week 2 PNS Flashcards
all pre ganglion neuron in PNS
acetylcholine
all post ganglion neuron in the PNS, except sweat gland
Norepinephrine
major neurotransmitter release by the adrenal medulla
epinephrine
primary receptor type in the peripheral nervous system
cholinergic and adrenergic
three type of cholinergic receptor
Nicotinic N
Nicotinic M
Muscarinic
four type of adrenergic receptor
alpha 1
alpha 2
beta 1
beta 2
dopamine *
location of Nicotinic N receptor
cell body of all post-ganglion neuron
cell of adrenal medulla
location of Nicotinic M receptor
skeletal muscle
location of muscarinic receptor
all organs regulated by parasympathetic nervous system
sweat gland
alpha , beta receptor located on
all organs regulated by then sympathetic nervous system
function of nicotinic M receptor on neuromuscular junction
contract skeletal muscle
functions of muscarinic receptor on the. eyes
contract the ciliary muscle, focus on the sense for near vision
contract he iris cause mitosis ( pupil constriction)
function of muscarinic receptor on the heart
decrease HR
function of muscarinic receptor on then lungs
constriction of bronchi
promotes secretions
function of muscarinic receptor on the bladder
constriction of destrusor increase bladder pressure
relax the sphincter allow urine to leave the bladder
cause voiding
function of muscarinic receptor on the GI track
salivation
increase gastric secretion
increase motility
defecation
function of muscarinic receptor on the blood vessel
vasodilation
function of Alpha 1 receptor on the eye
constrict the radial muscle of iris cause mydriasis ( pupil dilation)
alpha 1 receptor on arterioles skin
veins, prostatic capsule, and bladder
constriction
function of alpha 2 receptor on presynaptic nerve terminal
inhibits the release of transmitters
function of beta 1 receptor on the heart
inc heart rate,
inc force contraction
function of the beta 1 receptor on the kidney
release renin
function of the beta 2 receptor on the arterioles
heart
lung
bronchi
dilation
function of beta 2 receptor on uterus
relaxation
function of the beta 2 receptor on the liver
Glycogen lysis
function of beta 2 receptor on skeleton muscle
enhance contraction
glycogen lysis
what type receptors does epinephrine activates
alpha 1, 2
beta 1,2
what type receptors does norepinephrine activates
alpha 1, 2 beta 1
what types of receptors does dopamine activates
alpha 1, beta 1, and dopamine
cholinesterase inhibitor
actives cholinergic receptor indirectly by preventing the break down of acetylcholine
cholinesterase inhibitor
actives cholinergic receptor indirectly by preventing the break down of acetylcholine
muscarinic agonist
mimic acetylcholine at muscarinic receptor
Bethanechol ( Urecholine)
muscarinic agonist
binds to the muscarinic receptor cause activation
relieve urine retention by constrict detrusor muscle and relax bladder sphincter result in bladder emptying
off label for treating GERD, and GI paralysis
by increase tone motility of the GI tract
pupillary constriction (moisis ) and constrict ciliary muscle hence
alters the curvature of the lease result in accommodation for near vision
Pilocarpine (isoptocarpine)
muscarinic agonist
use for topical therapy in treating glaucoma
or oral form to treat dry mouth for PT with Sjogren
adverse effect of Bethanechol
hypotension and bradycardia
excessive salivation, increase production of gastric acid
risk of bladder wall rupture and exacerbate asthma
Cevileline ( Evoxac)
muscarinic agonist
treat xerostomia (dry mouth) for pt with Sjogren syndrome or going thru
radiation therapy
adverse effect
excessive sweating
blurry vison
Muscarinic (Cholinergic ) Toxicity
DUMBELS
Diaphoresis , diarrhea
Urination
Mitosis
Bradycardia brochospasm
Emesis
Lacrimation
Salivation
TX Atropine
what are the two categories of cholinesterase inhibitor
reservable inhibitor
irreversible inhibitor
pyridostigmine
reversible cholinesterase inhibitor
drug of choice management of myasthenia gravis
carries a + charge, can not cross brain blood barrier, absorb poorly after PO admin, hence minimal effect on the brain and Fetus
MOA - binds to cholinesterase, hence it decrease the amount of acetylcholine cholinesterase breaks down
pharmacological effect - bradycardia, bronchial constriction, urinary urgency, increase tone and motility of GI track, meiosis and focus the lens for near vision, increase tone of muscle contraction
*excessive amount of acetyl at NMJ will cause neuromuscular blockade
contradiction - GI obstruction, urinary obstruction, asthma, peptic ulcer disease and hyperthyroidism ( causes dysrhythmia )
common cholinesterase inhibitors
Neostigmine
physostigmine
pyridostigmine
cholinesterase inhibitors that are for treating Alzheimer
donepezil ( aricept ) galantamine
rivastigmine
irreversible cholinesterase inhibitor
use for treatment if glaucoma
Myasthenic crisis VS Cholinergic Crisis
Myasthenic crisis- A state of extreme muscle weakness cause by insufficient acetylcholine at the NMJ, can result in death due to paralysis of respiratory muscle
TX- Neostigmine
cholinergic crisis - also characterized by extreme muscle weakness, accompanied by excessive muscarinic stimulation
TX atropin
Edrophonium
ultrashort- acting cholinesterase inhibitor, use to differentiate myasthenic crisis and cholinergic crisis
atropine
muscarinic antagonist
competitive blockade muscarinic receptor
preventing receptor activation by endogenous acetylcholine
pharmacological effect
inc HR, decrease secretion from salivary gland, brocchial gland, sweat glad and GI
decrease tone and motility of GI tack and urinary bladder
cause dilation of the pupil
tx for sinus bradycardia and AV block , antidote for anticholinesterase poisoning
adverse effect of Bethanechol
hypotension and bradycardia
excessive salivation, increase production of gastric acid
risk of bladder wall rupture and exacerbate asthma
M3 Muscarinic receptor blocker that use to treat overactive bladder
Darifenacin ( highly M3 selective )
Oxybutynin (primary selective )
Tolterodine (nonselective )
Fesosterodine
Anti-muscarinic (Anti-cholinergic ) toxicity
HOT hyperthermia
DRY dry eye, dry mouth dry skin
RED flushed face
BLIND mydriasis
MAD delirium
TX physostigmine
mechanism of adrenergic receptor activation
direct binding
promotion of norepinephrine release
inhibitor of norepinephrine reputate
inhibition of norepinephrine inactivation
adverse effect of Bethanechol
hypotension and bradycardia
excessive salivation, increase production of gastric acid
risk of bladder wall rupture and exacerbate asthma
adverse effect of Bethanechol
hypotension and bradycardia
excessive salivation, increase production of gastric acid
risk of bladder wall rupture and exacerbate asthma
NE, dopamine and dobutamine can only be administered by what route
continuous infusion
due to rapidly inactivation by MAO and COMT in the liver and intestine wall
therapeutic application of a1 activation
evaluation of blood pressure hemostasis (stop bleeding )
nasal decongestion
delay anesthetic absorption
adverse effect of a1 activation
hypertension
reflex bradycardia
necrosis (when IV extravasates)
clinical application of B1 activation
heart failure
shock
AV block
cardiac arrest
adverse effect of B1 activation
tachycardia
dysthymia
angina
therapeutic application of B2 activation
asthma ( albuterol , isoproterenol )
delay preterm labor
adverse effect of B2 activation
hyperglycemia
tremor
epinephrine
binds to a1 receptor cause - vasoconstriction
hence elevated bp, controlled bleeding
binds B1 receptor, increase Cardiac contractility, VF, asystole , increase CO, used in cardiac arrest, and may be use to overcome AV block
binds B2 to promotes brochodialation
treatment for anaphylactic shock
list of adrenergic agonist
epinephrine
Norepinephrine
isoproterenol
dopamine
dobutamine
phenylephrine
albuterol
ephedrine
difference between epinephrine and norepinephrine
NE doesn’t activate B2 receptor hence doesn’t cause hyperglycemia
limited clinical use, only use in severe hypotensive crisis and cardia arrest
