SYMPATHETIC NS Flashcards by Zea Pineda

Epinephrine is an:

a. Direct acting sympathetic agonist
b. Indirect acting sympathetic agonist
c. Mixed acting sympathetic agonist

a. Direct acting sympathetic agonist

How well did you know this?

Not at all

Perfectly

Clonidine is a/an:

a. Direct acting sympathetic agonist
b. Indirect acting sympathetic agonist
c. Mixed acting sympathetic agonist

a. Direct acting sympathetic agonist

How well did you know this?

Not at all

Perfectly

Ephedrine is a/an:

a. Direct acting sympathetic agonist
b. Indirect acting sympathetic agonist
c. Mixed acting sympathetic agonist

c. Mixed acting sympathetic agonist

How well did you know this?

Not at all

Perfectly

Yohimbine is a/an:

a. Alpha antagonist
b. Beta antagonist
c. Mixed antagonist

c. Alpha antagonist

How well did you know this?

Not at all

Perfectly

Carvedilol is a/an:

a. Alpha antagonist
b. Beta antagonist
c. Mixed antagonist

c. Mixed antagonist

How well did you know this?

Not at all

Perfectly

Esmolol is a/an:

a. Alpha antagonist
b. Beta antagonist
c. Mixed antagonist

b. Beta antagonist

How well did you know this?

Not at all

Perfectly

Metoprolol is a

a. First generation beta blocker
b. 2nd generation beta blocker
c. 3rd generation non-selective beta blocker
d. 3rd generation B1 selective beta blocker

b. 2nd generation beta blocker

How well did you know this?

Not at all

Perfectly

Propranolol is

a. First generation beta blocker
b. 2nd generation beta blocker
c. 3rd generation non-selective beta blocker
d. 3rd generation B1 selective beta blocker

a. First generation beta blocker

How well did you know this?

Not at all

Perfectly

Carvedilol is a

a. First generation beta blocker
b. 2nd generation beta blocker
c. 3rd generation non-selective beta blocker
d. 3rd generation B1 selective beta blocker

c. 3rd generation non-selective beta blocker

How well did you know this?

Not at all

Perfectly

Celiprolol is a

a. First generation beta blocker
b. 2nd generation beta blocker
c. 3rd generation non-selective beta blocker
d. 3rd generation B1 selective beta blocker

d. 3rd generation B1 selective beta blocker

How well did you know this?

Not at all

Perfectly

This type of circulatory shock results from impedance of circulation by an intrinsic or extrinsic obstruction. Pulmonary embolism, dissecting aneurysm, and pericardial tamponade all result in this type of shock

a. Obstructive shock
b. Cardiogenic shock
c. Hypovolemic shock
d. Distributive shock

a. Obstructive shock

How well did you know this?

Not at all

Perfectly

This type of circulatory shock is characterized by primary myocardial dysfunction that renders the heart to be unable to maintain adequate cardiac output. These patients demonstrate clinical signs of low cardiac output, with adequate intravascular volume.

a. Obstructive shock
b. Cardiogenic shock
c. Hypovolemic shock
d. Distributive shock

b. Cardiogenic shock

How well did you know this?

Not at all

Perfectly

This is the drug of choice to improve cardiac contractility in patients experiencing cardiogenic shock and with hypotension

a. Dopamine
b. Esmolol
c. Aspirin
d. Nitrates

a. Dopamine

How well did you know this?

Not at all

Perfectly

This is used to diagnose pheochromocytoma

a. 24 hour urine collection for catecholamines and metanephrine
b. blood serum test for metanephrine
c. Blood serum test for catecholamines
d. Radioactive immunoassay test

a. 24 hour urine collection for catecholamines and metanephrine

How well did you know this?

Not at all

Perfectly

This is the gold standard in the treatment of Pheochromocytoma

a. Surgical resection
b. Radiotherapy
c. Alpha blockers
d. Beta blockers

a. Surgical resection

How well did you know this?

Not at all

Perfectly

This is a long-acting adrenergic alpha receptor blocker that is used in the management of Pheochromocytoma

a. Phenoxybenzamine
b. Dobutamine
c. Propranolol
d. Nitroprusside

a. Phenoxybenzamine

How well did you know this?

Not at all

Perfectly

A non-selective beta-adrenergic receptor blocker that is used as an adjunctive therapy in patients with pheochromocytoma for the control of tachycardia after alpha receptor blockade

a. Phenoxybenzamine
b. Dobutamine
c. Propranolol
d. Nitroprusside

c. Propranolol

How well did you know this?

Not at all

Perfectly

Orthostatic hypotension is defined as:

a. Sustained reduction of systolic BP >20mmHg or diastolic BP >10 mmHg within 3 minutes of standing or following head up tilt to >= 60 degrees
b. Sustained reduction of systolic BP >20mmHg or diastolic BP >10 mmHg within 15 minutes of standing or following head up tilt to >= 60 degrees
c. Sustained reduction of systolic BP >5mmHg within 3 minutes of standing or following head up tilt to >= 60 degrees
d. Sustained reduction of systolic BP >20mmHg or diastolic BP >10 mmHg within 10 minutes of standing or following head up tilt to >= 60 degrees

a. Sustained reduction of systolic BP >20mmHg or diastolic BP >10 mmHg within 3 minutes of standing or following head up tilt to >= 60 degrees

How well did you know this?

Not at all

Perfectly

A synthetic amino acid analog directly metabolized to norepinephrine by dopadecarboxylase that is used in the management of orthostatic hypotension

a. Droxidopa
b. Clonidine
c. Yohimbine
d. Prazosin

a. Droxidopa

How well did you know this?

Not at all

Perfectly

A selective alpha1-adrenergic agonist used for the treatment of hypotension

a. Midodrine
b. Clonidine
c. Norepinephrine
d. Dopamine

a. Midodrine

How well did you know this?

Not at all

Perfectly

Controls fight or flight response

Sympathetic NS

How well did you know this?

Not at all

Perfectly

Sympathetic NS is activated by

Release of Norepinephrine

How well did you know this?

Not at all

Perfectly

______ activates adrenoceptors from post synaptic sites

Norepinephrine

How well did you know this?

Not at all

Perfectly

In response to stress, ________ releases Epinephrine

Adrenal medulla

How well did you know this?

Not at all

Perfectly

Sympathetic NS is usually found in the

Thoracolumbar area

An example of neurotransmitter

Norepinephrine

An example of a hormone

Epinephrine

Collateral ganglia of the Sympathetic NS

Celiac ganglion Superior mesenteric ganglion Inferior mesenteric ganglion

Sympathetic NS is activated by

Excitement Exercise Emergency Embarrassment

Formation of IP3 and DAG | Increased intracellular Calcium

Alpha 1

Inhibits Adenylyl cyclase | Decreased cAMP

Alpha 2

Stimulates Adenylyl cyclase | Increased cAMP

Beta 1

Stimulation of Adenylyl cyclase Increased cAMP Activates cardiac G1 under some conditions

Beta 2

Stimulation of Adenylyl cyclase | Increased cAMP

D1 and D2

Inhibits Adenylyl cyclase | Increased K conductance

Inhibits Adenylyl cyclase

Effect of Alpha 1 in the Vascular smooth muscle

Contraction of the vascular smooth muscle

Effect of Alpha 1 in the Pupilary dilator muscle

Contraction of the pupillary dilator muscle -> Dilation of the pupils

Effect of Alpha 1 in the Pilomotor smooth muscle

Erects hair

Effects of Alpha 1 in the Prostate

Contraction of the Prostate

Effect of Alpha 1 in the Heart

Increase force of contraction

Effect of Alpha 2 in the Postsynaptic CNS Adrenoceptors

Probably multiple

Effect of Alpha 2 in the Platelets

Aggregation

Effect of Alpha 2 in the Adrenergic and Cholinergic nerve terminals

Inhibition of Transmitter disease

Effect of Alpha 2 in the Vascular smooth muscle

Contraction

Effect of Alpha 2 in the Fat cells

Inhibition of Lipolysis

Effect of Beta 1 in the Heart

Increase rate and force of contraction

Effect of Beta 1 in the Juxtaglomerular cells

Increase Renin release

Effect of Beta 2 in the Respiratory, Uterine, Vascular smooth muscle

Promotes smooth muscle relaxation

Effect of Beta 2 in the Skeletal muscle

Promotes Potassium uptake

Effect of Beta 2 in the Liver

Activates Glycogenolysis

Effect of Beta 3 in the Fat cells

Activates lipolysis

Effect of D1 in the smooth muscle

Dilates renal blood vessel

Effect of D2 in the nerve endings

Modulates transmitter disease

Effects of the Parasympathetic NS

1. Constrict pupils 2. Stimulate saliva 3. Slow heartbeat 4. Constrict airways 5. Stimulate activity of stomach 6. Inhibit release of glucose 7. Stimulate gallbladder 8. Stimulate activity of the intestine 9. Contract bladder 10. Promotes erection of genitals

Effects of the Sympathetic NS

1. Dilate pupils 2. Inhibit salivation 3. Increase heartbeat 4. Relax airways 5. Inhibit activity of stomach 6. Stimulate release of glucose 7. Inhibit gallbladder 8. Inhibit activity of the intestine 9. Secrete Epi and Norepi 10. Relax bladder 11. Promote ejaculation and vaginal contraction

Stimulation of the Alpha 1 by the catecholamine activates ________

Gq coupling protein

Activation of Gq coupling protein activates ______

Phospholipase C

Activation of Phospholipase C leads to the release of __________

IP3 and DAG

IP3 stimulates the release of

Calcium

IP3 and DAG are released from

Phosphatidyl 4,5 Bisphosphate

Calcium the activates ______ which can in turn phosphorylate their substrates

Calcium dependent protein kinases

DAG activates:

Protein kinase C Guanosine Diphosphate Guanosine Triphosphate

Agonist + Beta receptors = stimulation of

Adenylyl cyclase

Adenylys cyclase activates _______

Stimulatory G protein

Activation of Stimulatory G protein leads to

Dissociation of its Alpha subunit, charged with GTP

The activated Alpha S subunit diractly activates Adenylyl cyclase resulting in an increase in the rate of synthesis of ____

cAMP

Sympathetic agonists are also called as

Adrenomimetic agonists

Sympathetic agonists are divided into 2 classes:

Direct acting | Indirect acting

The Direct acting agonist is divided into 2

Alpha agonist | Beta agonist

Alpha agonist is further subdivided into 3

Non-selective Alpha 1 selective Alpha 2 selective

Beta agonist is further subdivided into 3

Non selective Beta 1 selective Beta 2 selective

The Indirect acting is divided into 2

Releasers | Reuptake inhibitors

Epinephrine

Phenylephrine

Isoproterenol

Norepi

Dobutamine

Clonidine

Tyramine

Amphetamine

Cocaine

Dopamine

Amphetamine

Metaraminol

Ephedrine

Phenylpropanolamine

Alpha and Beta agonist Very potent Vasocons and Cardiac stimulant Released from the Adrenal medulla

Epi

Alpha 1, Alpha 2, Beta 1 agonist No effect on Beta 2 receptor Increases peripheral resistance Increases both diastolic and systolic blood pressure

Norepi

Immediate precursor in the synthesis of Norepi Regulates Na excretion and Renal function CNS neurotrans involved in reward stimulus in addiction

Dopamine

Pure Alpha 1 agonist Mydriatic decongestant Can be used to raise BP

Phenylephrine

Prodrug that is enzymatically hydrolyzed to desglymidodrine Selective Alpha 1 receptor agonist Treat Orthostatic hypotension, due to impaired CNS function

Midodrine

``` Alpha 2 selective agonist Centrally acting antiHTN Has analgesic effect Decreases intraocular pressure Diagnostic for Pheochromocytoma Reduce withdrawal symptoms for narcotic abuse ```

Clonidine

``` 7x more selective Alpha 2 agonist than clonidine Sedation BP and HR reduction Decrease catecholamine Little respiratory depression ```

Dexmedetomidine

Alpha 2A Agonist Topical decongestant Promotes constriction of vessels in nasal mucosa and conjunctiva

Oxymetazoline

Very potent Beta receptor agonist Potent vasodilator Increases cardiac output Decrease in MAP and Diastolic pressure

Isoproterenol

Beta 1 selective agonist | Increases cardiac output with less reflex tachycardia

Dobutamine

High bioavailability Long duration of action Mild stimulant

Ephedrine

Enter the Sympa nerve endings and displace the store catecholamine transporter

Amphetamine-like: ``` Amphetamine Methamphetamine Methylphenidate Modafinil Tyramine ```

Inhibit the reuptake of the released neurotransmitters by interfering with the action of Norepinephrine transporter

Catecholamine Reuptake Inhibitors

Used in attention deficit disorders

Atomexitine

Used in major depression disorder

Reboxitine

Antidepressant

Duloxetine

Inhibit dopamine reuptake into neurons in the pleasure centers of the brain

Cocaine

Dopamine agonists:

Levodopa | Fenoldopam

Used in Parkinson's disease and Prolactinemia

Levodopa

D1 receptor agonist Selectively leads to vasodil in some vascular beds IV treatment of severe hypertension

Fenoldopam

Clinical uses / indication of Sympa agonists:

``` Acute hypotension Chronic orthostatic hypotension Dobutamine stress test Local vasocons COPD Asthma Anaphylaxis Ophthalmic applications Genitourinary CNS ```

Adrenergic neuron blockers (ANB)

Guanethedine, Reserpine

Adrenergic receptor blockers (Reversible):

Prazosin, Phentolamine, Tolazosine, Labetalol, Ergot alkaloids

Adrenergic receptor blockers (irreversible)

Phenoxybenzamine, Dibenamine

Treat Orthostatic hypotension Promotes NE release through blockade of Alpha 2 receptors Used for Erectile dysfunction Reverses the antiHTN effects of Clonidine Increases BP if given with Ne transport blocking drug

Yohimbine

Highly selective Alpha 1 receptor Relaxes both arterial and venous vascular smooth muscle, smooth muscle in the prostate Blockade to Alpha 1 receptors at the base of the bladder decreases resistance to urine flow Extensively metabolized in the liver 50% of the drug is available after oral admin T1/2 3 hours

Prazosin

Used in Hypertension and Benign prostatic hyperplasia | T1/2 3 hours

Doxazosin

Competitice Alpha 1 antagonist High bioavailability T1/2 9-15 hours Greater potency in inhibiting contraction in prostate smooth muscle vs Alpha 1 selective Antagonist Caution: Cataract surgery - intraoperative floppy iris syndrome

Tamsulosin

``` Irreversible non competitive blockade (14-48 hours) Inhibits NE reuptake Blocks: H1, Ach, Serotonin receptors Blocks catecholamine induced vasocons Epinephrine - used for reversal Indication: Pheochromocytoma Male erectile dysfunction Peripheral vascular diseases ADR: Postural hypotension Tachycardia ```

Phenoxybenzamine

``` Competitive antagonist T1/2 4 hours Epinephrine -used for reversal Reduce PVR Cardiac stimulation -> Baroreflex and Increased Norpepi release Inhibits Serotonin response Indications: Pheochromocytoma Male erectile dysfunction ADR: Severe tachycardia Arrhythmia Myocardial ischemia GI stimulation ```

Phentolamine

Classical Non-selective Beta blockers : First generation

Nadolol, Penbutolol, Pindolol, Propranolol, Timolol

Beta 1 Selective Beta Blockers : Second generation

Acebutolol, Atenolol, Bisoprolol, Esmolol, Metoprolol

Non-Selective Beta blockers with additional actions : Third generation

Carteolol, Carvedilol, Labetalol

Beta 1 Selective Beta blockers with additional actions : Third generation

Betaxolol, Celiprolol

Beta blockers oral peak in

3 hours

Beta blockers undergo

First pass metabolism

Beta blockers T1/2

3-10 hours

Esmolol T1/2

8-10 minutes

Nadolol T1/2

24 hours

Effects of Beta blockers in the CVS

+ Chronotropy | + Inotropy

Effects of Beta blockers in Respi

Bronchoconstriction

Effects of Beta blockers in eyes

Reduce IOP

Effects of Beta blockers in Metabolic and Endocrine

Inhibits lipolysis Partial inhibition of glycogenolysis Increase VLDL and decrease HDL + Decreased HDL: LDL ratio

Effects of Beta blockers in MSA

Local anesthetic action

Non selective with Alpha 1 blocking activity Inhibits Beta receptors Attenuate Oxygen free radical - initiated peroxidation Inhibit vascular smooth muscle mitogenesis Beneficial effects in Chronic heart failure

Carvedilol

Reversible adrenoceptor antagonist | Cause Hypotension and has less tachycardia

Labetalol

(R,R) Isomer of Labetalol

Beta blocker

(S,R) Isomer of Labetalol

Alpha blocker - Alpha 1 Selective

Most highly selective Beta 1 Adrenergic receptor blocker Vasodilator due to its action on endothelial Nitric oxide production May increase insulin sensitivity and does not affect lipid profile

Nebivolol

Drugs for CHF

Metoprolol, Bisoprolol, Carvedilol, Propranolol

Drugs for Glaucoma

Timolol, Betaxolol, Carteolol, Levobunolol

Drug interaction

Verapamil