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Term 3: Pharmacology > Autonomic Nervous System > Flashcards

Autonomic Nervous System Flashcards

1
Q

Which of the following neurotransmitters are released
by second order (post-synaptic) nerve terminals of the
Sympathetic nervous system?

A.  Dopamine
B.  Norepinephrine
C.  Epinephrine
D.  Acetylcholine
E.  All of the above
A

E. All of the above

**Acetylcholine on sweat glands

**Dopamine on kidneys

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2
Q

Which kind of G receptor do M2 and M4 receptors activate?

A

Gi

-decreases cAMP and opens K+ channels

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3
Q

What kind of G receptor do M1, 3, and 5 receptors activate?

A

Gq

-increases IP3 thus intracellular Ca

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4
Q

What kind of G receptor do alpha-2 receptors activate?

A

Gi

-Decreases cAMP and opens K+ channels

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5
Q

What kind of G receptor do alpha-1 receptors activate?

A

Gq

-increases IP3 and thus intracellular Ca2+

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6
Q

What kind of G receptor do beta-1, 2, and 3 receptors activate?

A

Gs

-increases cAMP, opening Ca2+ channels

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7
Q

What is the exception to the rule that ANS innervation is dual (both symp and parasymp)?

A

-skin and blood vessels only receive sympathetic innervation

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8
Q

What is happening in the autonomic ganglia?

A. Acetylcholine released; binds & Opens nicotinic ion channels

B. Acetylcholine released; activates G protein-coupled receptors

C. Norepinephrine released; binds & opens nicotinic ion channels

D. Acetylcholine released; binds & inhibits nicotinic ion channels

A

A. Acetylcholine released; binds & Opens nicotinic ion channels

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9
Q

Which ANS receptors in the airway constrict the airway?

A
  • M3

- H1 (histamine)

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10
Q

Which ANS receptors in the airway dilate the airway?

A
  • B2

- Nitric Oxide

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11
Q

Which receptors in the SA node will decrease HR when activated?

A

-M2

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12
Q

Which receptors in the SA node will increase HR when activated?

A

-B1

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13
Q

Which receptors in the myocardium will increase contractility when activated?

A

-B1 and B2

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14
Q

What receptors will dilate blood vessels when activated?

A
  • B2

- Nitric Oxide

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15
Q

What receptors will constrict blood vessels when activated?

A

a1

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16
Q

Which cells and receptors in pancreas will increase glucagon levels upon stimulation?

A
  • Alpha cells

- B2 receptors

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17
Q

Which cells and receptors in pancreas will decrease insulin release upon stimulation?

A
  • Beta cells

- a2 receptors

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18
Q

What receptors will cause the liver to release glucose when activated?

A

B2

Glucagon receptor

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19
Q

In a person who is jogging,
one is trying to keep glucose
and fatty acid levels high.

Which of the following hormone
levels will decrease under
these conditions?

A.  Epinephrine
B.  Norepinephrine
C.  Glucagon
D.  Insulin
E.  Growth hormone
A

D. Insulin

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20
Q

Describe Horner’s Syndrome?

A
  • occurs from lesion along sympathetic chain innervating the eye
  • only one side (chance of both trunks being severed is slim)
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21
Q

How does signal termination occur at an adrenergic nerve terminal?

A

-80-90% reuptake

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22
Q

How does histamine lead to fluid exiting capillaries?

A
  • H2 receptors on arteriole dilates vessel
  • Hi receptors in endothelial cells of capillaries constricts, causing gaps between cells for fluid to exit
  • H1 receptors on venule contract smooth muscle, constricting vessel
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23
Q

What do B1 receptors in the pituitary do when activated?

A

-cause increased ADH secretion, thus water reabsorption

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24
Q

Which of the following will improve renal blood flow?

A.  Dopamine
B.  Angiotensin II
C.  Prostaglandin E2
D.  Norepinephrine
E.  Dopamine and Prostaglandin E2
A

E. Dopamine and Prostaglandin E2

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25
Q

Adrenergic nervous system is generally mediated by
Norepinephrine and Epinephrine

Name an EXCEPTION to this general rule.

A.  Temperature control by acetylcholine
B.  Temperature control by angiotensin II
C.  ADH release by acetylcholine
D.  Aldosterone release by acetylcholine
E.  Sweat glands by acetylcholine
A

A. Temperature control by acetylcholine

&

E. Sweat glands by acetylcholine

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26
Q

What is the effect of albuterol (a Beta 2 agonist)
on blood glucose levels?

A. Increase
B. Decrease

A

A. Increase

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27
Q

Which of the following constricts mostly
efferent arterioles resulting in increased GFR?

A.  Dopamine
B.  Angiotensin II
C.  Prostaglandin E2
D.  Norepinephrine
E.  Atrial Natriuretic Factor
A

B. Angiotensin II

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28
Q

You prescribe Terazosin (Hytrin), an alpha-1 blocker to
an elderly male for an enlarged prostate.
(Remember BPH? Benign Prostatic Hypertrophy)).

What is the effect of an alpha-1 blocker on blood pressure?

A. Increase
B. Decrease

A

B. Decrease

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29
Q

On what type of neurons do N1/Nm and N2/Nn receptors present?

A

N1 = Neuromuscular

N2 = Ganglionic & neuronal

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30
Q

What is Bethanechol used to treat?

A

Urinary Retention

cholinergic agonist

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31
Q

What is Pilocarpine used to treat?

A

Acute Glaucoma

Dry mouth

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32
Q

What are the general adverse effects to cholinergic drugs?

A
  • Bradycardia, decreased CO, Hypotension
  • Bronchoconstriction
  • Nausea, Vomiting, diarrhea
  • Sweating, salivation, urinary urgancy

**DUMB BELSS

33
Q

What is Neostigmine used to treat?

A

Myasthenia Gravis

34
Q

What Donepezil used to treat?

A

Alzheimer’s

35
Q

Which of the following drugs helps Alzheimer’s patients?

A.  Scopalamine
B.  Bethanechol
C.  Neostigmine
D.  Donepezil
E.  Atropine
F.  Edrophonium
A

D. Donepezil

36
Q

Which of the following drugs is a reversible inhibitor?

  1. Aspirin
  2. Clopidogrel (Plavix)
  3. Omeprazole (Prilosec)
  4. Simvastatin
  5. Echothiophate
  6. Sarin
A
  1. Simvastatin
37
Q

What is the overall effect of epinephrine on blood glucose?

A

Will increase blood glucose.

-by decreasing insulin release and increasing glucagon release

38
Q

What do kidneys secrete when their B1 receptors are activated?

A

Renin, activates RAAAS pathway

39
Q

What does Atropine Do?

A

Treats Organophosphate poisoning.

-Muscarinic blocker

40
Q

What does pralidoxime (PAM) do?

A
  • treats insecticide (nerve gass) poisoning

- recovers ACE activity if given early

41
Q

Where is the site of action of ganglionic blockers?

A
  • nicotinic receptor in autonomic ganglia

- includes adrenal medulla

42
Q

Where is the site of action of antimuscarinic (muscarinic blocker) drugs?

A

-muscarinic receptors of post-ganglionic neurons in parasympathetic NS

43
Q

Where is the site of action of neuro-muscular blockers?

A
  • neuromuscular junction

- affect muscle contraction in somatic NS

44
Q

What is mydriasis?

A

dilation of the pupils

45
Q

What are the effects of antimuscarinics on the respiratory system?

A
  • bronchodilation

- decreased secretions

46
Q

What type of drugs are atropine, scopalamine, glycopyrollate, and ipratropium?

A
  • specific anti-muscarinic drugs

* work at synapse between postganglionic PNS neuron and organ

47
Q

What is Ipratropium used for?

A

-produce bronchial dilation in COPD

48
Q

What is Glycopyrollate used for?

A

-used preoperatively to reduce secretions

49
Q

What is Atropine used for?

A
  • can be used preoperatively to reduce secretions
  • bradycardia
  • antidote for cholinergic drugs
  • antidote for nerve gas
50
Q

What is scopalamine used for?

A
  • can be used preoperatively to reduce secretions

- Prevent motion sickness

51
Q

What does 2-PAM do?

A
  • regenerates ACh esterases
  • used for nerve gas poisoining

**doesn’t enter CNS

52
Q

Does 2-PAM enter the CNS?

A

No

53
Q

Does Atropine enter the CNS?

A

-yes

54
Q

Where are the majority of cholinergic receptors located in the airway?

A

-large central airways

55
Q

Where are the majority of adrenergic receptors located in the airway?

A

-small peripheral airways

56
Q

What is Theophyline used for? What receptor does it use?

A
  • asthma and COPD
  • Adenosine receptor

**LOW therapeutic index

57
Q

What is the mechanism of action of Ganglionic blockers?

A

-interfere with the postsynaptic action of ACh at the Nn receptor of autonomic ganglia

58
Q

What are the general uses of ganglionic blockers?

A

-treat hypertension in an emergency

**very limited clinical use

59
Q

What type of drugs are mecamylamine and trimethaphan?

A

ganglionic blockers

60
Q

What is the mechanism of action of depolarizing NMJ blockers?

A
  • binds to Nm receptor, OPENS THE CHANNEL, depolarizes the end-plate, then gets stuck
  • membrane repolarizes, but receptor is desensitized to the effect of ACh
61
Q

What are the uses of depolarizing NMJ blockers?

A

-to produce skeletal muscle relaxation

62
Q

What drug is a depolarizing NMJ blocker?

A

-Succinylcholine

63
Q

What is succinylcholine used for?

A

-relax muscles during surgery

depolarizing NMJ blocker

64
Q

What is the mechanism of action of Nondepolarizing neuromuscular antagonists?

A

-bind to Nm receptor, but do not open the channel

65
Q

What are the uses of nondepolarizing NMJ blockers?

A

-produce skeletal muscle relaxation

66
Q

What kind of drugs are d-tuboCURarine, panCURonium, atraCURium, and gallamine?

A

-nondepolarizing NMJ blockers

67
Q

How would you bring a patient off of one of the nondepolarizing blockers? Why?

A
  • Administer a cholinesterase inhibitor along with a muscarinic antagonist.
  • include a muscarinic antagonist to protect heart from excess acetycholine (remember location of muscarinic vs nicotinic receptors)
68
Q

What is the mechanism of malignant hyperthermia?

A
  • triggered by halothane or succinylcholine
  • agents trigger a release of calcium from SR
  • increased myoplasmic Ca activates myosin ATPase and generates heat
69
Q

What is Dantrolene used for? How does it work?

A
  • treats malignant hyperthermia

- blocks Ca release from SR

70
Q

How does Botox work?

A

-blocks vesicular release of ACh

71
Q

What is botox used for besides cosmetic effects?

A
  • focal dystonia (local movement disorders)
  • Strabismus (eyes not aligned
  • Cervical dystonia (head tilt)
  • chronic migraines
72
Q

How do you treat an overdose of atropine?

A
  • treat symptomatically
  • provide cholinesterase inhibitor
  • blankets and diazepam for seizure control
73
Q

How is an overdose of anti-cholinergic drugs treated?
In addition to support therapy, which of the following drugs
In low doses is helpful?

A.  Scopalamine
B.  Echothiophate
C.  Neostigmine
D.  Donepezil
E.  Physostigmine
A

E. Physostigmine

**Neostigmine only works in periphery. Physo works centrally AND peripherally

74
Q

Which one of these is a depolarizing neuromuscular junction blocker?

A.  Atropine
B.  Bethanechol
C.  Succinylcholine
D.  Curare
E.  Gallamine
A

C. Succinylcholine

75
Q

Which one of these drugs is a commonly used bronchodilator?

A.  Atropine
B.  Scopolamine
C.  Ipratropium
D.  Theophylline
E.  Diphenhydramine
A

C. Ipratropium

76
Q

What drug treats malignant hyperthermia?

A

-Dantrolene

77
Q

Why isn’t atropine used as a bronchodilator?

A

it enters the CNS

78
Q

Why isn’t scopalamine used as a bronchodilator?

A

-it enters the CNS

Term 3: Pharmacology (15 decks)

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