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RUSVM Pharmacology > Peripheral Nervous System- SNS > Flashcards

Peripheral Nervous System- SNS Flashcards

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1
Q

What adrenergic receptors are most common on vascular smooth muscle

A

A1

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2
Q

What adrenergic receptors are most common in the brain and spinal cord

A

A2

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3
Q

What adrenergic receptors are most common in myocardium

A

B1

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4
Q

What adrenergic receptors are most common in airway smooth muscle

A

B2

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5
Q

What receptors are on smooth muscle of blood vessels, direct vasodilation, and kidney?

A

D1 (dopamine)

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6
Q

What receptors are most common of post-ganglionic sympathetic nerve terminals, glomeruli, renal cortex and renal tubules, adrenal cortex, chemoreceptor trigger zone, and indirect vasodilation?

A

D2 dopamine

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7
Q

What are the direct acting sympathoMIMETICS

A 
*Catecholamines*
Epinephrine 
Norepinephrine 
Isoproterenol 
Dopamine 
Dobutamine
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8
Q

How should catecholamines be administered?

A

By injection
Absorbed from respiratory tract

Poorly absorbed after oral administration-> high first pass effect

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9
Q

Do catecholamines cross the BBB?

A

No

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10
Q

What is the onset and duration of Catecholamines ?

A

Rapid

Emergency use

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11
Q

What are the adverse effects of catecholamines ?

A

Narrow safety margin
Short half life

Predispose myocardium to tachycardia and tachyarrhythmias
Anxiety, restlessness, tremors
Altered perfusion-> direct to “flight tissue”
Extravasation of Norepinephrine or Dopamine can cause tissue damage and sloughing
Cerebral hemorrhange

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12
Q

What adrenergic receptor does epinephrine not have affinity for?

A

Dopamine

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13
Q

What receptor does norepinephrine not have receptor affinity for ?

A

B2 and Dopamine

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14
Q

What receptors does Isoproterneol have affinity for?

A

B1 and B2

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15
Q

What receptors does dopamine have affinity for?

A

Dopamine (low dose)
B1 (med dose)
A1 (high dose)

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16
Q

How is norepinephrine degraded/removed form the nerve endings?

A 
Active uptake (50-80%)
Diffusion 
Destruction 
-MAO= mono-amine oxidase (nerve endings) 
-COMT= catecholamine O-methyl transferease (tissue)
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17
Q

How is norepinephrine / epinephrine removed from the circulation

A

COMT destroy in tissues
Liver
Effects peak 10-30seconds, absent by 1 min

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18
Q

What is the mechanism of action of epinephrine

A

Direct acting catecholamine sympathomimetic

Competitive agonist at all alpha and beta receptors

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19
Q

Epinephrine will cause _________ at the B1 receptors

A

Cardiac contraction

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20
Q

Epinephrine will cause _________ at B2 receptors

A

Bronchodilation and vasodilation

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21
Q

Epinephrine will cause ___________ at a1 receptors

A

Vasocontriction

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22
Q

Epinephrine can be administered by what routes?

A

IV, IM, SQ, inhaled, IO

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23
Q

What are the systemic indications for using Epinephrine?

A
  • *Cardiopulmonary arrest (CPA)
  • *Anaphylaxis
  • *Increase mean arterial pressure by increasing systolic arterial pressure (SAP)

Vasopressor
Positive inotrope

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24
Q

What local effects can epinephrine be used for?

A

Local anesthetic (i.e. Lidocaine) to produce regional vasoconstriction -> delay systemic absorption

Topically to treat local hemorrhage

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25
What are precautions to using epinephrine?
Causes massive sympathetic output -increase myocardial workload and oxygen demand --> increased myocardial oxygen consumption (MvO2) Can result in myocardial ischemia Cardiac arrest is possible
26
What is the MOA of norepinephrine
Direct catecholamine sympathomimetic Mainly through a1 agonism
27
What are the indications for using Norepinephrine ?
Vasopressor support of CV is needed Treat hypotension Eg. Septic shock = sepsis and hypotension leading to refractory volume expansion
28
What is the main clinical effect of using Norepinephrine
Vasocontriction (a1 agonist-> MOST important catecholamine vasopressors) Less of an increase in MvO2 than with epinephrine
29
What re the precautions and contraindications to using Norepinephrine
Cardiac arrhythmias/ tachyarrhythias -> major adverse effect of concern -> used cautiously and with ECG Do not use in hypertensive patients
30
What is the MOA of isoproterenol
Direct acting catecholamine sympathomimetic Potent non specific beta agonist
31
What are the main indications to using isoproterenol
Cardiac stimulators effects -increase coronary, skeletal, renal, and mesenteric blood flow (positive inotropic effect) Bronchodilation
32
What are the contraindications to using isoproterenol
Side effects= tachycardia, anxiety, tremors, and arrhythmias IV infusion must be titrated to effect ECG monitoring and BP monitoring required
33
What is the MOA of dopamine
Direct acting sympathomimetic Dose-dependent effect Dopamine receptors -low dose Beta1 receptors- med dose Alpha1 receptor- high dose
34
A low does of dopamine will have what effect?
Acts on D1 and D2 receptors Dilation of renal, mesenteric, coronary and intracerebral vascular beds
35
A med-low dose of dopamine will have what effects?
Positive inotrope
36
A med-high dopamine dose will have what effects?
Positive chronotrope | Increase cardiac automaticity
37
A high dose of dopamine will have what effect
Vasoconstriction
38
What are the indications to using dopamine
Post-arrest vasopressor of choice Vasopressor support Treat hypotension due to inadequate vascular tone
39
What are precautions and contraindications to using dopamine
``` IV infusion has potential for necrosis Monitor for -tachycardia -tachyarrhythmias -change in BP ``` Contraindicated in hypertensive patients
40
What is the MOA of Dobutamine
Direct acting catecholamine sympathomimetic B1 agonist (Mimi also B2 and a1 agonist and NO dopamine receptor activity)
41
What are the main indications to using dobutamine
Patients requiring inotropic support Treat anesthesia associated hypotension Maintain CO and tissue organ perfusion
42
What are precautions to using dobutamine
Side effect= tachycardia and tachyarrhythias Tachyphylaxis Contraindicated with left atrial rupture or in cases where myocardial integrity is a concern
43
``` Which of the following will result in the least amount of vasodilation ? A. Epinephrine B. Norepinephrine C. Isoproterenol D. Dopamine E. Dobutamine ```
B. Norepinephrine
44
what drugs causes D1 receptor mediated vasodilation at low doses
Dopamine
45
What is the MOA of phenylephrine
Direct acting a1 selective agonist
46
What are the indications to using phenylephrine
Increase peripheral vascular resistance through systemic vasoconstriction Treat hypotension in cats and dogs Vasopressor effects are Short lasting (IV) Control hemorrhange (local/topical use) Mydriatic for open-angle glaucoma
47
What are the precautions and contraindications to using phenylephrine
Renal and GI vasocontriction may be undesirable Chronic use => nasal congestion Contradicted in hypertension
48
What are the non-selective Beta agonists and what are their main indications
Ractopamine and Zilpaterol Increase rate of weight gain, feed efficiency, and Caracas leanness in food animals
49
What agent is primarily used as bronchodilators in treatment of lower airway diseases like asthma and COPD
Selective B2 agonist
50
What are the selective B2 agonists in order of most selective to least selective
Albuterol Terbutaline Clenbuterol
51
What drug would you most likely see some B1 side effects like tachycardia A. Terbutaline B. Albuterol C. Clenbuterol
C. Clenbuterol
52
What are precautions and contraindications to using selective B2 agonists
``` Cardiac stimulation -> tachycardia Uterine relaxation (can cause fetal retention ). ``` Vasodilation Contraindicated in patients with cardiovascular disease
53
What is the drug of choice for treatment of bronchial asthma?
Albuterol
54
Indirect/mixed sympathomimetic are mainly used for their ___________ effects
CNS
55
What is the main drug used for behavior modification and in old dogs for cognitive dysfunction
Selegiline -> monoamine oxidase inhibitor (MAOI)
56
What is the MOA of phenylpropanolamine
Mixed (direct and indirect) sympathomimetic Indirect increase in NE in bladder neck/urethra (primary action) and direct alpha 1 agonist
57
What are the indications to using Pehnylpropanolamine
Urinary incontinence due to urethral sphincter hypotonia/incompetence
58
What drug synergistically works with phenylpropanolamine to increase tension in the urinary spinchter
Estrogens -> upregulate a1 receptors
59
What are the precautions to using phenylpropanolamine
``` Restlessness Urine retention Tachycardia Hypertension Occasionally anorexia ```
60
What is the MOA of ephedrine
Mixed (direct and indirect ) sympathomimetic Indirectly increase NE release and direct a1 and B activation
61
What are the main effects of ephedrine
CRI to maintain BP under anesthesia Increase BP> vasoconstriction and direct cardiac stimulation Bronchodialtion Urinary sphincter contraction-> urinary retention Mydriasis
62
What are precautions of using ephedrine
Hypertension | Arrhythmias
63
What are the direct acting sympatholytics ?
``` Phenoxybenzamine -alpha Prazosin - alpha Propranolol -non selective Beta Atenolol -selective Beta Esmolol -selective Beta ```
64
What is the MOA phenoxybenzamine
Non specific alpha antagonist | -binds irreversibly -> lasts lifetime of receptor (3-4day)
65
What are the indications to use phenoxybenzamine
Treat urinary retention due to urethral hypertonicity Treat pheochromocytoma-> prior to surgery you to treat associated hypertension caused by clamping the vena cava
66
What are the precautions to using penooxybenzamine
Excessive alpha blockage - hypotension - reflex tachycardia - miosis and change in IOP - GI signs
67
What is MOA of propranolol
Non selective B-antagonist Decrease SA firing and AV conduction =>bradycardia and decrease CO Increased airway resistance
68
T/F: Propranolol crosses the BBB
T | Significant first pass effect
69
Indications to using propranolol
Treat tachyarrhythmias - >supraventriclular tachyarrhythmias - >methylxanthine (chocolate) toxicosis Feline hyperthyroidism - >CV effects - arrhythmia and hypertension - >antagonize T4->T3 conversion in peripheral tissue
70
Precautions to using propranolol
Bradycardia, hypotension, brochospasm Receptor desensitization and upregulation Contraindicated with overt heart failure, sinus bradycardia, and heart block (neg inotrope) Contraindicated with bronchospastic lung disease (B2 effect)
71
What are the selective B1 antagonists and what is their effects?
Atenolol -longer half life than propranolol and more selective for B1-receptors Esmolol -ultra short acting (rarely used) Negative inotrope-> bradycardia
72
What is an indirect acting sympatholytic that blocks NE uptake into vesicles. What species is it used in?
Reserpine Used in equine for calming Blocked uptake =. Reduced storage and mediation depletion
73
What drug is used in the treatment of methylxanthine (chocolate) toxicity
Propranolol
74
What drug acts by inhibiting the reuptake of norepi into the presynaptic vesicles?
Reserpine

RUSVM Pharmacology (18 decks)

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