Pupil dilation
Tachycardia (blockage of vagal slowing)
Bronchodilation
Decreased salivation and GI motility
Bladder relaxation
CNS impairment (confusion)

Question 12

What are the clinical uses for anticholinergics?

Answer 12

Parkinson’s Disease
(benztropine)

Asthma/COPD
(ipratropium, tiotropium)

IBS (diarrhea)
(Atropine, dicyclomine, hysoscyamine)

Urinary incontinence
(oxybutynin;Ditropan, tolteradone;Detrol)

Motion sickness
(scopolamine, meclizine;Antivert, dimenhydrinate)

Question 13

Oh snap! You just ate a shroom while inhaling low doses of nerve gas. Now you’re sweating, wheezing, vomiting and convulsing. What medication might just save your life?

Answer 13

High doses of atropine.

Question 14

“Can’t see, can’t spit, can’t pee, can’t shit” This pneumonic applies to which class of drugs, and why?

Answer 14

Anticholinergics. Result in dry mouth, mydriasis, tachycardia, hot/flushed skin, agitation and delirium,decreased GI motility and urinary retention.

Question 15

Briefly summarize the physiological effects of sympathomimetics.

Answer 15

Fight or flight:

Increased HR
Peripheral vasoconstriction
Bronchodilation
Wakefulness and alertness

Question 16

What are the clinical uses for sympathomimetics?

Answer 16

Glaucoma
(brimonidine)

Hypotension
(midodrine)

Decongestant
(phenylephrine a1, pseudoephedrine a1)

Acute heart failure
( dobutamine b1, isoproterenol b1)

Respiratory
(albuterol)

Hypertension
(clonidine a2)

Uterine contractions:
(terbutaline b2)

Anaphylaxis:
(epinephrine)

Question 17

Briefly list the physiologic effects of antiadrenergics.

Answer 17

Slower HR
Lower BP
Bronchocontraction
Erectile dysfunction
Dulling of hypoglycemia symptoms

Question 18

What are some clinical uses of antiadrenergics?

Answer 18

Hypertension

doxazosin, prazosin, tamsulosin, terazosin alpha blockers; atenolol, metoprolol, propranolol