Autonomic Agents Flashcards
(39 cards)
1
Q
How is the CNS divided?
A
- Parasympathetic (cholinergic/muscarinic)
- Sympathetic (adrenergic)
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
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
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
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
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
7
Q
What are Autonomic-Parasympathomimetic (Cholinergic) Agents used to treat?
A
Myasthenia Gravis
8
Q
Examples of Autonomic-Parasympathomimetic (Cholinergic) Agents
A
- Ambenonium
- Bethanechol
- Cevimeline
- Donepezil
- Galantamine
- Neostigmine
- Physostigmine
- Pyridostigmine
- Rivastigmine
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
10
Q
Cholinergic Crisis
A
S - salivation
L - lacrimation
U - urination
D - defecation
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
12
Q
Antiparkinsonian Agents
A
- a type of autonomic-antichoinergic agent
1. Benztropine
2. Diphenhydramine
3. Procyclidine
4. Trihexyphenidyl
13
Q
Antimuscarinic/Antispasmodics
A
- Aclidinium
- Atropine
- Belladonna
- Dicyclomine
- Glycopyrrolate
- Hyoscyamine
- Ipratropium
- Mepenzolate
- Methscopolamine
- Propantheline
- Scopolamine
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
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
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
What are alpha adrenergic blocking agents used to treat?
- BPH
- migraines
26
Examples of nonselective alpha blocking agents
1. Dihydroergotamine
2. Ergoloid mesylate
3. Ergotamine
4. Phenoxybenzamine
5. Phentolamine
27
Examples of nonselective alpha (1) blocking agents
1. Doxazosin
2. Prazosin
3. Terazosin
28
Examples of selective alpha (1) blocking agents
1. Alfuzosin
2. Silodosin
3. Tamsulosin
29
What are beta adrenergic blocking agents used to treat?
Majority of therapeutic uses are for hypertension
30
Examples of nonselective beta blocking agents
1. Carvedilol
2. Labetalol
3. Nadolol
4. Nebivolol
5. Pindolol
6. Propranolol
7. Sotalol
8. Timolol
31
Categories of Skeletal Muscle Relaxant Agents
- Centrally acting
- Direct acting
- GABA derived
- Neuromuscular blocking agents (NMBAs)
- Autonomic (misc.)
32
Centrally Acting
- 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
Examples of Centrally Acting Skeletal Muscle Relaxants
1. Carisoprodol
2. Chlorzoxazone
3. Cyclobenzaprine
4. Metaxalone
5. Tizanidine
34
GABA derived
- 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
Examples of Direct Acting Skeletal Muscle Relaxants
1. Dantrolene
36
Examples of GABA Derived Skeletal Muscle Relaxants
1. Baclofen
37
Examples of NMBA Skeletal Muscle Relaxants
1. Atracurium
2. Cisatracurium
3. Pancuronium
4. Rocuronium
5. Succinylcholine
6. Vecuronium
38
Example of Miscellaneous Autonomic Agents
1. Orphenadrine
2. Nicotine
3. Varenicline
39
Varenicline
- 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
