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Pharm > Week 3 (Midterm) (Cholinergic) > Flashcards

Week 3 (Midterm) (Cholinergic) Flashcards

1
Q

Parasympathetic (adrenergic) pre-ganglionic neurons secrete:

A

ACh (receptor is nicotinic)

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2
Q

Parasympathetic (adrenergic) post-ganglionic neurons secrete:

A

ACh (receptor on end organ is muscarinic)

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3
Q

Somatic pre-ganglionic neurons secrete:

A

ACh (receptor is nicotinic)

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4
Q

Somatic post-ganglionic neurons secrete:

A

ACh (receptor on end organ is nicotinic)

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5
Q

What does SLUDGE stand for?

A 
Parasympathetic effects: 
Salvation
Lacrimation
Urination 
Defecation
Gastrointestinal 
Emesis
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6
Q

Choline is transported into terminals via:

A

Na+/ACh symporter

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7
Q

Enzyme that converts choline to ACh

A

choline acetyltransferase

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8
Q

ACh packaging into vesicles via:

A

ACh/H+ antiporter

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9
Q

How is ACh released?

A

Calcium-mediated fusion of vesicles with cell membrane

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10
Q

ACh –> _____ (breakdown)

A

Choline and acetate (acetylcholinesterase)

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11
Q

What sympathetic NE receptor is on the heart?

A

Beta-1

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12
Q

What parasympathetic ACh receptor is on the heart?

A

M2

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13
Q

Hemicholinium action

A

inhibits Na+/ACh symporter - choline into synapse

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14
Q

Hemicholinium effect

A

ACh depletion

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15
Q

Vesamicol action

A

inhibits ACh/H+ antiporter - packaging into vesicles

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16
Q

Vesamicol effect

A

ACh depletion (no ACh packaged)

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17
Q

Botulinum toxin action

A

inhibits vesicle release

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18
Q

Botulinum toxin use

A

local treatment for spastic disorders, wrinkles

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19
Q

Botulinum toxin SE

A

paralysis

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20
Q

Latrotoxin/Beta-Bungarotoxin (spiders) action

A

Destroys synaptic vesicles

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21
Q

Latrotoxin/Beta-Bungarotoxin (spiders) effect

A

flooding of ACh into cleft, overload and synaptic failure

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22
Q

Latrotoxin/Beta-Bungarotoxin (spiders) SE

A

localized diaphoresis, weakness, myoclonus (weak twitching), local paresthesias (tingling), abd pain –> CV collapse, pulmonary edema, ileus (bowel blockage)

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23
Q

3,4-diaminopyridine action

A

promotes vesicle fusion, release of ACh

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24
Q

3,4-diaminopyridine use

A

treatment of Lambert Eaton Myasthenic Syndrome (autoantibodies to presynaptic Ca++ channels block ACh release)

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25
Ganglionc agonists (used or nah?)
not clinically useful -effects are too systemic | - Nicotine (short term)
26
Nicotine (short term) mechanism
targets ganglionic nicotinic ACh receptors in CNS
27
Nicotine (short term) effects
mix of sympathetic/parasympathetic (effects decline with repeat dosage) - CV: tachycardia/↑CO, BP - nausea, vomiting, ↓GI motility - diaphoresis
28
Muscarinic agonists - clinically useful?
ACh not clinically useful because of acetylcholinesterase; derivatives have more effects and are more resistant to break-down
29
Muscarine mechanism
Bind muscarinic receptors
30
Muscarine effect
activates receptors like ACh (SLUDGE)
31
Carbachol mechanism
bind muscarinic receptors and nicotinic "receptors" resistant to ACE
32
Carbachol use
experimental
33
Bethanecol mechanism
bind muscarinic receptors only
34
Bethanecol use
urinary retention, neurogenic (Bowel and Bladder)
35
Pilocarpine stability
VERY stable, lasts one day
36
Pilocarpine mechanism
bind muscarinic receptors only
37
Pilocarpine use
local open/closed angle glaucoma
38
Pilocarpine SE
If in CNS, cause distrubances, sweating, salivation
39
Anticholinesterases mechanism
inhibit acetylcholinesterase activity --> increase ACh signaling, SLUDGE effects
40
What is Anticholinesterase used to treat?
Myasthenia Gravis, a disorder where autoantiboeis degrade nAChR __> leads to ptosis, diplopia, fatigable chewing, respiratory crisis
41
Reversible - Short acting antiacetylcholinesterase
Edrophonium | 10-20 min
42
Endrophonium
competes with autoantibodies | was used as a form of diagnosis
43
Reversible - medium acting anticholinesterase
Neostigmine Pyridostigmine Physostigmine (2-6 hrs)
44
Neostigmine
Oral, used for MG, also for neurogenic ileus and post-op urinary retention
45
Pyridostigmine
Used for MG
46
Physostigmine
Used for glaucoma (topical), atropine poisoning
47
Irreversible anticholinesterases
Organophosphates
48
Organophosphates action
Irreversibly binds ACE active site, alkyl group released (irreversible aging) --> cholinergic stimulation then paralysis
49
Organophosphate uses
Insecticides, nerve gas, achothiophate (open-angle glaucoma)
50
Ganglionic antagonist
Nicotine (long term) Hexamethonium Trimethaphan
51
Nicotine (long term) mechanism
chronic stimulation leads to antagonism
52
GANGLIONIC ANTAGONIST Hexamethonium use
antihypertensive (obsolete)
53
GANGLIONIC ANTAGONIST Trimethaphan mechanism
Competitive ganglionic nACh receptor blocker (shorter acting, must be given IV)
54
GANGLIONIC ANTAGONIST Trimethaphan use
emergent perioperative lowering of BP
55
Muscarinic Antagonists
Scopolamine | Atropine
56
MUSCARINIC ANTAGONISTS Atropine mechanism
competitively binds and inhibits mAChR, lasts 4 hours (longer in eye)
57
MUSCARINIC ANTAGONISTS Atropine use
``` eye: mydriasis, cycloplegia for eye exams bladder/GI: antispasmodic cholinergic overdose (mushroom/organophosphate poisoning) pre-op antisecretory agent for resp. tract ```
58
MUSCARINIC ANTAGONISTS Atropine SE
- cutaneous flushing "red as a beet" - fever "hot as a hare" - CNS disturbances "Mad as a hatter" - Dry mouth "dry as a bone" - events in older pts with narrow angle glaucoma
59
MUSCARINIC ANTAGONISTS Scopolamine use
Motion sickness, as amnesic in anesthesia
60
MUSCARINIC ANTAGONISTS Scopolamine SE
like atropine + short-term memory loss
61
Neuromuscular antagonists
Curare (non-depolarizing) | Succinylcholine (depolarizing)
62
Non-depolarizing blockers - what do they do?
inhibit ACh Rs at motor end-plate --> causes flaccid paralysis that can be overcome with anticholinesterases
63
Curare use
from plants, muscle relaxxants in anesthesia
64
Depolarizing agents - what do they do?
bind and activate ACh Rs repeatedly (agonism)
65
Depolarizing agents - 2 phases
1) fasciculations 2) paralysis (Channels inactivate with chronic stimulation)
66
Succinylcholine is acetylcholinesterase _____
resistant
67
Succinylcholine use
endotracheal intubation, anesthesia induction
68
Succinylcholine SE
malignant hyperthermia w/ halothane, apnea

Pharm (9 decks)

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