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Pharmacology > Autonomic Agents > Flashcards

Autonomic Agents Flashcards

1
Q

How is the CNS divided?

A
  • Parasympathetic (cholinergic/muscarinic)
  • Sympathetic (adrenergic)
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2
Q

Autonomic Agents Overview

A
  • influence and regulate vital functions within the nervous system
  • these agents lead to metabolic and endocrine changes that include glycogenolysis and modulation of insulin and other hormones
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3
Q

Central Nervous System

A
  • divided into parasympathetic and sympathetic
  • each of these systems have receptors that are responsive to endogenous neurotransmitters and exogenous drug therapy
  • respiration, GI motility, and muscular movements are also influenced and controlled by the autonomic system
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4
Q

Sympathetic Nervous System (SNS)

A
  • one of the 2 divisions of the autonomic nervous system
  • nerve fibers of the SNS arise from the shorter preganglionic neurons in the thorcolumbar division of the spinal cord at T1-L2/L3 “thoracolumbar outflow”
  • Preganglionic neurons release acetylcholine (Ach) that activated the nicotinic receptors stimulating the postganglionic neurons to release norepinephrine which activates adrenergic receptors
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5
Q

Parasympathetic Nervous System (PSNS)

A
  • one of the 2 divisions of the autonomic nervous system (ANS)
  • nerve fibers of the PSNS arise from the CNS “craniosacral outflow”
  • Acetylcholine (Ach) is the primary neurotransmitter
    + muscarinic receptors
    + nicotinic receptors
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6
Q

Autonomic-Parasympathomimetric (Cholinergic) Agents

A
  • imitate or influence (Ach); AKA “agonists”
    + nicotinic receptors
    + muscarinic receptors
  • muscarinic acetylcholine receptors in the peripheral nervous system are most abundant in the CNS
  • ACh is responsible for “cholinergic activity” that includes vasodilation, increased secretions and decreased HR
  • influence sweat glands, skeletal muscle, smooth muscle in blood vessels and other cardiac tissue
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7
Q

What are Autonomic-Parasympathomimetic (Cholinergic) Agents used to treat?

A

Myasthenia Gravis

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8
Q

Examples of Autonomic-Parasympathomimetic (Cholinergic) Agents

A
  1. Ambenonium
  2. Bethanechol
  3. Cevimeline
  4. Donepezil
  5. Galantamine
  6. Neostigmine
  7. Physostigmine
  8. Pyridostigmine
  9. Rivastigmine
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9
Q

Side Effects of Autonomic-Parasympathomimetic (Cholinergic) Agents

A
  • bone marrow suppression
  • sore throat
  • blurred vision
  • increased sweating/salivation
  • urinary frequency
  • fever
  • rash
  • palpitations
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10
Q

Cholinergic Crisis

A

S - salivation
L - lacrimation
U - urination
D - defecation

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11
Q

Autonomic-Anticholinergic Agents

A
  • muscarinic antagonists responsible for “anticholinergic effects” such as decreased secretions, increased HR and decreased GI motility (“universal prescribing alerts”)
  • include Antiparkinsonian agents
  • include antimuscarinic/antispasmodics
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12
Q

Antiparkinsonian Agents

A
  • a type of autonomic-antichoinergic agent
    1. Benztropine
    2. Diphenhydramine
    3. Procyclidine
    4. Trihexyphenidyl
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13
Q

Antimuscarinic/Antispasmodics

A
  1. Aclidinium
  2. Atropine
  3. Belladonna
  4. Dicyclomine
  5. Glycopyrrolate
  6. Hyoscyamine
  7. Ipratropium
  8. Mepenzolate
  9. Methscopolamine
  10. Propantheline
  11. Scopolamine
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14
Q

Anticholinergic Toxidrone Symptoms

A
  • “blind as a bat”
    + dilated pupils
  • “mad as a hatter”
    + confused
  • “red as a beet”
    + flushed skin
  • “hot as a desert”
    + hyperthermia
  • ” dry as a bone”
    + dry mouth
    + urinary retention
  • grabbing invisible options
  • tachycardia
  • shaking
  • absent bowel sounds
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15
Q

Autonomic-Sympathomimetic Adrenergic Agents

A
  • imitate or influence norepinephrine (i.e. facilitate the release, block reuptake or decrease the metabolism of NE)
  • adrenergic receptor “agonists” produce stimulant effects
  • are associated with increased HR, BP, and vasoconstriction
  • are divided into alpha and beta subtypes
  • beta subtypes further divided into 1 and 2
  • each category has unique benefits and side effects, refer to companion drug grid for additional information
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16
Q

Alpha Agonists

A
  • a type of autonomic-sympathomimetic adrenergic agents
    1. Midodrine
    2. Phenylephrine
    3. Clonidine
    4. Guanabenz
    5. Methyldopa
17
Q

Nonselective beta agonists

A
  • a type of autonomic-sympathomimetic adrenergic agents
    1. Isoproproterenol
18
Q

Selective beta (1) agonists

A
  • a type of autonomic-sympathomimetic adrenergic agents
    1. Dobutamine
    2. Dopamine
19
Q

Selective beta (2) agonists

A
  • a type of autonomic-sympathomimetic adrenergic agents
    1. Albuterol
    2. Arformoterol
    3. Formoterol
    4. Indacaterol
    5. Metaproterenol
    6. Olodaterol
    7. Salmeterol
    8. Terbutaline
    9. Vilanterol
20
Q

Combined alpha and beta agonists

A
  • a type of autonomic-sympathomimetic adrenergic agents
    1. Droxidopa
    2. Ephedrine
    3. Epinephrine
    4. Norepinephrine
    5. Pseudoephedrine
21
Q

Autonomic-Sympatholytic (adrenergic blocking) Agents

A
  • associated with cardiac stimulating effects which increase cardiac oxygen demand
  • many agents contraindicated for use in patients with recent MI, coronary insufficiency and/or angina (CAD)
  • reflex tachycardia can be expected
  • some agents within class may exhibit “histamine like” effects and thus stimulate gastric secretion
22
Q

Types of Autonomic-Sympatholytic (adrenergic blocking) Agents

A
  • Alpha adrenergic blocking agents
  • Beta adrenergic blocking agents
23
Q

Types of Alpha Adrenergic Blocking Agents

A
  • nonselective alpha blocking agents
  • nonselective alpha 1 blocking agents
  • selective alpha 1 blocking agents
24
Q

Types of Beta Adrenergic Blocking Agents

A
  • nonselective beta blocking agents
  • selective beta blocking agents
25
Q

What are alpha adrenergic blocking agents used to treat?

A
  • BPH
  • migraines
26
Q

Examples of nonselective alpha blocking agents

A
  1. Dihydroergotamine
  2. Ergoloid mesylate
  3. Ergotamine
  4. Phenoxybenzamine
  5. Phentolamine
27
Q

Examples of nonselective alpha (1) blocking agents

A
  1. Doxazosin
  2. Prazosin
  3. Terazosin
28
Q

Examples of selective alpha (1) blocking agents

A
  1. Alfuzosin
  2. Silodosin
  3. Tamsulosin
29
Q

What are beta adrenergic blocking agents used to treat?

A

Majority of therapeutic uses are for hypertension

30
Q

Examples of nonselective beta blocking agents

A
  1. Carvedilol
  2. Labetalol
  3. Nadolol
  4. Nebivolol
  5. Pindolol
  6. Propranolol
  7. Sotalol
  8. Timolol
31
Q

Categories of Skeletal Muscle Relaxant Agents

A
  • Centrally acting
  • Direct acting
  • GABA derived
  • Neuromuscular blocking agents (NMBAs)
  • Autonomic (misc.)
32
Q

Centrally Acting

A
  • a type of skeletal muscle relaxant
  • are among the most common agents used in the community for typical muscle relaxation
  • these agents interrupt neuronal “pain” pathways
33
Q

Examples of Centrally Acting Skeletal Muscle Relaxants

A
  1. Carisoprodol
  2. Chlorzoxazone
  3. Cyclobenzaprine
  4. Metaxalone
  5. Tizanidine
34
Q

GABA derived

A
  • a type of skeletal muscle relaxants
  • GABA derived agents such as baclofen are more effective when used for muscular spasm associated with multiple sclerosis
35
Q

Examples of Direct Acting Skeletal Muscle Relaxants

A
  1. Dantrolene
36
Q

Examples of GABA Derived Skeletal Muscle Relaxants

A
  1. Baclofen
37
Q

Examples of NMBA Skeletal Muscle Relaxants

A
  1. Atracurium
  2. Cisatracurium
  3. Pancuronium
  4. Rocuronium
  5. Succinylcholine
  6. Vecuronium
38
Q

Example of Miscellaneous Autonomic Agents

A
  1. Orphenadrine
  2. Nicotine
  3. Varenicline
39
Q

Varenicline

A
  • Chantix
  • a type of nicotine receptor agonist
  • can be used in place of nicotine replacement therapy
  • stimulates the nicotine receptor sufficiently to reduce nicotine craving, however also adequately blocks the receptor to prevent pleasurable associated sensations if there is a smoking relapse

Pharmacology (6 decks)

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