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Pharm Exam 1 > Autonomic Pharmacology > Flashcards

Autonomic Pharmacology Flashcards

1
Q

All preganglionic sympathetic neurons originate in the spinal cord from segments _____

A

T1 and L2

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2
Q

In the Parasympathetic Nervous System,
preganglionic neurons originate from the
brainstem and the sacral spinal cord and travel peripherally via

A

○ Cranial nerves III, VII, IX, and X
■ About 75% are in the Vagus Nerve
○ Pelvic splanchnic nerves

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3
Q

Parasympathetic preganglionic fibers travel a
relatively ____ distance before synapsing on the postganglionic neurons

A

long

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4
Q

Postganglionic neurons reside in ganglia and
plexuses located in the wall of the effector organ or in very close proximity to the tissue in which system?

A

Parasympathetic NS

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5
Q

Neurons that release _____ are called Cholinergic fibers

A

acetylcholine

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6
Q

Neurons that release norepinephrine are called _____

A

Adrenergic fibers

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7
Q

For both the sympathetic and parasympathetic nervous systems, all
preganglionic neurons are _____

A

cholinergic

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8
Q

most of the postganglionic
sympathetic neurons are ____ fibers while most all of the postganglionic parasympathetic neurons are ____ fibers

A

adrenergic; cholinergic

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9
Q

In order for a neurotransmitter released from a postganglionic fiber to stimulate an effector organ, it must ____

A

bind to a specific receptor on the effector organ cells

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10
Q

Two types of cholinergic receptors

A

Muscarinic and Nicotinic

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11
Q

Nicotinic receptors are ligand-gated ion
channels found at the NMJ of skeletal
muscle, and all synapses of _____

A

preganglionic and postganglionic cells (all ANS)

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12
Q

Muscarinic receptors are found on effector
cells that are stimulated by _____

A

postganglionic cholinergic neurons (all parasympathetic, a few sympathetic fibers)

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13
Q

Five subtypes of cholinergic receptors

A

○ M1 - Muscarinic, sweat glands of the skin
○ M2 - Muscarinic, SA and AV nodes of the heart; involved in slowing of the heart rate and conduction.
○ M3 - Muscarinic, smooth muscles and glands of various organ systems; involved in pupil constriction, contraction of
bronchioles, increased GI motility, stimulation of glandular secretions, urethral sphincter relaxation, etc.
○ NN - Nicotinic (nerve type), located on postganglionic cells.
○ NM - Nicotinic (muscle type), located at neuromuscular junction

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14
Q

The only cholinoreceptor involved in sympathetic function is ___

A

M1

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15
Q

Two classes of Adrenergic receptors

A

Alpha receptors are of two types: Alpha-1 and Alpha-2.
Beta receptors are of three types: Beta-1, Beta-2, and Beta-3.

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16
Q

Alpha receptors

A

Both Alpha-1 and 2 are found throughout the body on many effector organs; Alpha-1 is especially prominent in blood vessels
and intestinal musculature

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17
Q

Beta receptors

A

While there is some overlap, we generally think of Beta-1 as primarily cardiac, Beta-2 primarily pulmonary, and Beta-3 as minimally involved (thermoregulation).
○ Beta-2 is also found in blood vessels, intestinal musculature, the uterus, etc

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18
Q

Norepinephrine vs. epinephrine effects on alpha and beta receptors

A

Norepinephrine excites both, but mainly alpha receptors; Epinephrine excites both adrenergic receptors equally

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19
Q

T/F Most organ systems are dominantly controlled by either the sympathetic or the parasympathetic system.

A

T

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20
Q

Cholinergic agonists - Direct acting

A

○ Bethanechol
○ Pilocarpine (Salagen, Isopto Carpine)
○ Nicotine
○ Varenicline (Chantix)

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21
Q

Cholinergic agonists - Choninesterase inhibitors

A

○ Pyridostigmine (Mestinon)
○ Donepezil (Aricept)

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22
Q

Cholinergic agonists are also known as ____

A

Cholinomimetics

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23
Q

MICSAF - Behanechol

A

MOA: Direct acting, muscarinic
Indication: Neurogenic ileus and urinary retention
Contraindication: Known GI or bladder obstruction, recent GI or bladder surgery,
Side effects: Depending on where the drug is acting, side effects can
include blurry vision, nausea/vomiting, diarrhea, salivation,
sweating, bradycardia, bronchial secretions, etc *for all CA’s

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24
Q

MICSAF - Pilocarpine (Salagen,
Isopto Carpine)

A

MOA: Direct acting, muscarinic
Indications: Glaucoma (eye drops) and Sjogren’s-related xerostomia (tabs)
Contraindications: Acute iritis (tabs and eye drops), angle-closure glaucoma (tabs)

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25
Q

MICSAF - Nicotine

A

MOA: Direct acting, nicotinic
Indications: Smoking cessation
Contraindications: TMJ disorder (transmucosal), significant angina, recent MI
Follow up: (pregnancy) Nicotine benefits outweigh risks (risk of fetal harm is not expected based on limited human data)

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26
Q

MICSAF - Varenicline (Chantix)

A

MOA: direct acting, nicotinic
Indications: Smoking cessation
Contraindication: Under the age of 18 years
Follow up/monitoring: check creatinine at baseline. Watch for signs and symptoms of depression, agitation, behavior
changes, and suicidality with varenicline

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27
Q

MICSAF - Pyridostigmine (Mestinon)

A

MOA: Cholinesterase inhibitors- Indirectly
increase ACh receptor activation by
inhibition of ACh breakdown in the
synaptic cleft, NMJ
Indications: Myasthenia gravis
Contraindications: GI or GU tract obstructions
Follow up/monitor: check creatinine at baseline

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28
Q

MICSAF - Donepezil (Aricept)

A

MOA: Cholinesterase inhibitors - Indirectly
increase ACh receptor activation by
inhibition of ACh breakdown in the
synaptic cleft, CNS
Indication: Alzheimer’s dementia
Contraindication: Caution with GI and GU disorders or obstructions

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29
Q

Antimuscarinic Cholinergic Antagonists

A

○ Atropine
○ Ipratropium (Atrovent)
○ Tiotropium (Spiriva)
○ Oxybutynin (Ditropan)
○ Tolterodine (Detrol)
○ Tropicamide (Mydriacyl)

30
Q

MICSAF - Succinylcholine

A

MOA: blocks transmission at the NMJ by agonizing the ACh receptor (antagonizing by agonizing).
I: causes paralysis (neuromuscular blockade)
C: Myopathy
Monitor EKG, vitals, electrolytes, and neuro function when treating
patients with succinylcholine

31
Q

MICSAF - Atropine

A

MOA: antagonizing acetylcholine at
muscarinic receptors
I: Atropine is used for symptomatic bradycardia (ACLS drug) and as
a neuromuscular blockade reversal agent.
C: Atropine should be used with caution in those with CAD, recent MIs, arrhythmias, etc

32
Q

Common side effects of Cholinergic antagonists

A

Constipation
Urinary retention
Blurred vision
Flushing
Dry mouth

33
Q

Major adverse reactions of Cholinergic antagonists

A

○ Anticholinergic psychosis
○ Tachycardia
○ Severe anhidrosis
○ Heat stroke
○ Fever
○ Acute Angle-Closure Glaucoma

34
Q

MICSAF - Ipratropium (Atrovent)

A

M: antagonizing acetylcholine at
muscarinic receptors
I: COPD maintenance treatment

35
Q

Tiotropium (Spiriva)

A

M: antagonizing acetylcholine at
muscarinic receptors
I: COPD maintenance treatment
C: acute bronchospasm

36
Q

MICSAF - Oxybutynin (Ditropan)

A

M: antagonizing acetylcholine at
muscarinic receptors
I: overactive bladder
C: Angle-closure glaucoma

37
Q

MICSAF - Tolterodine (Detrol)

A

M: antagonizing acetylcholine at
muscarinic receptors
I: overactive bladder.
C: Angle-closure glaucoma

38
Q

MICSAF - Tropicamide (Mydriacyl)

A

M: antagonizing acetylcholine at
muscarinic receptors
I: to dilate pupils for some eye exams
C: Angle-closure glaucoma

39
Q

Anticholinergic side effects saying, monitor for these with all of the drugs!

A

Hot as a hare
Dry as a bone
Blind as a bat
Red as a beet
Mad as a hatter

40
Q

The side effect profile of ipratropium and tiotropium are less because
these are _____

A

inhaled and not systemically absorbed in large amounts

41
Q

Ipratropium inhaled, tropicamide ophthalmic, and succinylcholine all appear to be _____

A

safe in pregnancy

42
Q

MOA of all adrenergic agonists

A

agonize 𝛂 and/or β adrenergic receptors to some degree

43
Q

At certain doses, ____ causes cardiac
stimulation (β1) and increased blood
pressure (𝛂1)

A

Dopamine

44
Q

Direct acting Adrenergic agonists

A

○ Epinephrine
○ Dopamine
○ Dobutamine
○ Albuterol
○ Salmeterol (Serevent)
○ Phenylephrine (Neo-synephrine)
○ Oxymetazoline (Afrin)

45
Q

Inderect acting and mixed adrenergic agonists

A

○ Amphetamine (Adderall)
○ Pseudoephedrine (Sudafed)

46
Q

Centrally acting adrenergic agonists

A

Clonidine (Catapres)

47
Q

Albuterol and Salmeterol are ____ agonists, causing ______.

A

β2; bronchodilation

48
Q

Phenylephrine and Oxymetazoline both cause _____ (𝛂1) of some peripheral tissues, can increase blood pressure

A

vasoconstriction

49
Q

Amphetamine indirectly agonizes adrenergic receptors by _____ release of norepinephrine, which is a general agonist (all 𝛂 and β)

A

increasing

50
Q

Clonidine is a “centrally-acting” antihypertensive because it is an
𝛂2 agonist, resulting in ____ sympathetic outflow in general by decreasing NE and ACh release

A

decreased

51
Q

Because of its broad adrenergic action, ____ is indicated for use in several ACLS arrhythmias, cardiac resuscitation, treatment of anaphylaxis, severe asthma, and septic shock

A

Epinephrine

52
Q

____ and ____ are both for shock and heart failure

A

Dopamine and Dobutamine

53
Q

Clonidine is indicated for treatment of ___

A

hypertension

54
Q

Common side effects of adrenergic agonists

A

Tachycardia, palpitations, HTN, diaphoresis, tremor, nervousness, anxiety, restlessness, headache, nausea, vomiting, insomnia, etc

55
Q

Because of its 𝛂2 mechanism of action, ____ can cause hypotension, bradycardia, dizziness, fatigue, somnolence, etc.

A

Clonidine

56
Q

BBW of Adrenergic agonists

A

○ Dopamine - If extravasation occurs with IV administration, the area should be liberally infiltrated with saline with a hypodermic needle.
○ Salmeterol - Because it is a long-acting β2 agonist, is should not be used as asthma monotherapy; linked to asthma-related death. Also, can increase risk of asthma-related hospitalization in pediatric Pts.
○ Amphetamine - High abuse potential, may lead to drug dependence.
○ Clonidine - Should not be used for obstetrical-related pain as an epidural
pain treatment

57
Q

Those being treated with Epinephrine, Dopamine, and Dobutamine should be monitored with ____

A

EKG and vital signs

58
Q

Those being treated with Amphetamine and Clonidine should be assessed for ____ at baseline,

A

cardiovascular risk, HR, and BP

59
Q

Phenylephrine and Pseudoephedrine should not be used in _____

A

pregnancy, especially the first trimester

60
Q

Adrenergic antagonists are commonly referred to as _____

A

Alpha Blockers and Beta Blockers

61
Q

Alpha blockers

A

○ Doxazosin
○ Tamsulosin (Flomax)

62
Q

Beta blockers

A

○ Nonselective: Propranolol
○ Selective β₁ (beta₁) blockers
■ Atenolol
■ Metoprolol (Toprol)

63
Q

Mixed alpha and beta blockers

A

Carvedilol (Coreg)

64
Q

Because Tamsulosin is selective to prostate and urinary 𝛂1-a receptors, it is indicated for _____

A

Benign Prostatic Hyperplasia and (*) Nephrolithiasis

65
Q

Doxazosin causes general, peripheral 𝛂1 blockade and is indicated in
_____

A

hypertension and BPH

66
Q

Propranolol, Atenolol, Metoprolol, and Carvedilol are all indicated in
_____

A

HTN, heart failure, and post-MI cardiovascular event prevention

67
Q

Propranolol, Atenolol, Metoprolol, and Carvedilol are all contraindicated
in ______

A

shock, decompensated heart failure, bradycardia, hypotension, AV
heart blocks, significant asthma, and abrupt withdrawalC

68
Q

Common side effects of adrenergic antagonists

A

○ Fatigue
○ Dizziness
○ Bradycardia
○ Hypotension
○ Weakness

69
Q

Adverse reactions of adrenergic antagonists

A

○ Congestive heart failure
○ Cardiogenic shock
○ Bronchospasm
○ Heart blocks

70
Q

BBW of Adrenergic antagonists

A

Propranolol, Atenolol and Metoprolol - All have the same BBW: Avoid abrupt cessation

Pharm Exam 1 (7 decks)

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