Exam 2 Flashcards
(166 cards)
1
Q
What is the function of the NS?
A
To coordinate and integrate body systems and maintain homeostasis
2
Q
What comprises the CNS?
A
Brain and Spinal cord?
3
Q
What comprises the PNS?
A
Nerves, part of the Somatic and Autonomic NS
4
Q
Autonomic NS fx?
A
Innervates cardiac, smooth muscle and glands.
5
Q
Somatic NS fx?
A
Innervates skeletal muscles (voluntary)
6
Q
ANS is what kind of system?
A
2 neuron system: goes from spinal cord to synapse to another neuron that then goes to cardiac muscle, smooth muscle or glands
7
Q
Where is the site of synapse?
A
Ganglion
8
Q
What is a Ganglion?
A
Collection of nerve cell bodies in the peripheral NS that are located pre-ganglion or post-ganglion
9
Q
Parts of the ANS?
A
Sympathetic and Parasympathetic
10
Q
Sympathetic is also known as what and why?
A
Thoracolumbar division because pre-ganglionic neurons come out of the spinal cord T1-L2
11
Q
Site where pre and post ganglionic neurons synapse in sympathetic response?
A
Ganglionic chain
12
Q
Where is the ganglionic chain located?
A
Close to the spinal cord: pre-ganglionic = short, post-ganglionic = long (innvervate cardiac, smooth muscle and glands
13
Q
What is the ratio of pre to post ganglionic in Sympathetic response?
A
1:20 —> widespread response from sympathetic division
14
Q
Parasympathetic response is also known as what and why?
A
Craniosacral division because pre-ganglionic neurons are bundled with cranial nerves 3,7,9,10 and the other pre-ganglionic neurons comes off spinal cord segments S2,S3,S4.
15
Q
Where do pre and post ganglionic neurons synapse in parasympathetic response?
A
Close to or on an Effector: pre-ganglions are long and post-ganglions are short
16
Q
Ratio of pre to post ganglionic neurons in Parasympathetic response?
A
1:4 –> focused response
17
Q
Dual innervation?
A
When an organ is innervated by both sympathetic and parasympathetic fibers, they antagonize each other. Most organs have dual innevervation.
18
Q
Example of dual innervation?
A
Sympathetic increases HR, Parasympathetic decreases HR.
19
Q
When does the sympathetic and parasympathetic response work together?
A
Male reproductive system: Para = Erection, Symp=Ejaculation
20
Q
What is the net effect of both divisions?
A
To get the level of activity
21
Q
Example of single innervations?
A
Adrenal medulla and blood vessels = sympathetic innervation
Lacrimal glands = parasympathetic innervation
22
Q
Total activity of particular division Sympathetic?
A
Increase Symp = Constriction of BV’s
Decrease Symp = Dilation of BV’s
23
Q
What are the kinds of neurotransmitters released by neurons?
A
- Acetylcholine (Ach)
- Biogenic Amines
- Amino Acids
- Peptides
- Misc. (NO - Nitric oxide, ATP)
24
Q
Biogenic Amines examples?
A
Catecholamines and Indolamines
25
What do Catecholamines release?
Dopamine
Norepinephrine
Epinephrine
26
What do the Indolamines releases?
Histamine
| Serotonin
27
Amino Acid examples?
Glycine
GABA
Glutamate
28
Kinds of Peptides?
Endorphins
Enkephalins
Dynorphins
29
Which neurotransmitters act in the PNS?
Ach, Epinephrine, Norepinephrine, Dopamine
30
Neurons that synthesize and release Ach are called?
Cholinergic neurons
31
Neurons that synthesize and release NE?
Adrenergic Neurons
32
What organ synthesizes and releases Epinephrine and NE?
Adrenal Medulla
33
Dopaminergic neurons synthesize and release?
Dopamine
34
Receptors that bing Ach are called?
Cholinergic receptors
35
Two kinds of Cholinergic receptors?
Muscarinic
| Nicotinic
36
Subtype of Nicotinic receptors?
N1
| N2
37
What kind of receptors are N1 & N2 and where are they found in relation to the synapse?
Excitatory, found Postsynaptic
38
Subtype of Muscarinic receptors?
M1, M2, M3, M4, M5
39
Excitatory/Postsynaptic Muscarinic Receptors?
M1,M3,M5
40
Inhibitory/Postsynaptic Muscarinic receptor?
M2
41
Inhibitory/Presynaptic Muscarinic receptor?
M4
42
Excitatory/Postsynaptic Nicotinic receptors?
N1,N2
43
Adrenergic receptors respond to?
Epinephrine, NE, Dopamine
44
Two kinds of Adrenergic receptors?
Alpha
| Beta
45
Subtypes of Alpha/Beta?
A1,A2
| B1,B2
46
Excitatory/Postsynaptic Alpha receptors?
A1
47
Inhibitory/Presynaptic Alpha receptor?
A2
48
Excitatory/Postsynaptic Beta receptor?
B1
49
Inhibitory/Postsynaptic Beta receptor?
B2
50
Dopaminergic receptor subtypes?
D1,D2
51
Inhibitory/Postsynaptic Dopamine receptor?
D1
52
Inhibitory/Presynaptic Dopamine receptor?
D2
53
Why are Inhibitory/Presynaptic receptors called auto receptors?
Regulate the release of neurotransmitters from M4,A2,D2
54
Where can you find an N2 receptor?
Skeletal muscle
55
Where can you find an M2 receptor?
SA node of heart (hyper polarizes = deceased HR)
56
List Excitatory/Postsynaptic receptors.
```
N1
N2
M1
M3
M5
A1
B1
```
57
List Inhibitory/Presynaptic receptors.
M4,A2,D2
58
List Inhibitory/Postsynaptic receptors.
M2
B1
B2
D1
59
Fate of neurotransmitters?
1. Some diffuse away from synapse
2. Some are broken down by catabolic enzymes
3. some get taken back up by neuron that released them
60
Define Direct Mimicry
When the drug closely resembles in structure the endogenous molecule and it binds to the same receptor (having affinity and intrinsic activity).
61
Example of Direct mimicry drug?
Bethanechol (mimics Ach)
62
Define indirect mimicry?
When the drug increases the amount of neurotransmitters in the synapse, it can be done in 3 ways.
63
What are the three ways indirect mimicry occurs?
1. Drug enhances the release of neurotransmitters from neuron. Ex. Amphetamines ^ release of NE
2. Drug inhibits the catabolic enzymes that break down the neurotransmitter. Ex. Physostigmine (Myasthenia Gravis)
3. Drug blocks the re-uptake of the neurotransmitter. Ex. Cocaine - more NE in synapse
64
Define direct blockade and give example
Antagonist- Inhibits the synthesis of the neurotransmitter. Ex. Hemicholinium inhibits the synthesis of Ach, Atropine blocks cholinergic drug
65
Define indirect blockade and give an example
When a drug inhibits the release of the neurotransmitter. Ex. Botox- inhibits the release of Ach, no muscle contraction
66
Direct Acting Cholinergic Drugs Bind to?
Cholinergic receptors and cause receptor activity
67
What is the response you get from Direct Acting Cholinergic Drugs?
Response mimics those produced by stimulation of the parasympathetic nerve fibers, therefore they're called parasympathetic drugs
68
Characteristics of Ach?
- Lacks selectivity
- Rapidly broken down and makes dosage control difficult
- Used in opthalmology (cataract surgery, rapid miosis)
69
Adverse effects of Acetylcholine?
DUMBBELLS
```
Diarrhea
Urination
Miosis
Bronchoconstriction
Bradycardia
Excitation of Skeletal muscles
Lacrimation
Lots of sweat
Salivation
```
70
What are the therapeutic uses of Bethanechol (urecholine)?
- Urinary retention in post-op and postpartum patients
- Paralytic Ileus
- Abdominal Distention
71
Adverse effects of Bethanechol (urecholine)?
DUMBBELLS
72
Contraindications of Bethanechol?
- Physical obstruction of GI/Urinary tract
- Patients with low BP, low CO
- Patients with asthma
- Patients with hyperthyroidism (can cause cardiac dysrhythmias)
73
Therapeutic uses of Methacholine (Mecholyl)?
- Used for Bronchial Constriction or bronchial challenge test - given to patines believed to have hyperactive airways
- Antidote: Atropine (anti-muscarinic, anticholinergic drug)
74
List the direct acting cholinergic drugs
- Acetylcholine
- Bethanechol (urecholine)
- Methacholine
75
Types of indirect acting cholinergic drugs?
- Reversible
| - Irriversible
76
List the indirect acting cholinergic reversible drugs?
- Edrophonium (Tensilon)
- Pyridostigmine (Mestinon)
- Neostigmine (Prostigmin)
- Physostigmine (Antilium)
77
Action of Indirect acting drugs?
- Inhibits the enzyme Acetylcholinesterase, which is responsible for the hydrolysis of Acetylcholine; therefore, the response to Ach is enhanced
78
List the indirect acting cholinergic Irreversible drugs
- Echothiophate (Phospholine iodide)
- Malathion, Parathion, Diazinon
- Sarin, Soman
79
What is Edrophonium used for?
- To diagnose Myasthenia Gravis
| - Short duration of action of 5-15mins
80
What can happen if Edrophonium is given to someone without Myasthenia Gravis?
It can cause Ach concentration toxicity and cause cholinergic crisis - have Atropine on hand
81
What is Pyrodistigmine used for?
- To treat myasthenia gravis
| - Long lasting 3-6 Hours duration
82
What is Neostigmine used for?
- Tx of myasthenia gravis
- Tx of OD of a non-depolarizing neuromuscular blocker
- Short duration of action 2-4hrs
83
What is Physostigmine used for?
- Antidote for : - Atropine OD, Phenothiazine (antipsychotic OD), Tricyclic antidepressant OD
- Its a tertiary amine (non-charged) that can get into the CNS
84
Action of Indirect acting cholinergic irreversible drugs?
- Inhibits action of Acetylcholinesterase
| - Drug will work for a long time (1wk), long enough to re-synthesize enzyme
85
What is Ecothiophate used for?
Used clinically for opthalmology, with glaucoma
86
What are Malathion, Parathion, Diazinon used for?
Insecticides
87
What are Sarin and Soman used for?
- Chemical Warfare
- In soldiers Pralidoxime (PAM) is given to soldiers exposed to these drugs, but it must be given before AGING occurs making it irreversible.
88
Action of Cholinergic Antagonists?
Bind to cholinergic receptors, doesn't activate the receptor it blocks action of Acetylcholine
89
Types of Cholinergic Antagonist drugs?
- Antimuscarinic Drugs
- Ganglionic Blockers
- Neuromuscular Blocking Agents
90
Action of Antimuscarinic Drugs?
Selectively block muscarinic receptors of the parasympathetic division of the ANS and the muscarinic receptors of the sweat glands.
91
List Antimuscarinic drugs
- Atropine
- Scopolamine
- Overactive Bladder Drugs
- Quartenary Amine derivatives
92
Physiological Actions of Atropine?
[] Eye - Mydriasis
Prevents accommodation (Cycloplegia)
[] GI/Urinary Tract - Decreased motility
[] Heart - Increased HR
[] Secretions - decreased sweating, salivation, tearing, dry mouth (Xerostomia)
[] CNS - Mild excitation of CNS
93
Therapeutic uses if Atropine?
- Fundal observation of back of eye
- GI/Urinary tract antispasmatic (enuresis, cystitis [inflammation of the bladder])
- Pre-op antisecretory agent
- Pre-op vagolytic agent (inhibits the action of the vagus nerve to prevent decrease of heart rate
- Antidote for cholinergic poisoning
94
Adverse effects of Atropine?
- Dry mouth
- Blurred vision
- Photophobia
- Elevation of intraocular pressure
- Constipation
- Urinary retention
- Hyperthermia
- Tachycardia
95
Contraindications of Atropine?
- Glaucoma
- Paralytic ileus
- Urinary Retention
- Tachycardia
- Asthma (causes mucus plus that block passage of air)
96
How can you prevent mucus plugs from forming?
Giving Atrovent
97
Physiological Actions of Scopolamine?
[] Eye - Mydriasis
Prevents accommodation (Cycloplegia)
[] GI/Urinary Tract - Decreased motility
[] Heart - Increased HR
[] Secretions - decreased sweating, salivation, tearing, dry mouth (Xerostomia)
[] CNS - Sedation
[] Blocks emesis
[] used in obstetrics causes mild amnesia
98
Where in the body can you find M1,M2,M3 receptors?
M1 - CNS & Salivary glands
M2 - HEART
M3 - Salivary glands, detrusor muscle, GI tract
99
Name the drugs used for Overactive Bladder
- Darifenacin (Enablex)
- Oxybutynin (Ditropan)
- Solifenacin (VESIcare)
100
Used of overactive bladder drugs?
Urge incontinence
101
Sx's of Overactive Bladder?
Urinary urgency
Frequency
Nocturia
Urge Incontinence
102
Which overactive bladder drugs are primarily M3 selective?
Oxybutynin (Ditropan) & Solifenacin (VESIcare)
103
Which overactive bladder drug is highly M3 selective?
Darifenacin (Enablex)
104
Action of Ganglionic Blockers (Antagonists)?
Act on nicotinic receptors blocking autonomic ganglia of both the parasympathetic and sympathetic divisions of the ANS
105
List the Ganglionic Blockers?
Nicotine
| Mecamylamine (Inversine)
106
Physiologic actions of Nicotine?
- At low doses like in cigarettes no blockade rather it stimulates blood vessel innervations which increases BP, and GI/urinary motility.
- At high doses theres ganglionic blockade which decreases BP, and decreases GI/Urinary tract motility.
Ex. Chantix releases low doses of Dopamine
107
What is Mecamylamine used for?
Emergencies: it lowers BP when other methods have failed
108
Action of Neuromuscular Blocking Agents?
- Central acting muscle relaxant.
Ex. Diazepam enhances actions of GABA which is an inhibitory neurotransmitter
- Peripheral acting muscle relaxant.
a. Intracellular: Ex. Dantrolene inhibits the release of CA+ from the sarcoplasmic reticulum
b. Extracellular - nondepolarization, depolarization
109
Types of Neuromuscular Blocking Agents?
1. Nondepolarizing
| 2. Depolarizing (Agonists)
110
List Nondepolarizing Neuromuscular Blocking Agents
1. Tubocurarine
| 2. Cisatracurium (Nimbex)
111
Tubocurarine is what kind of antagonist?
Competitive
112
Tubocurarine binds to which receptor and what does it do and release?
N2 receptor, does not activate it and blocks actions of Ach and releases histamine and drops BP.
113
Order of Tubocurarine effects on body?
```
First = Facial muscles, eyes, fingers
Then = Muscles of limbs, neck, trunk, intercostals
Last = Diaphragm
```
114
Therapeutic use of Tubocurarine?
- Electric shock therapy
- Seizures
- Adjunct to a general anesthetic
- Patients on a mechanical ventilator
115
Adverse effects of Tubocurarine?
Bronchoconstriction
| Hypotension
116
Contraindications of Tubocurarine?
Any disorder that causes muscle weakness
117
Cisatracurium facts
- Doesn't release histamine
| - Don't give to patients who have trouble contracting muscles
118
List Depolarizing (Agonist) drug
1. Succinylcholine
119
Two phases that Succinylcholine works in?
Phase 1: Initial depolarization > muscle contracts (fasciculations), muscle stays in depolarized state flaccid paralysis occurs
Phase 2: Desensitization (muscles become desensitized to drug). > For short surgical procedures because it has a short duration of action a few minutes (3-6) because its broken down by pseudocholinesterase.
> Some people don't have pseudocholinesterase in their blood and can cause Apnea and respiratory paralysis.
> To prevent this blood is tested by adding Dibucaine to it which temporarily inhibits pseudocholinesterase. (A little Dibucaine (20) needed patient is not at risk, is a lot (80) is needed patient is at risk)
120
Adverse effects of Succinylcholine?
Malignant hyperthermia > temp increases
Post-op muscle pain
Hyperkalemia > Cardiac Arrest (patients with major burns, multiple trauma their K levels are already elevated)
121
Define Adrenergic Agonists
Drugs that mimic the actions of NE and E at adrenergic receptors (Sympathomimetic)
122
Classes of Adrenergic Agonists?
Catecholamines
| Non-Catecholamines
123
Define Catecholamines
Drugs that have the same basic chemical formula, but because of their biochemical properties they cannot be used orally, cross the blood-brain barrier, and have short 1/2 lives (rapid inactivation by MAO and COMPT)
124
List the Catecholamines
1. Epinephrine (Adrenalin)
2. Dopamine (Intropin) - NATURAL
3. Isoproterenol (Isuprel) - SYNTHETIC
4. Norepinephrine (Levphed) - NATURAL
5. Dobutamine (Dobutrex) - SYNTHETIC
1-5 > All Direct-acting
125
Define Non-Catecholamines
Drugs that are structurally similar to catecholamines but differ in 3 ways: 1. Usable orally
2. Can cross blood brain barrier
3. Longer 1/2 lives (not rapidly absorbed by MAO & COMT)
126
Types of Non-catecholamines
1. Regular non-catecholamines
2. Resorcinols
3. Saligenins
127
List Regular non-catecholamines
1. Ephedrine (Pretz-D) > Direct & Indirect Acting
2. Pseudoephedrine (Sudafed) > Direct Acting
3. Phenylephrine (Neosynephrine) > Direct Acting
128
List Resorcinols non-catecholamines
1. Terbutaline (Brethine) > Direct Acting
| 2. Metaproterenol (Alupent) > Direct Acting
129
What is Terbutaline used for?
Bronchodilation/Asthma
130
List Saligenins non-catecholamines
1. Albuterol
2. Pirbuterol (Maxair)
3. Levalbuterol (Xopenex)
4. Salmeterol (Serevent)
5. Formoterol (Foradil)
1-5 > All Direct Acting
* More B2 specific with less cardiac excitation than Terbutaline
131
How do Amphetamines work?
Act indirect in the CNS
132
Tyramine is found where?
Fermented foods (ripe cheese, wine)
133
Therapeutic uses of Drug that stimulate A1 activation?
- Hemostasis (stops bleeding, like in surgery)
- Nasal Decongestant (BV's in nose are dilated so it constricts the BV's)
- Adjunct to a local anesthetic
- Elevates BP
- Mydriasis (to look at fundus of eye)
134
Adverse effects of A1 activation?
- HTN
- Necrosis
- Bradycardia
135
Therapeutic use for A2 activation?
- no clinical use in the peripheral system
| - in CNS to lower BP: decreases sympathetic outflow to the heart and BV's decreasing BP
136
Therapeutic uses for B1 activation?
- Cardiac arrest
- Heart failure
- Increased myocardial contractility
- Shock (increased CO > improved BP)
- AV heart block (improves impulse conduction through the heart)
137
Adverse effects of B1 activation?
- altered heart rate and rhythm
| - angina pectoris (reduced blood flow)
138
Therapeutic use for B2 activation?
- asthma
| - to delay pre-term labor
139
Adverse effect for B2 activation?
- hyperglycemia (mostly in diabetics)
- tremor (start with low doses)
* patients with asthma and diabetes increase insulin if given B2 stimulants
140
Therapeutic uses for Dopamine activation?
- Shock (works on A1>vasoconstrictor, on B1>increased HR, myocardial contraction
141
Types of Adrenergic Antagonists?
1. Alpha Blockers
| 2. Beta Blockers
142
Action of Alpha Blockers?
Interrupt the action of E and NE at Alpha-Adrenergic Receptors
143
List A1 Blockers
1. Prazosin (Minipress)
2. Terazosin (Hytrin
3. Doxazosin (Cardura)
4. Tamsulosin (Flomax)
5. Alfuzosin (Uroxatral)
144
List A1 and A2 Blockers
1. Phentolamine (Regitine)
| 2. Phenoxybenzamine (Dibenzyline) > also noncompetitive antagonist
145
Therapeutic uses of A1 Blockers?
- Tx of patients with essential HTN (aka idiopathic aka primary HTN) 90-95% have this
- Reverse toxicity of Alpha agonist
- Benign prostatic hyperplasia
- Pheochromocytoma
- Raynaud's disease
146
Define benign prostatic hyperplasia
In this condition theres an increased number of cells in the prostate that puts pressure on the urethra which makes it difficult to urinate, alpha blockers helps by relaxing the sphincter.
147
Define Pheochromocytoma
A tumor often found on the adrenal medulla, secreted by catecholamines derived from cells of the sympathetic system. This disease causes Hypertensive emergencies. Tumor can be removed surgically.
148
Define Raynaud's disease
A peripheral vascular disorder characterized by vessel spasm (blood vessel narrowing) in fingers, toes, nose resulting in pain, cold due to no blood flow, change in color of skin.
149
Adverse effects of A1 Blockers?
1. Orthostatic Hypotension
2. Reflex tachycardia ( body tried to compensate for the decreased BP by trying to increase it)
3. Nasal congestion
4. Inhibition of ejaculation which is a sympathetic response (only while on drug)
5. Sodium retention and increased blood volume (prescribe diuretics with A1 blockers)
150
Adverse effect of A2 blockers?
Potentiation of reflex tachycardia
151
Action of Beta Blockers?
Interrupt the action of E & NE at beta-adrenergic receptors
152
Types of Beta Blockers?
1. Cardioselective B1 Blockers
| 2. Nonselective Beta Blockers
153
List the Cardioselective B1 blockers
1. Metropolol (Lopressor, Toprol XL)
2. Acebutolol (Sectral)
3. Atenolol (Tenormin)
4. Esmolol (Brevibloc)
154
List the Nonselective Beta Blockers
1. Propranolol (Inderal, Inno Pran XL)
2. Labetolol (Normodyne) > blocks A1 adrenergic receptors in addition to beta receptors
3. Carvedilol (Coreg) > blocks A1 adrenergic receptors also
4. Nadolol (Corgard)
5. Pindolol (Visken) > Intrinsic Sympathetic Activity
6. Sotalol (Betapace)
7. Timolol (Blocadren)
155
Therapeutic effects of Beta Blockers?
- Angina pectoris (decreased myocardial contractility)
- HTN
- Cardiac Dysrhythmias (suppress impulses in the heart)
- Myocardial infarction (decreased work load, increased blood flow, O2 supply in the myocardium)
- Heart Failure
- Hyperthyroidism
- Migraine Headaches
- Stage Fright
- Pheochromocytoma
- Glaucoma (B1 blockers decrease production of aqueous humor resulting in decreased intraocular pressure)
156
Adverse effects of B1 blockers?
- bradycardia
- reduced CO
- heart failure
- AV heart block
- rebound cardiac excitation
157
Adverse effects of B2 blockers?
- bronchoconstriction
| - inhibition of glycogenolysis
158
Indirect-Acting Adrenergic Drug types?
1. Adrenergic Neuron-Blocking Agents
| 2. Central-Acting Alpha-2 Agonists
159
Adrenergic Neuron-Blocking Agent drugs?
1. Reserpine
| 2. Guanethidine (Ismelin)
160
Central-Acting Alpha-2 Agonist drugs?
1. Clonidine
| 2. Methyldopa
161
MOC of Reserpine?
Blocks reuptake of Dopamine into synaptic vesicle so it gets broken down by MAO & NE isn't released and won't act on receptor
162
What do Reserpine & Guanethidine Tx?
HTN
163
Action of Guanethidine
Inhibits the release of NE
164
Action of Clonidine?
Acts on A2 receptors in the CNS, it inhibits sympathetic outflow through BV's & heart.
Tx - HTN
165
Action of Methyldopa?
1. Acts on A2 receptors in the CNS, it inhibits sympathetic outflow through BV's & heart.
2. Neurons of the brain stem take up Methyldopa and convert it into methylnorepinephrine and works on A2 receptors
Tx - HTN
166
Adverse effects of Methyldopa?
+ Coombs test = antibodies form against patients own blood (hemolytic anemia)
