Autonomics Disease & Therapeutics Flashcards by Jordan Sanger

How many nerves is the autonomic nervous system made up of?

2 neurons*Pre ganglionic, Post ganglionic

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Where are the cell bodies of the Sympathetic nervous system found?

Thoracolumbar*Axons extend to para-pre vertebral ganglia so they are short

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Post ganglionic neurons of the sympathetic nervous system extend from the para and pre vertebral ganglia to what?

Effecter tissues/organs

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Where are the cell bodies of parasympathetic pre-ganglionic neurons found?

Craniosacral*axons extend to ganglia near effector tissue

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Which system of the ANS uses ACh?

Both sympathetic and parasympathetic pre-ganglionic fibers

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What type of receptors does ACh act on in post-ganglionic fibers?

Nicotinic

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What three main transmitters are used for sympathetic post-ganglia?

1-Dopamine2-Norepi3-Epi*Most use NE

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NE and EPI act on what and are released by what?

-Act on A and B receptors-Released by adrenal gland

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What does DA mainly activate?

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What transmitter do post ganglionic parasympathetic neurons use?

ACh*acts on muscarinic receptors in effector tissues or nicotinic in somatic muscles

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What three drugs are agonists to the three main muscarinic receptors?

1-ACh2-bethanechol (GI motility and secretion)3-Pilocarpine (glaucoma)

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What tissue is the M1 receptor present in?

Stomach*increases acid secretion

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What 4 tissues are M2 receptors found in?

1-Sinoatrial node (Slows HR)2-Atria (Slows AP duration and contractility)3-AV node (Slows conduction velocity)4-Ventricle (Slows contractility

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What 2 tissues are M3 receptors found in?

1-GI smooth muscle (contract)2-Secretory glands (increase secretion)

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What are the 2 antagonists of muscarinic receptors?

1-Atropine (antidote for nerve gas)2-scopolamine (motion sickness)

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What is the agonist for Nicotinic receptors?

ACh

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Where are Nm and Nn receptors respectively found?

Nm-Neuromuscular junctionNn-autonomic ganglia, adrenal medulla, CNS

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What are the two antagonists for Nm receptors and the main antagonists for Nn receptors?

Nm- succinylcholine (depolarizing), d-tubocurarine (competes with ACh)Nn-mecamylamine

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Which cholinesterase inhibitor has a short duration, is used for glaucoma, and is the antidote for atropine?

Physostigmine

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Which cholinesterase inhibitor has extended duration and is used to treat alzheimer’s?

Donepezil (Aricept)

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Which cholinesterase inhibitor is irreversible, has long duration of action and is used in nerve gas?

Sarin

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What prevents release of ACh and used to relax intraocular muscles, treats muscle dystonia (spasms) and removes wrinkles?

Botulinim toxin

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What are 2 cholinergic agents used in dentistry?

1-Cevimeline (evoxac) for xerostomia in Sjogrens2-Pilocarpine (salagen) xerostomia after radiotherapy

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What are the 3 main agonists of a1 receptors of the sympathetic nervous system?

1-Epi (most)2-NE3-Phenylephrine

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What are the 4 main agonists of a2 receptors of the sympathetic nervous system?

1-Epi (most)2-NE3-clonidine4-guanfacine

What are the 3 main tissues that contract or constrict when a1 receptors are activated?

1-Radial muscle of iris2-genitourinary and GI sphincters3-Vasculature

What are the 3 main tissues that are effected by a2 receptor activation?

1-Vasculature (constrict)2-NE terminals (decrease NE release)3-Brainstem (decrease NE release)

What is the main antagonist of the a1 receptor in the sympathetic nervous system?

Prazosin (treat hypertension)

What are the 3 agonists of B1 receptors?

1-Epi2-NE3-Isoproterenol

What are the 5 agonists of B2 receptors?

1-Epi (Most)2-NE3-isoproterenol4-albuterol (asthma)5-terbutaline

What 5 tissues have B1 receptors?

1-SA node (increase HR)2-Atria (increase contract velocity)3-AV node (increase conduction)4-HIS-Purkinje fibers (increase conduction)5-Ventricles (increase conduction/contraction)

What is the main antagonist of B1 and B2 receptors?

Propranolol

What 4 tissues have B2 receptors?

1-ciliary muscle (relaxation for far vision)2-Vasular (relax/vasodilate)3-Lungs (relax)4-Urinary bladder/uterine wall (relax)

In the kidney, what does DA released from sympathetic nerve terminals do?

Increase renal blood flow

What is haloperidol used to treat?

Schizophrenia*is a D2 antagonist

Which receptors does Epinephrine work on?

B1=B2a1=a2

How does Epi effect the Cardiac system?

Increases HR and increases strength of ventricular contraction via B1 receptor

How does Epi effect vasculature?

-Low dose=decrease in TPR and diastolic pressure-high dose=increase TPR and BP

How does Epi effect respiration?

Relaxes smooth muscle of airways and dilates bronchioles

How does Epi effect the eyes?

Dilates (mydriasis)*also increases outflow of aqueous humor

How does Epi effect genitourinary?

Relax detrusor muscle and uterus, contracts bladder sphincter

What are 5 main therapeutic uses of Epi?

1-Bronchospasm2-Anaphylaxis3-Restore function in cardiac arrest4-Treat open-angle glaucoma5-Prolong local anesthetics

What are 3 side effects of Epi?

1-Cardiac (increase HR, palpitations, arrhythmias, anginal pain)2-Vascular (increase TPR and BP lead to pallor)3-Respiratory (increase TPR leading to pulmonary edema)

What receptors does Norepinephrine act on?

Both a and B*B1 more than B2

What is the physiological effect of NE?

Vasoconstriction, increase TPR and BP

What is the main therapeutic use for NE?

To treat shock*increases BP to get blood to all organs

What are 3 main side effects of NE?

1-Slow Heartbeat if BP increases (baroreceptors)2-Forceful beat (B1)3-Vasoconstrict (less blood to vital organs, a1)

Depending on the dose, what three receptors does Dopamine act on from most to least?

1-DA2-B3-a

What are three responses that Dopamine elicits?

1-Increases BP and TPR via a12-Increases HR via B13-Increases organ perfusion via D1

a1 agonists, such as Phenylephrine have what 3 effects?

1-Vasoconstriction and increase TPR2-Decreased HR3-Constrict Sphincter muscle of bladder

a2 agonists such as clonidine and guanfacine have what 3 effects?

1-Bradycardia in some2-Dry mouth3-decrease sympathetic output when stimulating CNS a2

What are the two main uses for a2 agonists such as clonidine and guanfacine?

1-hypertension2-attention-deficit hyperactivity disorder

B agonists such as isoproterenol, albuterol and terbutaline are used for what 4 things?

1-Asthma2-bronchospasm3-COPD4-OBGYN (relax uterine smooth muscle to slow contractions)

Mixed agonists such as ephedrine, ephedra and pseudoephedrine release NE and are mainly used in what two things?

1-Decongestants2-Dietary supplements

What are 3 side effects of Mixed agonists?

1-Increased HR2-Vasoconstriction3-Dilate airways*can also be a stimulant if penetrates CNS

Which hormone is an emergency hormone secreted in response to stress?

Epinephrine*a1=a2, B1=B2

What three main things does Epinephrine do?

1-Increase HR2-arteriole constiction in abdomen (a1) dilate pre-capillary resistance in skeletal muscle (B2)3-Increase TPR (if fast and high, a1)

Which hormone is for routine cardiovascular control?

Norepinephrine*A1=A2, B1>B2

The most common form, which glaucoma develops over time and is treated with epinephrine to decrease production of aqueous humor?

Open-angle glaucoma

Which form of glaucoma causes a blocked drainage and results in a sudden rise in intraocular pressure?

Angle-closure glaucoma*treat with pilocarpine to pull iris open and release trabecular meshwork

What are 4 other indirect adrenergic agents?

1-Amphetamine2-Cocaine3-Methylphenidate4-TCAs

Which other adrenergic agent releases DA and NE?

Amphetamine

Which other adrenergic agent blocks the reuptake channels?

Cocaine

Which other adrenergic agent blocks reuptake of dopamine?

Methylphenidate

Which other adrenergic agent blocks reuptake of NE and Serotonin?

TCA's

Which type of patient should you be worried about Tyramine filling up vesicles and depleting NE?

Those taking MAO inhibitor

Non-selective a Antagonists such as phenoxybenzamine and phentolamine have what two main effects?

1-Decrease TPR (thus decrease BP)2-Increase HR (baroreceptor response to decreased BP)

What are 2 side effects of non selective a antagonists such as phenoxybenzamine and phentolamine ?

1-Orthostatic hypotension2-Nasal Stuffiness

A1 antagonists such as Prazosin have what effect?

Vasodilation and thus decreased TPR and BP*used for hypertension and benign prostatic hypertrophy

Beta antagonists (blockers) such as propranolol (B1 and B2) and Atenolol (B1) have what 6 effects?

1-Cardiac (decrease HR and contractility)2-Vascular (increase TPR)3-Renal (decreased renin release)4-Respiratory (bronchial constriction)5-Metabolic (decrease glycogenolysis)6-Decrease aqueous humor

Cholinomimetic agents such as cholinesterase inhibitors, bethanechol, pilocarpine and nicotine are used to treat what 4 conditions?

1-Myasthenia graves2-Glaucoma3-Alzheimer's4-Smoking cessation

Antimuscarinic agents such as atropine and scopolamine are used to treat what 4 things?

1-Parkinsons (adjunct)2-Motion sickness3-COPD4-Urinary urgency

What are 5 effects of Antimuscarinic agents such as atropine and scopolamine?

1-Dry mouth2-Constipation3-Blurred vision4-Sedation5-Urinary retention