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Pharmacology & Anesthesiology > Autonomic Pharmacology > Flashcards

Autonomic Pharmacology Flashcards

1
Q

what are 2 key roles of the autonomic nervous system

A

1) modulate contraction of smooth muscle
2) secretion from (endocrine and exocrine) glands

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2
Q

where are the neural connections of the somatic vs the autonomic (PSNS and SNS) nervous systems

A

Somatic: in the CNS
Autonomic: in the PNS (PSNS - ganglia located close to the organ; SNS - ganglia located close to the spinal cord)

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3
Q

in the autonomic nervous system, ganglia are located in (afferent/efferent) pathways

A

efferent

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4
Q

the autonomic nervous system has (myelinated/unmyelinated) preganglionic neurons and (myelinated/unmyelinated) postganglionic neurons

A

myelinated; unmyelinated

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5
Q

what are the 2 arms of the autonomic nervous system

A

PSNS and SNS

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6
Q

what is the outflow of the sympathetic NS

A

thoracolumbar

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7
Q

what is the outflow of the parasympathetic NS

A

craniosacral

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8
Q

what is the ratio of pre to postganglionic neurons for the sympathetic ns? parasympathetic ns?

A

sympathetic: one pre to many post
parasympathetic: one pre to one post

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9
Q

what is the distribution of RESPONSE and DISCHARGE for the sympathetic ns? parasympathetic ns?

A

sympathetic: generalized response, diffuse discharge
parasympathetic: limited response; discrete discharge

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10
Q

T/F in general the SNS and PNS are physiological antagonists

A

T

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11
Q

is the SNS or PNS essential for life

A

PNS

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12
Q

what are 5 functions of the PNS:
1) pupillary ____________
2) _________ GI motility
3) __________ urination and defecation
4) __________ hr and bp
5) __________ absorption of nutrients

A

1) constriction
2) increased
3) increased
4) decreased
5) increased

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13
Q

which branch of the autonomic nervous system is not essential for life

A

sympathetic nervous system

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14
Q

what are the 6 functions of the SNS:
1) ________ heart rate and blood pressure
2) splenic ___________
3) ___________ of vessels in the skin
4) pupillary ____________
5) broncho___________
6) ________ blood glucose

A

1) increase
2) contraction
3) constriction
4) dilation
5) dilation
6) increase

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15
Q

where are the sites of chemical transmission in the autonomic nervous system

A

1) between the pre and post-ganglionic neuron
2) between the post-ganglionic neuron and the target organ

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16
Q

what are the 7 sites for pharmacological intervention in the PRESYNAPTIC neuron

A

1) action potential
2) synthesis of NT
3) storage of NT
4) metabolism of NT
5) release of NT
6) reuptake of NT
7) degradation of NT

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17
Q

what are the 3 sites for pharmacological intervention in the POSTSYNAPTIC neuron

A

1) receptor binding
2) receptor stimulation (effectors)
3) response (secondary messengers)

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18
Q

most drugs act via modifying actions on the pre or postsynaptic receptor

A

postsynaptic

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19
Q

cholinergic neurons release

A

ACh

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20
Q

all motor fibers to skeletal muscle use what NT at the neuromuscular junction

A

ACh

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21
Q

what is the subdivision of cholinoreceptors

A

nicotinic (Nn and Nm) and muscarinic (M1-M5)

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22
Q

what is the difference between Nn and Nm cholinoceptors

A

Nn: nicotinic neuronal (aka postganglionic)
Nm: nicotinic motor end plate (neuromuscular junction)

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23
Q

adrenergic neurons release

A

catecholamines (dopamine, E, NE)

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24
Q

the adrenal medulla releases primarily _________, and some _________

A

epinephrine; norepinephrine

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25
Q

α1 and α2 adrenoceptors are involved in

A

contraction

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26
Q

describe the location of the following adrenoceptors:
β1:
β2:
β3:

A

β1 - heart
β2 - smooth muscle
β3 - fat

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27
Q

all preganglionic neurons release the NT ______, which binds to ______ receptors on the postganglionic neuron

A

ACh; nicotinic (N)

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28
Q

what effectors have muscarinic ACh receptors for the PARASYMPATHETIC NS

A

cardiac and smooth muscle; gland cells; nerve terminals

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29
Q

what effectors have muscarinic ACh receptors for the SYMPATHETIC and PARASYMPATHETIC NS

A

sweat glands

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30
Q

what effector organs respond to dopamine as a NT from the SYMPATHETIC NS

A

renal vascular smooth muscle

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31
Q

what effector organs have α and β adrenergic receptors for NE from the SYMPATHETIC NS

A

gland cells; cardiac and smooth muscle

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32
Q

what type of ACh receptors exist at the gastrointestinal and genitourinary smooth muscle

A

M3

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33
Q

what type of ACh receptors exist at the bronchiolar SM

A

M3

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34
Q

what type of ACh receptors exist at the heart

A

M2

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35
Q

what type of ACh receptors exist at the salivary gland

A

M3

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36
Q

what type of ACh receptors exist at the eye

A

M3

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37
Q

what type of ACh receptors exist at the autonomic nerve endings

A

M2

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38
Q

what type of SNS receptors exist at the heart

A

β1

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39
Q

what type of SNS receptors exist on smooth muscle of the skin and splanchnic vessels

A

α1

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40
Q

what type of SNS receptors exist on smooth muscle of the skeletal muscle vessels

A

β2

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41
Q

what type of SNS receptors exist on splenic smooth muscle

A

α1

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42
Q

what type of SNS receptors exist at the bronchiolar SM

A

β2

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43
Q

what type of SNS receptors exist at the GI tract wall? GI tract sphincters

A

α2, β2; α1

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44
Q

what type of SNS receptors exist at the genitourinary tract SM of the:
1) bladder wall
2) sphincter
3) pregnant uterus

A

1) β2
2) α1
3) β2, α1

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45
Q

what type of SNS receptor exists at the penis and seminal vesicle smooth muscle

A

α1

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46
Q

what type of SNS receptor exists on salivary glands

A

α1

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47
Q

what type of SNS receptor exists on the eye muscles to cause:
1) contraction
2) relaxation

A

α1; β2

48
Q

what type of SNS receptor exists at autonomic nerve endings

A

α2

49
Q

adrenergic receptors alter

A

1) rate and force of contraction of the heart
2) tone of the blood vessels

50
Q

what is the effect of α receptors on vascular smooth muscle

A

contraction: increased TPR -> increased BP -> reflex decrease in heart rate

51
Q

what is the effect of β receptors on vascular smooth muscle

A

relaxation: decreased TPR -> decreased BR -> increased heart rate

52
Q

Epinephrine:
1) what type of agonist/antagonist
2) what receptors activated

A

1) mixed α/β agonist
2) activates all α and β subtypes

53
Q

What are the cardiac effects of epinephrine and why

A

increases rate (chronotropy) and force (ionotropy) of contraction via β1

54
Q

What are the vascular smooth muscle effects of epinephrine and why

A

mainly vasoconstriction -> increased TPR via α1
some vasodilation -> decreased TPR via β2

55
Q

By activating α1 receptors, what are some other effects of epinephrine

A

contraction of spleen, contraction of bladder sphincter, contraction of radial muscle of the iris causing mydriasis

56
Q

By activating β2 receptors, what are some other effects of epinephrine

A

bronchodilation, decreased GI contractions, decreased uterine motility, relaxed bladder

57
Q

How do drugs that stimulate α1 receptors cause the eyes to dilate

A

Contracting the radial muscle of the iris -> mydriasis

58
Q

Clenbuterol:
1) what type of agonist/antagonist
2) what receptors activated

A

1) selective β agonist
2) β2

59
Q

Terbutaline:
1) what type of agonist/antagonist
2) what receptors activated

A

1) selective β agonist
2) β2

60
Q

Dobutamine:
1) what type of agonist/antagonist
2) what receptors activated

A

1) selective β agonist
2) β1

61
Q

Phenylephrine:
1) what type of agonist/antagonist
2) what receptors activated

A

1) selective α agonist
2) α1

62
Q

Isoproterenol:
1) what type of agonist/antagonist
2) what receptors activated

A

1) non-selective β agonist
2) β1/β2

63
Q

What are the effects of clenbuterol/terbutaline and uses in the different species

A

bronchodilator
cats: asthma
dogs: chronic bronchitis
horses: lower airway disease

64
Q

Ractopamine:
1) what type of agonist/antagonist
2) what receptors activated

A

1) non-selective β agonist
2) mainly β1, some β2

65
Q

What is the therapeutic use of ractopamine and in what species

A

growth promotion in cattle; increases lean muscle deposition

66
Q

What is the main therapeutic use of dobutamine and why

A

cardiac support (CHF) -> improves contracility and bp without significant tachycardia

67
Q

what is a consequence of dobutamine overdose

A

ventricular tachycardia and hypertension

68
Q

what is the main use of isoproterenol and what is a benefit with this drug particularly

A

stimulates heart (heart block or bradycardia); β2 stimulation also results in decreased TPR and decreased BP

69
Q

what are the main therapeutic uses of phenylephrine

A

1) vasoconstriction and increased BP (with reflex drop in heart rate possible)
2) BP support
3) pupillary dilation
4) nasal decongestion (because of constriction)

70
Q

what is unique about dopamine

A

dose-dependent effects

71
Q

Dopamine receptor stimulation and effect:
1) low doses
2) moderate doses
3) high doses

A

1) D1: dilates renal vasculature -> increased GFR
2) β1: increases contractility
3) α1: increases TPR -> increased BP

72
Q

what are ephedrine, pseudoephedrine, and phenylpropanolamine

A

direct and indirect acting sympathomimetics -> activation of α and β and release of NE

73
Q

what are the two main therapeutic uses of ephedrine and pseudoephedrine

A

1) decongestion
2) urinary tract incontinence

74
Q

what is the main therapeutic use of phenylpropanolamine

A

urinary incontinence due to hypotonic urethra

75
Q

what 2 adrenergic agonists can you give a patient with low BP or reduced blood flow (vascular hypotension) in the short-term

A

1) epinephrine
2) phenylephrine

76
Q

what can you give a patient presenting with cardiac insufficiency (bradycardia, cardiogenic shock, CHF)

A

1) dopamine
2) dobutamine
3) epinephrine
4) isoproterenol

77
Q

what can you use in combination to produce LOCAL vasoconstriction

A

epinephrine and lidocaine

78
Q

what can you use to treat bronchoconstriction

A

1) clenbuterol (horse)
2) terbutaline (small animal)
3) epinephrine (respiratory issues associated with anaphylaxis)

79
Q

what can you use to treat nasal congestion

A

1) phenylephrine
2) pseudoephedrine
3) ephedrine

80
Q

what is the mainstay treatment of anaphylaxis (which causes both bronchospasm and cardiovascular collapse from vasodilation)

A

epinephrine

81
Q

what can you use as a mydriatic to facilitate retinal examination

A

phenylephrine

82
Q

phenoxybenzamine:
1) what type of agonist/antagonist
2) what receptors activated

A

1) non-selective α-antagonist
2) α1, a2

83
Q

prazosin:
1) what type of agonist/antagonist
2) what receptors activated

A

1) selective α-antagonist
2) α1

84
Q

atenolol:
1) what type of agonist/antagonist
2) what receptors activated

A

1) selective β-antagonist
2) β1

85
Q

metoprolol:
1) what type of agonist/antagonist
2) what receptors activated

A

1) selective β antagonist
2) β1

86
Q

proponalol:
1) what type of agonist/antagonist
2) what receptors activated

A

1) nonselective β antagonist
2) β1, β2

87
Q

carvedilol:
1) what type of agonist/antagonist
2) what receptors activated

A

1) mixed adrenergic antagonist
2) β > α1

88
Q

what are the therapeutic uses of phenoxybenzamine

A

1) diagnosis and treatment of pheochromocytoma
2) hypertonic urethra

89
Q

what is a major adverse effect of phenoxybenzamine and an important therapeutic consideration

A

can cause severe hypotension (blocking α1) -> do not want to give epinephrine to reverse because the α receptors are blocked, so only the β effects of epinephrine will remain -> can get even further hypotension

90
Q

what are the therapeutic uses of prazosin

A

hypertonic urethra due to functional obstruction; can be used to help treat CHF

91
Q

in regards to β antagonists, drugs with higher affinity for what receptor are more useful clinically

A

β1

92
Q

β antagonists are used for what 2 diseases

A

1) cardiovascular
2) ocular

93
Q

what is the therapeutic use of propanolol

A

supraventricular and ventricular tachyarrhythmias, thyrotoxicosis for cats with hyperthyroidism, pheochromocytoma, HCM in cats

94
Q

what β antagonist has minimal hepatic first pass effects

A

atenolol

95
Q

what are the therapeutic uses of atenolol and metoprolol

A

same as propanolol BUT they have reduced adverse effects like bronchospasm

96
Q

what are the therapeutic usees of carvedilol

A

cardiomyopathy in dogs, free-radical scavenger

97
Q

bethanechol:
1) what type of agonist/antagonist
2) what receptors activated

A

1) cholinergic agonist
2) muscarinic

98
Q

what is the therapeutic use of bethanechol

A

stimulates urinary bladder -> hypocontractile bladder

99
Q

when is bethanechol contraindicated

A

GI or urinary obstruction

100
Q

what is a possible side effect of bethanechol and what is the antidote

A

salivation, lacrimation, urination, defacation; atropine (muscarinic blocker)

101
Q

what are the therapeutic uses of pilocarpine

A

pupillary constriction (miosis) and tear production

102
Q

what is the mechanism of action of edrophonium and what are 2 key factors about it

A

prolongs half life of ACh by binding to the active site of acetylcholinesterase; short duration of action and poor penetration into the CNS

103
Q

what is the mechanism of action of neostigmine/pyridostigmine and what are 2 key factors

A

carbamylates active site of acetylcholinesterase; longer duration of action than edrophonium and poor penetration into CNS

104
Q

what are the therapeutic uses of edrophonium/neostigmine/pyridostigmine

A

intestinal motility disorders (ex. paralytic ileus)

105
Q

what are the 2 classes of non-selective muscarinic cholinergic antagonists

A

tertiary amides, quaternary ammonium compounds

106
Q

what cholinergic antagonists are tertiary amides

A

atropine, oxybutynin tropicamide

107
Q

what cholinergic antagonists are quaternary ammonium compounds

A

propantheline, ipratropium, hyoscine

108
Q

what are the therapeutic uses of atropine

A

mydriasis (pupil dilation) and reduced ciliary spasms (uveitis), treating organophosphate poisoning, bradyarrhythmias

109
Q

what are the therapeutic uses of tropicamide

A

pupil dilation (mydriasis)

110
Q

what are some possible adverse effects of oxybutynin

A

constipation and urine retention

111
Q

what are the therapeutic uses of oxybutynin and what is a general caution

A

spastic bladder; do not use if bladder or GI obstruction or if there is an infection

112
Q

do tertiary amines or quaternary ammoniums have more CNS effects

A

tertiary amines

113
Q

what are the therapeutic uses of propantheline

A

GI motility disorders, spastic bladder

114
Q

what are the therapeutic uses of ipratropium

A

bronchospasm associated with respiratory disorders

115
Q

what are the therapeutic uses of hyoscine and what is a potential adverse effect

A

GI motility disorders; can cause tachycardia and reduced GI motility

116
Q

what is a potential use of hyoscine

A

acute severe exacerbations of airway obstruction in horses -> it causes immediate bronchodilation

Pharmacology & Anesthesiology (22 decks)

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