Autonomic Pharmacology

Question 1

Neuromuscular blocking drugs
mainly used for
2 types acting on

Answer 1

Mainly used w/ anesthesia during dental surgery as paralyzing agent when assisted ventilation is also used
-Depolarizing neuromuscular junction (NMJ)- Succinylcholine
Nondepolarizing competetive blockers- Curare-like

Question 2

Drugs related to curare

Answer 2

Look for CURare in mane

PanCURonium, D-tuboCURARine, AtraCURium

Question 3

Dantrolene

Neuromuscular blocking drug

Answer 3

Relaxes skeletal muscle w/o acting at NMJ
Blocks Ca release from ER
Used for prophylaxis from malignant hyperthermia (genetic predisposition in some ppl- in rxn to gen anesthetics)

Question 4

Botox

Neuromuscular blocking drug

Answer 4

Blocks release of synaptic vesicles (pre-synaptic effect)
No ACh–> no contraction–> no wrinkles
Used to relax other muscles (dystonias, relax extraocular muscles)

Question 5

Nicotine

Nicotinic AChR agonist

Answer 5

Transdermal patches, gum, nasal sprays

Nicotinic AChR agonist

Question 6

Varenicline

Nicotinic AChR agonist

Answer 6

Partial agonist at neuronal nAChR with higher affinity than nicotine for smoking cessation

Question 7

Neuromuscular blocking drugs

Nicotinic AChR agonists

Answer 7

Succinylcholine
Curare-like
Dantrolene
Botox
Nicotene
Varenicline

Question 8

Muscarinic ACh Receptors
what kind of receptor
mainly at what of which path
blocked by

Answer 8

G protein coupled receptors
Mainly at postganglionic parasympathetic synapses
Several diff subtypes
All blocked by Atropine

Question 9

Effector tissues with Muscarinic ACh receptors

Answer 9

Heart
Lungs
Eye
Salivary and sweat glands
GI
Bladder

Question 10

Muscarinic ACh receptor antagonists

Answer 10

Ipratropium
Scopolamine
Tolterodine
Tropicamide

Question 11

Ipratropium (atrovent)

used for

Answer 11

Muscarinic ach AChR antagonist

Used to dilate bronchial smooth muscle

Question 12

Scopolamine

used for

Answer 12

Tx motion sickness

Muscarinic AChR antagonists

Question 13

Tolterodine (Detrol)

used

Answer 13

Tx overactive bladder

Muscarinic AChR antagonist

Question 14

Tropicamide

used

Answer 14

Dilate pupils (smooth muscle antagonist)
called mydriasis
Muscarinic AChR antagonist

Question 15

Muscarinic ACh receptor agonist
activated by
used to
tx for

Answer 15

Activated by Pilocarpine
Used to constrict pupils
-helps open Canal of Schlemm- reduce intraocular pressure (tx glucoma)

Question 16

Acetylcholinesterase Inhibitors 3 classes
Short acting 1
tx

Answer 16

Edrophonium

tx myasthenia gravis

Question 17

Acetylcholinesterase inhibitors
Medium acting
4 and tx

Answer 17

Neostigmine (myasthenia gravis)
Physostigmine (glaucoma)
Donepezil (alzheimers)
Tacrine (alzheimers)

Question 18

Acetylcholinesterase inhibitors

Long acting/ irreversible2

Answer 18

Organophosphate compounds (insecticides Malathion)
Nerve gas (sarin)

Question 19

Dental implications of antimuscarinic drugs

Contraindications

Answer 19

-Narrow-angle glucoma
-Prostate hypertrophy
-Paralytic ileus
-Tachycardia
Atropine- reduces salivary flow
Pilocarpine and cevimeline (muscarinic agonists) stimulate salivary flow

Question 20

Adrenergic Receptors
subtypes
respond to

Answer 20

Have alpha and beta families
- Have subtypes w/i families (alpha1, alpha2, beta1)
–Have further subtypes alpha1a
Respond to epinephrine and norepinephrine
-Have varying differences in agonist affinity by receptor type (both E and NE have full efficacy)
Ex alpha1 receptors more sensitive to NE, beta2 receptors to E, beta1 respond fairly similar to both

Question 21

Main effects of alpha adrenergic receptors

Answer 21

alpha1–> systemic vasoconstriction, relaxation of GI smooth muscle, salivary secretion, inc hepatic glycogenolysis
alpha2–> inhibition of transmitter release (ie autoreceptors) inhibition of insulin release

Question 22

Main effects of beta adrenergic receptors

Answer 22

beta1–> inc heart rate and contractile force
beta2–> bronchodilation, vasodilation in specific locations, relaxation of visceral smooth muscle
Beta3–> inc lipolysis