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Pharmacology > Autonomic Pharmacology 1 > Flashcards

Autonomic Pharmacology 1 Flashcards

1
Q

What is the major nuerotransmitter for the parasympathetic nervous system?

A

Acetylcholine

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2
Q

What are the major neurotransmitters for the sympathetic nervous system?

A

Acetylcholine & Norepinephrine

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3
Q

How can drugs modify ANS activity?

A
  • Synthesis
  • Storage
  • Release
  • Receptor interaction
  • Disposition
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4
Q

What are the 4 drugs that alter the autonomic nervous system?

A
  • Parasympathetic (PANS) stimulatory
  • Parasympathetic (PANS) inhibitory (blocking)
  • Sympathetic (SANS) stimulatory
  • Sympathetic (SANS) inhibitory (blocking)
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5
Q

What is a drug that acts at the location where acetylcholine is released termed?

A

Cholinergic

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6
Q

What is a drug that acts at the location where norepinephrine is released termed?

A

Adrenergic

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7
Q

Drugs that act at the location where the PANS acts has the prefix?

A

Parasympatho…

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8
Q

A drug that acts at the location where the SANS acts has the prefix?

A

Sympatho…

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9
Q

Drugs that acta at the location where a division of the ANS acts and produces the same effect as the neurotransmitter has the suffix?

A

…mimetic

“Mimics” neurotransmitters - aka agonist drug

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10
Q

Drugs that act at the location where a division of the ANS acts and blocks the action of the neurotransmitter has the suffix?

A

-lytic or -blocker

aka antagonist drugs

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11
Q

What are the parasympathetic PANS drugs?

A
  • Stimulatory
    • cholinergics
    • parasympathomimetics
  • Inhibitory
    • anticholinergics
    • parasympatholytics
    • cholinergic blockers
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12
Q

What are the sympathetic SANS drugs?

A
  • Stimulatory
    • adrenergics
    • sympathomimetics
  • Inhibitory
    • adrenergic blockers
    • sympathetic blockers
    • sympatholytics
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13
Q

What are the 2 types of cholinergic agonists?

A
  • Direct acting
    • agonists
  • Indirect acting
    • cholinesterase inhibitors - causes accumulation of ACH = stimulating PANS
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14
Q

Why do we use direct acting cholinergic drugs?

A
  • Longer duration of action
  • More selective in the effects produced
  • Stimulate the PANS
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15
Q

In order to be an effective mediator, ACH must do what?

A

Fit both physically and chemically at the receptor

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16
Q

What are the pharmacologic effects of cholinergic drugs (sympathetic effects)?

A
  • Cardiovascular
    • bradycardia, decreased BP and CO
  • Eye
    • Miosis, lowers intraocular pressure
  • GI
    • Increase in activity, motility and secretion
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17
Q

What are the primary indications for use of cholinergic drugs?

A
  • Glaucoma
  • Myasthenia gravis (autoimmune disorder)
  • GI disorders
  • Reverse urinary retention after surgery
18
Q

What are some examples of direct acting cholinergic agonists?

A
  • cevimeline (Evoxac) - Sjogren’s syndrome
  • **pilocarpine (Salagen) - glaucoma, Sjogren’s **
  • acetylcholine (MIochol) - eye surgery
  • bethanechol (Urecholine) - urinary retention
  • carbachol (Miostat) - glaucoma
19
Q

What does pilocarpine (Salagen) used for, do?

A
  • Used in eye for treatment of glaucoma
  • Causes pupil constriction, allows for drainage of fluid from eye
  • Decreases intraocular pressure
  • Stimulate salivary secretions in patients with xerostomia
20
Q

What do indirect-acting cholinergic drugs do?

A

Stop the breakdown of acetylcholine - build up of acetylcholine = same results/effects of cholinergics

Produce PANS stimulation

21
Q

What are the primary indications for indirect-acting cholinergic agonists (choilnesterase inhibitors)?

A
  • Myasthenia gravis
  • Glaucoma
  • Postoperatice urinary retention
  • Paralytic ileus
  • Antidotes to agents that produce nondepolarizing neuromuscular blockade (poisons)
22
Q

How are indirect-acting cholinergic drugs divided?

A
  • Into groups based on degree of reversibility with which they are bound to the enyme
    • Reversible (includes centrally-acting drugs)
    • Irreversible
23
Q

What are reversible indirect-acting cholinergic drugs used to treat and how do they do it?

A
  • Myasthenia gravis and glaucoma, and dementia with Alzheimer’s disease
  • Cause skeletal muscle activation followed by blockade = no muscle contraction
24
Q

What are the examples of reversible indirect-acting cholinergic drugs?

A
  • edrophonium (Enlon)
  • physostigmine - reverses toxic life-threatening delirium caused by overdoses of anticholinergic drugs (like Benadryl)
  • pyridostigmine (Mestinon)
25
Q

What is an example of a reversible indirect-acting cholinergic drug that is used to treat dementia with Alzheimers?

A

donepezil (Aricept)

26
Q

What do irreversible acetylcholinesterase inhibitors do?

A

Raise Acetylcholine = too much

POISONS!!

27
Q

What are used as insecticides (organophosphates) and nerve gases *sarin, Soman, tabun” for chemical warfare?

A

Irreversible Acetylcholinesterase Inhibitors

28
Q

If poisoned (overdose) with insecticides or organophophates, what do you use?

A
  • pralidoxime (2-PAM, Protopam) - regenerates the irreversibly bound ACH receptor sites that are bound by the inhibitors
  • atropine (antimuscarinic) - competitively blocks muscarinic effects of excess ACH
29
Q

What are the side effects of cholinergic drugs?

A

SLUD

  • Salivation
  • Lacrimation
  • Urination
  • Defecation

All mimics the parasympathetic nervous system

30
Q

What are the cholinergic antagonists?

A

Anticholinergics = antimuscarinics

Nueromuscular blocking agnets

Ganglionic blocking agents

31
Q

What do anticholinergic drugs (parasympatholytics) do?

A
  • Prevent action of ACT at postganglionic PANS nerve endings
  • Blocker drugs or antagonists
  • Block the receptor site for acetylcholine
  • AKA **antimuscarinic drugs **
32
Q

With anticholinergic drugs - acetylcholine cannot act on receptors where?

A

In smooth muscle, glands or the heart

33
Q

What are the major pharmacologic effects of anticholinergic drugs (reduce PANS)?

A
  • CNS = effects determined by dose
    • Sedation, motion sickness (scopolamine)
    • Stimulation, delirium, hallucinations, coma (atropine in high doses)
  • Exocrine glands
    • Dries up secretions
    • Used in dentistry to decrease salivation and create dry field for bonded restorations and impressions (atropine)
  • Smooth Muscle
    • Bronchodilators
  • GI tract
    • Decrease gut motility
  • Eye
    • Mydriasis, cycloplegia, drops used for opthalmologic examination -GRRR
34
Q

What are the clinical uses of anticholinergic drugs?

A
  • Preoperative medications - stops salivation, blocks slowing of heart rate caused by general anesthesia
  • GI disorders - that produce excess secretion and increased gut motility, stops excess acid secretion, stops diarrhea & cramping
  • Eye Exam - pupil dilation
  • Parkinson’s disease - Reduces tremors
  • GU disorders - overactive bladder
35
Q

How are anticholinergic drugs used in dentistry?

A

Atropine - to maintain a dry field

36
Q

What do atropine and pilocarpine do?

A
  • atropine - anticholinergic - dries saliva
  • pilocarpine - cholinergic - salivation
37
Q

What is scopolamine and opratropium (Atrovent) used for?

A
  • scopolamine - patch used for motion sickness
  • ipratropium (Atrovent) - emphysema = stops bronchial secretion
38
Q

What are the contraindications to anticholinergic drugs?

A
  • Glaucoma - cause an acute rise in intraocular pressure
  • Prostatic hypertrophy - cause urinary retention, may need catheterization
  • Intestinal or urinary obstruction or retention - slow GI motility and cause urinary retention
  • Cardiovascular disease - drugs can block the vagus nerve, tachycardia can result
39
Q

What are the adverse reactions to anticholinergic drugs?

A

Extensions of their pharmacologic effects - too much of what they typically do..

40
Q

What are the side effects for atropine toxicity?

A
  • Dry as a bone (lack of sweating)
  • Red as a beet (flushed skin)
  • Blind as a bat (blurred vision, mydriasis, cycloplegia)
  • Mad as a hatter (delirium, hallucinations)

Pharmacology (25 decks)

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