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RUSVM Pharmacology > Peripheral Nervous System- SNS > Flashcards

Peripheral Nervous System- SNS Flashcards

1
Q

What adrenergic receptors are most common on vascular smooth muscle

A

A1

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2
Q

What adrenergic receptors are most common in the brain and spinal cord

A

A2

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3
Q

What adrenergic receptors are most common in myocardium

A

B1

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4
Q

What adrenergic receptors are most common in airway smooth muscle

A

B2

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5
Q

What receptors are on smooth muscle of blood vessels, direct vasodilation, and kidney?

A

D1 (dopamine)

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6
Q

What receptors are most common of post-ganglionic sympathetic nerve terminals, glomeruli, renal cortex and renal tubules, adrenal cortex, chemoreceptor trigger zone, and indirect vasodilation?

A

D2 dopamine

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7
Q

What are the direct acting sympathoMIMETICS

A 
*Catecholamines*
Epinephrine 
Norepinephrine 
Isoproterenol 
Dopamine 
Dobutamine
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8
Q

How should catecholamines be administered?

A

By injection
Absorbed from respiratory tract

Poorly absorbed after oral administration-> high first pass effect

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9
Q

Do catecholamines cross the BBB?

A

No

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10
Q

What is the onset and duration of Catecholamines ?

A

Rapid

Emergency use

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11
Q

What are the adverse effects of catecholamines ?

A

Narrow safety margin
Short half life

Predispose myocardium to tachycardia and tachyarrhythmias
Anxiety, restlessness, tremors
Altered perfusion-> direct to “flight tissue”
Extravasation of Norepinephrine or Dopamine can cause tissue damage and sloughing
Cerebral hemorrhange

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12
Q

What adrenergic receptor does epinephrine not have affinity for?

A

Dopamine

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13
Q

What receptor does norepinephrine not have receptor affinity for ?

A

B2 and Dopamine

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14
Q

What receptors does Isoproterneol have affinity for?

A

B1 and B2

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15
Q

What receptors does dopamine have affinity for?

A

Dopamine (low dose)
B1 (med dose)
A1 (high dose)

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16
Q

How is norepinephrine degraded/removed form the nerve endings?

A 
Active uptake (50-80%)
Diffusion 
Destruction 
-MAO= mono-amine oxidase (nerve endings) 
-COMT= catecholamine O-methyl transferease (tissue)
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17
Q

How is norepinephrine / epinephrine removed from the circulation

A

COMT destroy in tissues
Liver
Effects peak 10-30seconds, absent by 1 min

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18
Q

What is the mechanism of action of epinephrine

A

Direct acting catecholamine sympathomimetic

Competitive agonist at all alpha and beta receptors

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19
Q

Epinephrine will cause _________ at the B1 receptors

A

Cardiac contraction

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20
Q

Epinephrine will cause _________ at B2 receptors

A

Bronchodilation and vasodilation

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21
Q

Epinephrine will cause ___________ at a1 receptors

A

Vasocontriction

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22
Q

Epinephrine can be administered by what routes?

A

IV, IM, SQ, inhaled, IO

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23
Q

What are the systemic indications for using Epinephrine?

A
  • *Cardiopulmonary arrest (CPA)
  • *Anaphylaxis
  • *Increase mean arterial pressure by increasing systolic arterial pressure (SAP)

Vasopressor
Positive inotrope

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24
Q

What local effects can epinephrine be used for?

A

Local anesthetic (i.e. Lidocaine) to produce regional vasoconstriction -> delay systemic absorption

Topically to treat local hemorrhage

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25
Q

What are precautions to using epinephrine?

A

Causes massive sympathetic output
-increase myocardial workload and oxygen demand
–> increased myocardial oxygen consumption (MvO2)
Can result in myocardial ischemia
Cardiac arrest is possible

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26
Q

What is the MOA of norepinephrine

A

Direct catecholamine sympathomimetic

Mainly through a1 agonism

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27
Q

What are the indications for using Norepinephrine ?

A

Vasopressor support of CV is needed
Treat hypotension

Eg. Septic shock = sepsis and hypotension leading to refractory volume expansion

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28
Q

What is the main clinical effect of using Norepinephrine

A

Vasocontriction (a1 agonist-> MOST important catecholamine vasopressors)

Less of an increase in MvO2 than with epinephrine

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29
Q

What re the precautions and contraindications to using Norepinephrine

A

Cardiac arrhythmias/ tachyarrhythias -> major adverse effect of concern
-> used cautiously and with ECG

Do not use in hypertensive patients

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30
Q

What is the MOA of isoproterenol

A

Direct acting catecholamine sympathomimetic

Potent non specific beta agonist

31
Q

What are the main indications to using isoproterenol

A

Cardiac stimulators effects
-increase coronary, skeletal, renal, and mesenteric blood flow (positive inotropic effect)

Bronchodilation

32
Q

What are the contraindications to using isoproterenol

A

Side effects= tachycardia, anxiety, tremors, and arrhythmias

IV infusion must be titrated to effect
ECG monitoring and BP monitoring required

33
Q

What is the MOA of dopamine

A

Direct acting sympathomimetic
Dose-dependent effect

Dopamine receptors -low dose
Beta1 receptors- med dose
Alpha1 receptor- high dose

34
Q

A low does of dopamine will have what effect?

A

Acts on D1 and D2 receptors

Dilation of renal, mesenteric, coronary and intracerebral vascular beds

35
Q

A med-low dose of dopamine will have what effects?

A

Positive inotrope

36
Q

A med-high dopamine dose will have what effects?

A

Positive chronotrope

Increase cardiac automaticity

37
Q

A high dose of dopamine will have what effect

A

Vasoconstriction

38
Q

What are the indications to using dopamine

A

Post-arrest vasopressor of choice

Vasopressor support
Treat hypotension due to inadequate vascular tone

39
Q

What are precautions and contraindications to using dopamine

A 
IV infusion has potential for necrosis 
Monitor for 
-tachycardia 
-tachyarrhythmias
-change in BP

Contraindicated in hypertensive patients

40
Q

What is the MOA of Dobutamine

A

Direct acting catecholamine sympathomimetic
B1 agonist
(Mimi also B2 and a1 agonist and NO dopamine receptor activity)

41
Q

What are the main indications to using dobutamine

A

Patients requiring inotropic support

Treat anesthesia associated hypotension
Maintain CO and tissue organ perfusion

42
Q

What are precautions to using dobutamine

A

Side effect= tachycardia and tachyarrhythias
Tachyphylaxis

Contraindicated with left atrial rupture or in cases where myocardial integrity is a concern

43
Q 
Which of the following will result in the least amount of vasodilation ?
A. Epinephrine
B. Norepinephrine 
C. Isoproterenol 
D. Dopamine 
E. Dobutamine
A

B. Norepinephrine

44
Q

what drugs causes D1 receptor mediated vasodilation at low doses

A

Dopamine

45
Q

What is the MOA of phenylephrine

A

Direct acting a1 selective agonist

46
Q

What are the indications to using phenylephrine

A

Increase peripheral vascular resistance through systemic vasoconstriction

Treat hypotension in cats and dogs
Vasopressor effects are Short lasting (IV)
Control hemorrhange (local/topical use)
Mydriatic for open-angle glaucoma

47
Q

What are the precautions and contraindications to using phenylephrine

A

Renal and GI vasocontriction may be undesirable
Chronic use => nasal congestion

Contradicted in hypertension

48
Q

What are the non-selective Beta agonists and what are their main indications

A

Ractopamine and Zilpaterol

Increase rate of weight gain, feed efficiency, and Caracas leanness in food animals

49
Q

What agent is primarily used as bronchodilators in treatment of lower airway diseases like asthma and COPD

A

Selective B2 agonist

50
Q

What are the selective B2 agonists in order of most selective to least selective

A

Albuterol
Terbutaline
Clenbuterol

51
Q

What drug would you most likely see some B1 side effects like tachycardia

A. Terbutaline
B. Albuterol
C. Clenbuterol

A

C. Clenbuterol

52
Q

What are precautions and contraindications to using selective B2 agonists

A 
Cardiac stimulation -> tachycardia 
Uterine relaxation (can cause fetal retention ).

Vasodilation

Contraindicated in patients with cardiovascular disease

53
Q

What is the drug of choice for treatment of bronchial asthma?

A

Albuterol

54
Q

Indirect/mixed sympathomimetic are mainly used for their ___________ effects

A

CNS

55
Q

What is the main drug used for behavior modification and in old dogs for cognitive dysfunction

A

Selegiline

-> monoamine oxidase inhibitor (MAOI)

56
Q

What is the MOA of phenylpropanolamine

A

Mixed (direct and indirect) sympathomimetic

Indirect increase in NE in bladder neck/urethra (primary action) and direct alpha 1 agonist

57
Q

What are the indications to using Pehnylpropanolamine

A

Urinary incontinence due to urethral sphincter hypotonia/incompetence

58
Q

What drug synergistically works with phenylpropanolamine to increase tension in the urinary spinchter

A

Estrogens -> upregulate a1 receptors

59
Q

What are the precautions to using phenylpropanolamine

A 
Restlessness 
Urine retention 
Tachycardia 
Hypertension 
Occasionally anorexia
60
Q

What is the MOA of ephedrine

A

Mixed (direct and indirect ) sympathomimetic

Indirectly increase NE release and direct a1 and B activation

61
Q

What are the main effects of ephedrine

A

CRI to maintain BP under anesthesia
Increase BP> vasoconstriction and direct cardiac stimulation
Bronchodialtion
Urinary sphincter contraction-> urinary retention
Mydriasis

62
Q

What are precautions of using ephedrine

A

Hypertension

Arrhythmias

63
Q

What are the direct acting sympatholytics ?

A 
Phenoxybenzamine -alpha 
Prazosin - alpha 
Propranolol -non selective Beta 
Atenolol -selective Beta
Esmolol  -selective Beta
64
Q

What is the MOA phenoxybenzamine

A

Non specific alpha antagonist

-binds irreversibly -> lasts lifetime of receptor (3-4day)

65
Q

What are the indications to use phenoxybenzamine

A

Treat urinary retention due to urethral hypertonicity

Treat pheochromocytoma-> prior to surgery you to treat associated hypertension caused by clamping the vena cava

66
Q

What are the precautions to using penooxybenzamine

A

Excessive alpha blockage

  • hypotension
  • reflex tachycardia
  • miosis and change in IOP
  • GI signs
67
Q

What is MOA of propranolol

A

Non selective B-antagonist

Decrease SA firing and AV conduction
=>bradycardia and decrease CO
Increased airway resistance

68
Q

T/F: Propranolol crosses the BBB

A

T

Significant first pass effect

69
Q

Indications to using propranolol

A

Treat tachyarrhythmias

  • > supraventriclular tachyarrhythmias
  • > methylxanthine (chocolate) toxicosis

Feline hyperthyroidism

  • > CV effects - arrhythmia and hypertension
  • > antagonize T4->T3 conversion in peripheral tissue
70
Q

Precautions to using propranolol

A

Bradycardia, hypotension, brochospasm
Receptor desensitization and upregulation

Contraindicated with overt heart failure, sinus bradycardia, and heart block (neg inotrope)

Contraindicated with bronchospastic lung disease (B2 effect)

71
Q

What are the selective B1 antagonists and what is their effects?

A

Atenolol -longer half life than propranolol and more selective for B1-receptors

Esmolol -ultra short acting (rarely used)

Negative inotrope-> bradycardia

72
Q

What is an indirect acting sympatholytic that blocks NE uptake into vesicles. What species is it used in?

A

Reserpine
Used in equine for calming

Blocked uptake =. Reduced storage and mediation depletion

73
Q

What drug is used in the treatment of methylxanthine (chocolate) toxicity

A

Propranolol

74
Q

What drug acts by inhibiting the reuptake of norepi into the presynaptic vesicles?

A

Reserpine

RUSVM Pharmacology (18 decks)

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