High-yield Autonomics questions slide

Question 1

Cholinesterase inhibitors can be used for

Answer 1

atropine overdose as well as Alzheimer’s

Question 2

Anti-muscarinic effects in CNS and heart also include

Answer 2

1. sedation, delirium, amnesia

2. initial slight brady (from block of inhibitory presyn receptors) and then tachy (block of M2 receptors in SA node)

Question 3

Anti-muscarinic effects on blood vessels include

Answer 3

1. block of muscarinic vasodilation but not manifested unless muscarinic agonist is present (it blocks M3 receptors on endothelium of vessels)

Question 4

The effects of tubo and mivacurium can be overcome with

Answer 4

acetylcholinesterase inhibitors and increased ACh at the synaptic cleft

Question 5

To prevent diffusion of an NT away from the synaptic cleft, use a

Answer 5

vasoconstricting agent!!

Question 6

To prevent BP spike from injection of tyramine, do what?

Answer 6

Tachyphylaxis (acute tolerance), so small cytoplasmic pool of NE is rapidly used up with repeated tyramine injections!!

Question 7

Use of fenoldopam?

Answer 7

Hypertensive emergences (lower the blood presssure)

Question 8

Alpha1 agonists like ____ can do what four things in particular?

Answer 8

Epi:
1. control hemorrhage 2. contain local anesthetic!!!! 3. Anaphylactic shock (can use alpha 1 and beta 2 properties) 4. Hypotension

Question 9

For shock, what might you NOT want to give?

Answer 9

Alpha agonist (vasoconstrictor) because of risk of not getting perfusion to your organs

Question 10

Side effects of alpha adrenergic agonists:

Answer 10

1. Hypertension/headache
2. Localized ischemia (alpha 1)
3. Dramatic fall in BP with RAPID WITHDRAW
4. Nervousness, anxiety, insomnia

Question 11

___ agonists on what receptors in _____ can ____ central symp output; this will do what?

Answer 11

alpha2; NTS; decrease; decrease BP and treat hypertension!!!!!

Question 12

The third generation non-selective beta blockers can also do WHAT?

Answer 12

Block alpha1 receptors allowing for vasodilation!!

Question 13

Third-generation beta-selective blockers can also do what?

Answer 13

Block Ca channels and entry!!

Question 14

What is a difference between metoprolol and propanolol in terms of bioavailability?

Answer 14

More dramatic differences in individual bioavailability due to first pass metabolism and plasma protein binding

Question 15

Least lipid soluble beta blocker is

Answer 15

atenolol (not much CNS activity)

Question 16

Proposed mech’s for how beta blockers treat hypertension include:

Answer 16

Blocking of renin release, pre-syn beta1 receptors inhibited, blocking alpha1 receptors, blocking Ca entry, opening K channels

Question 17

What could be potentially used to treat a migraine besides the ergot alkaloids and the triptans?

Answer 17

Something like propanolol!!

Question 18

What beta blockers should be used to treat CHF???

Answer 18

ONLY second and third gen!!!

Question 19

What is a possible explanation for ____ tachycardia and ____ hypotension with prazosin than the non-selective alpha blockers?

Answer 19

less; postural; Because you have LESS NE RELEASE!! If you don’t block the alpha 2 receptors, which would contribute to less NE release, then you can still control NE release and also block alpha 1 receptors which would mean minimal tachy and also treating the hypertension

Question 20

Prazosin can be used to treat

Answer 20

Raynaud’s and frost bite (peripheral vascular disease)

Question 21

Who might you not want to give a beta blocker (beta2) to?

Answer 21

Hypoglycemic patient or a diabetic patient on insulin (decreased glycogenolysis and lipolysis in response to hypoglycemia)

Question 22

Ephedrine for nasal decongestants could lead to

Answer 22

an increase in HR (alpha1 and vasoconstriction)

Question 23

Giving someone a MAO inhibitor and then she eats fermented foods, what are you worried about?

Answer 23

SEVERE HYPERTENSION; because tyramine is in the fermented foods and instead of NE being metabolized by liver and other organs with MAO, it runs rampant!!