Autonomic Pharmacology

Question 1

Actions of adrenergic receptors

Answer 1

Question 2

Examples of alpha 1 adrenergic agonists, overall effect?

Answer 2

Phenylephrine, midodrine, oxymetazoline

vasoconstriction

Question 3

Uses for each alpha 1 adrenergic agonist

Answer 3

Question 4

Examples of alpha 2 adrenergic agonsists

Answer 4

Clonidine, Dexmedetomidine – “Precedex”

Question 5

Uses of alpha 2 adrenergic agonsists

Answer 5

Methyldopa - lowers blood pressure, pregnancy safe

Question 6

Beta non specific adrenergci agonist example and use

Answer 6

Isoproterenol

• inotropic, chronotropic
• treatment for arrythmias

Question 7

Beta 1 specific adrenergci agonist example and use

Answer 7

Dobutamine

• inotropic, mild chronotropic
• cardiogenic shock
• pharmacologic stress testing

Question 8

Beta 2 specific adrenergic agonist examples abnd uses

Answer 8

Albuterol, Levalbuterol, Salmeterol

• bronchodilators
• Hint: -terols

Terbutaline

• tocolytic
• delays uterine contractions

Question 9

Epinephrine sensitivty for alpha vs. beta receptors

Answer 9

Question 10

Adrenergic agonists where α = β examples and uses

Answer 10

Epinephrine

• Cardiac Arrest
• Anaphylaxis
• Hemostasis

Ephedrine, Pseudoephedrine

• first orally available sympathomimetic
• bronchodilation, nasal decongestant
• base ingredient for manufactured drugs of abuse

Question 11

Adrenergic agonists where α = β1 >> β2 and use

Answer 11

Norepinephrine – “Levophed”

• Hypotension
• Shock (all forms)

Question 12

Mixed adrenergic agonist where β > α and use

Answer 12

Dopamine

• preference for beta-1 and alpha-1
• shock (cardiogenic and neurogenic)

Question 13

Mixed adrenergic agonist where α > β and use

Answer 13

Phentermine - “fen-phen”

• Appetite suppressant
• Remember sympathetic relationship with lipolysis and glycogenolysis

Question 14

Examples of indirect adrenergic agonists

Answer 14

Amphetamine blocks VMAT, indirectly stops reuptake through DAT, longer time for neurotransmitter in synapse

Cocaine blocks DAT directly

Question 15

Metabolism of epinephrine and norepinephrine

Answer 15

Question 16

Drugs that cause MAO inhibition

Answer 16

Selegiline, Tyramine Overload

Question 17

Side effects of adrenergic agonists

Answer 17

Question 18

Nonspecific adrenergic antagonists with α1> α2 example and use

Answer 18

Phenoxybenzamine

• advantages peri-operatively
• CNS availability

Question 19

Nonspecific adrenergic antagonist with α1= α2 example

Answer 19

Phentolamine

reversible

Question 20

alpha 1 antagonist examples and uses

Answer 20

Prazosin, Terazosin, Doxazosin

• can be used in hypertension
• may be more appropriate for Pheo
• BPH
• Hint: -zosin

Tamsulosin

• BPH
• urinary retention

Question 21

Pheochromocytoma symptoms

Answer 21

P – palpitations

H – headache, hypertension

E – episodic sweating

Question 22

Therapeutic uses for beta adrenergic antagonists

Answer 22

• Treatment of arrhythmia, angina
• Increased survival after myocardial infarction
• Decrease stress on blood vessels in ruptured aneurysm
• Treatment for social anxiety
• Treatment for thyroid storm
• Treatment of chronic hypertension

Question 23

Beta-nonspecific antagonists examples and uses

Answer 23

Atenolol, Metoprolol

-Prolong survival after ACS

Esmolol

• fast on/off

Propranolol

• Hyperthyroidism
• Anxiety/Tremors

Timolol

-glaucoma

Hint: -olol

Question 24

α/β mixed antagonists examples and uses

Answer 24

Labetalol

• high blood pressure

Carvedilol

• high blood pressure
• congestive heart failure

Question 25

β ADRENERGIC ANTAGONISTS side effects

Answer 25

* Bradycardia * Decreased myocardial activity * Bronchoconstriction * Hypoglycemia Abrupt withdrawal effects Interactions with cocaine

Question 26

Actions of cholinergic receptors (M1-M3)

Answer 26

Question 27

Direct cholinergic agonists and uses

Answer 27

**Metacholine** - challenge test, bronchoconstriction **Pilocarpine, Carbachol** - opening of canal of schlemm (eye drainage)

Question 28

What is the function of cholinesterase

Answer 28

Breaks down acetylcholine in the synapse (stops parasympathetic response)

Question 29

Cholinesetrase inhibitors examples and uses

Answer 29

Question 30

Side effects of cholinergic agonists

Answer 30

Question 31

Examples of muscarinic antagonists and uses

Answer 31

**Atropine** - treatment for bradycardia - eye dilation **Scopolamine** - motion sickness **Oxybutynin** - overactive bladder **Ipratropium, Tiotropium** - bronchodilation - anti-secretion **Benztropine** - motion sickness - antipsychotic dystonia

Question 32

Side effects of muscarinic antagonists

Answer 32

Question 33

Action of nicotinic receptors

Answer 33

Question 34

Neuromuscular Junction Antagonists depolarizing agents

Answer 34

Question 35

Neuromuscular Junction Antagonists Non-Depolarizing Agents

Answer 35

Question 36

Second messengers for cholinergic receptors

Answer 36

Question 37

Adrenergic receptor second messengers

Answer 37