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Autonomics Flashcards

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0
Q

Choline transport across plasma membrane blocked by? Inhibiting acetylcholine formation by ChAT

A

Hemicholinium

Block rate limiting step

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1
Q

Immune mediated degradation of voltage gated calcium channels?

A

Lambert Eaton

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2
Q

Inhibit active transport of ACh into vesicles for storage?

A

Vesamicol - “VESicle”

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3
Q

Alter synaptobrevins to prevent release of ACh into junction?

A

Botulinum toxin

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4
Q

Indirect acting cholinomimetics that inhibit acetylcholinesterase, prevent ACh degradation?

A

Carbamate

Organophosphate

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5
Q

Direct acting muscarinic cholinomimetic for post op bowel and bladder atony?

A

Betanechol

MOA: Activates M3. Bladder wall contraction, sphincter relaxation

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6
Q

Betanechol AE?

A

Cyclospasm. Diarrhea. Reflex tachycardia. Sweating.

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7
Q

Direct acting muscarinic cholinomimetic for glaucoma, sjogren and sicca?

A

Pilocarpine

MOA: Activate M3. Inc aqueous humor outflow, inc salivation.

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8
Q

Sjogren characterized by?

A

Xerostomia. Xerophthalmia. Rheumatoid arthritis.

Sicca: dry mouth, dry eyes only

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9
Q

Pilocarpine AE?

A

Cyclospasm - manifest as BOV

Miosis (excessive M3 action)

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10
Q

Direct acting nicotinic cholinomimetic used for smoking cessation?

A

Nicotine

MOA: Activate Nn and Nm

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11
Q

May cause mushroom poisoning?

A

Amanita muscaria

Nausea vomiting diarrhea

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12
Q

Toxicity of nicotine?

A

Paralysis (blocks depolarization of motor end plate)

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13
Q

MOA of indirect acting cholinomimetics?

A

Inhibit breakdown of ACh by acetylcholinerase. Enhance ACh action where it is normally secreted

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14
Q

indirect acting cholinomimetic used to DIAGNOSE myasthenia gravis?

A

Edrophonium given IV

aka Tensilon Test

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15
Q

Differentiate myasthenic crisis from cholinergic crisis by edrophonium

A

MC - improve after giving drug (Infection, stress, UNDERmedication)
CC - worsen (OVERmedication)
“MUCOr”

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16
Q

Autoimmune destruction of nicotinic ACh receptors - proximal muscle weakness, ocular and bulbar symptoms

A

Myasthenia gravis

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17
Q

indirect acting cholinomimetic for the TREATMENT of MG? Also for ogilvie (acute colonic pseudoobstruction)

A

Neostigmine

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18
Q

Neostigmine side effects may be blocked by?

A

Atropine

Cholinergic antag

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19
Q

indirect acting cholinomimetic used for treatment of alzheimer’s?

A

Rivastigmine

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20
Q

Signs and symptoms of organophosphate poisoning?

A

DUMBBELSS (wet patient)

Diarrhea. Urination. Miosis. Bronchospasm. Bradycard. Excitation of CNS. Lacrimation. Salivation. Sweating.

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21
Q

Antidote for organophos poisoning?

A

First choice: Atropine (muscarinic blocker)

Alt: Pralidoxime (regenerate more cholinesterase)

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22
Q

Golden period for giving pralidoxime?

A

6-8 hours

Before aging of organophosphate bond with cholinesterase

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23
Q

Muscarinic cholinergic antagonist for parkinson’s?

TRAP Tremors. Rigidity. Akinesia. Postural changes.

A

Benztropine
PARK your BENZ
Most effective vs Tremors

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24
Muscarinic cholinergic antagonist for asthma and COPD?
Ipratropium Prevent bronchoconstriction!! Less tachycardia and arrhythmia
25
Muscarinic cholinergic antagonist for motion sickness?
Scopolamine - as TD patch
26
Atropine toxicity?
``` Hot as a hare - hyperthermia Dry as a bone - Dec secretions Red as a beet - flushing, due to cutaneous vasodilation Blind as a bat - BOV Mad as a hatter - CNS tox ```
27
Contraindications for cholinergic blockers?
Infants - thermoreg still immature Acute angle closure glaucoma - dec outflow of aqueous humor, worsen iop BPH - worsen urinary retention
28
Nicotinic cholinergic antagonist used for hypertension but is now obsolete? Due to what AE?
Hexamethonium | AE: Massive postural hypotension
29
Example of depolarizing neuromuscular blocker? | Used intraop to produce complete skeletal muscle relaxation.
Succinylcholine | Deposit - Success
30
Sympathetic postganglionic use NE except:
Eccrine sweat glands - M, ACh | Skeletal muscle VD - M3, ACh
31
Blocks tyrosine hydroxylase, block formation of L-Dopa from tyrosine?
Metyrosine
32
Storage of norepi into vesicles blocked by?
Reserpine
33
Inhibit release of NE by blocking VAMP and SNAP? | What enhances release of NE?
Guanethidine inhibits | Amphetamines enhance
34
Inhibit diffusion and reuptake of NE from synaptic cleft?
Cocaine - prolong NE action in cleft | TCA
35
Metabolites of epi and NE?
Epi - metanephrines NE - VMA Urine markers of pheochromocytoma
36
Non selective, direct acting sympathomimetic for cardiac arrest, anaphylaxis and asthma?
Epinephrine | Inc BP, inc HR, bronchodilate
37
Non selective, direct acting sympathomimetic for neurogenic and cardiogenic shock?
Norepinephrine
38
Non selective, direct acting sympathomimetic with renal vessel action for heart failure and shock?
Dopamine
39
Dose dependent action of dopamine
Low dose 1-5: VD renal and splanchnic - D1 receptors Mid dose 5-15: Inc HR, CO, RBF - Beta receptors High dose >15: systemic VC - Alpha receptors
40
Alpha 1 selective sympathomimetic used as decongestant and mydriatic?
Phenylephrine | Causes mydriasis WITHOUT cycloplegia
41
Phenylephrine AE?
Rebound nasal congestion | Hypertension, stroke, MI
42
Alpha 2 selective sympathomimetic for hypertension? Taken sublingually
Clonidine | AE: Dry mouth
43
Significant AE of clonidine if not tapered?
Rebound HPN | Antidote: Phentolamine (nonselective alpha blocker)
44
Alpha 2 selective sympathomimetic used for preeclampsia?
Methyldopa
45
Methyldopa AE?
Hemolytic anemia | Positive coombs test
46
Alpha 2 selective sympathomimetic for glaucoma?
Apraclonidine Dec aqueous humor secretion AE: Dry eyes, BOV
47
Beta 1 selective sympathomimetic for acute HF and cardiogenic shock?
Dobutamine
48
Beta 2 selective sympathomimetic for asthma attacks and tocolysis of preterm labor?
Salbutamol
49
Contraindications for salbutamol?
COPD and heart disease | May precipitate arrhythmias
50
IRREVERSIBLE nonselective alpha adrenergic blocker for preop pheochromocytoma?
Phenoxybenzamine
51
Phenoxybenzamine AE?
Orthostatic hypotension plus reflex tachycardia
52
REVERSIBLE nonselective alpha blocker used as antidote for rebound hypertension caused by clonidine?
Phentolamine
53
Alpha 1 selective adrenergic antagonist for BPH and hypertension?
Prazosin
54
Prazosin AE?
First dose orthostatic hypotension (Give low dose, taken at night) LESS reflex tachy compared to nonselective alpha (phenoxyben and phentol)
55
Beta nonselective adrenergic antagonist for angina, hypertension, arrhythmia, hyperthyroidism?
Propanolol
56
Beta nonselective adrenergic antagonist with combined ALPHA AND BETA blockade for pheochromocytoma?
Labetalol | L-A-BETA-lol
57
Effect of beta nonselective adrenergic antagonist in diabetics?
Mask hypoglycemia symptoms | Tachycardia, tremors, anxiety
58
Used for angina and hypertension in patients with asthma? Due to this property.
Pindolol. Acebutolol. Due to ISA Intrinsic sympa activity Less bronchospasm!
59
Beta blocker with shortest half life? Longest?
Shortest - Esmolol (Small) | Longest - Nadolol (Nasa dolo)
60
Beta 1 selective adrenergic antagonist for angina, hpn, SUPRAVENTRICULAR TACHYCARDIA?
Atenolol | Esmolol

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