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Pharm Kaplan > Autonomic Pharm > Flashcards

Autonomic Pharm Flashcards

1
Q

Where are Nn receptors located?

A

on cell bodies in ganglia of both PANS and SANS and in the adrenal medulla

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2
Q

Where are Nm recepotrs located

A

On the skeletal muscle motor end plate innervated by somatic motor nerves

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3
Q

Where are M1-3 receptors located?

A

on all organs and tissues innervated by post-ganglionic nerves of the PANS and on thermoregulatory sweat glands innervated by the SANS

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4
Q

Aldosterone is released from the

A

adrenal cortex

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5
Q

Renin is released from the

A

juxtaglomerular cells in response to hypotension or increased sympathetic drive

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6
Q

Aldosterone MOA

A

DCT/CD: increase Na/ H20 retention; DECREASE K

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7
Q

Angiotensin II MOA

A

Vasoconstricts Efferent arteriole and systemic - increase TPR

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8
Q

Paralysis of accommodation - leading to only far vision

A

Cyclopegia

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9
Q

Muscarinic stimulation on the eye

A

Miosis (small) and accommodation

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10
Q

Alpha 1 (adrenergic) stimulation on the eye - radial muscles

A

Mydriasis (dilated), NO cycloplegia

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11
Q

MOA of Botulinum toxin (endotoxin from clostridium)

A

Binds synaptobrevin preventing Ach release

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12
Q

MOA of indirect-acting cholinomimetics

A

Target AchE for inhibition

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13
Q

3 Reversible AChE inhibitors

A

Edrophonium; Physostigmine; neostigimine

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14
Q

3 Irreversible AchE inhibitors

A

Echothiophate, malathion, parathion

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15
Q

Muscarinic Receptor activation does what to the eye

A

Sphincter: M3 (Gq) = contraction = miosis
Ciliary muscle: M3(Gq) = contraction = accommodation for near vision

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16
Q

Muscarinic Receptor Activation does what to the heart

A

SA node: M2 (Gi) - Decrease HR
AV node: M2 - decrease conduction velocity
DOES NOT AFFECT THE VENTRICLES

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17
Q

Muscarinic Receptor Activation does what to the Lungs?

A

Bronchioles: M3 - contraction = bronchospasm
Glands: M3 = secretion

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18
Q

Muscarinic Receptor Activation does what to the GI tract?

A

Stomach: M3 - Increase motility (Cramps)
Glands: M1 - Secretion (inc acid)
Intestine: M3 - Contraction = diarrhea, involuntary defecation

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19
Q

Muscarinic Receptor activation does what to the Bladder?

A

M3: Contraction (Detrusor), relaxation (trigone/sphincter), voiding, urinary incontinence

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20
Q

Muscarinic Receptor activation does what to sphincters?

A

M3: relaxation (except LES, which contracts)

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21
Q

Muscarinic Receptor activation does what to glands?

A

All M3 except GI tract, which are M1: Sweat (thermoregulatory), salivation, and lacrimation

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22
Q

What does Muscarinic Receptor activation do to the blood vessels (endothelium)

A

M3: Argine –> NO = dilation. No innvervation here so no effect of indirect agonist (only SANs effect, not PANS)

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23
Q

4 Muscarinic Agonists (direct-acting cholinomimetics)

A

Ach; Bethanechol; Methacholine; Pilocarpine

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24
Q

Muse of Bethanechol

A

Post op/neurogenic ileus; urinary retention

Muscarinic agonist

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25
Q

Use of Pilocarpine - a muscarinic agonist

A

Glaucoma, xerostomia, Increases sweating for a + sweat test in cystic fibrosis

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26
Q

7 Acetylcholinesterase Inhibitors (indirect-acting cholinomimetics)

A

Edrophonium; Physostigminie; Neostigmine; Pyridostigmine; Donepezil; tacrine; Organophosphates

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27
Q

Use of Edrophonium - an AChE inhibitor

A

Tensilon test for MG

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28
Q

Use of Physostigmine - an AChE inhibitor

A

Atrophine overdose, glaucoma

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29
Q

Uses of neostigmine, Pyridostigmine - AchE inhibitors

A

Ileus, urinary retention, myasthenia (Neo), reversal of Nm blockade (curare)

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30
Q

Use of Donepezil and Tacrine - AChe inhibitors

A

Alzheimer disease

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31
Q

Use of Organophosphates, AChE inhibitors

A

Glaucoma. Used as insecticides - malathiom, parathion and nerve gas (sarin). Irreversible, non-competitive (decrease Vmax

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32
Q

S/S of AChe inhibitor Poisoning

A

DUMB BELSS:

Diarrhea; urination; miosis; Bradycardia; Bronchoconstriction; Excitation; Lacrimation; Salivation; Sweating

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33
Q

Chronic toxicity of organophosphates

A

peripheral neuropathy with demylination - mimics MS

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34
Q

6 Muscarinic Receptor antagonists (anti-muscarinic)

A

Atropine; Tropicamide; Ipratropium; Scopalamine; Benztropine; Trihexyphenidyl

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35
Q

Alpha 1 activation on the eye

A

Radial (dilatory) muscle = contration = mydriasis w/o cycloplegia

36
Q

alpha 1 receptor activation on arterioles (skin/viscera) and veins

A 
Contraction = increase TPR - Increase diastolic pressure, Increase afterload
Veins = contraction = increase venous return, increase preload - increase systolic BP - therefore no net change in BP
37
Q

Alpha 1 receptor activation on bladder trigone and sphincter

A

Contraction - urinary retention

38
Q

Alpha 1 receptor activation on male sex organs

A

Vas deferens = ejaculation

39
Q

Alpha 1 receptor activation on the liver

A

increase glycogenolysis

40
Q

Alpha 1 receptor activation on the kidney

A

Decrease renin release

41
Q

Alpha 2 receptor activation on Prejunctional nerve terminal

A

Decrease transmitter release and NE synthesis

42
Q

Alpha 2 receptor activation on platelets

A

aggregation

43
Q

Alpha 2 receptor activation on the pancreas

A

Decrease insulin secretion (warning in diabetics)

44
Q

Beta 1 receptor activation on the SA node

A

Increase HR

45
Q

Beta 1 receptor activation on AV node

A

Increase conduction velocity

46
Q

B1 receptor activation on atrial and ventricular muscle

A

Increase force of contraction, conduction velocity, CO, and oxygen consumption

47
Q

Beta 1 receptor activation on His-Purkinje

A

Increase automaticity and conduction velocity

48
Q

B1 receptor activation on Kideny

A

Increase renin release

49
Q

B2 activation on blood vessels

A

Vasodilation - decrease TPR - decrease diastolic pressure - decrease afterload

50
Q

B2 activation on Uterus

A

Relaxation

51
Q

B2 activation on bronchioles

A

Dilation

52
Q

B2 activation on skeletal muscle

A

Increase glycogenolysis - contractility

53
Q

B2 activation on the liver

A

Increase glycogenolysis

54
Q

B2 activation on the pancreas

A

Increase insulin secretion

55
Q

D1 activation on the renal, mesenteric, and coronary vasculatorue

A

Vasodilation - in Kidney increase RBF, increase GFR, increase Na secretion

56
Q

Name an alpha 1 agonist and its use

A

Phenylephrine - nasal decongestant (optho too - mydrasis w/o cycloplegia)

57
Q

Alpha 1 agonist net effects (2)

A

increase TPR and increase BP

58
Q

Alpha 2 agonist net effect

A

Decrease sympathetic outflow @ prejunctional CNS receptors - Mild to moderate HTN

59
Q

Name 2 alpha 2 agonists and use

A

Clonidine, Methyldopa - mild-moderate HTN

60
Q

Beta 1 vs Beta 2 effects

A

B1 = Increases HR, SV, CO, and pulse pressure
B2 = decreases TPR, BP
TPR > CO for BP effect, so net effect is decrease BP

61
Q

Name 2 Beta 1 and 2 agonists and their uses

A

Isoproterenol (B1=B2): Bronchospasm, Heart block, brady arrhythmia
Dobutamine: B1>B2: CHF

62
Q

Name 4 Selective B2 agonists and their uses

A

Salmeterol, albuterol, terbutaline (ASTHMA);
Ritodrine: Premature labor

63
Q

Name 2 mixed acting adrenoceptor agonists and their receptors

A

Norepinephrine - alpha 1,2 and Beta 1

                    Epinephrine: Alpha 1,2 Beta 1,2. (B2 at low dose, B1 middle, and alpha 1 at high dose)
64
Q

Name 5 Indirect Acting adrenergic receptor agonists and their main MOA

A

Releasers: Tyramine, Amphetamines, Ephedrine
Reuptake inhibitors: Cocaine, TCA

65
Q

List the main effects of alpha receptor antagonists

A

Decrease TPR, decrease mean BP

May cause reflex tachycardia and salt/water retention (via renin–>aldosterone)

66
Q

List the 3 main uses of alpha receptor antagonists

A

HTN; Pheochromocytoma; BPH (symptomatic via trigone relaxation/sphincter relaxation)

67
Q

Name 2 nonselective alpha receptor antagonists and uses

A

Phentolamine (competitive inhibitor)
Phenoxybenzamine (non-competitive, irreversible inhibitor) DOC for pheochromocytoma

68
Q

Name the drug that actually treats BPH and its MOA

A

Finasteride: 5-alpha reductase inhibitor - decreases DHT, shrinks median zone

69
Q

Name 4 selective alpha 1 blockers

A

Prazosin, Doxazosin, terazosin, tamsulosin

70
Q

Name 2 selective Alpha 2 blockers and their use

A

Yohimbine: Postural hypotension, Impotence
Mirtazapine: Anti-depressant (causes weight gain secondary to increased appetite)

71
Q

List the main effects of B1 blockade

A

Decreased HR, SV, CO and therefore O2 comsumption;
Decreased Renin release (therefore Dec TPR and Edema)
Decreased aqueous humor production

72
Q

5 Uses for B1 blockers

A

Angina, MI, Supraventricular Tachycardia, HTN; CHF

73
Q

Name 4 Beta1 selective blockers and any important info

A
  1. Acebutolol: NO increase in blood lipids (Class II);
  2. Atenolol: Not sedating
  3. Esmolol: Class II
  4. Metoprolol
74
Q

List B2 blockade main effects and warnings

A

Avoid in asthmatics, peripheral vascular disorders, and diabetics. With fasting, get increased LDLs, TG - blocks glycogenolysis and gluconeogenesis.

75
Q

Name 3 B2 blockers

A
  1. Pindolol (no increase in blood lipids)
  2. Propranolol
  3. Timolol:
76
Q

What 4 things is propranolol used for

A

Very sedating, Class II antiarrhythimic:
Thyrotoxicosis (inhibit deiodinase - no T4-T3), Performance anxiety, MIgrane, essential tremor

77
Q

What is Timolol used for

A

Glaucoma

78
Q

Name 2 drugs with combined alpha 1 and B blocking activity and its use

A

Labetalol and Carvedilol - CHF

79
Q

Name a drug with K+ channel blocking ability and B-blocking activity

A

Sotalol

80
Q

What is narrow angle glaucoma

A

Iris is blocking canal of schlemm

81
Q

What is broad angle glaucoma

A

Degenerative changes in the canal

82
Q

Chronic condition with increased intraocular pressure due to decreased reabsorption of aqueous humor leading to progressive painless visual loss

A

Open-Angle Glaucoma

83
Q

An acute, painful condition with increased IOP due to blockade of the canal of schlemm - is an emergency

A

Close-Angle Glaucoma

84
Q

What drugs are contraindicated in closed-angle glaucoma

A

Anti-muscarinic drugs and alpha 1 agonists

85
Q

Beta blocker used to treat Glaucoma - MOA

A

Timolol - blocks actions of NE at ciliary epithelium - decrease aqueous humor formation

86
Q

2 Cholinomimetic drugs and MOA for tx of Glaucoma

A

Activation of M receptors causes contraction of ciliary muscles which increases flow through the canal.

87
Q

What 2 drugs do you use in an emergent case of closed angle glaucoma

A

Diuretics: mannitol, carbonic anhydrase inhibitors

Pharm Kaplan (4 decks)

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