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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
How does the baroreceptor reflex respond to high blood pressure?
Vasodilation and Dec. CO
26
What are the 2 main effects of alpha-1 stimulation and where can you find the receptor?
Postsynaptic 1. Vasoconstriction 2. Prostate contraction
27
List all the effects of alpha-1 stimulation and where you can find the receptor (7)
All postsynaptic 1. Vasoconstriction 2. Prostate contraction 3. Pupil dilation 4. Bladder sphincter contraction 5. Uterine contraction 6. Hair erection 7. Ejaculation
28
What is the main effect of alpha-2 stimulation and where can you find the receptor?
Presynaptic Dec. SNS outflow -> sedation
29
List all the effects of alpha-2 stimulation and where you can find the receptor (6)
Postsynaptic 1. Platelet aggregation 2. Vasoconstriction Presynaptic 3. Inhibition of NT release 4. Vasodilation 5. GI relaxation 6. Dec. SNS outflow -> sedation
30
What is the main effect of beta-1 stimulation and where can the receptor be found?
Postsynaptic Think heart: Inc. contractility, Inc. HR, Inc. AV node conduction velocity
31
List all the effects of beta-1 stimulation and where you can find the receptor (2)
All postsynaptic 1. Heart: Inc. contractility, Inc. HR, Inc. AV node conduction velocity 2. Renin release from kidneys
32
What are the main effects of beta-2 stimulation and where you can find the receptor (6)
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
33
List the main effects of dopamine-1 stimulation and where you can find the receptor
Postsynaptic Vasodilation of coronaries and renal vasculature
34
Agonist
Stimulates the receptor to do what it normally does
35
Antagonist
Blocks the normal activated receptor activity
36
Affinity
Strength of drug binding to the receptor
37
What is a catecholamine?
NT of SNS
38
Characteristics of catecholamines
Can't be given PO Can't cross BBB Short half-life bc metabolized by MAO and COMT
39
Characteristics of non-catecholamines
Can be given PO Can cross BBB Longer half-life bc not metabolized by COMT, only slowly metabolized by MAO
40
Possible complications of MAO inhibitor
Hypertension and tachycardia
41
Norepinephrine: Class and receptor selectivity
Adrenergic agonist a1, a2, B1
42
Ephedrine: Class and receptor selectivity
Indirect agonist a1, a2, B1
43
Phenylephrine: Class and receptor selectivity
A1 agonist a1>a2
44
Clonidine: Class and receptor selectivity
A2 agonist a2>a1
45
Dexmedetomidine: Class and receptor selectivity
A2 agonist a2>a1
46
Dobutamine: Class and receptor selectivity
B1 agonist B1>B2
47
Isoproterenol: Class and receptor selectivity
B1/B2 agonist B1 and B2
48
Terbutaline: Class and receptor selectivity
B2 agonist B2>B1
49
Albuterol: Class and receptor selectivity
B2 agonist B2>B1
50
List the two synthetic catecholamines
Dobutamine and isoproterenol
51
Dopamine: Class and receptor selectivity
Adrenergic agonist D1 = D2 > B1 > A1
52
Epinephrine: Class and receptor selectivity
Adrenergic agonist a1, a2, B1, B2
53
Epinephrine: Indications + contraindications
Indications: - Bronchoconstriction due to asthma - Acute allergic reaction - Cardiac arrest - Dec. myocardial contractility Contraindications: - Tachydysrhythmia
54
Epinephrine: What's unique?
Adrenergic agonist prototype, rapid onset, short duration unless used via IV
55
Norepinephrine: Indications + contraindications
Indications: - Acute hypotension - Any need for extreme vasoconstriction Contraindications: - Risk for metabolic acidosis - Risk for tissue necrosis if extravasation
56
Norepinephrine: What's unique?
- Vasoconstriction is unopposed - No glycogenolysis or hyperglycemia
57
Dopamine: Indications + contraindications
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
Ephedrine: Indications + contraindications
Indications: - Bradycardia - Hypotension Contraindications: - HTN - Can cause hypertensive crisis
59
Ephedrine: What's unique?
Indirect agonist: Blocks uptake of NE, prolonging NE in synapse
60
Phenylephrine: Indications + contraindications
Indications: - Hypotension - Nasal congestion Contraindications: - HTN
61
Phenylephrine: What's unique?
Vasoconstriction with no HR or contractility agonism
62
Clonidine: Indications + contraindications
Indications: - Hypertension - Need for sedation Contraindication: - Hypotension
63
Clonidine: What's unique?
More routes of administration routes available
64
Dexmedetomidine: Indications + contraindications
Same as clonidine
65
Isoproterenol: Indications
Indications: - Heart block
66
Isoproterenol: What's unique?
"Chemical pacemaker" (inc. HR, contractility, and bronchodilation)
67
Dobutamine: Indications
Indications: - Chronic heart failure
68
Dobutamine: What's unique?
Inc. contractility without inc. HR or BP substantially (by dilating coronary arteries)
69
Albuterol: Indications + contraindications
Indications: - Asthma-induced bronchospasm Contradictions: - Hypokalemia - Hyperglycemia in diabetics
70
Albuterol: What's unique?
Largely asthma use
71
Terbutaline: Indications + contraindications
Indications: - General respiratory distress that causes bronchoconstricton - Premature labor Contradictions: - Hypokalemia - Hyperglycemia in diabetics
72
Terbutaline: What's unique?
Use for bronchodilation AND premature labor
73
Phentolamine: Class and receptor selectivity
A antagonist A1 = A2
74
Phenoxybenzamine: Class and receptor selectivity
A antagonist A1 = A2
75
Prazosin: Class and receptor selectivity
A1 antagonist A1 >> A2
76
Metoprolol, Atenolol, Esmolol: Class and receptor selectivity
B1 antagonist B1 >> B2
77
Propranolol: Class and receptor selectivity
B antagonist B1 = B2
78
Labetalol, Carvedilol: Class and receptor selectivity
B antagonist + A at high doses B1 = B2 > A1 > A2
79
Phentolamine: Indications and contraindications
Indications: - HTN - Pheochromocytoma - Local infiltration post-extravasation Contraindications/AE: - Orthostatic hypotension - Reflex tachycardia - Nasal conjestion - Inhibition of ejaculation
80
Phenoxybenzamine: Indications and contraindications
Indications: - Pheochromocytoma management until surgery Contraindications/AE: - Orthostatic hypotension - Reflex tachycardia - Nasal congestion - Inhibition of ejaculation
81
Prazosin: Indications and contraindications
Indications: - HTN - Benign prostatic hyperplasia (BPH) Contraindications/AE: - Orthostatic hypotension - Reflex tachycardia - Nasal congestion - Inhibition of ejaculation
82
Metoprolol, Atenolol, Esmolol: Indications and contraindications
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
Propranolol: Indications and contraindications
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
Labetalol, Carvedilol: Indications and contraindications
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
Phentolamine: What's unique?
Shorter acting than phenoxybenzamine
86
Phenoxybenzamine: What's unique?
Uses covalent binding, thus, very long-acting. Long-term use inc. risk for cancer
87
Atenolol: What's unique?
Most selective B blocker, very useful in those with coronary artery disease
88
Nn/N1 receptor: Locations
All ANS ganglia Adrenal medulla
89
Nn/N1 receptor: Actions
ANS ganglia -> Agonizes post-ganglion nerves Adrenal medulla -> Release Epi/NE
90
M1 receptor: Location
Blood vessels (no nerve synapse)
91
M1 receptor: Action
Vasodilation
92
M2 receptor: Location
Heart
93
M2 receptor: Action
Dec. HR
94
M3 receptor: Locations (5)
Eye Lung Bladder Sweat glands Sex organs
95
M3 receptor: Actions (5)
Eye: Miosis, ciliary musc. contraction (near vision) Lung: Bronchoconstriction, inc. secretions Bladder: Facilitates urination Sweat glands: Sweating Sex organs: Erection
96
M1-5 receptor: Location
CNS
97
M1-5 receptor: Action
Memory
98
Atropine: Class and BBB status
Anticholinergic (Cholinergic antagonist) Can cross BBB
99
Scopolamine: Class and BBB status
Anticholinergic (Cholinergic antagonist) Can cross BBB
100
Glycopyrrolate: Class and BBB status
Anticholinergic (Cholinergic antagonist) Can't cross BBB
101
Ipratopium: Class and BBB status
Anticholinergic (Cholinergic antagonist) Can cross BBB
102
Atropine: Indications and contraindications
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
Scopolamine: Indications and contraindications
Indications: - Use for sedation - Mydriasis - Sea sickness Contraindications/AE: - Glaucoma - Dry mouth - Blurry vision - Tachycardia - Constipation
104
Glycopyrrolate: Indications and contraindications
Indications: - Excess salivary and respiratory secretions - Reversal of muscarinic effects of cholinergic agents Contraindications/AE: - Glaucoma - Dry mouth - Blurry vision - Tachycardia - Constipation
105
Ipratropium: Indications and contraindications
Indications: - Bronchoconstriction from asthma or COPD Contraindications/AE: - Glaucoma - Dry mouth - Blurry vision - Tachycardia - Constipation
106
Describe the actions of cholinergic antagonists
- 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
Bethanechol: Class
Muscarinic agonist
108
Bethanechol: Indications and contraindications
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
Describe the actions of AChE inhibitors
- Binds to AChE making it unfunctional - Leads to more ACh to interact with receptors -> inc. response ***Indirectly inc. PSNS response***
110
Neostigmine: Class
AChE inhibitor
111
Pyridostigmine: Class
AChE inhibitor
112
Neostigmine: Indications and contraindications
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
Pyridostigmine: Indications and contraindications
Indications: - Glaucoma - Myasthenia gravis - Neuromuscular block (NMB) Contraindications/AE: - Unstable/severe cardiac disease - Uncontrolled epilepsy - Active peptic ulcer disease - GI/GU obstruction - Bradycardia
114
Neostigmine: What's unique?
Can be used to improve GI/GU motility
115
Pyridostigmine: What's unique?
Can be used for glaucoma
116
Cholinergic crisis: Cause, presentation, and treatment
Cause: AChE inhibitors or muscarinic agonists Presentation: Extreme muscle weakness, salivation, cramps Treatment: Atropine, supportive care for respiratory failure
117
Myasthenic crisis: Cause, presentation, and treatment
Cause: Myasthenia gravis Presentation: Extreme muscle weakness Treatment: AChE inhibitor, supportive care for respiratory failure
118
How can you tell if a patient is experiencing a myasthenic crisis or a cholinergic crisis?
- 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
Succinylcholine: Class
Depolarizing NMB Nm agonist
120
Describe the actions of Nm agonists
- Agonizes Nm at neuromuscular junction -> continuous Nm activation - Muscle contracts and then relaxes but cannot receive another action potential
121
Succinylcholine: Indications and contraindications
Indications: - Any need for complete paralysis Contraindications/AE: - No sedation or analgesia - Hyperkalemia - Muscle pain
122
Rocuronium: Class
Nondepolarizing NMB Nm antagonist
123
Describe the actions of Nm antagonists
- Binds to Nm to prevent ACh from binding - Muscle cannot depolarize, no muscle contraction
124
Succinylcholine: What's unique?
Short duration, broken down by pseudocholinesterase
125
Rocuronium: Indications and contraindications
Indications: - Any need for complete paralysis Contraindications/AE: - No sedation or analgesia
126
Rocuronium: What's unique?
- Good for patients with end-stage renal disease (since no hyperkalemia) - Straight to flaccid paralysis

Pharmacology (15 decks)

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