PNS Flashcards by Aisha Farah

What is the PNS response?

Miosis
Increased salivation and lacrimation
Decreased HR
Bronchoconstriction
Stimulated peristalsis and secretion
Stimulated bile release
Increase bladder contraction.

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What is the PNS neurotransmitter?

ACh

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Which are the PNS receptors?

Nicotinic and Muscarinic receptors

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List the steps in ACh activity

ACh–> choline+acetate
ACh metabolised by ACh-E in synaptic cleft
Choline is transported back to axon terminal to form more ACh

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M1 receptors stimulate…

Gastric acid secretion

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M2 receptors stimulate

mediate the -ive chronotropic effects of PNS stimulation

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M3 receptors stimulate

Lacrimal and salivary gland secretion
May also be involved in gut smooth muscle contraction

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M4 and M5 receptors are…

present mainly in CNS

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Parasympathomimetics are divided into …

Direct and indirect acting

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What do the direct acting ones do?

they act directly on receptor

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What do the indirect acting ones do?

They act on ACh-E and inhibit it

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Which are the Muscarinic AGonists?

Pilocarpine
Bethanechol
Carbachol

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Which are the Reversible ACh-E inhibitors?

Neostigmine
Pyrridostigmine
Physostigmine
Edrophonium
Donepezil
Rivastigmine
Galantamine
Tacrine

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Which are the Irreversible ACh-E inhibitors?

Malathion, Parathion, Ectothiopate, Organophosphates, Nerve gases sarin and soman

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What is the MOA of Pilocarpine?

Its a muscarinic agonist

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What is the TU of Pilocarpine?

Glaucoma

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What are the S/E of pilocarpine?

Blurred vision, painful eye, night blindness

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What is the TU of Neostigmine?

Myasthenia Gravis
Reversal of NMBs
Stimulate GI motility: Paralytic ileus
Non-obstructive urinary retention

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WHat is the MOA of neostigmine?

Reversible ACh-E inhibitor

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What is the S/E of Neostigmine?

Diarhoea, increased sweating, lacrimation, salivation, abd. cramps, bradycardia, bronchospams

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What is the MOA of Pyridostigmine?

Reversible ACh-E inhibitor

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What is the TU of Pyridostigmine?

Chronic Myasthenia Gravis

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What is the S/E of Pyridostigmine?

Diarhoea, increased salivation and sweating, abd. pain, bradycardia, bronchospasm

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What is the MOA of Edrophonium?

Short acting Reversible ACh-E inhibitor

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TU of Edrophodium

Diagnosis of Myasthenia Gravis

S/E of Edrophonium

Diarrhoea, increased sweating and salivation, abd. cramps, Bradycardia

MOA of Physostigmine

Reversible ACh-E inhibitor

S/E of Physostigmine

Cholinergic crisis: Increase intestinal and bladder motility

MOA of Bethanecol

Strong muscarinic agonist

TU of Bethanecol

atonic bladder postpartum/postop, urinary retention, megacolon

S/E of Bethanecol

Cholinergic stimulation S/E

Antidote of Bethanecol

Atropine

MOA of Carbechol

Muscarinic and nicotininc agonist

TU of Carbechol

Rarely in glaucoma (decrease Intraocular pressure)

S/E of Carbechol

Low opthamology formulation

PK of pilocarpine

topically (ophthalmic)

admin of neostigmine

IM, IV, SC

Onset of neostigmine

20min in IM 4-8mins in IV

DOA of neostigmine

2-4hrs

PK of Pyridostigmine

Orally

DOA of pyridostigmine

3-6hrs

S/E of Physostigmine

Cholinergic crisis: Increase intestinal and bladder motility Convulsions, bradycardia, decreased CO, paralysis of skeletal muscle

MOA of tacrine, donepezil, rivastigmine and galantamine

Reversible ACh-E inhibitor

TU of tacrine, donepezil, rivastigmine and galantamine

Alzheimer's disease

S/E of tacrine, donepezil, rivastigmine and galantamine

Tacrine: hepatotoxicity Others: GI distress

Antidote for Incesticides, Pesticides, nerve gases, organophosphate poisoning

Atropine (MR antagonist) Pralidoxine (cholinesterase regenerator)

What are Parasympatholytics (anticholinergics)

agents the bind to cholinergic receptors and prevent effects of ACh and other cholinergic agonists

Effects of Antimuscarinics

Mydriasis,cycloplegia Reduces sweating Reduced GI motility and secretions Increased HR Bronchodilation and decreased lung secretion Urinary retention Drowsiness, hallucinations, coma

TU of antimuscarinics

Parkinsons Motion sickness Opthalmologic disorders Respiratory: COPD Urinary Disorders Cholinergic Disorders

MOA of muscarinic antagonist

block MR--> prevent muscarinic functions

T1/2 of atropine

short: 4hrs except eye applications >72hrs

Which tissues are most sensitive to atropine

bronchial, salivary and sweat glands

TU of atropine

Refrecative errors: to produce mydriasis and cycloplegia Antispasmodic Suppression of secretions pre-op Bradycardua Antidote for organophosphat poisioning, mushroom, mreve gases,

S/E of Atropine

dry eye, blurred vision, sandy eye, tachycardia, urinary retention, constipation CNS effects Dangerous in children= increased body temperature

Which drugs are used for motion sickness

Scopolamine

Effects of Scopolamine

reduces vertigo, post-op nausea

Indications of Scopolamine

prevention of motion sickness, post-op nausea and vomiting

PK of scopolamine

Motion sickness: transdermal patch Post-op: IM

A/E of Scopolamine

SeX-D Sedations Xerostomia Delirium

Drugs used for GIT

Hyoscine Butylbromide Dicylomine Mebeverine

Effects of GIT drugs

reduce smooth muscle and secretory activity of gut

Indications of GIT drugs

IBS, Antispasmodic

PK of GIT drugs

IM, IV, SC

A/E of GIT drugs

dry mouth, urinary retention, tachycardia, confusion, intraocular pressure

Which are the secretory drugs?

Glycopyrrolate

Effects of secretory drugs

Decrease salivary and bronchial secretions Relax Bronchial muscle

Indications of Secretory drugs

Drooling/sialorrhea: to diminish salivary secretions Anaesthesia adjunct Post-op with neostigmine: decrease undesirable A/Es COPD maintenanace

PK of Secretory drugs

IV Inhaler

Which are the respiratory drugs

GTI Glycopyyrolate (long-acting) Tiotropium (long-acting) Ipratropium bromide(short-acting)

Effects of respiratory drugs

Decrease salivary and bronchial secretions Relax Bronchial muscle

Indications of respiratory drugs

Asthma, COPD COPD maintenance

PK of respiratory drugs

Inhaler Long acting Inhaler

A/E of respiratory drugs

Xerostomia

Which are the opthalmology drugs

CAT Cyclopentolate (long-acting) Atropine (long-acting) Tropicamide (short-acting)

Effects of opthalmology drugs

cause mydriasis and cycloplegia

Indications of opthalmology drugs

Retinal exam Produce mydriasis and cycloplegia prior to refraction exam

PK of opthalmology drugs

Eye drops: 5-6 days

S/E of opthalomology drugs

increased intraocular pressure in closed angle glaucoma

Cholinergic poisoning drugs

Atropine (short- acting)

Effects of Cholinergic poisoning drugs

block muscarinic excess at exocrine glands, heart and smooth muscle

Indication of Cholinergic poisoning drugs

Antidote in organophosphate poisoning

Admin. Of Cholinergic poisoning drugs

IV, IM

Which are the CNS drugs

Atropine (short-acting)

Effects of CNS drugs (atropine)

Counteract vagal effects during anaesthesia Counteract muscarinic activity of NMBs

Indications of CNS drugs (atropine)

Pre-medical procedures Reversal of NMBs

PK of CNS drugs (atropine)

IV. IM

CNS drugs

TBB Trihexyohenidyl Biperiden Benzyltropine

Effects of CNS drugs

improve tremor

Indication of CNS drugs

Parkinsons

PK of CNS drugs

Trihexyphenidyl: oral Biperiden: oral, IM, IV

Which are the urinary incontinence drugs?

DOT-SP Darifenacin Oxybutinin Tolterodine Solifenacin Propiverine

Effects of urinary incontinence drugs

reduce detrusor muscle tone, spasms

Indications of urinary incontinence drugs

Eneuresis: overactive bladder

PK of urinary incontinence drugs

Oral

A/E of urinary incontinence drugs

Xerostomia, palpitations, constipation, confusion

Onset of Pilocarpine?

Miosis begins 15-30 mins

DOA of Pilocarpine

4-8 hrs

Administration of Pilocarpine

Topically: eye drops