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NBDE Part II > Autonomics Disease & Therapeutics > Flashcards

Autonomics Disease & Therapeutics Flashcards

1
Q

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

A

2 neurons*Pre ganglionic, Post ganglionic

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2
Q

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

A

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

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3
Q

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

A

Effecter tissues/organs

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4
Q

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

A

Craniosacral*axons extend to ganglia near effector tissue

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5
Q

Which system of the ANS uses ACh?

A

Both sympathetic and parasympathetic pre-ganglionic fibers

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6
Q

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

A

Nicotinic

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7
Q

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

A

1-Dopamine2-Norepi3-Epi*Most use NE

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8
Q

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

A

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

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9
Q

What does DA mainly activate?

A

D1

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10
Q

What transmitter do post ganglionic parasympathetic neurons use?

A

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

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11
Q

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

A

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

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12
Q

What tissue is the M1 receptor present in?

A

Stomach*increases acid secretion

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13
Q

What 4 tissues are M2 receptors found in?

A

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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14
Q

What 2 tissues are M3 receptors found in?

A

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

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15
Q

What are the 2 antagonists of muscarinic receptors?

A

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

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16
Q

What is the agonist for Nicotinic receptors?

A

ACh

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17
Q

Where are Nm and Nn receptors respectively found?

A

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

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18
Q

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

A

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

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19
Q

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

A

Physostigmine

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20
Q

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

A

Donepezil (Aricept)

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21
Q

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

A

Sarin

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22
Q

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

A

Botulinim toxin

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23
Q

What are 2 cholinergic agents used in dentistry?

A

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

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24
Q

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

A

1-Epi (most)2-NE3-Phenylephrine

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25
Q

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

A

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

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26
Q

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

A

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

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27
Q

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

A

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

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28
Q

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

A

Prazosin (treat hypertension)

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29
Q

What are the 3 agonists of B1 receptors?

A

1-Epi2-NE3-Isoproterenol

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30
Q

What are the 5 agonists of B2 receptors?

A

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

31
Q

What 5 tissues have B1 receptors?

A

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)

32
Q

What is the main antagonist of B1 and B2 receptors?

A

Propranolol

33
Q

What 4 tissues have B2 receptors?

A

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

34
Q

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

A

Increase renal blood flow

35
Q

What is haloperidol used to treat?

A

Schizophrenia*is a D2 antagonist

36
Q

Which receptors does Epinephrine work on?

A

B1=B2a1=a2

37
Q

How does Epi effect the Cardiac system?

A

Increases HR and increases strength of ventricular contraction via B1 receptor

38
Q

How does Epi effect vasculature?

A

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

39
Q

How does Epi effect respiration?

A

Relaxes smooth muscle of airways and dilates bronchioles

40
Q

How does Epi effect the eyes?

A

Dilates (mydriasis)*also increases outflow of aqueous humor

41
Q

How does Epi effect genitourinary?

A

Relax detrusor muscle and uterus, contracts bladder sphincter

42
Q

What are 5 main therapeutic uses of Epi?

A

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

43
Q

What are 3 side effects of Epi?

A

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)

44
Q

What receptors does Norepinephrine act on?

A

Both a and B*B1 more than B2

45
Q

What is the physiological effect of NE?

A

Vasoconstriction, increase TPR and BP

46
Q

What is the main therapeutic use for NE?

A

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

47
Q

What are 3 main side effects of NE?

A

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

48
Q

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

A

1-DA2-B3-a

49
Q

What are three responses that Dopamine elicits?

A

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

50
Q

a1 agonists, such as Phenylephrine have what 3 effects?

A

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

51
Q

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

A

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

52
Q

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

A

1-hypertension2-attention-deficit hyperactivity disorder

53
Q

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

A

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

54
Q

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

A

1-Decongestants2-Dietary supplements

55
Q

What are 3 side effects of Mixed agonists?

A

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

56
Q

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

A

Epinephrine*a1=a2, B1=B2

57
Q

What three main things does Epinephrine do?

A

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

58
Q

Which hormone is for routine cardiovascular control?

A

Norepinephrine*A1=A2, B1>B2

59
Q

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

A

Open-angle glaucoma

60
Q

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

A

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

61
Q

What are 4 other indirect adrenergic agents?

A

1-Amphetamine2-Cocaine3-Methylphenidate4-TCAs

62
Q

Which other adrenergic agent releases DA and NE?

A

Amphetamine

63
Q

Which other adrenergic agent blocks the reuptake channels?

A

Cocaine

64
Q

Which other adrenergic agent blocks reuptake of dopamine?

A

Methylphenidate

65
Q

Which other adrenergic agent blocks reuptake of NE and Serotonin?

A

TCA’s

66
Q

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

A

Those taking MAO inhibitor

67
Q

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

A

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

68
Q

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

A

1-Orthostatic hypotension2-Nasal Stuffiness

69
Q

A1 antagonists such as Prazosin have what effect?

A

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

70
Q

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

A

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

71
Q

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

A

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

72
Q

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

A

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

73
Q

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

A

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

NBDE Part II (13 decks)

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