Exam 5: THE BIG ONE.....AUTONOMICS

Question 1

What are the 5 types of receptors in the autonomic nervous system?

Answer 1

Nicotinic (Ach), Muscarinic (Ach), Adrenergic: Alpha, Beta-1, & Beta-2 (NorEpi)

Question 2

What are the two ligands of the autonomic nervous system?

Answer 2

Acetylcholine and Epinephrine/NorEpinephrine

Question 3

For the Sympathetic Nervous system: describe the length of the Pre-ganglionic fibers.

Answer 3

Short!

Question 4

For the Parasympathetic nervous systems: describe the length of preganglionic fibers.

Answer 4

Long!

Question 5

For the Sympathetic Nervous system: describe the length of the post-ganglionic fibers.

Answer 5

Long!

Question 6

For the Parasympathetic nervous systems: describe the length of post-ganglionic fibers.

Answer 6

Short!

Question 7

What are the two receptors involved in the parasympathetic nervous system?

Answer 7

nicotinic and muscarinic (both use Ach as the ligand)

Question 8

What are the 4 receptors used in the sympathetic nervous system?

Answer 8

Nicotinic (Ach), Alpha (NE), Beta-1 (NE), Beta-2 (Ne)

Question 9

For the nicotinic receptors…..Where are N1 or Nm receptors found?

Answer 9

NeuroMuscular Junction

Question 10

For the nicotinic receptors…Where are N2 or Nn receptors found? (3)

Answer 10

Autonomic ganglia, CNS, and the adrenal medulla

Question 11

What are the 4 groups of drugs that alter the ANS?

Answer 11

1.Parasympathetic Stimulatory 2. Parasympathetic Inhibitory (blocking) 3.Sympathetic Stimulatory 4.Sympathetic Inhibitory (blocking)

Question 12

Can both divisions of the ANS (sym and parasym) be affected by a drug that only targets one division?

Answer 12

YES. Both divisions can be affected by these drugs

Question 13

A drug that acts at the location where acetylcholine is released is termed = ________.

Answer 13

Chol-in-ergic

Question 14

A drug that acts at the location where norepinephrine is released is termed = ________.

Answer 14

Adren-ergic

Question 15

A drug that acts at the location where the PANS acts has the prefix ________.

Answer 15

parasympatho-

Question 16

A drug that acts at the location where the SANS acts has the prefix ________.

Answer 16

sympatho-

Question 17

A drug that acts at the location where a division of the ANS acts and produces the SAME EFFECT as the neurotransmitter has the suffix _______.

Answer 17

– mimetic (salagen-a parasympathomimetic)

Question 18

A mimetic drug is also known as an _______.

Answer 18

agonist

Question 19

A drug that acts at the location where a division of the ANS acts and blocks the action of the neurotransmitter has the suffix –_____ or –_____…they are also known as _______.

Answer 19

-lytic….-blocker…antagonists

Question 20

What are the two types of STIMULATORY Parasympathetic Drugs?

Answer 20

1.Cholinergics 2. Parasympathomimetics

Question 21

What are the 3 types of INHIBITORY Parasympathetic drugs?

Answer 21

1.Anticholinergics 2.Parasympatholytics 3.Cholinergic blockers

Question 22

What are the 2 types of STIMULATORY Sympathetic drugs?

Answer 22

1.Adrenergics 2.Sympathomimetics

Question 23

What are the 3 types of INHIBITORY Sympathetic drugs?

Answer 23

1.adrenergic blockers 2.sympathetic blockers 3.sympatholytics

Question 24

What are the 2 methods of action for cholinergic agonists?

Answer 24

1.Direct acting-agonists (at the Ach receptor) 2.Indirect acting (causes Ach release) (chopinesterase inhibitors)

Question 25

______________ = cause accumulation of ACH = stimulating PANS

Answer 25

Cholinesterase inhibitors

Question 26

Which drugs act like acetylcholine (“mimic” its effects) on receptors, are agonists, have longer duration of action, are more selective in the effects produced, and stimulate the PANS?

Answer 26

Direct Acting Cholinergic Drugs

Question 27

To be an effective mediator/ligand, ACH must fit both _______ and _______ at the receptor.

Answer 27

physically and chemically

Question 28

What are the two types of PANS ACh receptors?

Answer 28

1.Nicotinic 2.Muscarinic

Question 29

What are the 2 types of receptors in the PANS CNS?

Answer 29

1.muscarinic 2.nicotinic

Question 30

What are the 2 types of receptors in the PANS Autonomic system?

Answer 30

1.Muscarinic 2.nicotininc

Question 31

What is the type of receptor found in the PANS neuromuscular system?

Answer 31

nicotinic

Question 32

What are the 3 other factors that account for different receptor responses besides just being different receptors?

Answer 32

1.Amount of ACh released 2.Size of the synaptic cleft 3.Tissue penetration of the drug

Question 33

What are the 3 cardiac effects of cholinergic drugs?

Answer 33

1.(tom) Bradycardia 2.decreased BP 3. decreased cardiac output

Question 34

What are the 2 eye effects of cholinergic drugs?

Answer 34

1.Miosis 2.Decreases intraocular pressure

Question 35

What are the 3 GI effects of cholinergic drugs?

Answer 35

1.Increase in activity 2. increase in motility 3.increase in secretion

Question 36

What are the 4 primary indications for direct acting cholinergic drugs?

Answer 36

1.Glaucoma 2.Myasthenia Gravis(autoimmune disease) 3.GI disorders (increase motility) 4.reverse urinary retention post op

Question 37

What are the two direct acting cholinergic agonist sister drugs?

Answer 37

cevi-me-line (EvoXac)...pilo-car-pine (Salagen) (both for Sjogren's! woo!)

Question 38

Which drug am I talkin' bout? Used in the eye for the treatment of glaucoma, By causing pupil _________, allows for DRAINAGE of fluid from the eye through the canal of Schlem...Glaucoma is increased intraocular pressure due to fluid accumulation...if left untreated, causes blindness

Answer 38

pilocarpine (Salagen)....constriction

Question 39

________ is also used in DENTISTRY to stimulate salivary secretions in patients with xerostomia....Indicated for patients with _________ or salivary gland damage from _________.

Answer 39

pilocarpine (Salagen)...Sjogren’s syndrome...head and neck irradiation.

Question 40

Indirect-Acting Cholinergic Drugs are also known as "________"

Answer 40

"cholinesterase inhibitors"

Question 41

What is the mechanism of action for indirect-acting cholinergic drugs/cholinesterase inhibitors?

Answer 41

they STOP the breakdown of ACh...ACh builds up and stimulates the PANS

Question 42

indirect-acting cholinergic drugs/cholinesterase inhibitors produce PANS _______.

Answer 42

stimulation

Question 43

What are the 5 primary indications for INDIRECT-acting chopinergic agonists? (hint. 3 are the same as direct)

Answer 43

1.Myastheia Gravis 2.Glaucoma 3.Post-op urination 4.Paralytic ileus 5.ANTIDOTES to poisons that produce nondepolarizing neuro blockade

Question 44

How are Indirect-Acting Cholinergic Drugs divided?

Answer 44

Reversible and Irreversible

Question 45

PART II BIG BOARDS TOPIC!! Reversible, indirect-acting, cholinergic agonists hahaha are used to treat what 2 situations?

Answer 45

1.Myasthenia Gravis 2.Glaucoma

Question 46

PART II BIG BOARDS TOPIC!! What are the 2 Reversible, indirect-acting, cholinergic agonists to know??

Answer 46

1.Physo-stigmine 2.pyrido-stigmine

Question 47

PART II BIG BOARDS TOPIC!! Which Reversible, indirect-acting, cholinergic agonist Reverses toxic life-threatening delirium caused by overdoses of anticholinergic drugs, including atropine, and overdoses of drugs that produce anticholinergic effects, including antihistamines like diphenhydramine (Benadryl) or tricyclic antidepressants?

Answer 47

Phy-sos-tig-mine

Question 48

PART II BIG BOARDS TOPIC!! Which Reversible, indirect-acting, cholinergic agonist is used for myasthenia gravis, pretreatment for nerve gas exposure (Soman)?

Answer 48

Pyrid-os-tig-mine

Question 49

Which Reversible, CENTRALLY indirect-acting, cholinergic agonist is used to treat newly dosed dementia patients with Alzheimer's disease?

Answer 49

done-pez-il (Ari-cept)

Question 50

Malathion, parathion = poisons....used as agricultural insecticides (organophosphates)....sarin, Soman, tabun = nerve gases, chemical warfare....ARE EXAMPLES OF ________.

Answer 50

Irreversible Acetylcholinesterase Inhibitors

Question 51

If poisoned (overdose) with insecticides or organophosphates, use the following antidotes: (2)

Answer 51

pral-i-dox-ime (2-PAM, Protopam)....atropine (antimuscarinic)

Question 52

For the SIDE EFFECTS of Cholinergic Drugs remember the acronym: ______. What does it stand for???

Answer 52

SLUD! S-salivation L-lacrimation U-urinatoin D-defecation

Question 53

Cholinergic Antagonists. boom. What are the 3 synonyms of these babies?

Answer 53

1.AntiCholinergics 2.Antimuscarinics 3.ParasympathoLytics

Question 54

Cholinergic Antagonists work by blocking what two things?

Answer 54

1.Neuromuscular junctions 2.Glanglions

Question 55

AntiCholinergics/ParasympathoLytics Prevent the action of ___________ at the _____ganglionic PANS nerve endings

Answer 55

ACh...POSTganglionic

Question 56

AntiCholinergics/ParasympathoLytics are “_____” drugs or _______.

Answer 56

"blocker"/antagonists

Question 57

AntiCholinergics/ParasympathoLytics Block the receptor site for _________. They DO NOT prevent it's _______.

Answer 57

ACh...release

Question 58

AntiCholinergics/ParasympathoLytics--Acetylcholine CANNOT act on receptors in ________, glands or the ______.

Answer 58

smooth muscle...heart

Question 59

AntiCholinergics/ParasympathoLytics are also called ________ drugs (block muscarinic receptors but not nicotinic receptors)

Answer 59

antimuscarinic

Question 60

Pharmacologic Effects of Anticholinergic Drugs-the CNS effects are determined by ____.

Answer 60

dose

Question 61

Pharmacologic Effects of Anticholinergic Drugs- therapeutic doses of this drug are for Sedation and motion sickness....

Answer 61

Sco-pol-amine

Question 62

Pharmacologic Effects of Anticholinergic Drugs- ______ in high doses will cause stimulation: delirium, hallucinations, convulsions, coma

Answer 62

Atropine

Question 63

Pharmacologic Effects of _________ Drugs-HUGE implication in dentistry to decrease salivation and create dry field for bonded restorations and impressions!

Answer 63

AntiCholinergic

Question 64

Pharmacologic Effects of Anticholinergic Drugs- Big effect on _______ glands. Especially the respiratory, GI, and GU tracts to treat COPD and overactive bladder.

Answer 64

EXOCRINE

Question 65

Pharmacologic Effects of Anticholinergic Drugs- On smooth muscle-__________ to facilitate breathing

Answer 65

Bronchodilators

Question 66

Pharmacologic Effects of Anticholinergic Drugs-Smooth muscles-__________ (______) used to decrease secretions in emphysema and asthma

Answer 66

ipratropium (Atrovent)

Question 67

Pharmacologic Effects of Anticholinergic Drugs-Smooth muscle--GI tract = Antispasmotics – _______ gut motility and cause ________ as side effect

Answer 67

DECREASE... constipation

Question 68

Pharmacologic Effects of Anticholinergic Drugs-Eye: ________ (dilated pupils), ________ (paralysis of accommodation so that the lens is focused for distance vision and near vision is blurred), and drops used for _________.

Answer 68

my-dri-asis....cyclo-plegia..opthalmologic examination

Question 69

Pharmacologic Effects of Anticholinergic Drugs-CVS = Large therapeutic doses = vagal blockade, resulting in _______.

Answer 69

tachycardia (used to prevent cardiac slowing during general anesthesia)

Question 70

Clinical Uses of Anticholinergic Drugs- _________ medications....stop salivation and bronchial mucous (normally stimulated by general anesthesia)...Block slowing of heart rate caused by general anesthesia

Answer 70

Preoperative

Question 71

Clinical Uses of Anticholinergic Drugs- GI disorders that produce excess secretions and increased gut motility....Stops excess acid secretion (peptic ulcer disease)...Stops diarrhea and cramping – antispasmodic for ______

Answer 71

GI disorders....IRRETABLE BOWEL SYNDROME

Question 72

Clinical Uses of Anticholinergic Drugs- Eye examination: Causes pupil ______ to allow for examination of retina...______ lens for determining prescription for eyeglasses

Answer 72

dilation...relaxes

Question 73

Clinical Uses of Anticholinergic Drugs- _________: Reduces tremors and muscle rigidity

Answer 73

Parkinson’s disease

Question 74

Clinical Uses of Anticholinergic Drugs-GU disorders....________ (urinary antispasmodic)

Answer 74

Overactive bladder

Question 75

Clinical Uses of Anticholinergic Drugs- Motion sickness: _______ “patch” behind the ear...CNS _______

Answer 75

Scopolamine...depressant

Question 76

Clinical Uses of Anticholinergic Drugs- DENTISTRY-YAY! Used to ________...in order to do this we would give ______.

Answer 76

maintain a dry field....atropine

Question 77

HEY YO-think abooot these opposing actions! _______=anticholinergic=dries saliva...._________=cholinergic=salivation

Answer 77

atropine....pilocarpine

Question 78

Popular Anticholinergic Medications- _______...Used in dentistry to stop salivation before procedures

Answer 78

atropine

Question 79

Popular Anticholinergic Medications- _________: Patch used for motion sickness

Answer 79

sco-pol-amine

Question 80

Popular Anticholinergic Medications- ________ (______)....Drug of choice for emphysema = stops bronchial secretions

Answer 80

ipratropium (Atrovent)

Question 81

Contraindications to Anticholinergic Drugs!! They cause an acute rise in intraocular pressure, so this condition _______.

Answer 81

Glaucoma

Question 82

Contraindications to Anticholinergic Drugs!! They cause urinary retention; may need catheterization, so this condition is an issue....

Answer 82

Prostatic Hypertrophy (enlarged prostate)-difficulty passing urine

Question 83

Contraindications to Anticholinergic Drugs!! They slow GI motility and cause urinary retention so pt's with ________ don't take um.

Answer 83

intestinal/urinary obstruction/retention

Question 84

Contraindications to Anticholinergic Drugs!! They can block the vagus nerve; tachycardia can result..So Pts w/ ______ should avoid them.

Answer 84

Cardiovascular Disease

Question 85

What is Dr. S's kick ass mnemonic for ATROPINE TOXICICTY?

Answer 85

Dry as a bone (lack of sweating)...Red as a beet (flushed skin)....Blind as a bat (blurred vision; mydriasis/cycloplegia)...Mad as a hatter (delirium, hallucinations)