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Pharmacology E5 > Autonomic Pharm > Flashcards

Autonomic Pharm Flashcards

(53 cards)

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1
Q

In the sympathetic division of the ANS the pre-ganglionic fibers are _______ while the post ganglionic fibers are ________.

A

short pre-ganglionic

long post-ganglionic

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2
Q

In the parasympathetic division of the ANS the pre-ganglionic fibers are _______ while the post ganglionic fibers are ________.

A

long pre-ganglionic fibers

short post-ganglionic fibers

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3
Q

In the parasympathetic division, what do post ganglionic fibers release and onto what type of receptors?

A

ACH to muscarinic receptors at the effector organ

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4
Q

In the sympathetic division, what do post ganglionic fibers release and onto what type of receptors?

A

NE to alpha or beta adrenergic receptors

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5
Q

The first synapse regardless of the autonomic division is ____________ and is associated with what NT?

A

cholinergic

Ach

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6
Q

What is the MOA of direct acting cholinergic agonists?

A

act at the ACH receptor = longer duration of action

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7
Q

What is the MOA of indirect acting cholinergic agonists?

cholinesterase inhibitors

A

cause release of ACH = Ach accumulation by stopping breakdown of Ach

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8
Q

Where are nicotinic receptors located?

A

striated muscle
N1/Nm = neuromuscular junction
N2/Nn = autonomic ganglia, CNA, adrenal medulla

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9
Q

Where are muscarinic receptors located?

A

effector organ

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10
Q

What are the side effects of cholinergic drugs?

A 
S= salivation
L= lacrimation
U= urination
D= defaction
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11
Q

Indirect acting cholinergic drugs can be used for what types of tx?

A 
glaucoma 
myasthenia gravis 
post-op urinary retention
antidote to poisons 
GI disorders, paralytic illeus (inc. motility)
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12
Q

What are the pharmacological effects produced by cholinergic drugs?

A
  1. bradycardia
  2. decreased BP and cardiac output
  3. Miosis
  4. Decreases intraocular pressure
  5. Increases GI motility
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13
Q

What are 2 cholinergic agents used in dentistry and what do they do?

A

pilocarpine (Salagen)
cevimeline (Evaoxac)
fxn: increase salivary secretion

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14
Q

What is the MOA of indirect acting cholinesterase inhibitors?

A

Stop the breakdown of acetylcholine (via cholinesterase), which allows for the concentration of acetylcholine to build up = acetylcholine remains active and stimulates the PANS

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15
Q

What do reversible cholinesterase inhibitors do?

A

increase ACH

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16
Q

Centrally acting acetylcholinesterase inhibitors are used for what types of tx?

A

tx dementia with Alzheimer’s disease & investigational for mild to mod dementia with Parkinson’s disease

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17
Q

What is bad about irreversible cholinesterase inhibitors?

A

they increase ACH too much!

= poisons, nerve gases, chemical warfare, insecticides etc.

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18
Q

What are 2 agents that can be used to reverse the effects of organophosphate (insecticide) poisoning?

A

pralidoxime (2-PAM, Protapam)

atropine (antimuscarinic)

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19
Q

What is the MOA of Pralidoxime?

A

regenerates the irreversibly bound ACH receptor sites that are bound by the inhibitors

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20
Q

What is the MOA of atropine?

A

competitively blocks muscarinic effects of excess ACH

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21
Q

What is the MOA of anticholinergic drugs?

A

prevents ACH action at postganglionic PANS nerve ending blocks receptor site for ACH → ACH cannot act on smooth m, glands, heart
reduce PANS activity

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22
Q

T/F the CNS effects form anticholinergic drugs depends on the dose

23
Q

What anticholinergic drug is used in the tx for motion sickness?

24
Q

What is the effect of anticholinergic drugs on exocrine glands?

Study These Flashcards
A

dries up secretions

reduces flow/volume

25
What is the effect of anticholinergic drugs on smooth muscle?
respiratory bronchiodilation GI antispasmodics GU urine retention
26
What type of drug would you use for overactive bladder tx?
anticholinergic
27
What type of drug is used for tx of peptic ulcer disease and IBS?
anticholinergics
28
Why are anticholinergics given during an eye exam?
They cause mydriasis (dilation)
29
How are anticholinergics used in surgery?
used to prevent bradycardia during general anesthesia (can cause vagal blockade resulting in tachycardia in large doses)
30
What is the effect of anticholinergic drugs on the eye?
mydriasis | cycloplegia
31
What is the effect of anticholinergic drugs on skeletal muscle?
reduce tremor and muscle rigidity (Parkinson's tx)
32
What anticholinergic drug is commonly used in dentistry and why?
Atropine: used to decrease salivary flow and crease dry filed for bonded restoration and impressions in mouth and airway
33
What are the indications of atropine toxicity?
Dry as a bone (lack of sweating) Red as a beet (flushed skin) Blind as a bat (blurred vision; mydriasis and cycloplegia) Mad as a hatter (delirium, hallucinations)
34
What are the 3 neuromuscular blocking agents?
1. tubocurarine (Curare) 2. succinylcholine 3. Botulinum toxin (botox)
35
What does tubocurarine (Curare) do?
skeletal m. relaxant
36
What does succinylcholine do and what is it used for?
Causes flaccid paralysis | Used for endotracheal intubation
37
What does Botox do?
produces state of denervation | Prevents calcium- dependent release of ACH
38
What are the indications for botulinum toxin?
muscle tics, muscle disorders, cosmetic procedures
39
What are the 3 endogenous catecholamines and where do they come from?
Epinephrine: adrenal medulla Norepinephrine: terminal nerve endings Dopamine: brain, splanchnic, renal vasculature
40
What do B1 receptors do in response to sympathetic stimulation?
increase HR and contractility | breakdown glycogen
41
What do B2 receptors do in response to sympathetic stimulation?
smooth m. relaxation vasodilation bronchiodilation
42
What do alpha agonists cause?
vasoconstriction of vessels pale pallor smooth muscle contraction
43
What do alpha antagonists cause?
block vasoconstriction decrease TPR and BP reverse dilation of pupils
44
What do beta antagonists cause?
decrease HR, contractility, cardiac output, conduction velocity decrease cardiac oxygen demand reduce intraocular pressure
45
What type of cholinergic agent would you use to tx Sjogrens? Give examples.
Direct cholinergic agent: cevimeline (Evoxac) pilocarpine (Salagen)
46
What are the clinical uses for adrenergic agonists?
``` vasoconstriction decongestants Tx for shock - elevate low bp Tx for cardiac arrest (Epi) Asthma and emphysema CNS stimulation - amphetamines to tx ADD/ADHD ```
47
What are the tx indications for alpha blockers?
``` - second line agents for hypertension Raynaud's syndrome benign prostatic hypertrophy pheochromyocytoma peripheral vascular disease ```
48
Differentiate between selective and non-selective Beta blockers
Selective: B1 | Non selective: B1 & B2
49
How do you distinguish between selective and non-selective based off of the name only?
First letter: A to M = selective N to Z = non-selective
50
What are selective Beta blockers used for?
pt has diabetes or respiratory issues (atenolol, metoprolol)
51
What is the beta 2 agonist included in dental office emergency kits and its indication for use?
Albuterol - bronchodilator
52
What is the dose for epinephrine in dental anesthetics that is given to patients with heart disease?
0.04 mg of epinephrine (2 cartridges of epinephrine 1:1000,000)
53
What are the effects of epinephrine on heart rate and blood pressure if given to a patient taking a selective versus a non-selective beta blocker?
2-4 fold increase in the pressor response to epinephrine = Hypertension (increases risk for MI and stroke) Reflex bradycardia

Pharmacology E5 (3 decks)

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