Autonomic Nervous System 2 Flashcards
Which system exerts the predominant to in an effector organ?
For effector tissues with DUAL INNERVATION
Parasympathetic division is dominant, including: sinoatrial and atrioventricular nodes of the heart, the pupils, gastrointestinal and genitourinary muscles and sphincters
Sympathetic division is dominant only in terms of vascular tone and thermo sweat glands
What system is the predominant tone in arterioles?
Sympathetic- receptor type a1
What system is the predominant tone in veins
Sympathetic - receptor type @1
What system is the predominant tone in the heart?
Parasympathetic receptor type -M2
What system is the predominant tone in iris?
Parasympathetic - receptor type M3
What system is the predominant tone in the ciliary muscle?
Parasympathetic M3
What system is the predominant tone in the GI tract?
Parasympathetic- M3
What system is the predominant tone in the urinary bladder?
Parasympathetic-M3
What system is the predominant tone in salivary glands?
Parasympathetic -M3
What system is the predominant tone in sweat glands?
Sympathet8c- M3
What. Are the two types of ANS drugs?
Cholinergic drugs
Adrenergic drugs
What are the types of adrenergic drugs?
Adrenergic agonists adrenergic antagonists
What are the types of cholinergic drugs?
Cholinergic agonists and cholinergic antagonists
Describe cholinergic drugs
Are medications that inhibit, enhance, or mimic the action of the neurotransmitter acetylcholine
Cholinergic agonists: enhance or mimic acetylcholine effects
Cholinergic antagonists: block the action of acetylcholine
Describe adrenergic drugs
Are drugs that mimic or interfere with the release or action of norepinephrine and epinephrine
Adrenergic agonists: medications that act on receptors stimulated by norepinephrine or epinephrine
Adrenergic antagonists: inhibit the norepinephrine or epinephrine effect at the adrenergic receptors
What are the direct cholinergic agonists?
Acetylcholine
Carbachol
Bethanechol
Pilocarpine
Metacholine
What are the types of indirect cholinergic agonists?
- those that lead to reversible inhibition of acetylcholinesterase
- those that lead to irreversible inhibition of acetylcholinesterase
What are the indirect cholinergic agonists that lead to irreversible inhibition of acetylcholinesterase?
Orangophosphate poisoning:
- Parathion
- Malathion
Nerve agents
What are the indirect cholinergic agonists that lead to reversible inhibition of acetylcholinesterase?
Donepezil
Galantamine
Rivastigmine
Edrophonium
Physostigmine
Neostigmine
Pyridostigmine
What does Carbachol do?
Direct cholinergic agonists-relieves intraocular pressure in open angle glaucoma
What does methacholine do?
Challenge test for diagnosis for Bronchial Asthma
What does Pilocarpine?
Direct cholinergic agonists
Relieves intraocular pressure in open and closed angle glaucoma
Potent stimulator of sweat, tears, and saliva (Sjogren syndrome)
What does Bethanechol do?
Bethanechol
Activates bladder smooth muscle
Urinary retention
What does Donepizil, rivastigmine, galantamine do?
These are indirect cholinergic agonists (reversible inhibition of acetylcholinesterase )
First line for Ahlzeimer’s disease
What dies Edrophonium do?
Indirect cholinergic agonists (reversible inhibition of acetylcholinesterase)
Historically used to diagnose Myasthenia Gravis (now replaced by anti-AChR Ab)
What does Nostigmine do?
Indirect cholinergic against (reversible inhibition to acetylcholinesterase)
Post-operative and neurogenic ileus
Reversal of neuromuscular blockade
What does Pyridostigmine do?
Indirect cholinergic against (reversible inhibition to acetylcholinesterase)
Myasthenia graves medication
What is orangophosphate poisoning?
Farmers using insecticides (Malathion, Parathion),
Symptoms:
Muscuranic symptoms: diarrhea, urination, miosis, bronchospasm, bradychardia, emesis, lacrimation, sweating, salvation
Nicotinic symptoms: neuromuscular blockade
CNS effect: respiratory depression, lethargy, seizures, coma
How is orangophosphate poisoning treated?
Atropine (antimuscuranic drug )
Pralidoxime (reactive acetylcholinesterase)
What are the two types of cholinergic antagonists?
Muscuranic receptors antagonists(antimuscuranic/anti cholinergic)
And nicotinic receptor antagonists
What are the types of cholinergic antagonists- Muscuranic receptor antagonists?
- Atropine
- homatropine
- tropicamide
- benzotropine
- trihexyphenidyl
- glycopyrrolate
- hyoscyamine
- ipratropium
- tiotropium
- oxybutynin
- scopolamine
What is the only type of ganglionic nicotine receptor antagonists (cholinergic antagonists)?
Nicotine
What are the types of neuromuscular blockers (nicotine receptor antagonist)p- a type of cholinergic antagonists)?
Non-depolarizing agents:
- Rocuronium
- Pancuronium
- Cisatracurium
- Vecuronium
Depolarizing agents:
-Succinylcholine
What is atropine? What are the clinical applications?
Prototype of the antimuscuranic drugs
Clinical applications:
Bradychardia
Ophthalmic applications: pupil dilation and cycloplegia
What are the adverse effects of atropine?
Hint to remember: Hot as a hare Dry as a bone Red as a beet Blind as a bat Mad as a hatter Full as a flask
Adverse effects:
- increase body temperature
- increase heart rate
- dry mouth
- dry, flushed skin
- cycloplegia
- constipation
- disorientation
- urinary retention
Who is jimson weed poisoning primarily found in?
Adolescents who seek the hallucinogenic effects of the plant
How long before there are symptoms of jimson weed intoxication?
Usually begin 30-60 minutes after ingestion
What are the symptoms of jimson weed intoxication?
Initial symptoms include hallucinations, dry mucous membranes, thirst, dilated pupils, blurred vision, and difficulty speaking and swallowing
Subsequent effects may include tachycardia, urinary retention, and ileus
Rarely, late symptoms may include hyperthermia, respiratory arrest, and episodes of seizure
What are the types of adrenergic agonists?
Direct acting
Indirect acting
Direct and indirect (mixing)
What are the direct acting adrenergic agonists?
- Albuterol
- Salmeterol
- Terbutaline
- Dobutamine
- Dopamine
- Epinephrine
- Fenoldopam.
- Isoproterenol
- Midodrine
- Mirabegron
- Norepinephrine
- Phenylphrine
What are the indirect acting adrenergic agonists?
Amphetamine
Cocaine
What are the (mixed) adrenergic agonists?
Ephrine
Pseudoephedrine
What are the alpha-2 agonists adrenergic agonists?
- Clonidine
- Guanfacine
- a-methyldopa
- Tizanidine
What is the purpose of albuterol, salmeterol, terbutaline?
Direct acting adrenergic. agonist
B2>B1 stimulation
Use: bronchial asthma, chronic obstructive pulmonary disease (COPD)
What is the purpose of dobutamine?
Direct acting adrenergic agonists
B1>B2. Stimulation , a stimulation
Use: heart failure, carcinogenic shock
What is the use of dopamine?
Direct acting adrenergic agonists
D1= D2> B> a stimulation
Use: unstable bradychardia
What is epinephrine used for?
Direct acting adrenergic agonists
B> a stimulation
Use: anaphylaxis
What is phenylephrine used for?
Direct acting adrenergic agonists
a1 > a2
Use: hypotension (vasoconstrictor)
What is amphetamine(methylphenidate)?
Indirect-acting adrenergic agonists
Norepinephrine reuptake inhibitor and releases stored Catecholamines
Use: narcolepsy, attention deficit hyperactivity disorder(ADHD)
What is cocaine?
Indirect-acting adrenergic agonists
Powerful addictive stimulant drug
Norepinephrine reuptake inhibitor
Adverse effects: vasoconstriction with extreme hypertension, coronary vasospasm
What is the use of a-methyldopa?
Alpha 2 adrenergic agonists
Use: hypertension in pregnancy
What is the use of Tizanidine ?
Alpha 2 adrenergic agonists
Use: relief spasticity
What is the use of clonidine?
Alpha 2 adrenergic agonists
Use: hypertensive urgency (limited situations)
What are the types of adrenergic antagonists ?
Alpha blockers and beta blockers
What are the types of alpha blockers (adrenergic antagonists)?
Non-selective:
1. phenoxybenzamine
- Phentolamine
Alpha-1-selective:
- Prazosin
- Terazosin
- Tamsulosin
Alpha- 2- selective:
Mirtazapine
What are the types of beta blockers?
- Acebutolol
- Atenolol
- Betaxolol
- Bisoprolol
- Cervedilol
- Esmolol
- Labetalol
- Metoprolol
- Nadolol
- Pindolol
- Propranolol
- Timolol
