Autonomic Pharmacology Flashcards
origin of preganglionic neurons - Sympathetic NS
T/S
origin of preganglionic neurons - parasympathetic NS
Brain stem: CN 3,7,9,10
S2-S4
location of autonomic ganglia - sympathetic NS
vertebral/prevertebral
location of autonomic ganglia - parasympathetic NS
in or near the effector organs
length of the preganglionic axons - Sympathetic NS
short
length of preganglionic axons - parasympathetic NS
long
length of post ganglionic axons - sympathetic NS
long
length of postganglionic axons - parasympathetic NS
short
Effector organs of the sympathetic NS
smooth muscle, cardiac muscle (controls BP at rest), glands (sweat glands)
Effector organ of the parasympathetic NS
smooth muscle, cardiac muscle, glands
neuroeffector junctions of the sympathetic NS
diffuse, not located in one location
neuroeffector junctions of the parasympathetic NS
diffuse, not located in one location
Neurotransmitter and receptor in the ganglion of the sympathetic NS
AcH, nicotinic receptor
neurotransmitter and receptor in the ganglion of the parasympathetic NS
AcH, nicotinic receptor
neurotransmitter in effector organs of the sympathetic NS
Norepinephrine (except sweat)
neurotransmitter in the effector organs of the parasympathetic NS
AcH
what are the receptor types in the effector organs - sympathetic NS
a1,a2,B1, B2
what are the receptor types in the effector organs - parasympathetic NS
M1-M4 (muscarinic)
what is the role of the sympathetic NS
“fight or flight”
- blood flow to heart and skeletal muscles
- brochodilation
- liver releases glucose to provide energy
unique roles of the sympathetic NS / Sympathetic tone
- controls BP at rest (through vasoconstriction)
- sweat glands, medulla, and blood vessels only receive sympathetic fibers
- controls thermoregulary, renin release, and metabolic effects.
role of the parasympathetic NS
“rest and digest”
S: Salvation
L: Lachrymation
U: Urination
D: Defection
what input is AcH on nicotinic receptor
ALWAYS Stimulatory
what do B1 receptors typically do
part of the sympathetic NS and they increase the actions at the heart
what do parasympathetic M receptors do at the heart
decrease the actions at the heart
what are the actions of a1 receptors in the sympathetic nervous system
Constriction of sphincters, skeletal muscle
and dilation of the pupils
what are the actions of the a2 receptors in the sympathetic NS
relaxes the muscles of the GI
what is the role of B1 in the sympathetic NS
increases the action at the heart
what is the role of the B2 receptors in the sympathetic NS
dilate and relax the skin, skeletal muscle (aka bladder) and lungs
what are M2 receptors of the parasympathetic NS found on
the heart
what are M3 receptors of the parasympathetic NS found on
smooth muscle and the detrusor muscle
what is the primary therapeutic action of alpha 1 selective agonists
reduce nasal congestion
what are the alpha 1 selective agonists drugs
( -“rine” & -“line”)
1) phenylephrine
2) pseudoedrine
3) oxymetazoline
4) xylometazoline
what are the adverse effects of alpha 1 selective agonists
- increase BP leads to decrease HR (reflex brady)
- headache
(heart and head)
what is the therapeutic effect of alpha 2 selective agonist drugs
anti HTN
alpha 2 selective agonist drugs
1) clonidine
2) methydopa
what are the adverse effects of alpha 2 selective agonists
the 3 Ds
1) dizziness
2) dry mouth
3) drowsiness
what are the alpha 1 selective antagonists (alpha blockers)
drugs that end in (-osin)
with the exception of phenocybezamine with controls BP for the removal of pheochromaytoma
what is the function of alpha 1 angonists (alpha blockers)
1) anti HTN
2) urinatry retention and symptoms for benign prostatic hyperplasia
adverse effects of alpha 1 antagonists (alpha blockers)
1) reflex tachy (decrease BP leading to increase HR)
2) orthostatic hypotension
3) dizziness
beta 1 selective agonists drugs
end in -amine
1) dobutamine
2) dopamine
what are the therapeutic effects of beta 1 agonists
increases HR
what are the adverse effects of beta 1 selective agonists
the ABCs of the heart
1) A: arrhythmia
2) B: SOB
3) C: chest pain
what is the therapeutic function of beta 2 selective agonists
brochodilation
what are the beta 2 agonist drugs
1) Albuterol
2) salmeterol
3) terbutaline: helps to delay preterm labor
what are the adverse effects of B2 selective agonists
nervousness, restlessness, trembling
beta 1 selective antagonists (beta blockers) therapeutic function
decrease BP and HR - used for heart failure
what are the beta 1 secetive antagonist drugs
(olol)
1) atenolol
2) bisoprolol
3) metoprolol
4) esmolol
what are the mixed B1 and B2 antagonists
1) propranolol
2) timolol
what is the therapeutic function of propranolol
decrease BP and treat migraines
what are the adverse effects of beta blockers
1) bronchoconstriction
2) bradycardia
3) dizziness
4) depression
5) lethargy
what do direct acting cholinergic agonists do
mimic Ach at the cholinergic receptors
what do indirect acting cholinergic agonists do
ACE inhibitor
direct acting cholinergic agents
1) bethanechol
2) pilocarpine
3) methacholine
4) carbachol
5) nicotine
what is the therapeutic use of bethanechol
post op Gi and urinary atony - increases toicity in the detrusor muscle
what are the adverse reactions of bethanechol
- urinary urgency
- flushing of skin
- bronchial constriction
- asthma attacks
what is the therapeutic use of pilocarpine
used to treat glaucoma; decreases the fluid in the eye which reduces pressure in eyes
what are the adverse effects of pilocarpine
- blurred vision
- decreased night vision
- eye irritation
- headache
- increased sweating and salvation
what is methacholine theraputic use
dx asthma - bronchoconstrictor
what is the theraputic use carbachol
treat glaucoma
what are the drugs that are used to treat alzheimers
1) Donepezil
2) Rivastigmine
3) Galantamine
what are the drugs that are used to treat myasthenia gravis
1) neostigmine
2) pyridostigmine
3) edrophonium
4) ambenonium
what are the drugs that are used to treat glaucoma
1) physostigmine
2) echothipate
what are the common adverse effects of cholinergic agonists
- increase (SLUD)
- brochoconstriction
- bradycardia
- difficulty in visual accommodation due to pupil constriction.
Atropine
anti-cholinergic (M antagonist); used to treat bradycardia and dilate pupils
scopolamine
anti-cholinergic (M antagonist); used to treat motion sickness
Ipratropium bromide / tiotropium bromide
anti-cholinergic (M antagonist): COPD and asthma
oxybutynin/tolterodine
anti-cholinergic (M antagonist); used to treat overactive bladder
benztropine
anti-cholinergic (M antagonist); PD (reduce tremor and rigidity)
tropicamide
anti-cholinergic (M antagonist); used to dilate the eyes
dicyclomine
anti-cholinergic (M antagonist); IBS
Hyoscyamine
anti-cholinergic (M antagonist); GI disorders
PT considerations beta blockers
lower HR and BP: monitor vitals
pts might be fatigued quicker then normal
PT considerations alpha blockers
cause orthostatic hypotension
PT considerations for clonidine
cause orthostatic hypotension and dizziness
PT considerations for Anticholinergics
cause dry mouth with can cause discomfort during exercise. they also decrease sweating which can lead to overheating
PT considerations for beta agonists
bronchodilators used in COPD/ashma - make sure pt has their inhalers with them
PT considerations for ACE inhibitors
can cause bradycardia - monitor vitals
