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Pharmacology > Week 3: Autonomic Nervous System > Flashcards

Week 3: Autonomic Nervous System Flashcards

1
Q

What are the sympathetic and parasympathetic effects of stimulation on pupils?

A

Sympathetic: dilate
Parasympathetic: constrict

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2
Q

What are the sympathetic and parasympathetic effects of stimulation on salivation?

A

Sympathetic: decreases saliva production
Parasympathetic: increases saliva production

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3
Q

What are the sympathetic and parasympathetic effects of simulation on heart rate?

A

Sympathetic: increase
Parasympathetic: decrease

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4
Q

What are the sympathetic and parasympathetic effects of simulation on contractility (strength of heart contraction)?

A

Sympathetic: increase
Parasympathetic: decrease

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5
Q

What are the sympathetic and parasympathetic effects of simulation on the bronchi?

A

Sympathetic: bronchiole dilation
Parasympathetic: bronchiole constriction

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6
Q

What are the sympathetic and parasympathetic effects of simulation on the GI tract?

A

Sympathetic: decreases activity
Parasympathetic: increases activity

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7
Q

What are the sympathetic and parasympathetic effects of simulation on the adrenal medulla?

A

Sympathetic: increases epinephrine (and some norepinephrine) release
Parasympathetic: N/A

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8
Q

What are the sympathetic and parasympathetic effects of simulation on urination?

A

Sympathetic: decreases urination (relaxes urinary bladder, constricts sphincter)
Parasympathetic: increases urination (constricts urinary bladder, relaxes sphincter)

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9
Q

What are the sympathetic and parasympathetic effects of simulation on vasculature?

A

Sympathetic: general vascular tone. Increased sympathetic response leads to vasoconstriction.
Parasympathetic: N/A

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10
Q

Which branch of the ANS innervates sweat glands?

A

SNS

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11
Q

Which branch of ANS innervates blood vessels?

A

SNS

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12
Q

What is the somatic nervous system?

A

Nerve impulses that are under voluntary control as well as reflexes

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13
Q

4 main neurotransmitters of the ANS

A
  1. Epinephrine
  2. Norepinephrine
  3. Acetylcholine
  4. Dopamine
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14
Q

What is a synapse?

A

The endpoint of a nerve where it releases its neurotransmitter for cell to cell communication.

The recipient cell can be another nerve cell or of the target organ.

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15
Q

What neurotransmitter is released by the somatic nervous system?
What receptor binds this neurotransmitter here?

A

Acetylcholine
Nicotinic (type 1) receptor

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16
Q

What neurotransmitter is released into the synapse at all autonomic ganglion?
What receptor binds this neurotransmitter here?

A

Acetylcholine
Nicotinic (type 2) Receptor (Or Nn receptor)

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17
Q

What neurotransmitter is released onto target organs from the parasympathetic nervous system?
What receptor binds this neurotransmitter here?

A

Acetylcholine
Muscarinic (M) Receptor

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18
Q

What neurotransmitter is released onto target organs from the sympathetic nervous system?
What receptors bind this neurotransmitter here?

A

Norepinephrine
Adrenergic Receptors (alpha1, alpha 2, Beta 1, Beta 2)

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19
Q

What neurotransmitter is released by the adrenal medulla?
Where does this neurotransmitter go?

A

Primarily epinephrine (some norepinephrine)
It goes into the vascular circulation

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20
Q

How and where is acetylcholine metabolized?

A

Acetylcholinesterase (AChE) in synaptic cleft

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21
Q

How and where is epinephrine metabolized?

A

Primarily COMT, sometimes MAO in presynaptic terminal
If in systemic circulation, metabolized by liver

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22
Q

How and where is norepinephrine metabolized?

A

Primarily MAO, sometimes COMT in presynaptic terminal

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23
Q

Autonomic tone

A

Steady balance of SNS and PNS innervation

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24
Q

How does the baroreceptor reflex respond to low blood pressure?

A

Vasoconstriction and Inc. CO

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25
Q

How does the baroreceptor reflex respond to high blood pressure?

A

Vasodilation and Dec. CO

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26
Q

What are the 2 main effects of alpha-1 stimulation and where can you find the receptor?

A

Postsynaptic
1. Vasoconstriction
2. Prostate contraction

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27
Q

List all the effects of alpha-1 stimulation and where you can find the receptor (7)

A

All postsynaptic
1. Vasoconstriction
2. Prostate contraction
3. Pupil dilation
4. Bladder sphincter contraction
5. Uterine contraction
6. Hair erection
7. Ejaculation

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28
Q

What is the main effect of alpha-2 stimulation and where can you find the receptor?

A

Presynaptic
Dec. SNS outflow -> sedation

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29
Q

List all the effects of alpha-2 stimulation and where you can find the receptor (6)

A

Postsynaptic
1. Platelet aggregation
2. Vasoconstriction

Presynaptic
3. Inhibition of NT release
4. Vasodilation
5. GI relaxation
6. Dec. SNS outflow -> sedation

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30
Q

What is the main effect of beta-1 stimulation and where can the receptor be found?

A

Postsynaptic
Think heart: Inc. contractility, Inc. HR, Inc. AV node conduction velocity

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31
Q

List all the effects of beta-1 stimulation and where you can find the receptor (2)

A

All postsynaptic
1. Heart: Inc. contractility, Inc. HR, Inc. AV node conduction velocity
2. Renin release from kidneys

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32
Q

What are the main effects of beta-2 stimulation and where you can find the receptor (6)

A

All postsynaptic
1. Bronchodilation
2. Uterine relaxation
3. Vasodilation in skeletal muscle, heart, and lungs
4. Dec. GI/GU motility
5. Inc. K+ uptake -> tremor
6. Glycogenolysis

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33
Q

List the main effects of dopamine-1 stimulation and where you can find the receptor

A

Postsynaptic
Vasodilation of coronaries and renal vasculature

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34
Q

Agonist

A

Stimulates the receptor to do what it normally does

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35
Q

Antagonist

A

Blocks the normal activated receptor activity

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36
Q

Affinity

A

Strength of drug binding to the receptor

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37
Q

What is a catecholamine?

A

NT of SNS

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38
Q

Characteristics of catecholamines

A

Can’t be given PO
Can’t cross BBB
Short half-life bc metabolized by MAO and COMT

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39
Q

Characteristics of non-catecholamines

A

Can be given PO
Can cross BBB
Longer half-life bc not metabolized by COMT, only slowly metabolized by MAO

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40
Q

Possible complications of MAO inhibitor

A

Hypertension and tachycardia

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41
Q

Norepinephrine: Class and receptor selectivity

A

Adrenergic agonist
a1, a2, B1

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42
Q

Ephedrine: Class and receptor selectivity

A

Indirect agonist
a1, a2, B1

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43
Q

Phenylephrine: Class and receptor selectivity

A

A1 agonist
a1>a2

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44
Q

Clonidine: Class and receptor selectivity

A

A2 agonist
a2>a1

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45
Q

Dexmedetomidine: Class and receptor selectivity

A

A2 agonist
a2>a1

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46
Q

Dobutamine: Class and receptor selectivity

A

B1 agonist
B1>B2

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47
Q

Isoproterenol: Class and receptor selectivity

A

B1/B2 agonist
B1 and B2

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48
Q

Terbutaline: Class and receptor selectivity

A

B2 agonist
B2>B1

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49
Q

Albuterol: Class and receptor selectivity

A

B2 agonist
B2>B1

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50
Q

List the two synthetic catecholamines

A

Dobutamine and isoproterenol

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51
Q

Dopamine: Class and receptor selectivity

A

Adrenergic agonist
D1 = D2 > B1 > A1

52
Q

Epinephrine: Class and receptor selectivity

A

Adrenergic agonist
a1, a2, B1, B2

53
Q

Epinephrine: Indications + contraindications

A

Indications:
- Bronchoconstriction due to asthma
- Acute allergic reaction
- Cardiac arrest
- Dec. myocardial contractility
Contraindications:
- Tachydysrhythmia

54
Q

Epinephrine: What’s unique?

A

Adrenergic agonist prototype, rapid onset, short duration unless used via IV

55
Q

Norepinephrine: Indications + contraindications

A

Indications:
- Acute hypotension
- Any need for extreme vasoconstriction
Contraindications:
- Risk for metabolic acidosis
- Risk for tissue necrosis if extravasation

56
Q

Norepinephrine: What’s unique?

A
  • Vasoconstriction is unopposed
  • No glycogenolysis or hyperglycemia
57
Q

Dopamine: Indications + contraindications

A

Indications:
- Renal dose: Hemodynamic imbalances for renal, splanchnic, and cerebral blood flow
- Low dose: Want to inc. CO without inc. HR
- High dose: Need for general vasoconstriction
Contraindications:
- Higher dose = less specificity

58
Q

Ephedrine: Indications + contraindications

A

Indications:
- Bradycardia
- Hypotension
Contraindications:
- HTN
- Can cause hypertensive crisis

59
Q

Ephedrine: What’s unique?

A

Indirect agonist: Blocks uptake of NE, prolonging NE in synapse

60
Q

Phenylephrine: Indications + contraindications

A

Indications:
- Hypotension
- Nasal congestion
Contraindications:
- HTN

61
Q

Phenylephrine: What’s unique?

A

Vasoconstriction with no HR or contractility agonism

62
Q

Clonidine: Indications + contraindications

A

Indications:
- Hypertension
- Need for sedation
Contraindication:
- Hypotension

63
Q

Clonidine: What’s unique?

A

More routes of administration routes available

64
Q

Dexmedetomidine: Indications + contraindications

A

Same as clonidine

65
Q

Isoproterenol: Indications

A

Indications:
- Heart block

66
Q

Isoproterenol: What’s unique?

A

“Chemical pacemaker” (inc. HR, contractility, and bronchodilation)

67
Q

Dobutamine: Indications

A

Indications:
- Chronic heart failure

68
Q

Dobutamine: What’s unique?

A

Inc. contractility without inc. HR or BP substantially (by dilating coronary arteries)

69
Q

Albuterol: Indications + contraindications

A

Indications:
- Asthma-induced bronchospasm
Contradictions:
- Hypokalemia
- Hyperglycemia in diabetics

70
Q

Albuterol: What’s unique?

A

Largely asthma use

71
Q

Terbutaline: Indications + contraindications

A

Indications:
- General respiratory distress that causes bronchoconstricton
- Premature labor
Contradictions:
- Hypokalemia
- Hyperglycemia in diabetics

72
Q

Terbutaline: What’s unique?

A

Use for bronchodilation AND premature labor

73
Q

Phentolamine: Class and receptor selectivity

A

A antagonist
A1 = A2

74
Q

Phenoxybenzamine: Class and receptor selectivity

A

A antagonist
A1 = A2

75
Q

Prazosin: Class and receptor selectivity

A

A1 antagonist
A1&raquo_space; A2

76
Q

Metoprolol, Atenolol, Esmolol: Class and receptor selectivity

A

B1 antagonist
B1&raquo_space; B2

77
Q

Propranolol: Class and receptor selectivity

A

B antagonist
B1 = B2

78
Q

Labetalol, Carvedilol: Class and receptor selectivity

A

B antagonist + A at high doses
B1 = B2 > A1 > A2

79
Q

Phentolamine: Indications and contraindications

A

Indications:
- HTN
- Pheochromocytoma
- Local infiltration post-extravasation
Contraindications/AE:
- Orthostatic hypotension
- Reflex tachycardia
- Nasal conjestion
- Inhibition of ejaculation

80
Q

Phenoxybenzamine: Indications and contraindications

A

Indications:
- Pheochromocytoma management until surgery
Contraindications/AE:
- Orthostatic hypotension
- Reflex tachycardia
- Nasal congestion
- Inhibition of ejaculation

81
Q

Prazosin: Indications and contraindications

A

Indications:
- HTN
- Benign prostatic hyperplasia (BPH)
Contraindications/AE:
- Orthostatic hypotension
- Reflex tachycardia
- Nasal congestion
- Inhibition of ejaculation

82
Q

Metoprolol, Atenolol, Esmolol: Indications and contraindications

A

Indications:
- HTN
- Angina
- Post-MI / pre-op at risk for MI
- Tachyarrhythmias
- Excessive SNS activity
Contraindications/AE:
- AV heart block
- Cardiac failure
- Restrictive airway disease
- Uncontrolled diabetes
- Hypovolemia

83
Q

Propranolol: Indications and contraindications

A

Indications:
- HTN
- Angina
- Essential tremor
- Post-MI / pre-op at risk for MI
- Tachyarrhythmias
- Excessive SNS activity
Contraindications/AE:
- AV heart block
- Cardiac failure
- Restrictive airway disease
- Uncontrolled diabetes
- Hypovolemia

84
Q

Labetalol, Carvedilol: Indications and contraindications

A

Indications:
- HTN
- Angina
- Post-MI / pre-op at risk for MI
- Tachyarrhythmias
- Excessive SNS activity
Contraindications/AE:
- AV heart block
- Cardiac failure
- Restrictive airway disease
- Uncontrolled diabetes
- Hypovolemia
- Orthostatic hypotension
- Bronchospasm
- CHF
- Bradycardia

85
Q

Phentolamine: What’s unique?

A

Shorter acting than phenoxybenzamine

86
Q

Phenoxybenzamine: What’s unique?

A

Uses covalent binding, thus, very long-acting. Long-term use inc. risk for cancer

87
Q

Atenolol: What’s unique?

A

Most selective B blocker, very useful in those with coronary artery disease

88
Q

Nn/N1 receptor: Locations

A

All ANS ganglia
Adrenal medulla

89
Q

Nn/N1 receptor: Actions

A

ANS ganglia -> Agonizes post-ganglion nerves
Adrenal medulla -> Release Epi/NE

90
Q

M1 receptor: Location

A

Blood vessels (no nerve synapse)

91
Q

M1 receptor: Action

A

Vasodilation

92
Q

M2 receptor: Location

93
Q

M2 receptor: Action

94
Q

M3 receptor: Locations (5)

A

Eye
Lung
Bladder
Sweat glands
Sex organs

95
Q

M3 receptor: Actions (5)

A

Eye: Miosis, ciliary musc. contraction (near vision)
Lung: Bronchoconstriction, inc. secretions
Bladder: Facilitates urination
Sweat glands: Sweating
Sex organs: Erection

96
Q

M1-5 receptor: Location

97
Q

M1-5 receptor: Action

98
Q

Atropine: Class and BBB status

A

Anticholinergic (Cholinergic antagonist)
Can cross BBB

99
Q

Scopolamine: Class and BBB status

A

Anticholinergic (Cholinergic antagonist)
Can cross BBB

100
Q

Glycopyrrolate: Class and BBB status

A

Anticholinergic (Cholinergic antagonist)
Can’t cross BBB

101
Q

Ipratopium: Class and BBB status

A

Anticholinergic (Cholinergic antagonist)
Can cross BBB

102
Q

Atropine: Indications and contraindications

A

Indications:
- Bradycardia
- Excess salivary/respiratory secretions
- Cycloplegia for eye exams and surgery
- Excessive GI motility
- Bronchoconstriction caused by asthma
Contraindications:
- Glaucoma
- Dry mouth
- Blurry vision
- Tachycardia
- Constipation

103
Q

Scopolamine: Indications and contraindications

A

Indications:
- Use for sedation
- Mydriasis
- Sea sickness
Contraindications/AE:
- Glaucoma
- Dry mouth
- Blurry vision
- Tachycardia
- Constipation

104
Q

Glycopyrrolate: Indications and contraindications

A

Indications:
- Excess salivary and respiratory secretions
- Reversal of muscarinic effects of cholinergic agents
Contraindications/AE:
- Glaucoma
- Dry mouth
- Blurry vision
- Tachycardia
- Constipation

105
Q

Ipratropium: Indications and contraindications

A

Indications:
- Bronchoconstriction from asthma or COPD
Contraindications/AE:
- Glaucoma
- Dry mouth
- Blurry vision
- Tachycardia
- Constipation

106
Q

Describe the actions of cholinergic antagonists

A
  • Antagonizes ACh at all muscarinic receptors
  • Doesn’t cause vasoconstriction, just blocks vasodilation
  • Reverses effects of cholinergic agonists

Blocks PSNS response, mimics SNS response

107
Q

Bethanechol: Class

A

Muscarinic agonist

108
Q

Bethanechol: Indications and contraindications

A

Indications:
- Dec. GI/GU motility, especially post-op, post-partum, neurogenic bladder
Contraindications/AE:
- Bowel/bladder obstruction
- Heart block
- Hypotension and bradycardia
- Asthma
- Inc. secretions
- Sweating
- Bronchoconstriction
- Miosis

109
Q

Describe the actions of AChE inhibitors

A
  • Binds to AChE making it unfunctional
  • Leads to more ACh to interact with receptors -> inc. response

Indirectly inc. PSNS response

110
Q

Neostigmine: Class

A

AChE inhibitor

111
Q

Pyridostigmine: Class

A

AChE inhibitor

112
Q

Neostigmine: Indications and contraindications

A

Indications:
- Myasthenia gravis
- Neuromuscular block (NMB)
- Slow GI/GU motility
Contraindications/AE:
- Unstable/severe cardiac disease
- Uncontrolled epilepsy
- Active peptic ulcer disease
- GI/GU obstruction
- Bradycardia

113
Q

Pyridostigmine: Indications and contraindications

A

Indications:
- Glaucoma
- Myasthenia gravis
- Neuromuscular block (NMB)
Contraindications/AE:
- Unstable/severe cardiac disease
- Uncontrolled epilepsy
- Active peptic ulcer disease
- GI/GU obstruction
- Bradycardia

114
Q

Neostigmine: What’s unique?

A

Can be used to improve GI/GU motility

115
Q

Pyridostigmine: What’s unique?

A

Can be used for glaucoma

116
Q

Cholinergic crisis: Cause, presentation, and treatment

A

Cause: AChE inhibitors or muscarinic agonists
Presentation: Extreme muscle weakness, salivation, cramps
Treatment: Atropine, supportive care for respiratory failure

117
Q

Myasthenic crisis: Cause, presentation, and treatment

A

Cause: Myasthenia gravis
Presentation: Extreme muscle weakness
Treatment: AChE inhibitor, supportive care for respiratory failure

118
Q

How can you tell if a patient is experiencing a myasthenic crisis or a cholinergic crisis?

A
  • Take patient history for indications of autoimmune disorders
  • Give patient a short-acting AChE inhibitor and monitor CLOSELY. If patient gets worse, they are experiencing a cholinergic crisis
119
Q

Succinylcholine: Class

A

Depolarizing NMB
Nm agonist

120
Q

Describe the actions of Nm agonists

A
  • Agonizes Nm at neuromuscular junction -> continuous Nm activation
  • Muscle contracts and then relaxes but cannot receive another action potential
121
Q

Succinylcholine: Indications and contraindications

A

Indications:
- Any need for complete paralysis
Contraindications/AE:
- No sedation or analgesia
- Hyperkalemia
- Muscle pain

122
Q

Rocuronium: Class

A

Nondepolarizing NMB
Nm antagonist

123
Q

Describe the actions of Nm antagonists

A
  • Binds to Nm to prevent ACh from binding
  • Muscle cannot depolarize, no muscle contraction
124
Q

Succinylcholine: What’s unique?

A

Short duration, broken down by pseudocholinesterase

125
Q

Rocuronium: Indications and contraindications

A

Indications:
- Any need for complete paralysis
Contraindications/AE:
- No sedation or analgesia

126
Q

Rocuronium: What’s unique?

A
  • Good for patients with end-stage renal disease (since no hyperkalemia)
  • Straight to flaccid paralysis

Pharmacology (8 decks)

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