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Pharmacology > Autonomic Pharmacology 2 > Flashcards

Autonomic Pharmacology 2 Flashcards

1
Q

What drugs block cholinergic transmission at neuromuscular junctions?

A

Neuromuscular Blocking Drugs

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2
Q

What do neuromuscular blocking drugs act as?

A

Either:

  • Antagonists (non-depolarizing)
  • Agonists (depolarizing)

And inhibit release of ACH

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3
Q

What are the neuromuscular blocking agents?

A
  • Tubocurarine
  • Succinylcholine
  • Botulinum toxin
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4
Q

What are some characteristics of Curare (d-tubocurarine)?

A
  • “aarow poisons”
  • Originally used as skeletal muscle relaxants
  • Depolarization of membrane is inhibited and muscle contraction is blocked
  • Causes weakness of skeletal muscles
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5
Q

How can competitive blockers be overcome?

A

By administration of cholinesterase inhibitors

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6
Q

What are some characteristics of succinylcholine?

A
  • Attaches to nicotinic receptor and like ACH, results in depolarization
    • Constant stimulation of receptor causes sodium channel to open, producing depolarization
  • Flaccid paralysis
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7
Q

With succinylcholine, how long does the paraylsis last?

A

Only a few minutes because drug is broken down by plasma cholinesterase

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8
Q

What is succinylcholine used for?

A
  • Endotracheal intubation
  • Relax skeletal muscles during surgery
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9
Q

What does Botulinum Toxin do and what is it used for?

A
  • Prevents calcium-dependedn release of ACH
  • Produces state of denervation
  • For muscles tics, muscle disorders, cosmetic procedures
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10
Q

What do ganglionic blocking agents do?

A
  • Inhibit nicotinic receptors, so blocks nuerotransmission in both PANS and SANS
    • Nicotine
    • Trimethaphan
    • Hexamethonium
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11
Q

What does nicotine do?

A
  • Low doses - stimulation due to depolarization
  • High doses - no response at nicotinic receptors, but stimulates muscarinic receptors
  • Respiratory paralysis, increase BP, HR, GI motility and secretions
  • Indication: tobacco cessation therapy, insecticide
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12
Q

What type of drugs act at receptors of the sympathetic nervous system?

A

Adrenergic drugs

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13
Q

What drugs fall under the adrenergic drugs category?

A
  • Endogenous
    • Epinephrine - adrenal medulla
    • Norepinephrine - terminal nerve endings
    • Dopamine - brian, splanchnic, renal vasculature
  • Exogenous
    • isoproternol
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14
Q

What are the different types of adrenergic receptors?

A

Alpha & Beta

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15
Q

What are the subtypes of Adrenergic drugs?

A
  • Direct acting - produce effects by directly stimulating receptor
  • Indirect acting - cause release of endogenous norepinephrine, which produces response
  • Mixed action - either stimulate the receptor directly or cause release of norepinephrine
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16
Q

What does stimulation of Alpha Receptors cause?

A
  • Vasoconstriction of vessels in skin (pale when scared)
  • Protects you from bleeding if skin is damaged during trauma (“fight” response)
  • Smooth muscle contraction
17
Q

What does stimulation of Beta-1 Receptors cause?

A
  • Cardiac stimulation
  • Increased rate and force of contraction
  • Breakdown glycogen to increase glucose (need energy during fight or flight)
18
Q

What does stimulation of Beta-2 Receptors cause?

A
  • Smooth muscle relaxation
  • Vasodilation of vessels in skeletal muscle
  • Bronchodilation
19
Q

What do the adrenergic agonists (sympathomimetics) do?

A
  • CNS excitation
  • Increased peripheral resistance
  • Increased blood pressure
  • Dilates pupils
  • Ease breathing
  • Xerostomia
20
Q

What are the clinical uses for adrenergic agonists?

A
  • Vasoconstriction - (epinephrine) prolongs anesthetics and produce hemostasis
  • Decongestants - vasoconstriction of blood vessels in nose
  • Treatment of shock - elevate low BP
  • Treatment of cardiac arrest - epinephrine jump starts heart
  • Asthma & emphysema - bronchodilation
  • CNS stimulation - amphetamines (stimulants) used to treat ADD/ADHD
21
Q

What are some popular adrenergic agonists (non-catecholamines)?

A
  • Albuterol
  • Amphetamines
  • Clonidine
  • Dopamine
  • Oxymetazoline
  • Phenylephrine
  • Phentermine
  • Pseudoephedrine
  • Tetrahydrozoline
22
Q

What are some characteristics of Albuterol?

A
  • Beta2 adrenergic agonist
  • Potent bronchodilator
  • “Rescue drug” - asthma & COPD
  • Incuded in all dental office emergency kits for managing acute asthma attack
23
Q

What are the side effects of Adrenergic Agonists?

A
  • Anxiety/irritability
  • Tremors
  • Cardiac arrhythmias (tachycardia)
  • Hypertension
  • Constipation
  • Urinary retention
24
Q

What do Alpha Antagonists (blockers) do?

A
  • Block vasoconstriction in skin
  • Decrease total peripheral resistance
  • Decrease blood pressure
  • Reverse dilation of pupils
25
Q

What are the uses of Alpha Antagonists (blockers)?

A
  • Second line agents for the treatment of hypertension
  • Treatment of peripheral vascular disease
  • Diagnosis and treatment of pheochromocytoma
  • Treatment of benign prostatic hypertrophy
26
Q

Who are the main users of alpha1 - blockers (Alpha antagonists) and for what primary reasons?

A

Old Men!

  • Hypertension
  • Benign prostatic hypertrophy
27
Q

What alpha antagonist reverses dental anesthesia??

A

phentolamine (OraVerse)

28
Q

What are the popular Alpha Antagonists (blockers)?

A

All end in …sin

  • prazosin (Minipress)
  • terazosin (Hytrin)
  • doxazosin (Cardura)
29
Q

What are beta blockers used primarily for?

A

Beta1 effect - on the heart

30
Q

What’s the difference between selective and non-selective beta blockers (antagonists)?

A
  • Selective blockers - block only Beta1 receptors in heart and blood vessels
  • Non-selective blockers - block both Beta1 and Beta2 receptors in lungs (beta2)
31
Q

What is the most widely used beta blocking drug in the US?

A

Selective Blockers - Beta1

32
Q

What are the uses of Beta Antagonists (blockers)?

A
  • Cardiac arrhythmias - slows heart rate
  • Angina - decreases cardiac muscle O2 demand
  • Hypertension -
  • Hyperthyroidism - stops tremors/ heart palpitations
  • Parkinson’s disease - stops tremors
  • Anxiety
  • Glaucoma - lowers intraocular pressure
  • Migraine headache
33
Q

What are the popular Beta blockers - selective?

A
  • atenolol (Tenormin)
  • metoprolol (Lopressor, Toprol)
34
Q

What are the popular beta blockers - non-selective?

A
  • propranolol (Inderal)
  • nadolol (Corgard)
  • timolol (Timoptic) - eyedrops for glaucoma
35
Q

What is the most common selective beta blocker?

A

metoprolol (Lopressor, Toprol)

36
Q

What is the most common non-selective beta blocker?

A

propanolol (Inderal)

37
Q

When patients taking non-selective beta blockers are given epinephrine, they have a 2-4 fold increase in the ___________?

And what must you limit the dose to?

A

Pressure response to epinephrine

  • Hypertension
  • Reflex bradycardia

Limit dose of epinephrine given to patients to cardiac dose - 0.04 mg of epinephrine (2 cartridges of epinephrine 1:100,000)

Pharmacology (25 decks)

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