ANS FINAL

Question 1

Neurotransmission Steps

Answer 1

Synthesis, storage, release, binding, termination.

Question 2

Axonal Conduction

Answer 2

Action potentials propagate along an axon.

Question 3

Sympathetic Nervous System

Answer 3

Uses norepinephrine, increases HR, BP, and bronchodilation.

Question 4

Parasympathetic Nervous System

Answer 4

Uses acetylcholine, decreases HR, increases digestion.

Question 5

Receptor Subtypes in the ANS

Answer 5

Adrenergic: Alpha, Beta; Cholinergic: Nicotinic, Muscarinic.

Question 6

Adrenergic Receptor Activation

Answer 6

Alpha1: Vasoconstriction; Alpha2: Inhibits NE release; Beta1: Increases HR; Beta2: Bronchodilation.

Question 7

Cholinergic Receptors

Answer 7

Nicotinic: Autonomic ganglia, NMJ; Muscarinic: Heart, glands, smooth muscle.

Question 8

Bethanechol Use

Answer 8

Used for urinary retention; causes bradycardia, diarrhea; treat overdose with Atropine.

Question 9

Muscarinic Antagonists MOA

Answer 9

Blocks muscarinic receptors, reduces parasympathetic activity.

Question 10

Uses of Muscarinic Antagonists

Answer 10

Motion sickness, bradycardia, overactive bladder.

Question 11

Cholinesterase Inhibitors MOA

Answer 11

Prevent ACh breakdown, increasing cholinergic effects.

Question 12

Clinical Uses of Cholinesterase Inhibitors

Answer 12

Myasthenia gravis, Alzheimer’s disease.

Question 13

Reversible vs. Irreversible Cholinesterase Inhibitors

Answer 13

Reversible: Neostigmine; Irreversible: Organophosphates.

Question 14

Primary Neurotransmitters in ANS

Answer 14

Norepinephrine, Epinephrine, Dopamine.

Question 15

Alpha Agonist Drugs & Effects

Answer 15

Alpha1 (Phenylephrine) increases BP; Alpha2 (Clonidine) lowers BP.

Question 16

Beta Agonist Drugs & Effects

Answer 16

Beta1 (Dobutamine) increases HR; Beta2 (Albuterol) bronchodilates.

Question 17

Dopamine Receptor Activation Effects

Answer 17

Low dose: Increases renal perfusion; High dose: Increases BP.

Question 18

Alpha Blockers Uses

Answer 18

Treat hypertension (Prazosin), BPH (Tamsulosin).

Question 19

Beta Blockers Uses

Answer 19

Reduce HR, BP (Propranolol, Atenolol).

Question 20

Selective vs. Nonselective Beta Blockers

Answer 20

Propranolol: Nonselective; Atenolol: Cardio-selective; Labetalol blocks Alpha & Beta.

Question 21

Centrally Acting Alpha-2 Agonists

Answer 21

Lower BP, treat opioid withdrawal (Clonidine, Methyldopa).

Question 22

Direct acting cholinergic agonists

Answer 22

Acetylcholine, Bethanechol, Carbachol, Pilocarpine (poor specificity, limited clinical use)

Question 23

Cholinergic Agonists Indications

Answer 23

Treat glaucoma, increase GI/bladder tone

Question 24

Treatment for muscarinic OD

Answer 24

Atropine

Question 25

Indirect acting cholinergic agonists (reversible)

Answer 25

Edrophonium, Phygsostigmine, Neostigmine, Pyridostigmine (Tacrine, Donezepil, rivastigmine, galantamine)

Question 26

Indirect acting cholinergic agonists (reversible) MOA

Answer 26

Indirectly enhance cholinergic action by preventing breakdown of of Ach, resulting in accumulatin of Adh in synaptic space

Question 27

Physostigmine

Answer 27

Treats OD of anticholingeric drugs (ie Atropine); may leads to convulsions/ paralysis at high doses; renal dosing

Question 28

Neostigmine

Answer 28

Stimulates bladder/ GI tract; reversal agent for neuromuscular blocking agents; tx myasthenia gravis; CI in urinary obstructions; renal dosing

Question 29

Edrophonium

Answer 29

PROTOTYPE; short acting; increases muscle strength-used to diagnose myasthenia gravis; REMOVED FROM MARKET

Question 30

Cholinergic Agonists MOA

Answer 30

Bind to cholinergic receptors and prevent the effects of acetylcholine

Question 31

Atropine

Answer 31

PROTOTYPE; bradycardia; antidote for organophosphate poisoning, used in surgery to dry secretions, pupil dilation. CI in glaucoma; reversed by physostigmine

Question 32

Short acting antimuscarinic

Answer 32

Ipratroprium; Tx for bronchospasm in acute asthma/ COPD

Question 33

Long acting antimuscarinic

Answer 33

Tiatroprium; maintenance tx of bronchospasm

Question 34

Other antimuscarinic agents

Answer 34

Tropicamide (opthalmic), Benztropine (parkinsons), Oxybutnin (overactive bladder); all hepatically metabolized; careful with use in elders

Question 35

Ganglionic Blockers

Answer 35

LEAST clinically useful; Block the nicotinic receptor so used for Nicotine cessation

Question 36

Direct acting Adrenergic Agonists

Answer 36

Epi, Norepi, Dopamine, Phenylephrine, Midodrine, Clonidine, Dobutamine, Isoproterenool, Albuterol (Naphazoline, Formoterol, Mirabergron); hepatically metabolized

Question 37

Mixed acting Adrenergic Agonists

Answer 37

Ephedrine, Pseudoephedrine

Question 38

Nonselective alpha adrenergic Antagonists

Answer 38

Phenoxybezamine (irreversible), Phentolamine (reversible); used for prophylaxis of pheochromocytome and IV extravasion from Levo

Question 39

Selective Alpha Drenergic Antagonists

Answer 39

Tamulosin, Terazosin, Prazosin, Doxazosin; mainly treat elevated BP; hepatic metabolism; CI: patients that are already volume depleted; watch for "first-dose orthostasis"