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Pharmacology > Autonomic Nervous System > Flashcards

Autonomic Nervous System Flashcards

0
Q

What are come commonly used ANS drugs?

A

Atropine, Epinephrine, and Norepinephrine.

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1
Q

What is the Autonomic Nervous system made up of?

A

Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS)

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2
Q

What drug class is Atropine in?

A

Muscarinic Antagonists

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3
Q

What drug class is Epinephrine in?

A

Adrenergic Agonists

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4
Q

What drug class is norepinephrine in?

A

Adrenergic Agonists.

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5
Q

What are the therapeutic uses of Atropine?

A
  • Antidote for overdoses of cholinergic agonists.
  • Antisecretory- blocks upper & lower respiratory tract secretions prior to surgery.
  • Cardiac Arrest/ “code blue”- treats severe bradycardia & asystole.
  • Antispasmodic & antidiarrheal- relaxes GI tract and bladder
  • Ophthalmic- mydriatic- useful for ophthalmic exams and eye surgery
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6
Q

What are the therapeutic uses for epinephrine?

A
  • Treats asthma (inhaled)
  • Treats anaphylactic shock (inj, IV, or SC, EpiPen)
  • Stops small bleeding (inj.)
  • Injected with local anesthetics (like lidocaine) to prolong their effectiveness.
  • Cardiac arrest, Code Blue (inj).
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7
Q

What are the therapeutic uses of norepinephrine?

A

*severe septic shock (inj)

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8
Q

what are the mechanisms of action of muscarinic agonists? Name a medication.

A

bethanecol (Urecholine)
*mechanism of action: Bind directly to muscarinic receptors & mimic ACh. Bethanecol preferentially stimulates muscarinic receptors of the GI & urinary tract.

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9
Q

What are some adverse effects of muscarinic agonists?

A

Bethanecol

*incontinence, dehydration, diarrhea, tearing, drooling, heart burn, chest tightness, and low heart rate.

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10
Q

What are some therapeutic uses of muscarinic agonists?

A

Bethanecol
Therapeutic uses:
*treat atonic bladder & urinary retention in postpartum & postoperative patients.
*Rarely used to treat gastroesophageal reflux disease (GERD) to increase GI motility

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11
Q

What are the mechanisms of action of muscarinic agonists- Cholinesterase inhibitors?

A
  • Acetylcholinesterase is the body’s natural enzyme that normally inactivates acetylcholine by cleaving it into acetate and choline. In other words, AChE normally reduces ACh activity -“turns it off”
  • This class of drugs inhibits the activity of AChE. In other words, these drugs inhibit the breakdown of ACh, thereby increasing ACh levels/activity. This prolongs the lifetime of the endogenously released ACh.
  • At therapeutic doses, these drugs affect mostly muscarinic & nicotinic receptors with only minimal effects on the preganglionic ACh.
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12
Q

What is the name of a drug in the class Muscarinic Agonists- Cholinesterase Inhibitors?

A

Donepezil (Aricept)
Rivastigmine (Exelon)
Galantamine (Razadyne)

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13
Q

What is the mechanism of action for the three drugs in the class Muscarinic Agonists- Cholinesterase inhibitors?

A

they have the same mechanisms of action for the drug class but they also inhibit the enzyme AChE, but these agents are more specific for the acetylcholinesterases found in the CNS (brain)

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14
Q

What are the therapeutic uses for these 3 drugs in the Muscarinic Agonist- Cholinesterase inhibitors class?

A
  • before we can understand uses of these drugs, we must first understand a little about Alzheimer’s dementia (AD). AD is caused by the destruction/ degeneration of cholinergic neurons leading abnormally low levels of CNS ACh. ACh is an importnant neurotransmitter in the brain; it regulates higher learning, memory, reasoning, behavior, and emotional control. Therefore, to treat AD symptoms, we must increase ACh levels.
  • Treat symptoms of AD. These drugs will not slow down neuronal destruction and they do not “repair” the damaged brain tissue; they merely improve symptoms (cognition, behavior, and daily function) by increasing ACh levels. Patients and caregivers should not expect dramatic improvements; drug benefits are mild.
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15
Q

What are some adverse effects of the three drugs in the muscarinic agonist- Cholinesterase inhibitors class?

A
  • nausea
  • vomiting
  • dyspepsia
  • diarrhea
  • bronchoconstriction
  • liver injury
  • Cardiovascular effects.
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16
Q

what are the physiological actions of Muscarinc Antagonists?

A
  • Exocrine glands: lower salivary & bronchial secretions & lower acid production.
  • Heart: Increased heart rate (tachycardia)
  • Smooth muscle: Relaxation of the bronchi, decreased tone of the urinary bladder, (urinary retention), decreased tone and motility of the GI tract.
  • Eye: Mydriasis (pupil dilation) & cycloplegia (inability to focus for near vision)
17
Q

What are the mechanisms of action for Muscarinic Antagonists?

A
  • Competes with ACh for muscarinic receptors
  • These drugs bind with muscarinic receptors but do not stimulate them. They BIND AND BLOCK.
  • These drugs have no direct effects on tirrues themselves, but by blocking the PNS impulses, the SNS impulses are left unopposed.
  • These drugs have pharmacological actions similar to activation of the SNS.
18
Q

What are the Anticholinergic Adverse Effects of Muscarinic Antagonists?

A
  • Dry mouth
  • Blurred Vision (blurred near vision)
  • Constipation
  • Urinary retention
  • Tachycardia
  • CNS: memory loss, confusion, restlessness, agitation, hallucination, & delirium
19
Q 
What are the drugs names in the class Muscarinic Antagonists for Overactive Bladder?
(OAB)
A 
oxybutynin (Ditropan)
darifenacin (Enablex)
solifenacin (VESIcare)
tolterodine (Detrol)
trospium (Sanctura)
fesoterodine (Toviaz)
20
Q

What are the names of drugs listed in the class Adrenergic Agonists?

A 
epinephrine (Adrenaline)
norepinephrine (Levophed)
isoproterenol (Isuprel)
dobutamine (Dobutrex)
dopamine 
phenylephrine (Neo-Synephrine)
albuterol (Proventil, Ventolin)
21
Q

What are the Vascular effects of epinephrine (an adrenergic agonist)?

A
  • alpha 1 vasoconstriction in skin & mucous membranes.
  • beta 2 vasodilation in vasculature of liver, heart, & skeletal muscles.
  • Increases blood pressure overall.
22
Q

What are the cardiac effects of epinephrine? (an Adrenergic agonist)

A
  • beta 1 increases heart rate (positive chronotrope)

* beta 1 increases force of heart contractions (positive inotrope)

23
Q

What are the pulmonary effects of epinephrine? (an adrenergic agonist)

A
  • beta 2 bronchodilation

* alpha 1 decreased respiratory secretions.

24
Q

What are the physiological effects of isoproterenol? (an adrenergic agonist)

A
  • beta 2 vasodilation; decreases blood pressure
  • beta 2 bronchodilation
  • beta 2 hyperglycemia in diabetes
  • beta 1 dramatic increase in heart rate (due to both direction stimulation & reflex tachycardia)
  • beta 1 increases force of contraction
25
Q

what are the therapeutic uses of isoproterenol? (an adrenergic agonist)

A
  • treat bradycardia (inj)

* treat asthma (inhaled)

26
Q

what are the physiological effects of dobutamine? (an adrenergic agonist)

A
  • increased force of contraction
  • Increased cardiac output
  • Makes the heart pump more effectively without increasing heart rate or oxygen demand of the heart very much.
27
Q

What are the therapeutic uses of dobutamine? (an adrenergic agonist)

A

*treat acute heart failure (inj)

28
Q

what are the vascular effects of dopamine? (an adrenergic agonist)

A
  • low doses- vasoconstriction (except in the kidney & brain)

* higher doses- vasoconstriction in all areas.

29
Q

What are the cardiac effects of dopamine? (an adrenergic agonist)

A
  • Beta 1 increased force of contraction; beta 1 increased systolic blood pressure
  • increased cardiac output
  • will increase blood pressure without cutting off blood supply to the kidneys. In cases of cardiovascular shock, dopamine will usually increase kidney function.
30
Q

What are the therapeutic uses of dopamine? (an adrenergic agonist)

A
  • *Drug of choice to treat cardiovascular shock

* treats acute heart failure

31
Q

what are the physiological effects of phenylephrine? (an adrenergic agonist)

A
  • alpha 1 intense vasoconstriction of skin & mucous membranes; increased blood pressure
  • reflex bradycardia
32
Q

what are the therapeutic uses of phenylephrine? (an adrenergic agonist)

A
  • decongestant (short-acting nasal sprays, Afrin)
  • increase blood pressure (inj)
  • cousin to phenylephrine, oxymetolazone, usedin Afrin-12 hr & Visine eye drops.
33
Q

What are the physiological effects of albuterol? (an adrenergic agonist)

A
  • beta 2 some vasodilation, Bronchodilation
  • beta 2 relaxation of uterine smooth muscle
  • minimal cardiac effects at normal doses.
34
Q

what are the therapeutic uses of albuterol? (an adrenergic agonist)

A
  • bronchodilators to treat asthma (inhalation)

* Terbutaline used to halt pre-term labor (oral, injection)

35
Q

what kind of receptors does epinephrine use?

A

alpha 1, alpha 2, beta 1, beta 2

36
Q

what kind of receptors does norepinephrine use?

A

alpha 1 = alpha 2 > beta 2

37
Q

what kind of receptors does isoproterenol use?

A

beta 1 = beta 2

38
Q

what kind of receptors does dobutamine use?

A

beta 1 (mostly)

39
Q

what kind of receptors does dopamine use?

A

dopamine & beta 1 > alpha 1

40
Q

what kind of receptors does phenylephrine use?

A

alpha 1 (mostly)

41
Q

what kind of receptors does albuterol use?

A

beta 2 (mostly)

Pharmacology (9 decks)

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