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1 Mega Step 1 Deck > Pharmacology of ANS > Flashcards

Pharmacology of ANS Flashcards

1
Q

cholinergic receptors

A

*receive Ach as neurotransmitter
*nicotinic and muscarinic receptors

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2
Q

adrenergic receptors

A

*receive norepinephrine as neurotransmitter
*alpha (1 + 2) and beta (1, 2, 3) receptors

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3
Q

cholinomimetics

A

drugs that mimic or augment the action of acetylcholine (parasympathetic agonists)

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4
Q

muscarinic receptors are found on

A

*organs innervated by PARASYMPATHETIC nerves
*PLUS sweat glands (innervated by ACh sympathetic nerves)
*CNS

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5
Q

M2 receptor - location

A

HEART, nerves, smooth muscle

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6
Q

M3 receptor - location

A

GLANDS, smooth muscle, endothelium

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7
Q

direct-acting cholinomimetics: MOA

A

bind and activate muscarinic and/or nicotinic receptors

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8
Q

indirect-acting cholinomimetics - MOA

A

*inhibits acetylcholinesterase
*result: amplification of endogenous ACh (keeps for ACh around at the receptor)
*note: affect both nicotinic and muscarinic receptors

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9
Q

important direct-acting cholinomimetics to know

A

1) bethanechol
2) pilocarpine
3) carbachol
4) muscarine-containing mushrooms

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10
Q

bethanechol

A

*muscarinic agonist (direct-acting cholinomimetic; results in parasympathetic responses)

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11
Q

pilocarpine

A

*muscarinic agonist, penetrates CNS
(direct-acting cholinomimetic; results in parasympathetic responses)

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12
Q

carbachol

A

*muscarinic AND nicotinic agonist (direct-acting cholinomimetic; results in parasympathetic responses)
*mostly used as eye drops for GLAUCOMA

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13
Q

important indirect-acting cholinomimetics to know

A

1) edrophonium (we don’t use this anymore)
2) neostigmine
3) pyridostigmine
4) physostigmine - crosses BBB
*also, organophosphates (parathion, sarin)

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14
Q

neostigmine

A

*indirect acting cholinomimetic (acetylcholinesterase inhibitor)
*quaternary: poor CNS penetration

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15
Q

pyridostigmine

A

*indirect acting cholinomimetic (acetylcholinesterase inhibitor)
*quaternary: poor CNS penetration

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16
Q

physostigmine

A

*indirect acting cholinomimetic
(acetylcholinesterase inhibitor)
*tertiary: better CNS penetration - crosses the blood-brain barrier

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17
Q

main difference in effect of indirect-acting cholinomimetics (compared to direct-acting)

A

act like direct-acting agents, EXCEPT FOR THE VASCULATURE EFFECTS

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18
Q

what cholinomimetic do we use to treat dry mouth

A

pilocarpine (direct-acting cholinomimetic)

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19
Q

ACh toxicity (organophosphate poisoning) - SLUDGE

A

Salivation
Lacrimation
Urination
Defecation
GI symptoms
Emesis
(also, constricted pupil, slow heart rate, and bronchospasm)

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20
Q

ACh toxicity (organophosphate poisoning) - DUMBBELSS

A

Diarrhea
Urination
Miosis
Bronchoconstriction
Bradycardia
Emesis
Lacrimation
Salivation
Sweating

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21
Q

carbamates

A

*pesticide; reversible AChE inhibitors

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22
Q

what do you treat carbamate toxicity with

A

atropine (antimuscarinic) alone

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23
Q

what do you treat organophosphate poisoning with

A

atropine + pralidoxime

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24
Q

anticholinergics

A

*acetylcholine receptor-blocking drugs
*antimuscarinics are a subtype
*atropine is the protype

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25
Q

antimuscarinic drug actions

A

loss of parasympathetic activities: sedation, mydriasis, cycloplegia (can’t accommodate), dry “sandy” eyes, tachycardia, bronchodilation, decreased respiratory secretions, dry mouth, decreased GI secretions + motility, relaxes smooth muscles of ureters and bladder, slows voiding, suppresses thermoregulatory sweating

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26
Q

important antimuscarinic drugs to know

A

1) atropine
2) scopolamine
3) ipratropium
4) glycopyrrolate
5) oxybutynin

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27
Q

what antimuscarinic drug is used for asthma and COPD

A

inhaled ipratropium

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28
Q

what antimuscarinic drug is used for bradycardia

A

atropine

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29
Q

what antimuscarinic drug is used for motion sickness

A

scopolamine

30
Q

what antimuscarinic drug is used for overactive bladder/spasms

A

oxybutynin (inhibits detrusor contraction, leading to urinary retention)

31
Q

what antimuscarinic drug is used to decrease secretions

A

glycopyyrolate

32
Q

what antimuscarinic drug is used to counteract muscarinic effects when neostigmine is given to reverse muscle relaxants

A

glycopyyrolate

33
Q

symptoms of excess cholinergic blockade (too much antimuscarinic effects) - “mnemonic”

A

mad as a hatter
blind as a bat
dry as a bone
hot as a pistol
red as a beet
full as a flask

34
Q

symptoms of excess cholinergic blockade (too much antimuscarinic effects) - symptoms

A

*CNS delirium & irritability (mad as a hatter)
*mydriasis & blurry vision (blind as a bat)
*loss of sweating, dry mouth, decreased tear production (dry as a bone)
*loss of sweating and temperature control (hot as a pistol)
*vasodilation in response to increased temp (red as a beet)
*urinary retention (full as a flask)

35
Q

what drug is used to treat anticholinergic toxicity

A

physostigmine (a direct-acting cholinomimetic that crosses the BBB)

36
Q

sympathomimetics

A

drugs that mimic or augment sympathetic responses

37
Q

direct-acting sympathomimetics - MOA

A

norepinephrine (neurotransmitter) ; epinephrine (hormone)

38
Q

indirect-acting sympathomimetics - MOA

A

1) displace stored catecholamines from nerve ending
2) decrease clearance of NE (inhibit reuptake or prevent metabolism)

39
Q

epinephrine

A

*direct acting sympathomimetic (agonist)
*both alpha and beta

40
Q

norepinephrine

A

*direct acting sympathomimetic (agonist)
*alpha-1, alpha-2 > beta-2

41
Q

phenylephrine

A

*direct acting sympathomimetic (agonist)
*alpha-1 agonist

42
Q

midodrine

A

*direct acting sympathomimetic (agonist)
*alpha-1 (oral drug to tx orthostatic hypertension)

43
Q

clonidine

A

*direct acting sympathomimetic (agonist)
*alpha-2 agonist

44
Q

isoproterenol

A

*direct acting sympathomimetic (agonist)
*beta-1, beta-2 agonist

45
Q

dobutamine

A

*direct acting sympathomimetic (agonist)
*mostly beta-1 agonist

46
Q

albuterol

A

*direct acting sympathomimetic (agonist)
*beta-2 agonist

47
Q

terbutaline

A

*direct acting sympathomimetic (agonist)
*beta-2 agonist

48
Q

important direct-acting sympathomimetics to know

A

1) epinephrine
2) norepinephrine
3) phenylephrine
4) midodrine
5) clonidine
6) isoproterenol
7) dobutamine
8) albuterol
9) terbutaline

49
Q

pulse pressure

A

systolic pressure - diastolic pressure

50
Q

uses of epinephrine

A

*ANAPHYLAXIS
*local vasoconstrictor
*cardia arrests

note - epi is an alpha and beta receptor agonist

51
Q

uses of norepinephrine

A

BP support (IV) (increases BP)

note - NE is an alpha 1, alpha 2, and beta 1 agonist

52
Q

uses of phenylephrine

A

BP support
mydriatic
decongestant

note - phenylephrine is an alpha 1 agonist

53
Q

uses of isoproterenol

A

increase cardiac output

note - isoproteronol is a beta 1 and beta 2 agonist

54
Q

uses of dobutamine

A

increase cardiac output
cardiac stress tests

note - dobutamine is a beta-1 agonist

55
Q

uses of dopamine

A

support BP and cardiac output
NOTE: effects are related to dose

56
Q

uses of albuterol

A

asthma & COPD

note - albuterol is a beta 2 agonist

57
Q

uses of terbutaline

A

asthma & COPD
reduce premature uterine contractions

note - terbutaline is a beta 2 agonist

58
Q

uses of clonidine

A

hypertension (decreases central sympathetic outflow)
withdrawal symptoms

note - clonidine is an alpha-2 agonist

59
Q

important indirect-acting sympathomimetics

A

1) ephedrine
2) amphetamine
3) cocaine

60
Q

ephedrine

A

*indirect acting sympathomimetic
*causes the release of stored catecholamines

61
Q

use of ephedrine

A

hypotension with anesthesia

*ephedrine is an indirect-acting sympathomimetic (promotes release of stored catecholamines)

62
Q

use of pseudoephedrine

A

nasal decongestant
make meth

63
Q

phentolamine

A

*reversible alpha blocker
*blocks alpha 1 and alpha 2

64
Q

prazosin

A

*reversible alpha blocker
*blocks alpha 1
*used for BPH (benign prostatic hypertrophy)

65
Q

phenoxybenzamine

A

*irreversible alpha blocker
*blocks alpha 1 more than alpha 2
*used for pheochromocytoma

66
Q

important alpha blockers to know

A

1) phentolamine
2) prazosin
3) phenoxybenzamine

67
Q

effects of beta blockers

A

*decrease HR, contractility, and conductance
*block beta 2 vasodilation (lower blood pressure)
*increased airway resistance, especially in asthma
*reduce intraocular pressure
*inhibit lipolysis
*decrease renin release

68
Q

beta blockers to know

A

1) propranolol
2) metoprolol
3) labetalol

69
Q

propranalol

A

*beta blocker
*non-selective (blocks beta-1 and beta-2)

70
Q

metoprolol

A

*beta blocker
*selectively blocks beta-1

71
Q

labetalol

A

*beta blocker
*blocks alpha-1 in addition to beta-1 and beta-2

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