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Pharmacology > ANS > Flashcards

ANS Flashcards

1
Q

Dysautonomia

A

Impairment of multiple aspect os daily life

  1. orthostasis
  2. Ataxia
  3. aches/pains
  4. numbness/tingling
  5. issues with blinking
  6. digestive issues
  7. HR (fast or slow)
  8. Sweating
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2
Q

Cause of dysautonomia

A
  1. Genetic
  2. Diabetes
  3. Parkinson’s disease
  4. Guillain-Barre syndrome
  5. Trauma to brain or SC
  6. Stroke
  7. Autoimmune disorders
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3
Q

Division of the peripheral nervous system

A
  1. Somatic nervous system

2. Autonomic nervous system

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4
Q

Somatic nervous system

A

Voluntary muscle movement. Skeletal muscle movement

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5
Q

Neurotransmitter for somatic nervous system

A

ACh

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6
Q

Receptors for somatic nervous system

A

Nicotinic

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7
Q

Autonomic nervous system divisions

A

Sympathetic Nervous system (fight or flight)

Parasympathetic Nervous system (rest and digest)

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8
Q

Neurotransmitters for sympathetic nervous system

A
  1. Epinephrine

2. NE

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9
Q

System of sympathetic nervous system

A

adrenergic

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10
Q

Receptors of sympathetic nervous system

A

B1, B2, B3, a1, a2

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11
Q

Primary purpose of sympathetic nervous system

A
  1. mobilize energy stores for use by muscle and brain
  2. Regulation of CV system and body temperature
  3. Redistributes blood flow during exercise
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12
Q

Location and response of B1 receptors

A

Location: heart
Response: Increase HR, AV conduction velocity, and force of contraction

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13
Q

Location of B2 receptors

A
  1. Lungs
  2. Liver
  3. Vasculature
  4. Uterus
  5. Gut
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14
Q

Response of B2 receptors at lungs and liver

A

Lungs: bronchodilation (improved oxygenation)
Liver: Increased glucagon and liver sugar production

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15
Q

Response of B2 receptors at Vasculature, uterus, and gut

A

Vasculature: arterial vasodialtion
Uterus: uterine muscle relaxation
Gut: decreased GI motility, reduced salivation

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16
Q

Location of alpha1 receptors

A

Eye, vasculature, gut

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17
Q

Response of alpha1 receptors at eye and gut

A

Eye: Pupil dilation (mydriasis)
Gut: Decreased GI motility and reduced salivation

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18
Q

Response of alpha1 receptors at vasculature

A

vasoconstriction of vessels of skin, mucuous membranes, and most organs

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19
Q

Parasympathetic nervous system neurotransmitters

A

ACh

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20
Q

System of the parasympathetic nervous system

A

Cholinergic

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21
Q

Primary purpose of parasympathetic nervous system

A
  1. conserve energy
  2. digestion of food and excretion of wastes
  3. Dominant system at rest
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22
Q

Parasympathetic response at heart, lungs, liver

A

Heart: decresed HR, AV conduction velocity, and force of contraction
Lungs: Bronchoconstriction, increased respiratory secretion
Liver: decreased liver sugar production

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23
Q

Parasympathetic nervous system respone at eye, gut and urinary tract

A

Eye: Pupil constriction (miosis), tearing, easier accommodation for near vision
Gut: increased stomach acid, salivation, defecation, increased GI motility
Urinary tract: urinary voiding (stronger bladder contractions and loose urinary sphincter)

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24
Q

What is considered the negative feedback receptors

A

alpha 2 receptors - tells to slow down. Stimulation decreases further NE release (SNS)

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25
Q

Describe reflex tachycardia

A

Drops in BP (vasodilation) trigger sympathetic nervous system to increase HR and vasoconstrictor. This is an increase in HR due to baroreceptor reflex

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26
Q

Describe reflex bradycardia

A

Increase in BP (vasoconstriction) triggers parasympathetic NS to decrease HR and vasodilate. Decrease in HR due to baroreceptor reflex

27
Q

Indirect acting Muscarinic Agonists for myasthenia gravis

A

Cholinesterase inhibitors/Acetylcholineesterase inhibitors

28
Q

Myasthenia gravis cholinesterase inhibitors

A
  1. Edrophonium
  2. Neostigmine
  3. Physostigmine
  4. Pyridostigmine
29
Q

MOA for Muscarinic agonists (Myasthenia gravis)

A

Inhibit activity of AChE. Therefore inhibit breakdown of ACh and thereby increase ACh levels and activity

30
Q

MOA muscarinic agonisits (MG) work on nicotinic receptors of which system?

A

Somatic nervous system (skeletal muscle movement)

31
Q

Adverse effects of muscarinic agonists (MG)

A

SLUD

  1. Salivation, lacrimation, diarrhea, abdominal cramps, heart burn
  2. Pin-point pupils and blurry vision
  3. bronchoconstriciton (sweating)
  4. loss of bladder control, bradycardia, weak pulse
  5. CNS related - N/V, loss of appetite, dizziness, HA, seizures
  6. Muscular - joint pain/cramps
32
Q

What is myasthenia gravis

A

Grave muscle weakness where body immune system attacks and destroy its own nicotinic receptors

33
Q

PT benefits with myasthenia gravis

A

Promote strength, ROM and improved lung function

34
Q

Muscarinic Agonists (indirect) for alzheimers

A

Choinesterase inhibitors and AChE inhibitors

35
Q

Cholinesterase inhibitors of muscarinic agonists (Alz)

A
  1. Donepezil
  2. Galantamine
  3. Rivastigmine
36
Q

MOA muscarinic agonists (Alz)

A

Inhibit activity of AChE. Inhibit breakdown of ACh and increase ACh levels at synapse. Work on AChE of CNS

37
Q

Adverse effects of muscarinic agonists (Alz)

A

SLUD - salivation, lacrimation, diarrhea, abdominal cramps, heartburn, loss of bowel bladder control, brady cardia, weak pulse, pin-point pupils, blurry vision, bronchoconstriction, sweating
CNS related - N/V, loss of appetite, seizures, dizziness, HA

38
Q

What accounts of 60-80% of all cases of late-life cognitive dysfunction

A

Alzheimers disease

39
Q

Death with AD is indirectly associated with

A

Sepsis, pneumonia, choking, aspiration, nutritional deficits, dehydration, trauma

40
Q

Drug used with AChE-inhibitors to block activation of glutamate

A

Memantine

41
Q

Symptoms of AD

A

Cognitive symptoms: memory loss, language problems, disorientation (self, place, time), and executive function impaired
Noncognitive symptoms: depression, psychotic symptoms, behvioral disturbances
Functional symptoms: inability to care for self ADLs

42
Q

Muscarinic Agonists direct acting - ANS

A

Bethanecol

43
Q

MOA muscarinic agonists (direct acting)

A

Bind directly to muscarinic receptors and mimic ACh

44
Q

MOA muscarinic agonists (direct acting) stimulate what preferentially?

A

muscarinic receptors of GI and urinary tract to treat tonic bladder (weak detrusor muscle)

45
Q

Therapeutic use of MA (direct acting)

A
  1. Treat atonic bladder and urinary retention

2. Treat GI paralysis or slowness by increasing GI motility

46
Q

Adverse Effects MA (direct acting)

A 
Salivation = drooling
Lacrimation = tearing
Urinary incontinence
Defecation = diarrhea
GI = stomach acid, heartburn, cramping
Bronchoconstriction - SOA, wheezing, tight chest
Vasodilation = hypotension
47
Q

Muscarinic antagonist MOA

A

Compete with ACh for muscarinic receptors - instead of binding and stimulating activity, they bind and block. Effects similar to sympathetic nervous system

48
Q

Anticholinergic side effects (Anti-SLUD)

A
  1. Dry mouth
  2. Blurred vision (blurred near vision)
  3. Constipation
  4. Urinary retention
  5. Tachycardia
  6. CNS: memory loss, confusion, restlessness, agitation, hallucination, delirium
49
Q

Atropine

A
  1. Antidote for overdoses of cholinergic agonists (insecticides/nerve gas)
  2. cardiac arrest/code blue
  3. antispasmodic/antidiarrheal - relaxes GI tract and bladder
  4. Opthalamic: dilates pupils
50
Q

Scopolamine

A

Motion sickness reduced

1. Produces CNS sedation instead of excitation

51
Q

Hyoscyamine + atropine + scopolamine + phenobarbital

A
  1. Treat GI spasms
  2. Treat irritable bowel
  3. Treat spastic bladder
52
Q 
Darifenacin
Oxybutynin
Propantheline
Solifenacin
Tolterodine
Trospium
A

Treat over active bladder, urinary incontinence, and urge incontinence

53
Q

Do pharmacologic or non-pharmacologic treatments work better for overactive bladder

A

Non-pharmacologic

54
Q

What substances worse overactive bladder?

A

Caffeine, loop diuretics and muscarinic agonists

55
Q

Adrenergic Agonists

A

Mirabegron
Midodrine
Epinephrine

56
Q

MOA of adrenergic agonist Mirabegron

A

B3 agonists. stimulating B3 receptors relaxes bladder and increase storage capacity and reduces symptoms of overactive bladder

57
Q

Adverse effects of adrenergic agonist Mirabegron

A

slight increase in BP, increased rate of UTI

58
Q

MOA of adrenergic agonist Midodrine

A

alpha 1 agonist - stimulating alpha 1 receptors vasoconstrictor the vessels to prevent orthostatic hypotension

59
Q

Therapeutic use of midodrine

A

dysautonomia and orthostatic hypotension

60
Q

Adverse effects of midodrine

A

hypertension, urinary incontinence, HA, dry mouth, nervousness/anxiety

61
Q

Vascular effects of Epinephrine

A
  1. a1
    • Location = skin/mucous membranes
    • Stimulation = vasoconstriction BP increases
  2. B2
    - Location = vasculature of liver, heart, and skeletal muscles
    - Simulation = vasodilation - BP decreased

Overall BP increases - more vasculature of skin/mucous membranes

62
Q

Cardiac effects of epinephrine

A

B1 Increase HR (positive chronotrope)

B1 Increase contractility (positive inotrope)

63
Q

Pulmonary effects of epinephrine

A

B2 - bronchodilation (want more O2 in system)

a1 - decreases respiratory secretions (drying effect)

64
Q

Epinephrine and glucose level

A

B2 hyperglycemia - usually only problem in diabetics

Pharmacology (6 decks)

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