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Pharm Kaplan > Autonomic Pharm > Flashcards

Autonomic Pharm Flashcards

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1
Q

Where are Nn receptors located?

A

on cell bodies in ganglia of both PANS and SANS and in the adrenal medulla

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2
Q

Where are Nm recepotrs located

A

On the skeletal muscle motor end plate innervated by somatic motor nerves

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3
Q

Where are M1-3 receptors located?

A

on all organs and tissues innervated by post-ganglionic nerves of the PANS and on thermoregulatory sweat glands innervated by the SANS

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4
Q

Aldosterone is released from the

A

adrenal cortex

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5
Q

Renin is released from the

A

juxtaglomerular cells in response to hypotension or increased sympathetic drive

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6
Q

Aldosterone MOA

A

DCT/CD: increase Na/ H20 retention; DECREASE K

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7
Q

Angiotensin II MOA

A

Vasoconstricts Efferent arteriole and systemic - increase TPR

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8
Q

Paralysis of accommodation - leading to only far vision

A

Cyclopegia

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9
Q

Muscarinic stimulation on the eye

A

Miosis (small) and accommodation

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10
Q

Alpha 1 (adrenergic) stimulation on the eye - radial muscles

A

Mydriasis (dilated), NO cycloplegia

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11
Q

MOA of Botulinum toxin (endotoxin from clostridium)

A

Binds synaptobrevin preventing Ach release

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12
Q

MOA of indirect-acting cholinomimetics

A

Target AchE for inhibition

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13
Q

3 Reversible AChE inhibitors

A

Edrophonium; Physostigmine; neostigimine

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14
Q

3 Irreversible AchE inhibitors

A

Echothiophate, malathion, parathion

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15
Q

Muscarinic Receptor activation does what to the eye

A

Sphincter: M3 (Gq) = contraction = miosis
Ciliary muscle: M3(Gq) = contraction = accommodation for near vision

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16
Q

Muscarinic Receptor Activation does what to the heart

A

SA node: M2 (Gi) - Decrease HR
AV node: M2 - decrease conduction velocity
DOES NOT AFFECT THE VENTRICLES

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17
Q

Muscarinic Receptor Activation does what to the Lungs?

A

Bronchioles: M3 - contraction = bronchospasm
Glands: M3 = secretion

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18
Q

Muscarinic Receptor Activation does what to the GI tract?

A

Stomach: M3 - Increase motility (Cramps)
Glands: M1 - Secretion (inc acid)
Intestine: M3 - Contraction = diarrhea, involuntary defecation

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19
Q

Muscarinic Receptor activation does what to the Bladder?

A

M3: Contraction (Detrusor), relaxation (trigone/sphincter), voiding, urinary incontinence

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20
Q

Muscarinic Receptor activation does what to sphincters?

A

M3: relaxation (except LES, which contracts)

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21
Q

Muscarinic Receptor activation does what to glands?

A

All M3 except GI tract, which are M1: Sweat (thermoregulatory), salivation, and lacrimation

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22
Q

What does Muscarinic Receptor activation do to the blood vessels (endothelium)

A

M3: Argine –> NO = dilation. No innvervation here so no effect of indirect agonist (only SANs effect, not PANS)

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23
Q

4 Muscarinic Agonists (direct-acting cholinomimetics)

A

Ach; Bethanechol; Methacholine; Pilocarpine

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24
Q

Muse of Bethanechol

A

Post op/neurogenic ileus; urinary retention

Muscarinic agonist

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25
Use of Pilocarpine - a muscarinic agonist
Glaucoma, xerostomia, Increases sweating for a + sweat test in cystic fibrosis
26
7 Acetylcholinesterase Inhibitors (indirect-acting cholinomimetics)
Edrophonium; Physostigminie; Neostigmine; Pyridostigmine; Donepezil; tacrine; Organophosphates
27
Use of Edrophonium - an AChE inhibitor
Tensilon test for MG
28
Use of Physostigmine - an AChE inhibitor
Atrophine overdose, glaucoma
29
Uses of neostigmine, Pyridostigmine - AchE inhibitors
Ileus, urinary retention, myasthenia (Neo), reversal of Nm blockade (curare)
30
Use of Donepezil and Tacrine - AChe inhibitors
Alzheimer disease
31
Use of Organophosphates, AChE inhibitors
Glaucoma. Used as insecticides - malathiom, parathion and nerve gas (sarin). Irreversible, non-competitive (decrease Vmax
32
S/S of AChe inhibitor Poisoning
DUMB BELSS: | Diarrhea; urination; miosis; Bradycardia; Bronchoconstriction; Excitation; Lacrimation; Salivation; Sweating
33
Chronic toxicity of organophosphates
peripheral neuropathy with demylination - mimics MS
34
6 Muscarinic Receptor antagonists (anti-muscarinic)
Atropine; Tropicamide; Ipratropium; Scopalamine; Benztropine; Trihexyphenidyl
35
Alpha 1 activation on the eye
Radial (dilatory) muscle = contration = mydriasis w/o cycloplegia
36
alpha 1 receptor activation on arterioles (skin/viscera) and veins
``` Contraction = increase TPR - Increase diastolic pressure, Increase afterload Veins = contraction = increase venous return, increase preload - increase systolic BP - therefore no net change in BP ```
37
Alpha 1 receptor activation on bladder trigone and sphincter
Contraction - urinary retention
38
Alpha 1 receptor activation on male sex organs
Vas deferens = ejaculation
39
Alpha 1 receptor activation on the liver
increase glycogenolysis
40
Alpha 1 receptor activation on the kidney
Decrease renin release
41
Alpha 2 receptor activation on Prejunctional nerve terminal
Decrease transmitter release and NE synthesis
42
Alpha 2 receptor activation on platelets
aggregation
43
Alpha 2 receptor activation on the pancreas
Decrease insulin secretion (warning in diabetics)
44
Beta 1 receptor activation on the SA node
Increase HR
45
Beta 1 receptor activation on AV node
Increase conduction velocity
46
B1 receptor activation on atrial and ventricular muscle
Increase force of contraction, conduction velocity, CO, and oxygen consumption
47
Beta 1 receptor activation on His-Purkinje
Increase automaticity and conduction velocity
48
B1 receptor activation on Kideny
Increase renin release
49
B2 activation on blood vessels
Vasodilation - decrease TPR - decrease diastolic pressure - decrease afterload
50
B2 activation on Uterus
Relaxation
51
B2 activation on bronchioles
Dilation
52
B2 activation on skeletal muscle
Increase glycogenolysis - contractility
53
B2 activation on the liver
Increase glycogenolysis
54
B2 activation on the pancreas
Increase insulin secretion
55
D1 activation on the renal, mesenteric, and coronary vasculatorue
Vasodilation - in Kidney increase RBF, increase GFR, increase Na secretion
56
Name an alpha 1 agonist and its use
Phenylephrine - nasal decongestant (optho too - mydrasis w/o cycloplegia)
57
Alpha 1 agonist net effects (2)
increase TPR and increase BP
58
Alpha 2 agonist net effect
Decrease sympathetic outflow @ prejunctional CNS receptors - Mild to moderate HTN
59
Name 2 alpha 2 agonists and use
Clonidine, Methyldopa - mild-moderate HTN
60
Beta 1 vs Beta 2 effects
B1 = Increases HR, SV, CO, and pulse pressure B2 = decreases TPR, BP TPR > CO for BP effect, so net effect is decrease BP
61
Name 2 Beta 1 and 2 agonists and their uses
Isoproterenol (B1=B2): Bronchospasm, Heart block, brady arrhythmia Dobutamine: B1>B2: CHF
62
Name 4 Selective B2 agonists and their uses
Salmeterol, albuterol, terbutaline (ASTHMA); Ritodrine: Premature labor
63
Name 2 mixed acting adrenoceptor agonists and their receptors
Norepinephrine - alpha 1,2 and Beta 1 Epinephrine: Alpha 1,2 Beta 1,2. (B2 at low dose, B1 middle, and alpha 1 at high dose)
64
Name 5 Indirect Acting adrenergic receptor agonists and their main MOA
Releasers: Tyramine, Amphetamines, Ephedrine Reuptake inhibitors: Cocaine, TCA
65
List the main effects of alpha receptor antagonists
Decrease TPR, decrease mean BP | May cause reflex tachycardia and salt/water retention (via renin-->aldosterone)
66
List the 3 main uses of alpha receptor antagonists
HTN; Pheochromocytoma; BPH (symptomatic via trigone relaxation/sphincter relaxation)
67
Name 2 nonselective alpha receptor antagonists and uses
Phentolamine (competitive inhibitor) Phenoxybenzamine (non-competitive, irreversible inhibitor) DOC for pheochromocytoma
68
Name the drug that actually treats BPH and its MOA
Finasteride: 5-alpha reductase inhibitor - decreases DHT, shrinks median zone
69
Name 4 selective alpha 1 blockers
Prazosin, Doxazosin, terazosin, tamsulosin
70
Name 2 selective Alpha 2 blockers and their use
Yohimbine: Postural hypotension, Impotence Mirtazapine: Anti-depressant (causes weight gain secondary to increased appetite)
71
List the main effects of B1 blockade
Decreased HR, SV, CO and therefore O2 comsumption; Decreased Renin release (therefore Dec TPR and Edema) Decreased aqueous humor production
72
5 Uses for B1 blockers
Angina, MI, Supraventricular Tachycardia, HTN; CHF
73
Name 4 Beta1 selective blockers and any important info
1. Acebutolol: NO increase in blood lipids (Class II); 2. Atenolol: Not sedating 3. Esmolol: Class II 4. Metoprolol
74
List B2 blockade main effects and warnings
Avoid in asthmatics, peripheral vascular disorders, and diabetics. With fasting, get increased LDLs, TG - blocks glycogenolysis and gluconeogenesis.
75
Name 3 B2 blockers
1. Pindolol (no increase in blood lipids) 2. Propranolol 3. Timolol:
76
What 4 things is propranolol used for
Very sedating, Class II antiarrhythimic: Thyrotoxicosis (inhibit deiodinase - no T4-T3), Performance anxiety, MIgrane, essential tremor
77
What is Timolol used for
Glaucoma
78
Name 2 drugs with combined alpha 1 and B blocking activity and its use
Labetalol and Carvedilol - CHF
79
Name a drug with K+ channel blocking ability and B-blocking activity
Sotalol
80
What is narrow angle glaucoma
Iris is blocking canal of schlemm
81
What is broad angle glaucoma
Degenerative changes in the canal
82
Chronic condition with increased intraocular pressure due to decreased reabsorption of aqueous humor leading to progressive painless visual loss
Open-Angle Glaucoma
83
An acute, painful condition with increased IOP due to blockade of the canal of schlemm - is an emergency
Close-Angle Glaucoma
84
What drugs are contraindicated in closed-angle glaucoma
Anti-muscarinic drugs and alpha 1 agonists
85
Beta blocker used to treat Glaucoma - MOA
Timolol - blocks actions of NE at ciliary epithelium - decrease aqueous humor formation
86
2 Cholinomimetic drugs and MOA for tx of Glaucoma
Activation of M receptors causes contraction of ciliary muscles which increases flow through the canal.
87
What 2 drugs do you use in an emergent case of closed angle glaucoma
Diuretics: mannitol, carbonic anhydrase inhibitors

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