Sweatman: ANS and Bronchial Tone

Question 1

In Lungs, Hypoxia induces

Answer 1

Vasoconstriction–> shunt blood to more well-ventilated areas

Question 2

Dominant Arm of ANS in lungs

Answer 2

PNS

Question 3

Bronchial smooth muscle tone is dominated by ____ tone

Answer 3

PNS

Question 4

Three areas the ANS oversees in LUNGS

Answer 4

1. bronchial smooth muscle tone
2. mucous production
3. Inflamtory process behind asthma

Question 5

Receptors in the lungs (major)

Answer 5

beta 2
muscarinic
*both employed to control asthma

Question 6

direct innervation of bronchial smooth muscle and glands

Answer 6

PG PNS fibers directly to smooth muscle

Question 7

SNS to smooth muscle and glands

Answer 7

does not directly innervate…acts via adrenergic receptors found in these tissues: SM, Type II alveolar, mast cells, epithelial cells
*respond to nerutransmitter, and neurohormones

Question 8

exampls of beta 2 agonists

Answer 8

isoproteronol
albuterol
epinephrine

Question 9

Muscarinic antagonists

Answer 9

ipratroprium, hydroxyzine, atropine,

Question 10

SNS modulates the activity of the PNS via

Answer 10

HETERORECEPTORS and beta 2 receptors responding to ciruclating epinephrine or exogenous drugs tx.

Question 11

define heteroreceptor

Answer 11

receptor mediating the release/synthesis of mediators other than its own ligand
respond to neurotransmitter released from adjacent neurons and not NT’s relased from the cell in whose wall they are embedded

Question 12

M1 receptors act via

Answer 12

Gq–> excitatory

Question 13

M1 receptors are located

Answer 13

on Post ganglionic membrane

Question 14

M1 receptors function

Answer 14

1. transduce vagal signal to both sub-mucosal glands and airway smooth muscle
2. increase secretions in nasal mucosa

Question 15

M2 receptor function

Answer 15

inhibitory autoreceptors in pre-synaptic membrane of PG fibers

Question 16

Ach released onto airway smooth muscle causes

Answer 16

bronchiconstrcition via M3

mucous secretion via M1 and M3

Question 17

receptor that opposes the excitation by beta 2 stimulation

Answer 17

M2 receptors

*also found in bronchial smooth muscle,

Question 18

M2 GPCR TYPE

Answer 18

Gi

*both post synaptic and pre-ganglionic (autoreceptors) can inhibit the release of more ACH

Question 19

blockade of the M2 autoreceptor leads to…

Answer 19

increase the release of exogenous ACH and can partially offset the bronchodilatory effects
*by inhibiting negative feedback mechanisms–> you can actually potentiate more Ach being released)

Question 20

atropine and ipratropium specificity

Answer 20

antagonize the M2 and M3 receptors equally well

Question 21

more selective anticholinergic for the M1 and M3 receptor

Answer 21

tiotropium

Question 22

1st gen antihistamines with anticholinergic activity

Answer 22

Chlorpheniramine
Doxylamine
Diphenhydramine

Question 23

1st gen antihistamines can cause

Answer 23

drying of secretions–> blockade of muscarinic receptors= drying and thickening of mucus

Question 24

acetylcholinesterase inhibitors MOA

Answer 24

increase cholinergic activity–> delay break down of Ach–> increases secretions

Question 25

exampl of Ach-ase inhibitors

Answer 25

edrophonium

neostigimine

Question 26

another drug that can increase mucouse secretions

Answer 26

marijuana

Question 27

Beta 2 receptors

Answer 27

7–80% of receptors in the lung

Question 28

beta agonists are effective against

Answer 28

early bronchospastic response to inhaled antigen

Question 29

beta agonist ineffective against

Answer 29

late inflammatory phase

Question 30

CV side effect of beta 2 agonists

Answer 30

QT prolongation especially in
hypokalemia
-also widened pulse pressure
-arterial dilation in pulm, skeletal, coronary muscle

Question 31

beta 2 stimulation effect on K

Answer 31

stimulated Na/K and can result in hypokalemia–> worsening QT prolongation

Question 32

musculoskeletal effect of too much Beta 2 agonism

Answer 32

twitching of skeletal muscle–> activity agaisnt the ATPase–> over excited tissues

Question 33

D-D Interaction of beta 2 agonists with Non-specific beta blockers (propranolol)

Answer 33

offset each other–> less effective, removes the ability to treat acute bronchospasm with first line beta 2 agonist therapy

Question 34

D-D Interaction of beta 2 agonists with Loop/thiazides

k wasting

Answer 34

hypokalemia, qt prolong–> arryhtmias

Question 35

D-D Interaction of beta 2 agonists with saquinavir

Answer 35

hypoK qt prolong

Question 36

D-D Interaction of beta 2 agonists with MAOI’s

Answer 36

block metabolism of amine by MAO-b

Question 37

D-D Interaction of beta 2 agonists with Tricyclic antidepressant

Answer 37

block reuptake of drug & NE into nerve terminal

Question 38

M1 and M3=

Answer 38

Gq

Question 39

M2=

Answer 39

Gi/o

Question 40

BETA 2=

Answer 40

Gs

Question 41

over stimulation by adrenergic agonists leads to

Answer 41

decrease in the receptor number

Question 42

corticosteroids advantages to their use

Answer 42

1. treat the underlying inflammatous cause of asthma
2. transcriptionally upregulate the expression of the beta-adrenergic receptor–> leading to renewed response to the beta 2 agonist inhaler tratment

Question 43

steroid therapy can….

Answer 43

renew beta agonist response by restoring receptor density

Question 44

beta 2 agonist effect on mast cells

Answer 44

stimulation reduces histamine release

Question 45

Mucosilliary clearance and beta agonist

Answer 45

increase glycoprotein content, increase beating of cillia frequency (alpha’s incease luid secretion)

Question 46

mucociliary clearance is mainly under

Answer 46

PNS tone

Question 47

vascular endothelial permeability and beta agonisst

Answer 47

beta2 agonism–> decrease microvascular leakage–> decreases airway obstruction