Quiz 8 Flashcards
Adrenal Medulla secretes?
80% Epi
20% Norepi
Which Cranial and Which Sacral nerves control parasympathetic nervous system?
III, VII, IX, and X
Sacral nerves 2, 3, and 4
SNS and PNS effects on heart?
increases everything
decreases everything
SNS and PNS effects on bronchial smooth muscle
Relaxation
Contraction
SNS and PNS effects on GI Tract
Decreases motility/sphincter contraction
increased motility/sphincter relaxation
SNS and PNS effects on gallbladder
relaxation
contraction
SNS and PNS effects on urinary bladder
muscle relaxation/sphincter contraction
muscle contraction/sphincter relaxation
SNS and PNS effects on the eye
Mydriasis (dilation)
Miosis (contraction)
SNS and PNS effects on the liver
Glycogenolysis/Gluconeogenesis
Glycogen synthesis
SNS and PNS effects on the pancreas
decrease Beta cell secretion
no effect
SNS and PNS effects on the salivary glands
increased secretion
marked increase secretion
SNS and PNS effects on the sweat glands
Both increase
PNS stimulation of arterioles
relaxation
SNS stimulation of what causes relaxation, and where?
Beta cells in coronary and skeletal muscle arterioles
Movement of receptors from the cell surface to intracellular compartments?
sequestration (occurs slowly)
Movement of receptors from the cell surface to intracellular compartments, but then destroyed.
downregulation (prolonged process)
Inability of the receptor to bind G protein (alter the function of the receptor)?
Receptor Uncoupling (occurs rapidly)
uncontrolled release of catecholamines due to an adrenal gland tumor. Constant SNS stimulation
Pheochromocytoma
how is the release of epi and norepi triggered?
triggered by Ach at cholinergic fibers due to calcium ion influx
Type of tertiary amines? what drug? how does it differ?
Physostigmine, an anticholinesterase drug
more lipophilic can get into CNS causing complications
Type of Quaternary ammoniums? what drug? how does it differ?
Edrophonium
Neostigmine
Pyridostigmine
anticholinesterases
more hydrophillic
goal of anticholinesterase drugs? how does it work?
increase amount of ACH to bully off NDNMBs (competative antagonism)
enzyme inhibition (acetylcholinesterase) by presynaptic and post-synaptic/direct effects
look at slide 20
do it
presynaptic effect of anticholinesterases?
In the absence of neuromuscular blockers, acetylcholinesterase inhibitors may produce fasiculations.
look at slide 23
do it
which drug is glycopyrrolate not recommended?
Edrephonium
Edrephonium pneumonics
E for early onset/Electrostatic
Electrostatic attachment to the anionic site
Age and dosing
Neostigmine: infant
muscarinic side effects?
Bradycardia salivation, bronchoconstriction miosis, hyperperistalsis increased risk of PONV.
produce marked and prolonged inhibition of plasma cholinesterase?
Neostigmine and pyridostigmine
Where do the nicotinic effects take place of anticholinergic drugs?
Act at the neuromuscular junction and autonomic ganglia
What is largest contributor to PONV?
Neostigmine
look at slide 28
do it
clinical uses of anticholinergics
- Antagonist-assisted Reversal of Neuromuscular Blockade
- Treatment of CNS Effects of Certain Drugs (Tertiary amines cross the BBB.)
- Treatment of Myasthenia Gravis (Increase ACh at the neuromuscular junction.)
- Treatment of Glaucoma (Cause miosis.)
- Post op analgesia
- Post op shivering
faster recover with fast or slow acting NMB?
fast
Administer reversal only after twitch height has recovered to ____.
> 10%
what can physostigmine do for opioids?
reverses ventilatory depression not analgesia
what can physostigmine do for anticholinergics?
- Treat Central Anticholinergic Syndrome
- Reverses the restlessness and confusion
what can physostigmine do for anesthetics?
- Decreases postoperative somnolence after volatile anesthetic
- Reverse adverse CNS effects of ketamine
look at slide 40-42
do it
treatment for physostigmine OD?
atropine (for anti-muscarinc effects)
pralidoxime (Acetylcholinesterase reactivator)
Anticholinergics: Naturally occurring tertiary amines?
Atropine
Scopolamine
Anticholinergics: Semisynthetic congeners (quaternary ammonium):
Glycopyrrolate
deffrerence b/w tertiary amines and semisynthetic congeners?
tertiary amines cross BBB well
look at slide 48
do it
Anticholinergics: MOA
Reversibly bind with muscarinic receptor preventing ACh from binding.
Small doses may stimulate receptors and decrease the HR
5 Distinct Subtypes of muscarinic receptors
M1 – CNS and Stomach M2 – Lungs and Heart M3 – CNS, Airway, Smooth muscle, glandular tissue M4 - CNS M5 - CNS
G stimulatory receptors? G inhibitory receptors?
1-3-5
2-4 (Most inhibitory effects in M2)
(both cause confirmational change in second messengers)
muscarinic receptor sensitivity
m3
drugs for preop sedation?
scopolomine and atropine (also have amnestic properties)
post-op concern for atropine?
post-op confusion
look at slides 64-67
do it
build of suggamadex molecule
Hydrophobic center, hydrophillic exterior
use alternate form BC for how long after suggamadex? why?
1 week
steroid-like center
anticholinesterase side effects?
DUMBBELLS
Diarrhea Urination Miosis Bradycardia Bronchoconstriction Emesis Lacrimation Laxation Salivation
