Autonomic Pharmacology Flashcards
Preganglionic neuron receptors and neurotransmitters
Nicotinic cholinergic receptor for both parasympathetic and sympathetic nervous system, both NT’s acetylcholine
Postganglionic neuron receptors and neurotransmitters
Sympathetic nervous system: NoEpi, Epi, and Dopamine on Adrenergic receptor (Alpha, Beta, or Dopamine receptors)
Parasympathetic nervous system: Acetylcholine and muscarinic cholinergic receptor
Synthesis of catecholamine’s
Phenylalanine -> Tyrosine (Tyrosine Hydroxylase rate limiting enzyme, inhibited by increased NE synthesis) -> DOPA -> Dopamine -> Norepinephrine -> Epinephrine (primarily synthesized in adrenal medulla)
Metabolism of catecholamine’s
COMT (cathechol-O-methyl transferase): Metabolizes catecholamine in the synapse (~20%)
MAO (monoamine oxidase): Metabolizes catecholamine when it is reuptaked into the neuron if it isn’t in a vesicle
Presynaptic Receptor
“Auto receptor”
Inhibitory effect/negative feedback, when stimulated decreases NT release from the synapse
Alpha agonist affect on eye, HR, blood vessels, GI tract, uterus, liver
Eye: Mydriasis (pupil dilation) HR: Bradycardia (reflex) Blood vessels: Vasoconstriction GI tract: Decreased motility and secretion Uterus: Contraction Liver: Increased blood sugar
Alpha blocker affect on eye, HR/contractility, blood vessels
Eye: Slight Miosis (pupil constriction)
HR: Tachycardia (reflex), slight reflex increase in contractility
Blood vessels: Vasodilation
Beta agonist affect on HR/contractility/conduction velocity, blood vessels, lungs, GI tract, uterus, liver
Heart: Tachycardia, increased contractility, increased conduction velocity
Blood vessels: Vasodilation
Lungs: Bronchodilation
GI Tract: Decreased motility and secretion
Uterus: Relax
Liver: Increased blood sugar
Beta blocker affect on eye, HR/contractility/conduction velocity, blood vessels, lungs, liver
Eye: Decreased intra-ocular pressure Heart: Bradycardia, decreased contractility, decreased conduction velocity Blood vessels: Vasoconstriction Lungs: Bronchoconstriction Liver: Hypoglycemia
Cholinergic agonist affect on eye, heart, lungs, GI tract
Eye: Miosis (pupil constriction), decreased intraocular pressure
HR: Bradycardia, slightly decreased contractility, decreased conduction velocity
Lungs: Bronchoconstriction
GI Tract: Increased motility and secretion
Anticholinergic affect on eye, heart, lungs, GI tract
Eye: Mydriasis (dilation), cycloplegia (loss of accommodation for distance), increased intraocular pressure
Heart: Tachycardia, slightly increased contractility, increased conduction velocity
Lungs: Slight bronchodilation
GI Tract: Decreased motility and secretion
Phenylephrine (receptor, effect on SBP, DBP, HR, SVR)
Pure alpha agonist SBP: +++ DBP: +++ HR - SVR: +++
Norepinephrine (receptor, effect on SBP, DBP, HR, SVR)
Alpha agonist, some beta SBP: +++ DBP: ++ HR: + SVR: +++
Epinephrine (receptor, effect on SBP, DBP, HR, SVR)
Beta agonist, some alpha SBP: ++ DBP: -- HR: +++ SVR: -
DoButamine (receptor, effect on SBP, DBP, HR, SVR)
Pure beta agonist SBP: ++ DBP: --- HR: +++ SVR: ---
Dopamine (receptor, effect on SBP, DBP, HR, SVR)
Dopamine, beta, alpha (dose dependent) SBP: + DBP: -- HR: + SVR: -- (+ in high doses)
Alpha agonists = ____
Vasoconstriction
Beta 2 receptor agonist = _____
Vasodilation
Beta 1 receptor agonist = _____
In heart (exception=renal stimulate to secrete renin)
Dopamine dose dependent effects
- Low dose (2-5mcg/kg/min): Increased renal and mesenteric blood flow
- Increased dose (5-10mcg/kg/min): Beta agonist (Increased HR)
- High dose (>10mcg/kg/min): Alpha and beta 1 agonist
Beta blocker that accumulates in renal disease
Atenolol
Beta blocker that is metabolized by hydrolysis by RBC esterases (all others are hepatic)
Esmolol
Ephedrine receptors and initial dose
Alpha and beta agonist, direct and indirect, central and peripheral (passes BBB)
Initial dose: 5-25mg
Phenylephrine receptors and initial dose
Alpha agonist, direct
Initial dose: 100-500mcg (0.1-0.5mg)
Anticholinergic drug preferred for pregnant patients
Glycopyrrolate, doesn’t cross the placental barrier
Atropine vs glycopyrrolate for sedation, antisialogogue, mydriasis (dilated pupils), increased HR
Sedation: Atropine > glycopyrrolate (crosses BBB)
Antisialogogue: Glycopyrrolate > atropine
Mydriasis: Atropine > glycopyrrolate
Increased HR: Atropine > glycopyrrolate
Anticholinergic that can initially cause bradycardia
Atropine: At low doses 0.5 mg (can go to CNS first before affecting heart)
Also can get inhibition of sweating and fever
