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SNS Flashcards

1
Q

What is the SNS response?

A

Mydriasis
Decreased salivation
Increased HR, SV
Vasoconstriction
Bronchodilation and decreased lung secretions
Reduced GI motility and secretions
Inhibition of bladder contraction
Glycogenolysis

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2
Q

Which are the Adrenergic Receptors

A

Alpha: a1 and a1
Beta: B1, B2, B3

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3
Q

In which 2 places do the SNS neurons behave differently

A

Adrenal medulla: where NE–>E by Phenylethanolamine N methyl transferase
Sweat glands: ACh is neurotransmitter

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4
Q

Which enzymes metabolise NE and E

A

COMT: catechol-o-methyl transferase
MAO: monoamine oxidases

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5
Q

Steps in NE neurotransmission

A
  1. Hydroxylation of tyrosine
  2. Dopamine enters vesicle and is converted to NE
  3. Influx of Ca causes release of NE via exocytosis
  4. Binding of NE to postsynaptic receptor activates the receptor
  5. Released NE is rapidly taken into neuron.
  6. NE is metabolised by MAO and COMT
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6
Q

What inhibits re-uptake of NE?

A

Cocaine and Imipramine

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7
Q

NE acts on which receptors

A

a1, a2, B2 and its direct acting

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8
Q

E acts on which receptors

A

a1,a2,B1,B2 and its direct acting

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9
Q

Ephedrine acts on which receptors

A

its acts on all adrenergic receptors both direct and indirect acting by weakly stimulating the release of NE and E from nerve endings in SNS

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10
Q

Amphetamine causes…

A

strong NE and E release indirectly

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11
Q

Cocaine causes

A

Directly inhibits NE and Dopamine re-uptake

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12
Q

a1 receptors are located…

A

on post synaptic membrane

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13
Q

a1 receptors are specific to

A

vascular smooth muscle
Eye

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14
Q

a2 receptors are located…

A

Presynaptic nerve endings

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15
Q

a2 receptors are specific to

A

GIT, pancreas and platelets
They inhibit release of NE

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16
Q

Which alpha receptors is stimulatory and which is inhibitory

A

a1: stimulatory
a2: inhibitory

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17
Q

B1 receptor is specific to

A

Cardiac tissue

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18
Q

B2 receptor is specific to

A

Respiratory, uterus, Liver, VSM

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19
Q

B3 receptors are specific to

A

Detrusor muscle of bladder
are involved in Lipolysis

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20
Q

Adrenergic receptors have affinity for which neurotransmitter

A

a1: NE > E
a2: E > NE
B1: NE=E
B2: E»NE

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21
Q

Response of a1 stimulation

A

Vasoconstriction
Incr. Peripheral Resistance
Incr. BP
Mydriasis
Incr closure of bladder sphincter

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22
Q

Response of a2 stimulation

A

Inhibits NE release
Incr. Acetylcholine release
Inhibition of insulin release

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23
Q

Response of B1 stimulation

A

Incr HR
Incr. Lipolysis
Incr. Myocardial contractility
Incr. Renin

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24
Q

Response of B2 stimulation

A

Vasodilation
Decr. Peripheral Resistance
Bronchodilation
Incr. Glycogenolysis
Incr. Glucagon release
Relaxes uterine smooth muscle

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25
Q

Indications of Adrenaline

A

Drug of choice in Anaphylaxis
Combined with LA=incr. DOA
During cardiac arrest

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26
Q

CI of Adrenaline

A

Tachyarrythmias
Pheochromocytoma

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27
Q

Administration of Adrenaline

A

IM,SC
IV in severe cases

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28
Q

A/E of adrenaline

A

peripheral vasoconstriction: prolonged use can cause necrosis/gangrene
Angina
hypertension
Tachycardia
Ventricular arrythmias

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29
Q

MOA of Adrenaline

A

Potent stimulant of a and B adrenoreceptors
Potent vasoconstrictor and cardiac stimulant
 +ve inotropic & chronotropic actions on heart ( β1)
 vasoconstriction in vascular beds (α)
Also activates β2 receptors in skeletal muscles vasodilation
Respiratory : bronchodilation (β2)
Hyperglycemia : increased glycogenolysis in liver (β2) decreased
release of insulin (α2)

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30
Q

Phenylephrine is a

A

A1 agonist

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31
Q

MOA of Phenylephrine

A

Vasoconstrictor= Incr BP
Causes mydriasis
Vasoconstriction of nasal mucosa= decreased nasal secretions

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32
Q

Indications of Phenylephrine

A

Nasal decongestant
Hypotension
Mydriatic in Eye exams

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33
Q

Administration of Phenylephrine

A

Oral, topical
IV
Eye drops

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34
Q

A/E of Phenylephrine

A

Nausea
Hypertension

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35
Q

Oxymetazoline and Xylometazoline are

A

Alpha adrenergic agonists

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36
Q

Administration of Oxymetazoline and Xylometazoline

A

Topical nasal sprays

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37
Q

MOA of Oxymetazoline and Xylometazoline

A

Vasoconstrict nasal mucosa and conjunctiva

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38
Q

Indications of Oxymetazoline and Xylometazoline

A

Nasal decongestant

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39
Q

How long can Oxymetazoline and Xylometazoline be used

A

Max. 5 days
>5 days: Rebound congestions

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40
Q

Clonidine is

A

a2 adrenoreceptor in CNS

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41
Q

Indications of Clonidine

A

Migraine prophylaxis

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42
Q

a-metyldopa is

A

a2 agonist in brain

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43
Q

MOA of a-methyldopa

A

decr. sympathetic outflow= decr HR, decr. CO and TPR= Decr. BP

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44
Q

Indications of a-methyldopa

A

Hypertension in pregnancy

45
Q

A/E of a-methyldopa

A

Sedation
Hyperprolactinaemia

46
Q

Dopamine is

A

immediate metabolic precursor of NE
a and B agonist
D1 and D2 agonist(dopaminergic)

47
Q

Low dose of dopamine causes

A

activation of dopaminergic Rs in renal vessel–> incr. cAMP= renal vasodilation and diuresis

48
Q

Higher dose of dopamine cause

A

acts on B1in heart: +ive chronotopic and -ive iontropic effects on myocardium=
incr. HR and contractility (incr. SV)

49
Q

Large doses of Dopamine cause

A

a1 adrenoreceptor activation
=vasoconstriction

50
Q

Indications of Dopamine

A

Shock treatment
Severe HF
Acute Hypotension

51
Q

A/E of Dopamine

A

Nausea
Hypertension
Arrythmians

52
Q

Dobutamine is a

A

B1 selective agonist

53
Q

MOA of Dobutamine

A

Causes +ive inotropic effects
= Incr. CO

54
Q

Indications of Dobutamine

55
Q

A/E of Dobutamine

A

Atrial Fibrilation

56
Q

Which are the short-acting B2 agonists

A

Salbutamol
Fenoterol
Terbutaline

57
Q

Which are the long-acting B2 agonists

A

Salmeterol
Formoterol

58
Q

Which are the ultra-long acting B2 agonists

A

Indacaterol
Vilanterol

59
Q

MOA of B2 agonists

A

bronchodilation- relaxes bronchial SM

60
Q

Indications of B2 agonists

A

Asthma
COPD

61
Q

Administration of B2 agonists

62
Q

A/E of Salbutamol and Salmeterol

A

Restlessness
Tremor
Tachycardia or arrythmia

63
Q

Indication of Ephedrine

A

Treatment of Hypotension

64
Q

DOA of Ephedrine

65
Q

What does Ephedrine do to CNS

A

Causes a mild stimulant effect

66
Q

Administration of Ephedrine

67
Q

Etilefrine is a

A

a and B agonist

68
Q

Administration of Etilefrine

69
Q

Indications of Etilefrine

A

Treats hypotension

70
Q

Pseudephedrine is a

A

mainly a1 agonist
lesser B2 agonist

71
Q

Indications of Pseudoephedrine

A

Systemic nasal decongestant

72
Q

Administration of Pseudoephedrine

73
Q

A/E of Pseudoephedrine

A

CNS stimulation with anxiety
Restlessness
Tremor
Hypertension
Tachycardia
Palpitation

74
Q

Selective a1 blockers are

A

Prazosin
Doxazosin
Tamulosin
Terazosin

75
Q

Non-selective a blockers

A

Reversible: Phentolamine
Irreversible: Phenoxybenzamine

76
Q

Indications of Phenoxybenzamine

A

Pheochromocytoma (pre-op)
Raynaud disease

77
Q

A/E of Phenoxybenzamine

A

Postural Hypotension
nasal stuffiness
Nausea and vomiting
Decr. ejaculation

78
Q

CI of Phenoxybenzamine

A

CV disease

79
Q

Indications of Phentolamine

A

Pheochromocytoma
HPT crisis
(MAO I tyramine food, Clonidine withdrawal)

80
Q

A/E of Phentolamine

A

Postural Hypotension
Arrythmias
Angina pain

81
Q

CI of Phentolamine

A

IHD: Ischemic Heart Disease

82
Q

Indications of Prazosin, Terazosin, Doxazosin

A

Hypertension
BPH

83
Q

A/E of a1 selective blockers

A

Postural Hypotension
Headache
Drowsiness
Nasal Congestion

84
Q

Selective a1a blockers are

A

Tamulosin
Alfuzosin

85
Q

Indications of a1a blockers

A

BPH: drugs of choice

86
Q

A/E of a1a blockers

A

Retrograde ejaculation
Floppy eye syndrome

87
Q

DOA of phenoxybenzamine

88
Q

DOA of phentolamine

89
Q

DOA of Prazosin

90
Q

T1/2 of selective a-blockers

A

Prazosin: 3hrs
Terazosin: 9-12hrs
Tamsulosin: 9-15hrs
Doxazosin: 22hrs

91
Q

A1 receptor antagonism results is

A

Arteriolar dilation=decr. afterload
Venous dilation=decr. preload–> decr. VR

92
Q

Prazosin and its analogues act

A

at vascular SM and prostate

93
Q

Tamsulosin acts

A

Selectively at prostate

94
Q

B1 Blocker effects are

A

decr. HR
Incr. AV conduction
decr. CO
decr. O2 consumption
decr. BP
decr. Renin
decr. aqueaous humour

95
Q

B2 Blocker effects are

A

incr. airway resistance
Arterial vasoconstriction
decr. Gluconeogenesis
decr. Glycogenolysis
decr. tremors

96
Q

Selective B1 blockers are

A

Atenolol
Bisoprolol
Metaprolol
Nebivolol
Esmolol

97
Q

Non-selective B-blockers are

A

Propranolol
Timolol

98
Q

B1,B2 and a1 blockers are

A

Carvedilol
Labetolol

99
Q

Indications of Propranolol

A

Hypertension
Migraine
Hyperthyroidism
Angina pectoris
MI

100
Q

Indications of Timolol

A

Glaucoma
Hypertension

101
Q

Indications of B1 blockers (know which ones)

A

Hypertension
Angina
Acute MI: Atenolol
CHF: Bisoprolol+ACE1+diuretics

102
Q

Indication of Nebivolol

A

Hypertension

103
Q

Indications of B1,B2 and a1 blockers

A

Hypertension
Non-acute Congestive HF

104
Q

S/E of B-blockers

A

Bronchospasm: B2
Bradycardia: All
Heart block/HF: All
Fatigue
Impotence in males
Hypoglycaemia: B2
Cold extremities: B2
Vivid dreams

105
Q

CI of Beta blockers

A

Asthma/COPD
Diabetics
LVHF, Cardiogenic shock
SInus Bradycardia

106
Q

TU of Propranolol

A

HT
Migraine prevention
Hyperthyroidism: thyrotoxicosis
Angina
MI
Essential Tremor
Anxiety symptoms

107
Q

MOA of Timolol

A

Decreases intraocular pressure in glaucoma by decr. secretion of aqueous humour of ciliary body

108
Q

MOA of Bisoprolol, Atenolol,Metoprolol

A

Reduce HR, CO
Decr. O2 demand and workload
SLow AV conduction
Reduces Renin release from JG cells

109
Q

MOA of B1, B2 and a1 blocker

A

Peripheral vasodilation= decr. BP
Reduce afterload, contractility and O2 demand

Pharmacology (50 decks)

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