Autonomic Nervous System (with Sympathetic NS)

Question 1

Subdivision of efferent peripheral nervous system (neurons outside the CNS)

Answer 1

Autonomic Nervous System

Question 2

Mechanism of impulse transport across a synapse

Answer 2

Synaptic Neurotransmission

Question 3

Parts of Synapse (3)

▪️ Sending
▪️ Synthesis storage RELEASE of neurotransmitters
▪️ Autoreceptors or presynaptic receptors; for modulation or regulation of NT release

Answer 3

Pre-synapse

Question 4

Parts of Synapse (3)

▪️ Responsible for inactivating NTs
▪️ Metabolizing enzyme containing

Answer 4

Synaptic cleft

Question 5

Parts of Synapse (3)

▪️ Receptors primary location
▪️ Majority of receptors:Excitatory

Answer 5

Post-Synapse

Question 6

▪️Origin of Neurons: Thoracolumbar (T1-T12, L1-L5)
▪️Length of PRE-GANGLIONIC fiber: shorter
▪️Length of POST-GANGLIONIC fiber: longer
▪️Location of Ganglion: Near the Spinal Cord

Answer 6

Sympathetic Nervous System

Question 7

▪️Origin of Neurons: Craniosacral (CN 3,7,9,10, S1-S4)
▪️Length of PRE-GANGLIONIC fiber: loger [ParaLongPre]
▪️Length of POST-GANGLIONIC fiber: shorter
▪️Location of Ganglion: Near the Target Organ / Effector

Answer 7

Parasympathetic Nervous System

Question 8

NEUROTRANSMITTERS
Pre-Ganglionic: ACh
Post-Ganglionic: NE, Epi, Dopa

RECEPTORS [Adrenergic]
Ganglion: Nicotinic neural (Nn)
Target Organ/Effector: a,B,D

Answer 8

Sympathetic Nervous System

Question 9

NEUROTRANSMITTERS
Pre-Ganglionic: ACh
Post-Ganglionic: ACh

RECEPTORS [Cholinergic]
Ganglion: Nicotinic neural (Nn)
Target Organ/Effector: M,N

Answer 9

Parasympathetic Nervous System

Question 10

Funtional [General]
NE: Adrenergic NS
□ Stress
□ Fight/Flight/Fright

Answer 10

Sympathetic Nervous System

Question 11

Funtional [General]
ACh: Cholinergic NS
□ Basal
□ Rest and Digest

Answer 11

Parasympathetic Nervous System

Question 12

Funtional [Specific]
▪️HEART: Tachycardia
▪️SMOOTH MUSCLES: Relaxation ( ↓pressure)
▪️PUPILS: MyDriasis (dilation)
▪️BRONCHI: BronchoDilation
▪️GIT: Ileus (loss of peristalsis)
▪️URINARY BLADDER (Walls): Urinary Retention
▪️SWEAT GLANDS: Apocrine (palms/soles)

Answer 12

Sympathetic Nervous System

Question 13

Funtional [Specific]
▪️HEART: Bradycardia
▪️SMOOTH MUSCLES: Contraction ( ↑ pressure)
▪️PUPILS: Miosis (constriction)
▪️BRONCHI: BronchoConstriction
▪️GIT: Bowel Mvmt. (diarrhea)
▪️URINARY BLADDER (Walls): Urination
▪️SWEAT GLANDS: Eccrine (thermoregulation)

Answer 13

Parasympathetic Nervous System

Question 14

Sympathetic Drugs (4-EAAA)

Answer 14

1. Endogenous Catecholamines
2. Adrenoceptors
3. Agonist: (-mimetic)
4. Antagonist (-lytic)

Question 15

Biosysthesis of Cathecholamines:
Precursor: Tyrosine
STEPS: [True Love Does Not Exist]

Answer 15

Tyrosie→L-DOPA→Dopamine→NE→Epinephrine

Question 16

Enzymes on the ff.
1. Formation of L-Dopa
2. Formation of Dopamine
3. Formation of Norepinephrine
4. Formation of Epinephrine

Answer 16

Enzymes on the ff.
1. Tyrosine hydroxylase
2. L-DOPA decarboxylase
3. Dopamine-B-hydroxylase
4. Phenyl Ethanolamine-N-Methyl Transferase (PENMT)

Question 17

What is the First Catecholamine

Answer 17

Dopamine

Question 18

Storage of Dopamine

Answer 18

Vesicle

Question 19

Exocytotic release of NT
Stimulators: [TEAAM]
Inhibitors: [GGB]

Answer 19

Stimulators: Tyramine, Ephedrine, Amphetamine, Angiotensin II,

Inhibitors: Guanethidine, Guanadrel, Bretylium

Question 20

What adrenoceptors?
▪️Vascular Smooth Muscles = Qontraction; Vasoconstriction (↑BP)

▪️Urinary Bladder, Trigone & Sphincter: Closure (urinary retention)

▪️Prostatic Smooth Muscles: Contraction (urinary retention)

▪️Radial Muscles (iris): Mydriasis

▪️Pilometer SM: Piloerection (goosebumps)

Answer 20

Alpha 1 (Q1)

Question 21

What adrenoceptors?
▪️Autoregulation - inhibits further release of NE
▪️Consequences:
● Central: Sedation & Depression
● Peripheral: Vasodilation (↓ BP)

Answer 21

Pre-Synaptic Inhibitory Gi (Alpha 2)

Question 22

Alpha 2
▪️Pre-synaptic : Inhibitory (?)
▪️Post-synaptic : Excitatory (?)

Answer 22

▪️Pre-synaptic : Inhibitory Gi
▪️Post-synaptic : Excitatory Gq

Question 23

What adrenoceptors?
▪️Location: Blood Vessels
▪️Vasoconstriction

Answer 23

Post-Synaptic Excitatory Gq (Alpha 2)

Question 24

What adrenoceptors?
▪️Heart:
○ (+) Inotropy- force of contraction
○ (+) Chronotropy-HR
○ (+) Dromotropy-Conduction Velocity

▪️Kidneys:Juxtaglomerular Apparatus
○ ↑ Renin release=↑BP

Answer 24

Beta 1

Question 25

What adrenoceptors? ▪️Smooth Muscle: ○ Bronchi: Bronchodilation ○ Uterus: Relaxation (Tocolysis) ○ BV: Vasodilation ▪️Skeletal Muscle ○ ↑ K intake=Hypokalemia occurs ○ Contriction=tremors

Answer 25

Beta 2

Question 26

What adrenoceptors? ▪️Adipocytes ○ Lipocytes=weight loss

Answer 26

Beta 3

Question 27

What adrenoceptors? ▪️Receptors: GIT ○ ↓GIT Motility (Ileus) Constipation

Answer 27

Dopamine 2 (D2)

Question 28

▪️First line cardiac stimulant ▪️First line for anaphylaxis and anaphylactic shock (due to allergy) ▪️Local vasoconstrictor

Answer 28

Epinephrine or Adrenaline

Question 29

▪️ First line inotropic agent for septic shock ▪️ Aka Levarterenol

Answer 29

Norepinephrine or Noradrenaline

Question 30

▪️ First line for cardiogenic shock ▪️ Alternative: Management of septic shock ▪️ Management of acute heart failure complicated by oliguria (< 500mL/day) or anuria (<50mL/day)

Answer 30

Dopamine (B1-Selective Agonist)

Question 31

Eye Drops Treatment of Red Eye

Answer 31

Tetrahydrozoline Eye Drops (Eye Mo Red)

Question 32

Intranasal Treatment of Nasal Congestion

Answer 32

Oxymetazoline Nasal Spray (Drixine)

Question 33

Non-selective beta agonist Uses: ▪️Alternative during shock states ▪️Mgt. of AHF (pwedeng B1 Agonist) ▪️Synthetic Catecholamime

Answer 33

Isoproterenol or Isoprenaline

Question 34

▪️ Binds to pre-synaptic alpha 2 receptors in general ▪️ Anti glaucoma and Antihypertensive drugs

Answer 34

Selective alpha 2 Agonist

Question 35

Alpha 2 ▪️Antiglaucoma Agents (2-AB)

Answer 35

1. Apraclonidine 2. Brimonidine

Question 36

Alpha 2 ▪️Antihypertensive Agents (4-MCGG)

Answer 36

1. Methyldopa 2. Clonidine 3. Guanfacine 4. Guanabenz

Question 37

First line reliever for Bronchial Asthma

Answer 37

SABA

Question 38

Controllers in BA with inhaled corticosteroids

Answer 38

LABA

Question 39

What type of drug class are? ▪️Ritodrine ▪️Isoxsuprine-most common ▪️Tx: Mgt. of Pre-term labor

Answer 39

Tocolytics

Question 40

Indirect Acting ▪️Releasers (4-TEAM)

Answer 40

Tyramine Ephedrine Amphetamine Metamphetamine

Question 41

From Ma Huang

Answer 41

Ephedrine

Question 42

1. 1st line Mgt. ADHD 2. Alternative for ADHD

Answer 42

1. Methylphenidate 2. Amphetamine &Atomoxetine

Question 43

Aka Shabu

Answer 43

Metamphetamine

Question 44

1st Line: Narcolepsy

Answer 44

Modafinil

Question 45

Indirect-Acting (under Releasers) ▪️For Anorexiant

Answer 45

Phenmetrazine

Question 46

Management of Obesity

Answer 46

Sibutramine

Question 47

Tx. Nasal Congestion & Hypotension T/E: ↑ risk of hemorrhagic stroke

Answer 47

Phenylpropanolamine (PPA)

Question 48

What class of drugs are the following: ▪️ Prazosin ▪️ Doxazocin ▪️ Terazosin ▪️ Tamsulosin

Answer 48

Alpha 1 Selective (-zosin) [Sympathetic Antagonist] ▪️Vasodilators →AntiHTNsive

Question 49

What drug use in Benign Prostatic Hyperplasia (BPH) | Prostate Enlargement?

Answer 49

Selective Alpha 1 ▪️Finasteride ▪️Dutasteride

Question 50

What class of drugs are the following: ▪️Yohimbine ▪️Rauwolscine

Answer 50

Alpha 2 Selective [Sympathetic Antagonist]

Question 51

▪️Non-Selective ▪️Irreversible; Non-competitive ▪️DOC for management of Carcinoid Syndrome

Answer 51

Phenoxybenzamine [Sympathetic Antagonist]

Question 52

▪️Non-Selective ▪️Reversible; Competitive ▪️Mgt. of Pheochromocytoma ▪️Tx. of Erectile Dysfunction (local injection)

Answer 52

Phentolamine [Sympathetic Antagonist]

Question 53

Tumor/ hyperplasia in adrenal medulla; causes hypersecretion of catecholamines

Answer 53

Pheochromocytoma

Question 54

Neuroendocrine condition associated with malignancy affecting enterochromaffin cells

Answer 54

Carcinoid Syndrome

Question 55

Digital vasospasm in response to stress/cold environment; vasoconstriction causes necrosis Tx: alpha blockers (DOC), CCBs (alternative)

Answer 55

Raynaud's Syndrome

Question 56

Cardioselective B-blockers less likely to cause bronchospasm

Answer 56

Selective B1-Blockers

Question 57

What are the Cardioselective (B1) [Sympathetic Antagonist] Mnemonics: CBEAM

Answer 57

Celiprolol Bisoprolol, Betaxolol Esmolol (shortest t1/2; given IV) Atenolol, Acebutolol Metoprolol

Question 58

What are the Non-Selective (B2) Bronchoconstriction [Sympathetic Antagonist] Mnemonics: NSTP

Answer 58

Nadolol Sotalol - Class III B-blocker Anti-arrhytmic Timolol - Antiglaucoma Propranolol - Prototype (Inderal)

Question 59

Beta-blockers with special properties: 1. Intrinsic Sympathomimetic Activity (ISA) [CLAP] 2. Membrane stabilizer [PALM] 3. Vasodilation (Mixed Action) [CLN]

Answer 59

1. Carteolol, Celiprolol, Lebatalol, Acebutalol, Pindolol, Penbutolol 2. Propranolol, Acebutolol, Labetalol, Metoprolol 3.Carvedilol, Labetalol, Nebivolol

Question 60

▪️Most Cardioselective ▪️HTN: 1st line-px w/hx of post-myocardial infarction ▪️Mgt. of Angina Pectoris & Stable HF

Answer 60

Nebivolol

Question 61

Drug use for Management of Stable Heart Failure (only useful) BCMN

Answer 61

Bisoprolol Carvedilol Metoprolol succinate Nebivolol

Question 62

Drug use for Management of Arrhythmia

Answer 62

Class II Arrhythmics

Question 63

Drug use for Management of Glaucoma [↓ IOP] (TB-lol)

Answer 63

Timolol Betaxolol

Question 64

Drug use for treatment of sympathetic symptoms of hyperthyroidism

Answer 64

Propranolol (inh. the peripheral conversion of T4 to T3) Carvedilol - less sedating

Question 65

Drug use for: ▪️Prophylaxis: Migraine Headache ▪️For Stage Fright

Answer 65

Propranolol

Question 66

What adrenoceptors; ▪️Mgt. Of BA & COPD ▪️Mgt. of Pre-term labor ▪️Adjuncts in the mgt. of hyperkalemia (B2 has hypOkalemic effects)

Answer 66

Selective B2 Agonist