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Pharmacology > Autonomic Nervous System > Flashcards

Autonomic Nervous System Flashcards

1
Q

“Fight or Flight”

A

Sympathetic Nervous System

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2
Q

Stimulus for the SNS

A

Neurotransmitters

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3
Q

What is a stimulus?

A

Something to get it started

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4
Q

3 Neurotransmitters

A
  1. Norepinephrine
  2. Epinephrine
  3. Dopamine
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5
Q

What do the 3 neurotransmitters do to the SNS?

A

The 3 neurotransmitters get the SNS going and keep it going.

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6
Q

Where are norepinephrine and epinephrine located?

A

The adrenal gland.

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7
Q

Where does dopamine come from?

A

The brain. (Technically, everywhere)

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8
Q

What 3 items halt the stimulus?

A
  1. Re-uptake pump
  2. Enzymes
  3. Liver Metabolism
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9
Q

What are the 2 stopping (halting) enzymes?

A
  1. MAO (monoamine oxidase)

2. COMT

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10
Q

What do MAO and COMT do to the neurotransmitters?

A

They break down the neurotransmitters so they don’t work anymore.

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11
Q

How does the re-uptake pump halt the neurotransmitters?

A

The re-uptake pump brings the neurotransmitters back home.

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12
Q

How does liver metabolism halt the neurotransmitters?

A

When the neurotransmitters get to the liver, the liver breaks them down.

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13
Q

What would happen if there wasn’t a halt to the stimulus?

A

If nothing stopped the neurotransmitters the body would be on a high all the time.

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14
Q

SNS Receptors are _____ receptors?

A

Adrenergic Receptors

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15
Q

What do adrenergic receptors do?

A

They stimulate a sympathetic response.

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16
Q

What are the 4 adrenergic receptors?

A
  1. Alpha 1
  2. Alpha 2
  3. Beta 1
  4. Beta 2
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17
Q

Alpha 1 receptors are also known as?

A

Alpha blockers

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18
Q

How can the body respond to Alpha 1 receptors?

A
  • Primarily smooth muscle contraction
  • Vasoconstriction of coronary arteries
  • Vasoconstriction of veins
  • Decreased motility of smooth muscle of GI tract
  • Glycogenolysis and gluconeogenesis from adipose tissue and liver
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19
Q

Do Alpha 1 receptors increase or decrease speed of the GI tract?

A

Decrease - no time to stop to go to the bathroom in fight or flight

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20
Q

What does a stimulus effect?

A

Receptors

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21
Q

What is gluconeogenesis?

A

Break down fat and glycogen for energy

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22
Q

Is the autonomic nervous system voluntary or involuntary?

A

involuntary

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23
Q

How can the body respond to Alpha 2 receptors?

A
  • Primarily located at presynaptic ganglion

- Few drugs that impact these receptors

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24
Q

How can the body respond to Beta 1 receptors?

A
  • Increase cardiac output

- Increase renin release in kidneys

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25
Q

Beta 1 receptors are known to effect what organ?

A

Heart

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26
Q

What is renin?

A

Renin is a vasoconstrictor

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27
Q

How can the body respond to Beta 2 receptors?

A

-Relax smooth muscles
(bronchi, urinary sphincters, bladder, uterus,
arteries)
-Contract GI sphincters
-Dilate arteries to skeletal muscles and cardiac muscle
-Increase renin from kidneys

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28
Q

What happens to vital signs if you constrict veins?

A

BP goes up and so does heart rate

29
Q

Important Note:

A

Drugs can be selective OR activate multiple receptors.

30
Q

Selective Receptors?

A

Only effect one receptor. (alpha 1 or beta 1 or beta 2)

31
Q

Multiple Receptors?

A

May affect a lot, alphas and betas.

Older drugs: more general = more side effects

32
Q

What do Adrenergic Agents do?

A

Stimulates sympathetic response.

33
Q

Adrenergic Agents are also called?

A

Adrenergic Agonists

Sympathomimetics

34
Q

Adrenergic Agents mechanism of action?

A

Stimulates sympathetic response, mimicking the sympathetic response

35
Q

Adrenergic Agents Indications:

A
  • Alpha 1: hypotension, nasal congestion
  • Beta 1: cardiac arrest, heart failure, shock
  • Beta 2: asthma, premature labor
36
Q

In the Adrenergic Agents indications, Beta 1…

A

Beta 1 is used to stimulate the heart

37
Q

In the Adrenergic Agents indications, Beta 2…

A

Relaxes smooth muscles in asthma and premature labor; this can relax the muscle that are contracting in the uterus

38
Q

Adrenergic Agents Contraindications

A
  • Known allergy

- Severe hypertension

39
Q

Adrenergic Agents side effects and adverse effects in the CNS?

A

CNS: HA, restlessness, excitement, insomnia and euphoria

Hyped up

40
Q

Adrenergic Agent side effects and adverse effects for cardiovascular?

A

CV: vasoconstriction, hypertension, tachycardia, palpitations, dysrhythmias

Palpitations - how the patient feels with a fast heart rate

41
Q

Adrenergic Agent interactions

A
  • Adrenergic blocking agents: reduced therapeutic effects
  • Anesthetics: risk of cardiac dysrhythmias
  • TCA: increased vasopresser effects: hypertension; respiratory depression
  • MAO inhibitors: hypertensive crisis
42
Q

What is TCA?

A

Tricyclic antidepressant

High blood pressure already

43
Q

Adrenergic Blocking Agents are also know as?

A

Adrenergic antagonists and sympatholytics

44
Q

Adrenergic Blocking Agents mechanism of action?

A

Blocking or preventing of sympathetic response

Blocking the receptors

45
Q

Adrenergic Blocking Agents indications?

A
  • Alpha 1 blockers: hypertension, BPH
  • Beta 1 & 2 blockers: angina, hypertension, dysrhythmias, migraines, glaucoma

Angina - heart pain from constriction of arteries
Migraines - can be caused by vasoconstriction
Glaucoma - pressure in eye; dilating causes pressure

46
Q

Adrenergic Blocking Agents contraindications?

A
  • Alpha blockers: drug allergy, peripheral vascular disease, CAD, renal or liver disease
  • Beta blockers: drug allergy, uncompensated heart failure, heart block or bradycardia, severe pulmonary disease

Bradycardia - you don’t want to slow the heart rate even more
If you have a rescue inhaler you don’t want to block the lungs

47
Q

Adrenergic Blocking Agents side effects and adverse effects?

A
  • Alpha blockers: based on vasculature

- Beta blockers: usually mild. May mask hypoglycemia. Angina or precipitate MI if withdrawn suddenly

48
Q

Adrenergic Blocking Agents interactions?

A
  • Adrenergic Agonists (epi, dopamine, etc) = decrease effects of each
  • Other CV drugs, diuretics = potentiate effects = profound hypotension
  • Anti-cholinergic and hypoglycemias = antagonistic effects

CV drugs if they do the same thing it could increase the effects

49
Q

Adrenergic antagonist is…

A

Antagonist is “stronger” than the agonists

50
Q

“Rest and Digest”

A

Parasympathetic Nervous System

51
Q

What is the initiating stimulus in the PNS?

A

Imitating Stimulus: neurotransmitters

-Acetylcholine (Ach)

52
Q

What is the halting stimulus in the PSN?

A

Halting stimulus: enzyme

- cholinesterase - breaks down Ach ( almost immediately )

53
Q

PSN receptors?

A

Receptors: cholinergic receptors

- nicotinic
- muscarinic
54
Q

Cholinergic Agents are also known as?

A

Cholinergic agonists and parasympathomimetics

Parasympathomimetics - mimics the parasympathetic response

55
Q

What do Cholinergic Agents do?

A

Stimulates the parasympathetic response

  • Direct-acting = act on receptors
  • Indirect-acting = increase available Ach by inhibiting cholinesterase; non-selective
56
Q

What does cholinesterase do?

A

Cholinesterase breaks down Ach, so if I stop this, there is more Ach available = more of a parasympathetic response

57
Q

Cholinergic Agents mechanism of action?

A

SLUDGE: salivation, lacrimation, urinary incontinence, diarrhea, GI cramps, and emesis

  • Stimulate intestine and bladder
  • Constriction of pupil (miosis), decrease IOP
  • Constriction of bronchi and airways (you don’t need to breathe a lot)

Decrease IOP - constrict; most glaucoma eye drops are cholinergic

58
Q

Cholinergic Agents indications?

A
  • Reduce IOP
  • Treat various GI and bladder disorders
  • Diagnosis and treatment of myasthenia gravis (neuromuscular disease - muscle spasms)
  • Treatment of Alzheimer’s disease
59
Q

Cholinergic Agents contraindications?

A

Drug allergy, GI or GU obstruction, bradycardia (will just slow HR more), COPD (don’t want to constrict bronchioles), hypotension (will just relax more)

GI or GU obstruction = if you have an obstruction you don’t want to force it

60
Q

Cholinergic Agents side effects and adverse effects?

A

Overstimulation if the PSNS

Ex) going to the bathroom All The Time

61
Q

Cholinergic Agents interactions?

A

Anticholinergics, antihistamines and sympathomimetics = antagonistic effects = decrease response

Antihistamines and sympathomimetics do the opposite

62
Q

What do Anti-Cholinergic Agents do?

A

Blocking the parasympathetic response

63
Q

Anti-Cholinergic Agents are also known as?

A

Cholinergic blocking agents and parasympatholytics

64
Q

Anti-Cholinergic Agents mechanism of action?

A

(Opposite of cholinergic)

  • Pupils dilate (increase IOP - like at the eye doctor)
  • Decrease in GI motility, GI secretions, and salivation
  • Increase heart rate (sometimes)
  • Decreased bladder contraction = urinary retention
  • Reduce sweating; dry mucous membranes
  • Prevents bronchial constriction
65
Q

Anti-Cholinergic Agents indications?

A

(Anti-cholinergics)

  • Decreasing muscle rigidity and diminish tremors
  • Bradycardia
  • Chronic bronchitis, exercise induced bronchospasms, COPD ( not because they open airways, but they prevent constriction)
  • Irritable bowel disease and diarrhea
  • Neurogenic bladder and incontinence
66
Q

Anti-Cholinergic Agents contraindications?

A

Known drug allergy, narrow-angle glaucoma, acute asthma (rescue), myasthenia gravis, acute CV instability, GI or GU obstruction

67
Q

Anti-Cholinergic Agents side effects and adverse effects?

A

Increased HR; CNS excitation, restlessness; increased IOP; dry mouth; constipation; urinary retention; decreased bronchial secretions.

Main side effect is DRYING!!!

68
Q

Anti-Cholinergic Agents interactions?

A

Antihistamines, phenothiazines, TCA, MAOI’s = potentiate effects p

Pharmacology (12 decks)

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