Autonomic Pharmacology of the Respiratory System

Question 1

What is the sympathetic receptor on the adrenal medulla which causes activation of the medulla by acting as a pore for sodium?

Answer 1

an ACh-sensitive nicotinig receptor (odd)

Question 2

What does the adrenal medullar release when that nicotinic receptor is activated?

Answer 2

epinephrine

Question 3

What are two nictoine antagonists?

Answer 3

trimethaphan

hexamethonium

Question 4

What is the potency of alpha1 receptors?

Answer 4

epinephrine = norepinephrine»isoproterenol

Question 5

What does activation of alpha1 receptors do

Answer 5

contraction of vsacular smooth muscle by stimulating phospholipase C and generating IP3 to elevate calcium concentration

NOT ON BRONCHIOLES

Question 6

What is the potetncy for beta2 receptors?

Answer 6

(isoproterenol > epinephrine&raquo_space; norepinephrine

Question 7

What happens with activation of beta2 receptors?

Answer 7

relax bronchial smooth muscle and glycogenlyosis

both by activating adenylyl cyclase

Question 8

What is the natural hormone stimulus for beta2 activation in the lung?

Answer 8

epinephrine

Question 9

What type or receptor is located on the postsynaptic surface of a postganglionic nerve causing activation of the parasympathetic postganglionic nerve?

Answer 9

nicotinic

Question 10

What is the parasympathetic receptor for all end0rgan responses?

Answer 10

muscarinic

Question 11

What are the two things muscarinic receptors can do

Answer 11

activates phospholipase C

suppress adenylyl cyclase activity

Question 12

Where do the parasympathetic nerves to the lung originate?

Answer 12

medulla oblongata is where vagus starts

Question 13

Where do the sympathetic nerves to the lung originate?

Answer 13

thoracic -lumbar spine

Question 14

What do the parasympathetic nerves trigger in the lungs?

Answer 14

constrict bronchioles

increase secretions

Question 15

Gi-alpha
Gs-alpha
Gq-alpha
G12, 13

Answer 15

i - inhibition of adenylyl cyclyase - inhibits cAMP procutiosn
s- stimulates AC (cholera!)
q - increase DAG, IP3 and Ca2+
12, 13 - activates Rho

Question 16

What is the most comon initial treatment for asthma?

Answer 16

inhaled SABA like albuterol

Question 17

What are the beta 2 agonists from trachte’s lecture?

Answer 17

metaproterenol
terbutaline
albuterol
pirbuterol
salmeterol 
isoetharine
bitolerol (produg)
formoterol
Aftormoterol

Question 18

What are the three long-acting beta 2 agonists?

Answer 18

formoterol
arformoterol
salmeterol

Question 19

What are hte major side effects of the beta 2 agonists?

Answer 19

tachycardia and palpitations (beta 1)
tremor (skeletal muscle beta 2)
and headache

Question 20

IF asthma is well controlled, patient should only be using short acting beta 2 agonist how many times per week?

Answer 20

2 or less (not counting exercise)

Question 21

How can epinephrine be given to relax bronchioles?

Answer 21

parenteral IV for anaphylaxis or inhaled

can also give intraocular

Question 22

How is epi metabolized?

Answer 22

MAO and COMT

Question 23

What are the contraindications for epi use?

Answer 23

hyperthyroidism
hypertension
halogen-hydrocarbon anesthetics

Question 24

What does isoproterenol od?

Answer 24

it’s a synthetic catecholamine stimulating beta receptors, so it relaxes bronchioles

Question 25

How is isoproterenol administered?

Answer 25

parenteral or aerosol

Question 26

How is isoproterenol metabolized

Answer 26

COMT but not mAO

Question 27

What does ephedrine do?

Answer 27

it's an indirectly acting agent that causes NE release

Question 28

How is ephedrine administered?

Answer 28

orally

Question 29

What do we use ephedrine for?

Answer 29

``` bronchospasm (does have wimpy direct beta2 agonism) allergy narcolapsy stokes-adams syndrome in cold meds ```

Question 30

What is a stereoisomer of ephedrine commonly used to treat nasal congestion?

Answer 30

pseudoephedrine

Question 31

What is our favorite alpha1 agonist?

Answer 31

phenylephrine

Question 32

What do we use phenylephrine for clinically?

Answer 32

decongestant - constricts nasal vasculature

Question 33

What are our two muscarinic receptor antagonists? What ar they used for?

Answer 33

ipratropium and tiotropium bronchodilation used more in COPD than asthma

Question 34

What is roflumilast?

Answer 34

a phosphodiesterase 4 inhibitor

Question 35

What do the pshophodiesterase 4 inhibitors do?

Answer 35

they inhibit the degradation of cAMP, so are bronchodilators used for chronic obstructive pulmonary diseases

Question 36

WHat's the major side effect of the phosphodiesterase inhibitors?

Answer 36

nausea

Question 37

What are the 4 drugs used for COPD?

Answer 37

SABA LABA long-acting muscarinic antagonist (tiotroprium) glucocorticoids

Question 38

What is the pulmonary side effect of the alpha1 inhibitors?

Answer 38

they cause mucosal stuffiness

Question 39

What is the pulmonary side effect of beta blockers?

Answer 39

increased airway resistance (particularly in asthmatics)

Question 40

If zafirlukast is an effective treatment for asthma, the asthma is most likely caused by?

Answer 40

Leukotrienes

Question 41

``` If diphenhydramine is NOT effective in asthma, the asthma is most likely: Caused by Acetylcholine Caused by Bradykinin Caused by Histamine Not caused by Acetylcholine Not caused by Bradykinin Not caused by histamine ```

Answer 41

Not caused by histamine

Question 42

``` Which of the following is the best treatment for anaphylaxis? Albuterol Beclomethasone Cromolyn Diphenhydramine Epinephrine Ibuprofen Zafirlukast ```

Answer 42

epinephrine

Question 43

``` Which of the following is the best decongestant? Albuterol Beclomethasone Cromolyn Ibuprofen Phenylephrine Theophylline Zafirlukast ```

Answer 43

Phenylephrine

Question 44

``` What is the most likely mechanism accounting for beneficial effects of ipratropium in COPD? Bronchodilation Induction of elastin synthesis Reduction of inflammation Suppressed secretions Tachycardia ```

Answer 44

suppresses secretions but also bronchodilates

Question 45

``` Which of the following have pulmonary side effects? Anticholinesterases Alpha receptor antagonists ACE Inhibitors ß Blockers Muscarinic agonists ```

Answer 45

all of them

Question 46

What are the major asthma treatments?

Answer 46

``` beta2 agonists corticosteroids leukotriene antagonists adenosine antagonists mast cells tabilizers IgE antibody ```