Autonomic Nervous System part 2

Question 1

SLUDGE to describe the effects of anticholinesterases

Answer 1

– Salivation
– Lacrimation
– Urination
– Defecation
– Gastrointestinal upset – Emesis

– Bradycardia
– Hypotension
– Bronchoconstriction
– Pupillary constriction (miosis)

Question 2

Nicotinic ACh Receptors locations

Answer 2

Neuromuscular junction
sympathetic ganglia
parasympathetic ganglia
CNS

Question 3

Muscarinic ACh Receptors locations

Answer 3

Parasympathetic target organs
Sweat glands (sympathetic)
Vascular smooth muscle
CNS

Question 4

How can muscarinic receptors be classified

Answer 4

by their tissue distribution and their cellular response

Question 5

Not all muscarinic receptors are in the ANS, what are these exceptions and where are they found

Answer 5

– M1, M2, M4 and M5 also found in CNS

– M3 found on vascular endothelial and smooth muscle cells

Question 6

pilocarpine

Answer 6

Pharmacological properties: Non-selective muscarinic agonist
Clinical uses:
Constriction of pupils (miosis)
Glaucoma (to decrease IOP)
Xerostomia (following head/neck radiotherapy)

Question 7

Bethanechol

Answer 7

Pharmacological properties: non-selective muscarinic agonist
Clinical use:
Bladder and gastrointestinal hypotonia

Question 8

General problem of selectivity with antagonists

Answer 8

– Few differentiate between subtypes effectively
– Muscarinic ACh receptors widespread  side effects
– Control by route of administration and distribution

Question 9

Atropine

Answer 9

• Non-selective antagonist
• Well absorbed orally CNS effects
• Adjunct for anaesthesia -Anticholinesterase poisoning
• Bradycardia / cardiac arrest

Question 10

Glycopyrronium

Answer 10

• Similar to atropine
• Does not cross blood brain barrier
• Adjunct for anaesthesia - Anticholinesterase poisoning
• Bradycardia / cardiac arrest

Question 11

Hyoscine hydrobromide

Answer 11

• hydrobromide
• Similar to atropine CNS effects
• hypersalivation and motion sickness

Question 12

Hyoscine butylbromide

Answer 12

Similar to atropine but poorly absorbed
Does not cross blood brain barrier
- gastrointestinal spasms

Question 13

Ipratropium

Answer 13

Delivered via inhaler or nebuliser Does not cross blood brain barrier
- Maintenance treatment of COPD

Question 14

Tropicamide

Answer 14

Similar to atropine but shorter acting

- Ophthalmic use (mydriasis)