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Step 1 Pharm > Autonomics > Flashcards

Autonomics Flashcards

1
Q

What part of sympathetic nervous system

is innervated by cholinergic fibers?

(2 places)

A

Adrenal medulla

Sweat glands

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2
Q

What prevents release of NT at all cholinergic terminals?

A

Botulinum toxin

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3
Q

System, receptor, G-protein?

Increases:

VSM contraction, pupillary dilation (mydriasis), intestinal and bladder sphincter contraction

A

Sympathetic

Alpha 1

Gq

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4
Q

System, receptor, G-protein?

Increases:

Platelet aggregation

Decreases:

Sympathetic outflow, insulin release, lipolysis

A

Sympathetic

Alpha 2

Gi

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5
Q

System, receptor, G-protein?

Increases:

HR, contractility, renin release, lipolysis

A

Sympathetic

Beta 1

Gs

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6
Q

System, receptor, G-protein?

Increases:

HR, contractility, lipolysis, insuline release, aqueous humor production

Decreases:

VSM tone, bronchial SM tone, uterine tone (tocolysis), ciliary muscle tone

A

Sympathetic

Beta 2

Gs

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7
Q

System, receptor, G-protein?

Effects in CNS, eneteric nervous system

A

Parasympathetic

M1

Gq

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8
Q

System, receptor, G-protein?

Decrease:

HR, contractility of atria

A

Parasympathetic

M2

Gi

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9
Q

System, receptor, G-protein?

Increases:

Exocrine gland secretions, gut peristalsis, bladder contraction, broncial SM tone, pupillary sphincter tone (miosis), ciliary muscle tone (accommodation)

A

Parasympathetic

M3

Gq

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10
Q

System, receptor, G-protein?

Decreases:

Renal VSM tone

A

Dopamine

D1

Gs

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11
Q

System, receptor, G-protein?

Modulates transmitter release, esp. in brain

A

Dopamine

D2

Gi

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12
Q

System, receptor, G-protein?

Increases:

Nasal and bronchial mucus production, bronchial SM tone, pruritis, pain

A

Histamine

H1

Gq

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13
Q

System, receptor, G-protein?

Increases:

Gastric acid secretion

A

Histamine

H2

Gs

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14
Q

System, receptor, G-protein?

Increases:

VSM tone

A

Vasopressin

V1

Gq

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15
Q

System, receptor, G-protein?

Increases:

H2O permeability, reabsoption in collecting duct

A

Vasopressin

V2

Gs

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16
Q

Which enzyme, which second messenger?

Gq

Gs

Gi

A

Gq- phospholipase C, protein kinase C

Gs- adenylyl cyclase, protein kinase A

Gi- adenylyl cyclase, protein kinase A

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17
Q

Modulates NE release

by acting on

alpha-2, M2, angiotensin II

presynaptic autoreceptors

A

Norepinephrine

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18
Q

Activated bowel, bladder smooth muscle

Postoperative ileus, neurogenic ileus

Urinary retention

Direct cholinergic agonist

AChE resistant

A

Bethanechol

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19
Q

Glaucoma, pupillary contraction

Direct cholinergic agonist

A

Carbachol

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20
Q

Potent stimulator of sweat, tears, saliva

Open and closed-angle glaucoma

(What does it contract?)

Direct cholinergic agonist

Resistant to AChE

A

Pilocarpine

Contracts:

ciliary muscle (open-angle glaucoma)

pupillary sphincter (closed-angle glaucoma)

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21
Q

Challenge test for asthma diagnosis

Stimulates muscaric receptors in airway when inhaled

Direct cholinergic agonist

A

Methacholine

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22
Q

Postoperative and neurogenic ileus, urinary retention

Myasthenia gravis

Reversal of NMJ blockade (post-op)

Anticholinesterase (AChE-i)

No CNS penetration

A

Neostigmine

increases endogenous ACh

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23
Q

Myasthenia gravis (long-acting)

Anticholinesterase (AChE-i)

No CNS penetration

A

Pyridostigmine

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24
Q

Diagnosis of myasthenia gravis

(extremely short acting)

Anticholinesterase (AChE-i)

A

Edrophonium

25
Q

Anticholinergic toxicity

(atropine OD)

Crosses BBB

A

Physostigmine

“Phyxes” atropine OD

26
Q

Alzheimer’s disease

Anticholinesterase (AChE-i)

A

Donepezil

27
Q

Side effects of cholinomimetics

A

COPD exarcerbation, asthma, peptic ulcers

28
Q

AChE-i poisoning

(due to organophosphates, i.e. parathion)

Irreversibly inhibit AChE

Symptoms:

Diarrhea, urination, miosis, bronchospasm, excitation of skeletal muscle and CNS, lacrimation, sweating, salivation

A

Treatment for AChE-i poisoning =

Atropine

+

Pralidoxime

(regenerates active AChE)

29
Q

Mydriasis, cycloplegia (no accommodation)

Muscarinic antagonists (3)

A

Atropine, homatropine, tropicamide

30
Q

Parkinson’s disease

Muscarinic antagonist

A

Benztropine

Park my Benz

31
Q

Motion sickness

Muscarinic antagonist

A

Scopolamine

32
Q

COPD, asthma

Muscarinic antagonists (2)

A

Ipratropium, tiotropium

I pray I can breathe soon

33
Q

Reduce urgency in mild cystitis, reduce bladder spasms

Muscarinic antagonist

A

Oxybutynin

34
Q

Reduce airway secretions (post-op)

Oral: drooling, peptic ulcers

Muscarinic antagonist

A

Glycopyrrolate

35
Q

Bradycardia, eye exams

Increases:

Pupil dilation (mydriasis), cycloplegia (no accommodation)

Decreases:

Airway secretions, gastric acid secretion, gut motility, bladder urgency in cystitis

Muscarinic antagonist

A

Atropine

36
Q

Dry mouth, dry, flushed skin, increased body temperature, cycloplegia, mydriasis, disorientation

Acute closed-angle glaucoma (elderly)

Urinary retention (BPH)

Hyperthermia (infants)

A

Atropine overdose

(HOT as a hare
DRY as a bone
RED as a beet
BLIND as a bat
MAD as a hatter)

(Tx: physostigmine)

37
Q

alpha-1, alpha-2, beta-1, beta-2

Anaphylaxis, open-angle glaucoma, asthma, hypotension

A

Epinephrine

38
Q

alpha-1, alpha-2, > beta-1

Hypotension

A

Norepinephrine

39
Q

beta-1, beta-2

Torsade de pointes, bradyarrhythmias

A

Isoproterenol

(May worsen ischemia by causing tachycardia)

40
Q

High doses: alpha-1, alpha-2

Medium doses: beta-1, beta-2

Low doses: D1

Shock (renal perfusion), heart failure

inotropic and chronotropic

A

Dopamine

41
Q

beta-1 > alpha-1, alpha-2, beta-2

Heartfailure, cardiac stess test

inotropic and chronotropic

A

Dobutamine

42
Q

alpha-1, alpha-2

Hypotension, eye exams, rhinitis

A

Phenylephrine

43
Q

beta-2 > beta-1

Asthma, COPD, premature uterine contractions

(3)

A

Albuterol- acute asthma

Salmeterol- long-term asthma, COPD

Terbutaline- premature uterine contractions

44
Q

beta-2

Premature uterine contractions

A

Ritodrine

45
Q

Releases stored catecholamines

Narcolepsy, obesity, ADD

A

Amphetamine

46
Q

Releases stored catecholamines

Nasal decongestion, urinary incontinence, hypotension

A

Ephedrine

47
Q

Catecholamine reuptake inhibitor

Vasoconstriction, local anesthesia

No beta-blockers!

A

Cocaine

beta-blockers = unopposed alpha-1 activation

= extreme hypertension

48
Q

Centrally acting alpha-2 agonists

Decrease sympathetic outflow

Hypertension, esp. with renal disease

A

Clonidine, alpha-methyldopa

(No decrease in blood flow to kidney)

49
Q

Non-selective alpha blocker

Irreversible

Pheochromocytoma

SE: orthostatic hypotension, reflex tachycardia

A

Phenoxybenzamine

50
Q

Non-selective alpha blocker

Reversible

Pt on MAO-I who eats tyramine foods

A

Phentolamine

51
Q

Alpha-1 blockers

Hypertension

Urinary retention in BPH

1st dose orthostatic hypotension, dizziness, headache

A

Prazosin, terazosin, doxazosin, tamsulosin

52
Q

Alpha-2 blocker

Depression

SE: sedation, increased serum cholesterol, appetite

A

Mirtazapine

53
Q

Beta-1 blockers

Angina pectoris, MI, SVT (2), HTN, CHF

A

_Ace_butolol, _bet_axolol, esmolol, atenolol, metoprolol

SVT- metoprolol, esmolol

Esmolol is short acting

Acebutolol is partial agonist

“Muck A TEN, BET ACEs ESpecially”

54
Q

Nonselective beta blockers

Angina pectoris, MI, HTN, CHF, glaucoma (1)

A

Propranolol, timolol, nadolol, pindalol

Glaucoma- timolol

decreases secretion of aqueous humor

55
Q

Nonselective alpha and beta antagonists

A

Carvedilol, labetalol

Vasodilatory effects

56
Q

Partial beta agonists

A

Pindolol, acebutolol

57
Q

Impotence, exacerbation of asthma

Adverse CV effects, CNS effects

Use with caution in diabetics

A

Beta blocker toxicities

58
Q

How do beta blockers reverse SVT?

A

Decreased AV conduction velocity

(class II antiarrhythmics)

59
Q

How do beta blockers reverse HTN?

A

Decreased CO

and

Decreased renin secretion

(B-1 receptor block on JGA cells)

Step 1 Pharm (19 decks)

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