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Anesthesiology > Autonomic Modulators > Flashcards

Autonomic Modulators Flashcards

1
Q

Where does the synthesis of NE happen?

A

Liver, presynaptic cytoplasm, vesicles

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2
Q

What part of the synthesis of NE happens in the liver?

A

Phenylalanine to tyrosine

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3
Q

What part of the synthesis of NE happens in the presynapic cytoplasm?

A

tyrosine to dopa to dopamine

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4
Q

What part of the synthesis of NE happens in the vesicle?

A

Dopamine to NE to epi

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5
Q

What is the effect of alpha 1 agonism?

A

Increased intracellular calcium –> smooth muscle contraction, sphincter contraction, vasoconstriction, bronchoconstriction, uterine contraction

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6
Q

What is the effect of alpha 2?

A

Decreased exocytosis of NTs.
Causes smooth muscle relaxation and vasodilation
CNS sedation

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7
Q

What are the effects of Beta 1?

A

Increased adenylate cyclase: increased HR, contractility, and conduction

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8
Q

What are the effects of Beta 2?

A 
Bronchodilation
Vasodilation
Uterine relaxation 
Relaxation of bladder and gut
Increased glycogenolysis, lipolysis, gluconeogenesis and insulin release
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9
Q

Which receptors does epi act on?

A

Alpha 1, Beta 1 and 2

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10
Q

What are the effects of epi?

A

Increased contractility, CO, and O2 demand
Decreased SVR (B2)
Increased cerebral and coronar perfusion
Decreased splanchnic and renal perfusion

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11
Q

What receptors does norepi act on?

A

Alpha 1 and Beta 1 (acts more on alpha)

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12
Q

What are the effects of norepi?

A

Increased SVR, contractiliy, CO, HR

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13
Q

What are the effects of dopamine at low levels?

A 
Increased urine output via vasodilation of renal vessels
Decreased aldosterone
Increased CO (B1)
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14
Q

What are the effects of dopamine in the moderate range (2-10 ugm)?

A

Mainly Beta effects:
Increased contractility
Coronary O2 demand is higher than supply

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15
Q

What are the effects of dopamine in high doses?

A

Mostly alpha effects: vasoconstriction, bronchoconstriction, uterine constriction.
Predisposes myocardium to ventricular arrythmia

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16
Q

What are the effects of ephedrine?

A

Increased CO, HR and BP

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17
Q

What is the MOA of ephedrine?

A

SNS mimetic - indirectly releases NE

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18
Q

What receptors is isoproterenol acting on?

A

B1 and B2

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19
Q

What are the effects of isoproterenol?

A

Increased HR, contractility, O2 demand and decreased SVR.

O2 demand exceeds supply because of drop in diastolic BP

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20
Q

What receptors does dobutamine act on?

A

Beta 1

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21
Q

What are the effects of dobutamine?

A

Primarily increased CO and contractility

22
Q

What receptor does phenylephrine act on?

A

alpha 1

23
Q

What are the effects of phenylephrine?

A

vasoconstriction, reflex brady, increased afterload and BP

24
Q

What receptor is methyldopa acting on?

A

alpha 2

25
Q

What receptor is clonidine acting on?

A

alpha 2

26
Q

What are the effects of methyldopa?

A

Produces false NTs which activate alpha 2 receptors and causes a decrease in SNS stimulation –> vasodilation and lower BP

27
Q

What are the effects of clonidine?

A

Direct alpha 2 agonist

Sedating properties are effective for lowering anesthetic requirements intraoperatively.

28
Q

What is clonidine used for?

A

As an adjunct in regional anesthesia for increased quality an duration of nerve blocks

29
Q

What receptor does dexmedotomidine act on?

A

alpha 2

30
Q

What are the effects of dexmedetomidine?

A

More potent alpha 2 agonist than clonidine
Initial HTN then brady and hypotension
Sedating and analgesic
lowers anesthetic requirement

31
Q

What is the MOA of nitroprusside?

A

metabolized to NO

32
Q

What are the effects of nitroprusside?

A

Vaso and venodilation
Decreased afterload, preload and BP while CO and RBF are well maintained
Reflex tachy
Decreased O2 demand on the heart

33
Q

What are the cerebral effects of nitroprusside?

A

increased CBF and ICp

34
Q

What are the pulmonary effects of nitroprusside?

A

Dilates pulmonary vessels causing pulm. a. pressure to be lowered and decreasing the shunt fraction

35
Q

How is nitroprusside metabolized?

A

Receives an electron from hemoglobin resulting in methemoglobin and then a nitroprusside free radial –> cyanide

36
Q

What are the signs of cyanide toxicity?

A

arrythmia, metabolic acidosis, and increased mixed venous oxygen content

37
Q

What is the tx of cyanide toxicity?

A

Mechanical ventilation of 100% O2
Sodium nitrate to make methemoglobin which will bind cyanide
Sodium thiosulfate to bind cyanide

38
Q

What are the effects of nitroglycerin?

A

Decreased preload through venodilation
Increased coronary perfusion
Antiplatelet effects

39
Q

What is a possible side effect of nitroglycerin?

A

Methemoglobinemia

40
Q

What is the MOA of hydralazine?

A

Vasodilator

41
Q

What is atropine?

A

A tertiary amine that can cross the bb barrier ad the placenta

42
Q

What is a potential side effect of atropine at toxic doses?

A

CNS stimulation: hallucination, irritability, nervousness

43
Q

What is atropine known to cause?

A

Fever

44
Q

What are the CV effects of anticholinergics?

A

Tachycardia by blocking vagal stimulation

Shortened PR interval

45
Q

What are the pulmonary effects of anticholinergics?

A

Decreased airway secretions

Relaxes bronchial smooth muscle

46
Q

What are the cerebral effects of anticholinergics?

A

Excitation or depression

47
Q

What are the GI effects of anticholinergics?

A

Decreased salivation, motility, peristalisis

48
Q

What are the GU effects of anticholinergics?

A

Urinary retention

49
Q

What are the effects of anticholinergics on sweat glands?

A

Inhibits sweat glands so may have increased basal body temp

50
Q

what are the uses of glycopyrrolate?

A

decrease salivation and respiratory secretion

51
Q

Why can’t glycopyrrolate cross the bb barrier?

A

It is a quaternary structure

52
Q

What does scopolamine cause that atropine does not?

A

Sedation

Anesthesiology (19 decks)

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