M2 L2: sympathetic NS

Question 1

sympathomimetic agents

Answer 1

= adrenergic drugs
- stim SNS

Question 2

sympatholytic agents

Answer 2

= antiadrenergic drugs
- inhibit SNS

Question 3

classes of sympathomimetic agents

Answer 3

direct-acting: bind to receptors and elicit a response (ex: epinephrine). they mimic the effect of epinephrine.

indirect-acting: increase release of NE from presynaptic neuron (ex: amphetamines). same effect in a diff mechanism, stim the release of the natural transmitters (epinephrine and norepinephrine).

mixed: both direct and indirect effect (ex: ephedrine). mix between both some effect on receptors, some can stimulate.

Question 4

albuterol

Answer 4

more important beta-2 for treating asthma

Question 5

therapeutic indications: anaphylaxis

Answer 5

α and β agonists
- severe allergies; penicillin, peanuts, shellfish, etc.
- Epi pens are full of epinephrine - save lives but also monitor after
- Epinephrine: acts on both alpha and beta receptors

Question 6

therapeutic indications: heart

Answer 6

β1 agonists
- complete heart block - cardiac arrest
- cardiogenic shock
- ex: dobutamine

Question 7

therapeutic indications: asthma

Answer 7

β2 agonists

Question 8

therapeutic indications: nasal congestion

Answer 8

α1 agonists
- decongestants ex: pseudoephedrine
disadvantage: rebound congestion

Question 9

therapeutic indications: pupil dilation

Answer 9

α1 agonists
- for fundas examination

Question 10

alpha agonists

Answer 10

constricts the blood vessels - nasal congestion the nose is dilated and engorged with blood so this would reduce nasal congestion, can also be used in pupil dilation

Question 11

anaphylaxis

Answer 11

• severe hypersensitivity reaction to certain types of food, drugs, bee sting, etc
• affect resp and cardio sys: severe bronchospasm, mucous membrane congestion, severe hypotension -> shock

treatment: EPINEPHRINE
- activates α & β receptors -> bronchodilation
- vasoconstriction of blood vessels -> restores bp
- increased heart rate and myocardial contraction

Question 12

adverse effects anaphylaxis

Answer 12

CNS: headache, restlessness, tremors, dizziness, anxiety, insomnia

CVS: dysrhythmia and palpitation, vasoconstriction -> hypertension and myocardial ischemia

• anorexia, nausea, vomiting
• dry mouth
• muscle cramps

Question 13

classes of sympatholytic agents

Answer 13

α receptor antagonists: non-selective, α1 blockers, α2 blockers

β receptor antagonists: non-selective, β1 blockers, β2 blockers

α and β receptors antagonists

• Alpha receptors: will block a1 or a2
• A1 - helpful in hypertension
• B-2 blockers don’t have a ton of use, mostly on b1’s
• B1 blockers are IMPORTANT
• Beta 1 blockers for the treatment of hypertension and the heart, beta 2 agonist treatment for asthma (both very clinically relevant)

Question 14

therapeutic indications for CVS: hypertension

Answer 14

• β blockers especially selective β1 blockers (cardioselective)
• α1 blockers - not preferred due to adverse effects
• α and β blockers - during pregnancy

Beta 1 main - cardio selective and cardioprotective

Beta receptors on heart rate - increase the heart rate, increase cardiac output

If you block beta receptors - becomes slow

Question 15

therapeutic indications for CVS: angina and congestive heart failure

Answer 15

selective β1 blockers

Question 16

therapeutic indications for CVS: dysrhythmias

Answer 16

selective β1 blockers
extrasystoles and tachyarrhythmias ex: SVT

Question 17

impaired peripheral circulation (Raynaud’s disease)

Answer 17

α1 blockers

makes your blood circulation to extremities low, and makes your feet and hands cold. This can lead to extremities becoming pale. Alpha 1 blocks help here to dilate blood vessels.

Question 18

therapeutic indications for CVS: pheochromocytoma

Answer 18

• adrenal medulla tumor -> increased secretion of E and NE
• manifestations:
  CVS: hypertension, tachycardia, palpations
  CNS: headache, anxiety, tremors
  sweating
  hyperglycemia
• treatment:
  1st choice treatment is surgery
  α and β blockers can be used temporarily b4 surgery

makes epinephrine and norepinephrine and sends them to the blood, this leads to too much effect of the system. Can cause severe tachycardia, severe increased blood pressure, malignant hypertension, can lead to rupture of blood vessels, as well as heart attack (can be detrimental), also can lead to stroke if its blood vessels to the brain. Worst part is cardiovascular effect. Give them alpha and beta blocks, you need to block the effects of the system.

Question 19

therapeutic indications for CVS: benign prostatic hyperplasia (BPH)

Answer 19

α1 blockers
relax smooth muscle in prostate and bladder - facilitate urination

A1 are useful for blood vessels, and benign prostatic hyperplasia

Question 20

therapeutic indications for CVS: glaucoma

Answer 20

β blockers: non-selective or selective β1 blockers

Beta blockers or alpha agonists can be used to treat glaucoma
Add beta blockers to reduce heart rate if you want

Question 21

therapeutic indications for CVS: neurological disorders

Answer 21

β blockers
migraine, anxiety, Parkinson’s disease (reduce tremors)

Beta blockers or alpha agonists can be used to treat glaucoma
Add beta blockers to reduce heart rate if you want

Question 22

adverse effects - α1 blockers

Answer 22

• orthostatic hypotension
• 1st dose effect - hypotension
• nasal congestion
• headache, dizziness, weakness, fatigue

Take meds before bed, or take something else
Can happen especially with the first dose (Be in bed when it is taken)
They are a decongestant

Question 23

adverse effects - β blockers

Answer 23

• bronchoconstriction
• CVS: bradycardia and AV-block, hypotension, exacerbation of heart failure, cold extremities
• CNS: depression and nightmares, hallucination, paresthesia
  Mask the effect of hypoglycemia

Question 24

what drugs have similar but not identical effects (2 groups)

Answer 24

1. sympathomimetic and parasympatholytic drugs - both produce fight or flight response
2. sympatholytic and parasympathomimetic drugs - both produce rest and digest response