Autonomics Flashcards
What is the primary neurotransmitter for symphathetic preganglionic?
Acetylcholine
What is the primary neurotransmitter for sympathetic postganglionic?
Norepinephrine
What is the primary neurotransmitter for parasympathetic preganglionic?
Acetylcholine
What is the primary neurotransmitter for parasympathetic postganglionic?
Acetylcholine
What is the primary postsynaptic receptor type for sympathetic preganglionic?
Nicotinic-2
What is the primary postsynaptic receptor type for sympathetic postganglionic?
Adrenergic (alpha and beta)
What is the primary postsynaptic receptor type for parasympathetic preganglionic?
Nicotinic-2
What is the primary postsynaptic receptor type for parasympathetic postganglionic?
Muscarinic
What is the length of sympathetic preganglionic fibers?
Short
What is the length of sympathetic postganglionic fibers?
Long
What is the length of parasympathetic preganglionic fibers?
Long
What is the length of parasympathetic postganglionic fibers?
Short
What is the rate limiting factor in acetylcholine synthesis?
Choline availability
This synthetic enzyme for acetylcholine is used as a cholinergic marker
Choline acetyltransferase
Receptors in cholinergic transmission are of either of these types
Muscarinic or nicotinic
Termination of cholinergic neurotransmission occurs by ACh degradation, involving this enzyme in the synapse
Acetylcholinesterase
Termination of cholinergic neurotransmission occurs by ACh degradation, involving this enzyme in the blood and liver
Pseudocholinesterases
This is the rate limiting factor of catecholamine synthesis
Tyrosine hydroxylase enzyme
How does termination of cholinergic transmission occur?
By acetylcholine degradation
How does termination of adrenergic transmission occur?
Synpatic reuptake
Type of adrenergic receptor that increases calcium, causes contraction or secretion
Alpha 1
Type of adrenergic receptor that decreases neurotransmitter release (presynaptic effect), and causes contraction (postsynaptic effect)
Alpha 2
Type of adrenergic receptor that relaxes renal and mesenteric vascular smooth muscle
D1 (dopamine 1)
Type of adrenergic receptor that increases heart rate and force of contraction
Beta 1
Type of adrenergic receptor that relaxes smooth muscle
Beta 2
Type of adrenergic receptor that promotes relaxation of bladder
Beta 3
This is the single metabolite endpoint associated with dopamine biotransformation
Changes in this compound crudely reflect dopamine activity levels
HVA: homovanillic acid
This is sometimes used as a neuronal marker of activity and MAO, especially in the brain, is located in the nerve terminal
Changes crudely reflect brain dopamine activity
Dihydroxyphenylacetic acid (DOPAC)
Dihydroxyphenylacetic acid (DOPAC) is sometimes used as a neuronal marker of the activity of this enzyme
DOPAC changes crudely reflect brain dopamine activity
MAO (especially in the brain)
Isoform of monoamine oxidase that has nonspecific location and action
MAO-A
Monoamine oxidase isoform that has preference for dopamine; highest in CNS
MAO-B
In response to high blood pressure, the baroreceptors discharge and:
Heart rate falls due to these 2 factors
Vagal stimulation and loss of sympathetic tone
In response to high blood pressure, the baroreceptors discharge and:
Force of contraction falls due to these 2 factors
Vagal stimulation and loss of sympathetic tone
In response to high blood pressure, the baroreceptors discharge and:
Vasodilation occurs mainly by this
Loss of sympathetic tone
(to decrease peripheral resistance)
In response to high blood pressure, the baroreceptors discharge and have these 3 effects
Heart rate falls
Force of contraction falls
Vasodilation occurs
Type of cholinergic receptors that stimulates secretion of GI glands
M1 receptors (Gq)
Type of cholinergic receptors that act on the heart (atria but not ventricles)
SA node to slow heart rate and AV node to slow conduction velocity
M2 receptors (Gi)
M2 receptors act on the SA node to slow this
heart rate
M2 receptors act on the AV node to slow this
conduction velocity
M1 receptors stimulate secretion of these
GI glands
M2 receptors act on this organ
Heart
Type of cholinergic receptors that act on smooth muscle, eye, lung, GI tract, bladder, sphincters and glands
M3 receptor (Gq)
What effect do M3 receptors have on sphincter muscles of the eye?
Cause contraction for miosis
What effect do M3 receptors have on ciliary muscles in the eye?
Contract for accommodation for near vision
What effect do M3 receptors have on the GI tract?
Increase motility and activity
Form of cholinesterase that is located neuronally pre- and post-junctional
Acetylcholinesterase
Form of cholinesterase that is located in liver and plasma
Pseudocholinesterase
Do Methacholine, Bethanechol and Carbachol cross the blood brain barrier?
No; they are quaternary amines
Methacholine, Bethanechol and Carbachol are this type of amine so they do not cross the blood brain barrier
Quaternary amines
Cholinergic agonist that is used for bladder and bowel activation
Bethanechol
Do Cevimeline and Pilocarpine cross the blood brain barrier?
Yes; are tertiary amines
Thus produce central changes - Parkinson and seizures
Cevimeline and Pilocarpine are this type of amine, so they cross into the CNS
Tertiary amines
This muscarinic agonist has a black box warning for bronchial hyperreactivity
Methacholine
What reaction does tyrosine hydroxylase catalyze?
Tyrosine to Dopa
What enzyme catalyzes the conversion of tyrosine to dopa?
Tyrosine hydroxylase
What reaction does Aromatic L-amino acid decarboxylase catalyze?
Dopa to Dopamine
What enzyme catalyzes the conversion of Dopa to dopamine?
Aromatic L-amino acid decarboxylase
What reaction does Dopamine β-hydroxylase catalyze?
Dopamine to Norepinephrine
What enzymes catalyzes the conversion of dopamine to norepinephrine?
Dopamine β-hydroxylase
Degradative enzyme in adrenergic transmission that is located mainly in terminal
Monoamine oxidase
Degradative enzyme in adrenergic transmission that is located terminally, in plasma and liver
Catechol-O-methyltransferase
What enzyme in adrenergic biosynthesis is a therapeutic target?
Aromatic L-amino acid decarboxylase
What enzyme in adrenergic biosynthesis is rate limiting?
Tyrosine hydroxylase
Agonists to this cholinergic receptor can be used to treat glaucoma (both primary open-angle and closed-angle)
Muscarinic agonist
(causes contraction of ciliary muscle and iris sphincter)
Agonists to this cholinergic receptor can be used to treat dry mouth in Sjogren’s syndrome
Muscarinic agonist
Agonists to this cholinergic receptor can be used to treat urine retention, leading to urine release
Muscarinic agonists
Agonists to this cholinergic receptor can be used in diagnosis of bronchial hyperreactivity
Muscarinic agonists
Agonists to this type of receptor are contraindicated in asthma patients
Muscarinic agonist
Agonists to this cholinergic receptor are contraindicated in Parkinsonism
Muscarinic agonists
Agonists to this type of receptor are contraindicated in hyperthyroidism
Muscarinic agonists
Agonists to this type of receptor are contraindicated in seizure disorders
Muscarinic agonists
A patient with a tumor on the adrenal gland may have increased levels of this molecule that crudely reflects dopamine activity levels
HVA: homovanillic acid
Homovanillic acid is the breakdown product of this
Dopamine biotransformation
Catechol-0-methyl transferase is involved in this process
Adrenergic biotransformation
What effect does cholinergic (parasympathetic) transmission have on heart rate?
Decreases
What effect does cholinergic (parasympathetic) transmission have on heart force?
Decreases
What effect does cholinergic (parasympathetic) transmission have on bronchial tree?
Bronchoconstriction
What effect does cholinergic (parasympathetic) transmission have on circular muscle of iris?
Miosis
What effect does cholinergic (parasympathetic) transmission have on ciliary muscle of eye?
Accommodation
What effect does cholinergic (parasympathetic) transmission have on GI tract?
Contraction
What effect does adrenergic (sympathetic) transmission have on heart rate?
Increases (by beta 1)
What effect does adrenergic (sympathetic) transmission have on heart force?
Increases (by beta 1)
What effect does adrenergic (sympathetic) transmission have on arterial vessels?
Vasoconstriction (by alpha 1)
What effect does adrenergic (sympathetic) transmission have on skeletal blood vessels?
Vasodilation (by beta 2)
What effect does adrenergic (sympathetic) transmission have on venous vessels?
Vasoconstriction (by alpha 2)
What effect does adrenergic (sympathetic) transmission have on bronchial tree?
Bronchodilation
What effect does adrenergic (sympathetic) transmission have on the uterus?
Contraction (by alpha 1)
What effect does adrenergic (sympathetic) transmission have on radial muscle of iris?
Mydriasis (by alpha 1)
What effect does adrenergic (sympathetic) transmission have on the kidney?
Renin release increased by beta 1
Renin release decreased by alpha 1
What effect does adrenergic (sympathetic) transmission have on the ureter?
Contraction (by alpha 1)
What effect does adrenergic (sympathetic) transmission have on the GI tract?
Relaxation (by alpha 2)
What effect does adrenergic (sympathetic) transmission have on insulin release?
Decreases (by alpha 1)
Renin release is increased by this adrenergic receptor
Beta 1
Renin release is decreased by this adrenergic receptor
Alpha 1
Carbamates and organophosphates inhibit this enzyme
Cholinesterase
(thus prolong acetylcholine duration and are analogous to agonist action)
Ambenonium, Edrophonium, Neostigmine, Physostigmine, Pyridostigmine are examples of this type of drug
Carbamates
(cholinesterase inhibitors)
Edrophonium is this type of drug
Carbamate
Carbamate that is indicated in diagnosis of myasthenia gravis and treatment
Edrophonium
Carbamate that is indicated in reversal of neuromuscular blockage by non-depolarizing muscle relaxants
Edrophonium
Edrophonium is this type of amine
Quaternary
Carbamate that is quarternary and highly water soluble
Rapid renal elimination
Edrophonium
Edrophonium is used in diagnosis and treatment of this condition
Myasthenia gravis
Carbamate that is a tertiary amine and is readily absorbed
Penetrates the CNS (crosses blood brain barrier)
Physostigmine
Physostigmine is this type of drug
Carbamate
DUMBBELSS is an acronym describing the toxicities of this type of drug
(Diarrhea, urination, miosis, bronchoconstriction, bradycardia, excitation (muscles and CNS), lacrimation, salivation and sweating)
Cholinesterase inhibitors
(e.g. carbamates, organophosphates)
What are the toxicities of cholinesterase inhibitors?
DUMBBELSS
Diarrhea
Urination
Miosis
Bronchoconstriction
Bradycardia
Excitation (muscles and CNS)
Lacrimation
Salivation
Sweating
Delayed toxicity of organophosphates is related to this, and results in flaccid and spastic paralysis
Demyelination
(delayed toxicity is independent of cholinesterase inhibitory activity)
Delayed toxicity of this type of drug is related to demyelination and results in flaccid and spastic paralysis
Organophosphate
What is the MOA of carbamates?
Cholinesterase inhibitors
What is the MOA of organophosphates?
Cholinesterase inhibitors
The treatment of cholinesterase inhibitor overdose involves administration of this type of drug FIRST
Anticholinergic (e.g. atropine)
Atropine may be given first in overdose of this type of drug
Cholinesterase inhibitor
(e.g. Carbamates, organophosphates)
In overdose of cholinesterase inhibitors, is atropine or pralidoxime chloride (2-PAM) given first?
Atropine
(atropine saves the patient, 2-PAM saves the enzyme)
In overdose of cholinesterase inhibitor, this is always supplemental to atropine and will improve neuromuscular toxicity by restoring cholinesterase activity
Pralidoxime chloride (2-PAM)
Do quaternary amines cross the blood brain barrier?
No
so they remain peripheral
(examples: Methacholine, Bethanechol)
Cholinergic agonist that is used for bladder and bowel activation
Bethanechol
Bethanechol is a cholinergic agonist used to treat this
Bladder and bowel activation
Bethanechol is an agonist to this, and is used for bladder and bowel activation
Cholinergic agonist
Methacholine, Bethanechol and Carbachol are agonists to this
Cholinergic agonists
Are Methacholine, Bethanechol and Carbachol found centrally or peripherally?
Peripherally - are quaternary amines so they do not cross blood brain barrier
Do tertiary amines cross into the CNS?
Yes
(examples: Cevimeline and Pilocarpine)
Cevimeline and Pilocarpine are agonists to this type of receptor
Cholinergic agonists
Methacholine is this type of drug
Cholinergic (muscarinic) agonist
Methacholine has this black box warning
Bronchial hyperreactivity
How do you treat cholinesterase inhibitor overdose?
Administration of anticholinergic (atropine) THEN pralidoxime chloride (2-PAM)
Atropine saves the patient - 2-PAM saves the patient
Cholinesterase inhibitors are indirect agonists to this
Cholinergic agonists
Organophosphate that is used as insecticides as mammals inactivate the cholinesterase forms of each drug before toxic to mammalian system
Insects do not detoxify the toxic form
Malathion
Atropine, Darifenacin, Oxybutynin, Scopolamine, Solifenacin, Tolterodine are antagonists to this
Muscarinic receptors
Atropine, Darifenacin, Oxybutynin, Scopolamine, Solifenacin, Tolterodine are this type of drug
Muscarinic antagonists
Do muscarinic agonists or antagonists inhibit sweating?
Antagonists
Do muscarinic antagonists cause mydriasis or miosis?
Mydriasis
Do muscarinic antagonists increase or decrease aqueous outflow resistance of the eye?
Increase
Do muscarinic antagonists result in increased or decreased GI tract salivation and secretions?
Decreased
What effect do muscarinic antagonists have on the bladder?
Urinary retention
Do muscarinic antagonists cause bronchial dilation or constriction?
Dilations
(and decreased secretions)
Do muscarinic antagonists cause bradycardia at high or low doses?
Presynpatic and central low dose effect
Muscarinic antagonist indicated for bradycardia
Atropine
Muscarinic antagonist indicated for cycloplegia or mydriasis
Atropine
Muscarinic antagonist indicated for aspiration prophylaxis
Atropine
Muscarinic antagonist indicated for overactive bladder and urinary incontinence
Darifenacin
Muscarinic antagonist indicated for amnesia and sedation induction
Scopolamine
Muscarinic antagonist indicated for motion sickness
Scopolamine
Muscarinic antagonist indicated for Parkinson’s disease
Scopolamine
Are muscarinic agonists or antagonists contraindicated in glaucoma?
Antagonists
Type of drugs that are contraindicated in glaucoma, prostatic hyperplasia and cardiac disease
Muscarinic antagonists
Infants are more likely to become hyperthermic with use of this type of drug
Muscarinic antagonists
Infants are more likely to have this with use of muscarinic antagonists
Hyperthermia
Blurred vision, dry mouth/skin, confusion, mydriasis, constipation, urinary retention and sedation are toxicities of this type of drug
Muscarinic antagonists
Hyperthermia may occur in small individuals with use of this type of drug
Muscarinic antagonists
What are some of the toxicities of Muscarinic antagonists?
Blurred vision
Dry mouth/skin (hyperthermia)
Confusion
Mydriasis (dilated pupils)
Constipation
Urinary retention
Sedation
This compound stimulates and desensitizes receptors
Nicotine
What effect do nicotine agonists have on heart rate?
Increase
What effect do nicotine agonists have on BP?
Increase
How do nicotine agonists increase heart rate and BP?
Stimulates adrenal release of catecholamines
This drug is a partial agonist at some nicotinic receptor sites (a4B2) and full agonist at other (a7) sites
Varenicline
Varenicline is a partial agonist at some of these sites
Nicotinic receptor sites (a4B2)
(is a full agonist at other sides; a7)
What is an adverse effect of Varenicline?
Negative mood and behavioral changes
Adverse neuropsychiatric events (unusual and aggressive behavior) as a result of Varenicline use may be worsened with concomitant use of this
Alcohol
Adverse neuropsychiatric events (unusual and aggressive behavior) as a result of use of this drug may be worsened with concomitant use of alcohol
Varenicline
OnabotulinumtoxinA inhibits this
Acetylcholine release
What are the two phases of depolarizing neuromuscular blockers?
1: depolarization block
2: desensitization
These inhibitors will not reverse a depolarizing blocker but may intensify blockade
Cholinesterase inhibitors
(do not treat paralysis with cholinesterase inhibitors)
Succinylcholine is inactivated by this enzyme
Pseudocholinesterase
Adverse effect of this includes malignant hyperthermia, especially when used with halothane (inhalation anesthetic)
Depolarizing muscular blockers - Succinylcholine
Depolarizing muscular blockers (Succinylcholine) can cause malignant hyperthermia, especially when used with this
Halothane (inhalation anesthetic)
Depolarizing muscular blockers (Succinylcholine) can cause this, especially when used with Halothane (inhalation anesthetic)
Malignant hyperthermia
Rocuronium is this type of drug
Non-depolarizing neuromuscular blockers (AKA competitive nicotinic receptor inhibitors)
At low doses, this type of drug is competitive reversible blockers of the neuromuscular junction
Non-depolarizing neuromuscular blockers (AKA competitive nicotinic receptor inhibitors)
E.g. Rocuronium
These can reverse the action of Non-depolarizing neuromuscular blockers (AKA competitive nicotinic receptor inhibitors; e.g. Rocuronium)
Cholinesterase inhibitors
Cholinesterase inhibitors can reverse action of this type of drug
Non-depolarizing neuromuscular blockers (AKA competitive nicotinic receptor inhibitors)
E.g. Rocuronium
Can cholinesterase inhibitors reverse the action of Rocuronium?
Yes
(Rocuronium is a non-depolarizing neuromuscular blocker)
Nicotine effects on heart are triggered by nicotine release of these from adrenal
Catecholamines
This is a partial nicotine agonist and has some increased risk of psychiatric problems with use
Is used for tobacco cessation
Varenicline
This inhibits release of acetylcholine by interfering with SNAP25
OnabotulinumtoxinA
OnabotulinumtoxinA inhibit release of acetylcholine by interfering with this
SNAP25
OnabotulinumtoxinA inhibit release of this by interfering with SNAP25
Acetylcholine
Varenicline is a partial agonist of this and has some increased risk of psychiatric problems with use
Nicotine
This causes tachyphylaxis at neuromuscular junction and results in total paralysis
Should only last minutes due to rapid inactivation by pseudocholinesterases (patient deficit in this enzyme and paralysis may last hours)
Succinylcholine
What effect does succinylcholine have at the neuromuscular junction?
Causes tachyphylaxis
(results in total paralysis)
Reversible neuromuscular receptor blockers allow greater dosage flexibility and can be reversed by these inhibitors
Cholinesterase
What is a Alpha-1 Adrenergic action on vascular smooth muscle, pupillary radial (dilator) muscle and prostate?
Contraction
What is a Alpha-1 Adrenergic action on the heart?
Increased force of contraction
What is alpha-2 adrenergic effect on presynaptic nerve terminals?
Inhibition of neurotransmitter release
What are two beta-1 adrenergic effects on the heart?
Increase heart rate at SA node
Increase force of contraction
Beta-1 adrenergic action on heart includes increased heart rate at this
SA node
What is beta-1 adrenergic effect on the kidney?
Increase renin release
What is beta-2 adrenergic effect on skeletal muscle?
Stimulates glycogenolysis to promote contractility (tremor)
What is beta-2 adrenergic effect on bronchioles and uterus?
Relaxation
What is beta-3 adrenergic effect on the bladder?
Relaxes detrusor smooth muscle
What is dopamine-1 effect on renal, mesenteric and coronary vasculature?
Vasodilation
Norepinephrine, epinephrine, isoproterenol, dopamine, and dobutamine are agonists of this
Adrenergic agonists
Norepinephrine is an agonist of these adrenergic receptors
Alpha-1 and -2, beta-1 and -3
(more powerful at alpha activation)
Epinephrine is an agonist of these adrenergic receptors
Alphas and betas
Dopamine is an agonist of these adrenergic receptors
Dopamine-1, beta-1, alpha-1
With norepinephrine, heart rate may decrease by this reflex
Vagal reflex
What effect does norepinephrine have on arteries and veins?
Vasoconstriction
Tissue necrosis and sloughing in extravasation are black box warnings of this adrenergic agonist
Norepinephrine
What is an adverse effect of norepinephrine?
Tissue necrosis and sloughing in extravasation (black box)
Epinephrine results in vasoconstriction in most arterial beds except:
Vasodilation in skeletal muscle beds
Epinephrine results in this effect on vasculature in most arterial beds (except skeletal muscle beds)
Vasoconstriction
Adrenergic agonist used for emergency treatment of anaphylactic shock
Epinephrine
Is atropine indicated for bradycardia or tachycardia?
Bradycardia
What effect does Isoproterenol have on arteries?
Vasodilation
What effect does Isoproterenol have on lungs?
Bronchodilation
These are adverse effects of this adrenergic agonist:
Palpitation, headache, flushed skin
Tachycardia
Cardiac ischemia and arrhythmias
Isoproterenol
Adrenergic agonist used for short-term cardiovascular support (shock - following hypovolemia correction)
Dopamine
Extravasation of this adrenergic agonist can produce ischemic necrosis and sloughing (black box warning)
Dopamine
Extravasation of dopamine can produce this
Ischemic necrosis and sloughing (black box warning)
Does the alpha or beta effect predominate with use of dobutamine?
Beta
Type of adrenergic agonists used as bronchodilators and smooth muscle relaxants
Beta-selective agents
Type of adrenergic agonists used for asthma and uterine relaxation
Beta-selective agents
Type of adrenergic agonist with adverse effects of:
Tremor
Cardiovascular effects (tachycardia)
Decreased arterial oxygen tension
Possible increased risk of death
Beta-selective agents
Tachycardia is an adverse effect of beta-selective agents that is mainly due to this stimulation
Beta-1
Do beta-selective agents have an adverse effect of bradycardia or tachycardia?
Tachycardia (mainly due to beta-1 stimulation)
Tachycardia is an adverse effect of this type of adrenergic agonist mainly due to beta-1 stimulation
Beta-selective agents
Arterial oxygen tension may fall during treatment of asthma with beta-selective agents due to vasodilation of these
Pulmonary beds
Arterial oxygen tension may fall during treatment of asthma with beta-selective agents due to vasodilation or vasoconstriction of pulmonary beds?
Vasodilation
Salmeterol is this type of adrenergic agonist
Beta-selective agent
Salmeterol is a beta-selective agent with this black box warning
Possible increased risk of death and near death from asthma
Possible increased risk of death and near death from asthma is a black box warning for this beta-selective agent
Salmeterol
Adrenergic agonist that is a beta-3 selective agent
Mirabegron
What effect does Mirabegron have on the bladder?
Relaxes the detrusor smooth muscle to increase bladder capacity
Oxymetazoline, Phenylephrine, and Pseudoephedrine are this type of adrenergic agonist
Alpha-1 selective agents
Type of adrenergic agonist used for nasal decongestant, mydriasis, maintenance of BP during surgery
Alpha-1 selective agents
(examples: Oxymetazoline, Phenylephrine, Pseudoephedrine)
Oxymetazoline, Phenylephrine, and Pseudoephedrine are selective agonists of this adrenergic receptor
Alpha-1
Clonidine and Alpha-methyldopa are selective agents of this adrenergic receptor
Alpha-2
What is the MOA of Clonidine and Alpha-methyldopa?
Alpha-2 selective agents so Antihypertensive actions
Alpha-2 selective agents (e.g. Clonidine, Alpha-methyldopa) have this dominant action
Antihypertensive
Rebound effect may occur with abrupt discontinuation of this type of adrenergic agonist
Alpha-2 selective agents
(E.g. Clonidine, Alpha-methyldopa)
This alpha-2 selective agent is a substrate for catecholamine synthesis pathway
End product of alpha-methyl norepinephrine
Alpha-methyl Dopa
Alpha-methyl Dopa is an alpha-2 selective agent that is a substrate for this synthesis pathway
Catecholamine
Alpha-methyl Dopa is an end product of this
(involved in catecholamine synthesis pathway)
Alpha-methyl norepinephrine
Adverse effects of this type of adrenergic agonist includes low incidence of rebound hypertension, hemolytic anemia, Parkinson-like effect and hyperprolactinemia
Alpha-2 selective agents
(e.g. Clonidine, Alpha-methyldopa)
Hemolytic anemia is an adverse effect of this type of adrenergic agonist
Alpha-2 selective agents
(e.g. Clonidine, Alpha-methyldopa)
Parkinson-like effect and hyperprolactinemia are adverse effects of this type of adrenergic agonist
Alpha-2 selective agents
(e.g. Clonidine, Alpha-methyldopa)
Alpha-methyl dopamine is partial agonist at this receptor
dopamine
Alpha-methyl dopamine is this type of agonist at dopamine receptor
Partial
What effect do mixed action agonists have on vascular resistance and BP?
Increases
What effect do mixed action agonists have on respirations?
Increased
Type of adrenergic agonists with central actions including Increased respiration, increased alertness/confidence, Psychogenic effects, Appetite suppressant
Mixed action agonists
Amphetamine, Methamphetamine, Methylphenidate, Ephedrine, and Tyramine are this type of adrenergic agonist
Mixed action agonist
Pulmonary hypertension (especially in women) is an adverse effect of this type of adrenergic agonist
Mixed action agonist
In presence of monoamine oxidase inhibitors, this mixed action agonist can result in increased pressure (systolic increase > 30 mmHg)
Tyramine
In presence of this type of drug, tyramine can result in increased pressure (systolic increase > 30 mmHg)
Monoamine oxidase inhibitors
In presence of monoamine oxidase inhibitors, tyramine can result in increased pressure (systolic increase > 30 mmHg), mainly through this mechanism
Release of catecholamine
In presence of monoamine oxidase inhibitors, tyramine can result in increased pressure (systolic increase > 30 mmHg), mainly through the release of these
Catecholamines
Adrenergic receptor that:
vasoconstricts the peripheral vascular system (increases resistance), increase heart force
Alpha 1
Adrenergic receptor that is a weaker vasoconstrictor, presynaptic modulator
Alpha-2
Adrenergic receptor that increases heart rate and force of contraction
Beta-1
Adrenergic receptor that relaxes bronchial structures, relaxes skeletal muscle vessels (reduces resistance), and triggers tremor
Beta 2
Adrenergic receptor that enlarges bladder
Beta 3
Is norepinephrine mainly an alpha or beta response?
Alpha
Is epinephrine mainly an alpha or beta response?
Beta
Adrenergic agonist that maintains heart rate and opens mesenteric/ renal vascular beds
Dopamine
Type of adrenergic agonist that relaxes bronchioles for treatment of hyperreactive airways
Beta 2 selectives
Adrenergic agonist that enlarges bladder
Mirabegron
Non-selective alpha antagonists are used for acute control of this
Hypertension
Phenoxygenzamine is a non-selective alpha antagonist that is a reversible or irreversible binding agent?
Irreversible
Phentolamine is a non-selective alpha antagonist that is a reversible or irreversible binding agent?
Reversible
Phenoxybenzamine is this type of drug
Non-selective alpha antagonist
Phentolamine is this type of drug
Non-selective alpha antagonist
This type of adrenergic antagonist has cardiovascular effects including vasodilation, hypotension, tachycardia and venous pooling
Non-selective alpha antagonist
(Phenoxybenzamine, Phentolamine)
Non-selective alpha antagonists are used for control of this in pheochromocytoma
Blood pressure
Non-selective alpha antagonists are used for blood pressure control in patients with this
Pheochromocytoma
Type of adrenergic antagonist used for BP control in pheochromocytoma
Non-selective alpha antagonist
(Phenoxybenzamine, Phentolamine)
Type of adrenergic antagonist used for benign prostatic hypertrophy
Non-selective alpha antagonists
(Phenoxybenzamine, Phentolamine)
What is the First Doses effect?
Severe postural hypotension that occurs early in therapy or when dose is increased
Antagonists to this have First Doses effect
Alpha
(Non-selective alpha antagonists especially)
Hypotension, tachycardia and sexual dysfunction are adverse effect to these types of drugs
Non-selective alpha antagonists
(Phenoxybenzamine, Phentolamine)
This non-selective alpha antagonist can be used in clonidine-withdrawal hypertension
Phentolamine
Drug names that end in -osin are this type of drug
Selective alpha-1 antagonists
Are selective alpha-1 antagonists reversible or irreversible blockers?
All are reversible blockers
Selective alpha-1 antagonists have names ending in this
“-osin”
Type of adrenergic antagonist that is indicated for general treatment of hypertension and benign prostatic hypertrophy
Selective alpha-1 antagonists
What effect do Selective alpha-1 antagonists have on vascular resistance?
Reduce
Do non-selective alpha or selective alpha-1 antagonists have a lower incidence of postural hypotension?
Selective alpha-1 antagonists
Fluid retention, tachycardia and nasal stuffiness are adverse effects to this type of adrenergic antagonist
Selective alpha-1 antagonists
Drug names that end in -olol are this type of drug
Beta blockers
Beta blockers have drug names that end in this
“-olol”
Severe bradycardia, bronchospasm, peripheral vascular disease and withdrawal with abrupt stoppage of drug are adverse effects of this type of adrenergic antagonist
Non-specific beta blockers
Do alpha antagonists cause bradycardia or tachycardia?
Tachycardia
Do beta blockers cause bradycardia or tachycardia?
Bradycardia
Depression, elevated LDL and triglyceride levels, and blunted responses and recovery from hypoglycemia are common toxicities to this type of adrenergic antagonists
Beta blockers
A toxicity of this type of drug includes blunted responses and recovery from hypoglycemia - may increase risk of diabetes
Beta blockers
As a result of use of beta blockers, loss of vasodilation from this increases alpha vasoconstriction in extremities
Beta 2
With use of beta blockers, patients may have blunted responses and recovery from this
Hypoglycemia
The first letter of this type of drug spells “BEAM”
Beta-1 antagonists
(Acebutolol, Atenolol, Bisoprolol, Esmolol, Metoprolol)
Acebutolol, Atenolol, Bisoprolol, Esmolol, and Metoprolol are this type of drug
Beta-1 antagonists
These 2 drugs are non-selective beta blockers that are also alpha-1 blockers
Carvedilol and Labetalol
Carvedilol and Labetalol are non-selective beta blockers that also block this
Alpha-1
Beta 2 blockage increases risk for patients with these 3 conditions
Diabetes
Asthmatics
Peripheral artery disease
Pindolol and Acebutolol are this type of adrenergic antagonist
Beta blockers with ISA (intrinsic sympathomimetic activity)
Beta blocker with ISA (intrinsic sympathomimetic activity) that is primarily used in patients with low resting heart rate (50 beats/min)
Acebutolol
Acebutolol is a beta blocker with ISA (intrinsic sympathomimetic activity) that is primarily used in patients with this
Low resting heart rate (50 beats/min)
This is the enzyme that mediates the initial step of norepinephrine and epinephrine metabolism the in presynaptic cell cytoplasm
Monoamine oxidase
This compound blocks neuronal uptake transporter (NET) function, thereby inhibiting termination of adrenergic neurotransmission
Cocaine
Cocaine blocks neuronal uptake transporter (NET) function, thereby inhibiting termination of this type of neurotransmission
Adrenergic
This drug treats glaucoma by inducing miosis to allow drainage of aqueous humor via the trabecular meshwork (Canal of Schlemm)
Pilocarpine
What is the MOA of pilocarpine in treatment of glaucoma?
Induces miosis
(allows drainage of aqueous humor via the trabecular meshwork)
Pilocarpine is this type drug
Cholinergic agonist
This adrenergic receptor induces both chronotropic and ionotropic effects on cardiac muscle contraction
Beta 1
Which 2 beta adrenergic inhibitor drugs are indicated to treat hypertension in patients with bradycardia?
Acebutolol and Pindolol
Why are Acebutolol and Pindolol indicated to treat hypertension in patients with bradycardia and not other beta blockers?
Because they have sympathomimetic activity
This beta-2 selective agent is not recommended for acute treatment of asthma due to slow onset of action
Salmeterol
Uterine relaxant is a secondary use for this beta-2 selective agent, which arrests premature labor
Terbutaline
Terbutaline is a selective adrenergic agonist for this
Beta-2
