Parasympathetic Activation & Inhibition

Question 1

PNS nervous system

Answer 1

CN III, VII, IX, X

2nd & 3rd sacral spinal nerves

Question 2

What organs do the vagus nerve effect?

Answer 2

Heart
Lungs
Esophagus
Stomach
Small intestine
Proximal 1/2 colon
Liver
Gallbladder
Pancreas
Kidneys
Upper portions of Ureters

Question 3

End organ receptor for parasympathetic

Answer 3

Muscarinic Receptor

Question 4

Nicotinic receptors

Answer 4

Ligand-gated Na/K channels

• Autonomic ganglia
• Neuromuscular junction

Question 5

Muscarinic receptors

Answer 5

G-protein-coupled receptors
5 subtypes (M1-M5)

Question 6

Patient profile for Parasympathetic activation

Answer 6

Old MacDonald gets Leaky

DUMBBELSS
D: Diarrhea
U: Urination
M: Miosis
B: Bronchospasm
B: Bradycardia
E: excitation of skeletal muscle
L: Lacrimation
S: Salivation
S: sweating

Question 7

How do organophosphates stimulate parasympathetic activation?

Answer 7

Organophosphates INHIBIT AChE.

Question 8

Treatment of organophosphate poisoning (parasympathetic activation)?

Answer 8

Atropine (competitively bind ACh)

Pralidoxime (reactivate AChE)

Question 9

Direct Cholinergic agonists

Answer 9

Bethanecol
Carbachol
Pilocarpine
Methacholine

Question 10

Indirect Cholinergic agonists

Answer 10

Neostigmine
Pyridostigmine
Edrophonium
Physostigmine
Donepezil / Galantamine / Rivastigmine

Question 11

Alzheimer’s disease tx

Answer 11

Donepezil
Galantamine
Rivastigmine

Question 12

Myasthenia Gravis

Answer 12

Antibodies to ACh receptors

Question 13

Ptosis & diplopia worsens throughout day

Answer 13

Myasthenia Gravis

Always check Thymus

Question 14

Myasthenia Gravis tx

Answer 14

Pyridostigmine
Neostigmine

Immunotherapy (steroids)

Thymectomy

Plasmapharesis

Question 15

PNS inhibition

Answer 15

HOT as a hare
RED as a beet
BLIND as a bat
DRY as a bone
MAD as a hatter
BLOATED as a toad

Question 16

Muscarinic Antagonist

Answer 16

Atropine
Homatropine
Tropicamide

Cyclopentolate

Benztropine

Scopolamine

Ipratropium
Tiotropium

Oxybutynin

Question 17

Atropine

Answer 17

Bradycardia
Pupil dilation
Organophosphate poisoning

Question 18

Benztropine

Answer 18

Parkinson disease

“Park my Benz”

Question 19

Scopolamine

Answer 19

motion sickness

decrease oral secretion

Question 20

Ipratropium, Tiotropium

Answer 20

Asthma

COPD

Question 21

Oxybutynin

Answer 21

decrease overactive bladder symptoms

Question 22

Urge incontinence

Answer 22

“On The Darn Toilet”

Oxybutynin
Tolterodine
Darifenacin
Trospium

Question 23

Atropine
Homatropine
Tropicamide

Answer 23

Muscarinic Antagonist

Question 24

Cyclopentolate

Answer 24

Muscarinic Antagonist

Question 25

Benztropine

Answer 25

Muscarinic Antagonist

Question 26

Scopolamine

Answer 26

Muscarinic Antagonist

Question 27

Ipratropium | Tiotropium

Answer 27

Muscarinic Antagonist

Question 28

Oxybutynin

Answer 28

Muscarinic Antagonist

Question 29

Bethanecol

Answer 29

Direct Cholinergic agonists

Question 30

Carbachol

Answer 30

Direct Cholinergic agonists

Question 31

Pilocarpine

Answer 31

Direct Cholinergic agonists

Question 32

Methacholine

Answer 32

Direct Cholinergic agonists

Question 33

Neostigmine

Answer 33

Indirect Cholinergic agonists

Question 34

Pyridostigmine

Answer 34

Indirect Cholinergic agonists

Question 35

Edrophonium

Answer 35

Indirect Cholinergic agonists

Question 36

Physostigmine

Answer 36

Indirect Cholinergic agonists

Question 37

Donepezil / Galantamine / Rivastigmine

Answer 37

Indirect Cholinergic agonists