Sympathetic and parasympathetic

Question 1

name four things that inhibit at the cholinergic axon terminus and what they do

Answer 1

hemicholinium - entry of choline
vesamicol - packaging of ACh into vesicles
botulinum - prevents release of ACh vesicles
AChE inhibitors - allow ACh to stay longer in synapse

Question 2

name five things that inhibit something at the noradrenergic axon terminus and what they do

Answer 2

• metyrosine - prevents conversion of tyrosine to DOPA (tyrosine hydroxylase)
• reserpine - prevents entry of dopamine into vesicles
• bretylium - prevents release of NE
• NE - by activating a2 receptors potentiates its own reuptake
• cocaine, amphetamines, TCAs - block reuptake

Question 3

name the direct cholinomimetic agents (4) and their main uses

Answer 3

• bethanechol - ileus, urine retention
• carbachol - glaucoma, pupil constriction
• pilocarpine - open and closed angle glaucoma
• methacholine - asthma challenge test

Question 4

name 7 indirect cholinomimetics and their uses

Answer 4

• neostigmine - post-op ileus, MG, anti-NMJ blockade
• pyridostigmine - MG long acting, no CNS
• physostigmine - antichol toxicity (atropine overdose), goes to CNS
• donepezil, rivastigmine, galantamine - Alz D
• edrophonium - MG diagnosis

Question 5

cholinesterase inhibitor poisoning/organophosphate

Answer 5

DUMBBELSS

Diarrhea
Urination
Miosis
Bradycardia
Bronchospasm
Excitation of skeletal muscle and CNS
Lacrimation
Sweating
Salivation

Question 6

name 11 muscarinic antagonists and what they do

Answer 6

atropine, homatropine, tropicamide - mydriasis in the eye
benztropine - CNS - parkinsons
scopolamine - CNS - motion sickness
ipratropium, tiotropium - COPD, asthma
oxybutynin, darifenacin, solifenacin - reduce urinary urgency
glycopyrrolate - reduce airway secretions

Question 7

name 9 direct sympathomimetics and the receptors they activate and uses

Answer 7

• epinephrine - a1, a2, b1, b2, b > a - anaphylaxis
• NE - a1 > a2 > b1 - hypotension
• isoproterenol - b1 = b2 - test arrhythmias
• dopamine - D1 = D2 > b > a - shock, heart failure
• dobutamine - b1 > b2, a - heart failure, stress testing
• phenylephrine - a1 > a2 - hypotension, mydriatic
• albuterol, salmeterol, terbutaline - b2 > b1 - asthma, COPD

Question 8

name 3 indirect sympathomimetics, mechanisms and uses

Answer 8

• amphetamine - reuptake inhibitor and releases stored catecholamines - narcolepsy, obesity, ADHD
• ephedrine - releases stored catecholamines - nasal decongestion, urinary incontinence
• cocaine - reuptake inhibitor -

Question 9

name two a2 agonists and their effect

Answer 9

• effect is sympatholytic
• clonidine - for hypertensive urgency, off label for ADHD, severe pain, ethanol, opioid withdrawal
• a-methyldopa - hypertension in pregnancy, safe

Question 10

name 2 non-selective a-blockers and their uses

Answer 10

• phenoxybenzamine - pheochromocytoma to prevent hypertensive crisis, irreversible
• phentolamine - give to patients on MAOIs who eat tyramine containing foods, reversible

Question 11

name 4 a1-selective a-blockers and what they do

Answer 11

prazosin, terazosin, doxazosin, tamsulosin - all used for urinary symptoms of BPH, prazosin used for PTSD, all used for hypertension except tamulosin

Question 12

a1-blockade toxicity can cause

Answer 12

orthostatic hypotension and reflex tachycardia

Question 13

name the 1 a2 selective a-blocker

Answer 13

mirtazapine - depression

Question 14

what are the b1 selective b-blockers? 5

Answer 14

acebutolol
atenolol
betaxolol
esmolol
metoprolol

Question 15

what are the non-selective b-blockers? 4

Answer 15

nadolol
pindolol
propranolol
timolol

Question 16

name 2 non-selective alpha/beta blockers

Answer 16

carvedilol

labetalol