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GT BSN/CNL PHARM > Autonomic Nervous System > Flashcards

Autonomic Nervous System Flashcards

1
Q

What are the sympathetic and parasympathetic effects of stimulation on pupils?

A

sympathetic: dilate
parasympathetic: constrict

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2
Q

What are the sympathetic and parasympathetic effects of stimulation on salivation?

A

sympathetic: decreases saliva production
parasympathetic: increases saliva production

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3
Q

What are the sympathetic and parasympathetic effects of simulation on heart rate?

A

sympathetic: increase
parasympathetic: decrease

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4
Q

What are the sympathetic and parasympathetic effects of simulation on contractility (strength of heart contraction)?

A

sympathetic: increase
parasympathetic: decrease

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5
Q

What are the sympathetic and parasympathetic effects of simulation on the bronchi?

A

sympathetic: bronchiole dilation
parasympathetic: bronchiole constriction

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6
Q

What are the sympathetic and parasympathetic effects of simulation on the GI tract?

A

sympathetic: decreases activity
parasympathetic: increases activity

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7
Q

What are the sympathetic and parasympathetic effects of simulation on the adrenal medulla?

A

sympathetic: increases epinephrine (and some norepinephrine) release
parasympathetic: N/A

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8
Q

What are the sympathetic and parasympathetic effects of simulation on urination?

A

sympathetic: decreases urination (relaxes urinary bladder, constricts sphincter)
parasympathetic: increases urination (constricts urinary bladder, relaxes sphincter)

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9
Q

What are the sympathetic and parasympathetic effects of simulation on vasculature?

A

Sympathetic: general vascular tone. Increased sympathetic response leads to vasoconstriction.
Parasympathetic: N/A

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10
Q

Which branch of the ANS innervates sweat glands?

A

SNS

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11
Q

Which branch of ANS innervates blood vessels?

A

SNS

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12
Q

What is the somatic nervous system?

A

nerve impulses that are under voluntary control as well as reflexes

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13
Q

List a few endogenous neurotransmitters of the ANS

A

epinephrine
norepinephrine
dopamine
acetylcholine

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14
Q

What is a synapse?

A

The endpoint of a nerve where it releases its neurotransmitter for cell to cell communication.

The recipient cell can be another nerve cell or of the target organ.

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15
Q

What neurotransmitter is released by the somatic nervous system? What receptor binds this neurotransmitter here?

A

Acetylcholine
Nicotinic (type 1) Receptor (Or Nm receptor)

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16
Q

What neurotransmitter is released into the synapse at all autonomic ganglion? What receptor binds this neurotransmitter here?

A

Acetylcholine
Nicotinic (type 2) Receptor (Or Nn receptor)

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17
Q

What neurotransmitter is released onto target organs from the parasympathetic nervous system? What receptor binds this neurotransmitter here?

A

Acetylcholine
Muscarinic (M) Receptor

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18
Q

What neurotransmitter is released onto target organs from the sympathetic nervous system? What receptors bind this neurotransmitter here?

A

Norepinephrine
Adrenergic Receptors (alpha1, alpha 2, Beta 1, Beta 2)

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19
Q

What neurotransmitter is released by the adrenal medulla? Where does this neurotransmitter go?

A

Primarily epinephrine (some norepinephrine)
It goes into the vascular circulation

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20
Q

How is acetylcholine metabolized?

A

Acetylcholinesterase (AChE)

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21
Q

How are epinephrine and norepinephrine metabolized?

A

COMT (catechol-o-methyltransferase) and
MAO (monoamine oxidase)

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22
Q

How does the baroreceptor reflex respond to low blood pressure?

A

results in vasoconstriction & increased heart rate and/or contractility (increased cardiac output)

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23
Q

How does the baroreceptor reflex respond to high blood pressure?

A

results in vasodilation & decreased heart rate and/or contractility (decreased cardiac output)

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24
Q

List the main effects of alpha1 stimulation.

A

**vasoconstriction
pupillary dilation
bladder sphincter contraction
uterine contraction
**prostate contraction

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25
List the main effects of alpha2 stimulation
platelet aggregation **decreased SNS outflow (CNS & nerve terminals) vasoconstriction & vasodilation
26
List the main effects of beta1 stimulation
**heart: increased contractility, rate, AV node conduction velocity renin release from kidneys
27
List the main effects of beta2 stimulation
**bronchodilation **uterine relaxation **vasodilation in skeletal muscle, heart, & lungs **decreased GI/GU motility **increased K+ uptake (--> hypokalemia) tremor **glycogenolysis (--> hyperglycemia)
28
List the main effects of dopamine1 stimulation
vasodilation of coronaries & renal vasculature
29
Agonist
stimulates the receptor to do what it normally does
30
Antagonist
blocks the normal activated receptor activity
31
Affinity
strength of drug binding to the receptor
32
List the two synthetic catecholamines
dobutamine isoproterenol
33
What can happen when giving a patient a MAO inhibitor?
Hypertension and tachycardia (this can lead to stroke, myocardial infarction, etc.)
34
Which receptors does epinephrine agonize?
a1, a2, B1, B2
35
Which receptors does norepinephrine agonize?
a1, a2, B1
36
Which receptor does phenylephrine agonize?
a1
37
Which receptor does midodrine agonize?
a1
38
Which receptor does clonidine agonize?
a2
39
Which receptor does dexmedetomidine agonize?
a2
40
Which receptor does dobutamine agonize?
B1
41
Which receptors does isoproterenol agonize?
B1 & B2
42
Which receptor does terbutaline & albuterol agonize?
B2
43
Which receptor does dopamine agonize at low doses? At medium doses? At high doses?
dopaminergic medium dose = B1 high dose = a1
44
Do catecholamines or noncatecholamines have a longer duration of action?
noncatecholamines
45
Major adverse effect of epinephrine?
tachydysrhythmias (tachycardia with rapid AV conduction that can lead to abnormal beats) this can lead to myocardial infarction
46
Since norepinephrine doesn't agonize ____, it produces the strongest _____.
B2; vasoconstriction
47
three effects of alpha2 agonists
decreased blood pressure sedation analgesia
48
receptor agonized by albuterol
beta2
49
adverse effects of beta2 agonists
tremor hypokalemia hyperglycemia
50
what is an indirect agonist
drug that acts via a mechanism that is NOT directly agonizing the receptor examples: - blocking reuptake of neurotransmitter - blocking metabolism of a neurotransmitter - increasing release of neurotransmitter from presynaptic nerve terminal
51
what receptors does labetalol antagonize?
B1 & B2 most strongly weakly antagonizes a1, even more weakly antagonizes a2
52
what receptor does prazosin antagonize?
a1 mostly
53
name a B1 blocker (antagonist) name a B2 blocker name a B nonselective blocker
B1 blocker = metoprolol, atenolol, esmolol B2 blocker = butoxamine B nonselective = propanolol, nadolol, timolol
54
when giving a beta antagonist for hypertension, what are side effects of using a nonselective antagonist?
bronchoconstriction (esp risk with asthma) hypoglycemia (esp risk with diabetes) hyperkalemia
55
name two reasons why alpha antagonists are prescribed
hypertension BPH
56
list side effects of alpha antagonists
orthostatic hypotension (postural hypotension) reflex tachycardia (d/t baroreceptor reflex) nasal congestion (d/t vasodilation) inhibition of ejaculation
57
what is the main difference between phentolamine and phenoxybenzamine
phenoxybenzamine covalently binds the receptor = very long half life
58
list indications for administration of a beta blocker (beta antagonist)
- HTN - angina and post-myocardial infarction - tachydysrhythmias - use PRN for stage fright/anxiety prevention
59
list RELATIVE contraindications for beta antagonist administration
- AV heart block or symptomatic bradycardia - cardiac failure - asthma - uncontrolled diabetes - hypovolemia
60
does receptor selectivity increase or decrease when the dose of medication increases
decrease
61
what are the three types of receptors in the parasympathetic nervous system?
nicotinic N (N1 or Nn) nicotinic M (N2 or Nm) muscarinic (5 major subtypes)
62
what neurotransmitter is released in the parasympathetic and somatic nervous systems
acetylcholine
63
Nn agonism occurs where?
all SNS & PSNS ganglia adrenal medulla
64
Nm agonism occurs where?
neuromuscular junction (the synapse between a nerve and the muscle cell)
65
Nm agonism results in _______.
skeletal muscle contraction
66
agonism of muscarinic receptors result in:
- vasodilation - **decreased heart rate - miosis - **bronchoconstriction - **increased secretions - **GI/GU motility increase (urination/defecation) - sweating - erection
67
what drug class is atropine
muscarinic antagonist aka: anticholinergic
68
what are the effects of atropine administration
- increased HR - decreased secretions - bronchodilation - mydriasis
69
what is the indication for administration of bethanecholol?
decreased GI/GU motility
70
side effects of bethanecholol
- bradycardia - sweating - increased secretions - bronchoconstriction - miosis
71
contraindications/cautions for bethanecholol administration
bowel or bladder obstruction heart block hypotension/bradycardia asthma
72
what is an acetylcholinesterase inhibitor
medication that blocks the actions of acetylcholinesterase, which results in increased acetylcholine concentration
73
what are the contraindications to the use of acetylcholinesterase inhibitors
- bradycardia - seizures - peptic ulcer disease - GI/GU obstruction
74
name two acetylcholinesterase inhibitors that work peripherally. name two that work in the central nervous system
peripheral: - neostigmine - pyridostigmine CNS: - tacrine - donepezil - rivastigmine - galantamine
75
what is cholinergic crisis
excessive ACh activity or muscarinic receptor stimulation
76
s/s cholinergic crisis
muscle weakness (including respiratory muscles) cramps d/t excessive GI activity salivation
77
treatment for cholinergic crisis
atropine support for respiratory system
78
what is myasthenic crisis
extreme muscle weakness (including of respiratory muscles)
79
what is the treatment for myasthenic crisis
acetylcholinesterase inhibitors supportive care for respiratory failure
80
why do we talk about cholinergic crisis and myasthenic crisis together?
both exhibit extreme muscle weakness the treatment for myasthenic crisis is a CAUSE for cholinergic crisis
81
mechanism of action of succinylcholine
agonism of Nm at neuromuscular junction = single muscle contraction followed by flaccid paralysis this is why it's caused a depolarizing muscle relaxant
82
precautions when administering a depolarizing or nondepolarizing muscle relaxant
**requires mechanical ventilation **requires sedation +/- analgesia
83
adverse effects of succinylcholine
hyperkalemia myalgias (muscle pain)
84
mechanism of action of nondepolarizing muscle relaxants
antagonize Nm at neuromuscular junction and prevent depolarization of muscle cell --> flaccid paralysis

GT BSN/CNL PHARM (26 decks)

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