week 4

Question 1

pregnaglionic neurotransmitter for SNS

Answer 1

ACH

Question 2

preganglionic neurotransmitter for PSNS

Answer 2

ACH

Question 3

postganglionic neurotransmitter SNS

Answer 3

NE

Question 4

postganglionic neurotransmitter PSNS

Answer 4

ACH

Question 5

post-ganglionic receptor SNS

Answer 5

adrenergic

Question 6

post-ganglionic receptor PSNS

Answer 6

cholinergic

Question 7

what is acetylcholinesterase

Answer 7

enzyme
lives in synapse
inactivates ACH that’s outside a nerve ending

Question 8

3 types of cholinergic receptors

Answer 8

1) muscarinic receptor
2) nicotinic neural receptor
3) nicotinic muscle receptor

Question 9

where and what target is muscarinic receptor located

Answer 9

PSNS

target the smooth and cardiac muscle

Question 10

where and what target is the nicotinic neural receptor

Answer 10

PSNS and SNS
only at ganglion
target smooth and cardiac muscle

Question 11

where and what target is nicotinic muscle receptors

Answer 11

neuromuscular junction - not part of PNS/SNS

target is skeletal muscle cell

Question 12

2 types of cholinergic drugs

Answer 12

1) indirect

2) direct

Question 13

direct acting, name: action, duration, effects

Answer 13

action: direct muscarinic R agonist
duration: until ACHenzyme degrades
effects: increase GI motility and secretions/vasodilation/increase GU activity/miosis/ decrease BP and HR

Question 14

indirect acting, name: action, duration

Answer 14

action: binds to ACHe, inhibiting action
duration: prolonged post-synaptic ACH concentration

Question 15

types of indirect acting cholinergic drugs

Answer 15

1) reversible inhibitors of ACHe

2) irreversible inhibitors of ACHe

Question 16

duration and primary usage of reversible inhibitors of ACHe

Answer 16

short acting
diagnosis and treatment of myasthenia gravis
Alzheimers

Question 17

duration and primary usage of irreversible inhibitors of ACHe

Answer 17

irreversibly bind to ACHe, causing structural change
long acting
primary: chemical warfare, pesticides
low doses: treatment of glaucoma

Question 18

another name for cholinergic drug

Answer 18

Parasympathomimetic

Question 19

another name for anticholinergic drug

Answer 19

parasympatholytic

Question 20

where do anticholinergic drugs bind

Answer 20

muscarinic receptors

Question 21

action of anticholinergic drugs

Answer 21

competitive antagonism = compete with ACH for R sites

less binding to Receptors = decrease effectiveness

Question 22

anticholinergic MOA on CVS

Answer 22

block vagus nerve action on heart

decrease innervation of the heart: increase SA node firing and increase AV conduction speed

Question 23

anticholinergic MOA on respiratory

Answer 23

recall ACH acts to increase secretions in respiratory track, causes bronchoconstriction at high levels
blockage of ACH used preoperatively (decreases secretions) and for asthma

produces bronchodilation

Question 24

anticholinergic MOA on GI

Answer 24

drugs decrease motility of GI tract (opposite effect of PSNS)
treatment of IBS

Question 25

What is cholinergic toxicity

Answer 25

excess activation of PSNS

Question 26

how does cholinergic toxicity present

Answer 26

nausea and vomitting, sweating, blurred vision, tremors, bradycardia, hypotension, bronchoconstriction

Question 27

what is a cholinergic crisis

Answer 27

very high doses of ACH

Question 28

cholinergic toxicity signs and symptoms

Answer 28

``` DUMBELLS diarrhea and diaphoresis and abdominal cramping urination miosis bradycardia (muscarinic) and tachycardia (nicotinic) emesis (nausea and vomiting) lacrimination (flow of tears) lethargy salivation ```

Question 29

what does atropine do for cholinergic toxicity

Answer 29

anticholinergic competitive antagonist at muscarinic R antidote for organophosphate poisoning/nerve agents

Question 30

what does pralidoxime do for cholinergic toxicity

Answer 30

reactivates ACHe | usually given with atropine for nerve agent poisoning

Question 31

what is anticholinergic toxicity

Answer 31

excessive blockage of PSNS

Question 32

5 manifestations of anticholinergic toxicity

Answer 32

1) dry mouth 2) urinary retention 3) visual disturbance (excessive dilation) 4)constipation 5) flushing skin reaction = inhibit sweating

Question 33

how is anticholinergic toxicity treated

Answer 33

induced vomiting, gastric lavage

Question 34

what 2 ways do peripherally acting skeletal muscle relaxants act?

Answer 34

1) inhibit muscle contraction at NMJ | 2) inhibit muscle contraction within skeletal muscle fibers

Question 35

what 2 ways do centrally acting skeletal muscle relaxants act?

Answer 35

1) block conduction at spinal cord | 2) prevent impulse from reaching muscle

Question 36

when do we need skeletal muscle relaxants?

Answer 36

1) spastic disease ie// MS and CP 2) SC damage - paraplegia 3) painful muscle overexertion 4) surgical procedures

Question 37

non-depolarizing blockers - peripheral muscle relaxants

Answer 37

combine with Nm but do not stimulate | occupy R sites, preventing ACH from triggering reaction (no depolarization)

Question 38

depolarizing blockers- peripheral muscle relaxants

Answer 38

2 step process 1) succinylcholine attaches to Nm, induces depolarization (fasciculation's) 2) succinylcholine alters Nm - cannot respond to endogenous ACH

Question 39

route, onset, duration and adverse effects for peripheral acting muscle receptors

Answer 39

IV, not well absorbed PO typically onset 3-5min duration: 20-30min (succinylcholine much less) adverse effects: paralysis of respiratory muscles

Question 40

adverse effects of succinylcholine

Answer 40

ventricular arrhythmias some people lack the enzyme to metabolize quickly - effects prolonged, risk for malignant hyperthermia increase in temp, acidosis, electrolyte imbalance = high mortality

Question 41

action of direct acting peripheral muscle relaxants

Answer 41

inhibit skeletal muscle fibre contraction by interfering with calcium release

Question 42

name direct acting skeletal muscle relaxant

Answer 42

dantrolene (dantrium)

Question 43

indication for direct acting skeletal muscle relaxant

Answer 43

treatment of malignant hyperthermia, spastic conditions

Question 44

adverse effects of direct acting skeletal muscle relaxant

Answer 44

dizziness, weakness, fatigue, possible hepatotoxicity

Question 45

how do central acting muscle relaxants work

Answer 45

depress reflex impulse condition within spinal cord no effect on Nm R do not alter skeletal muscle fibers

Question 46

MOA for centrally acting muscle relaxants

Answer 46

enhance inhibition - sedate neurons

Question 47

abuse of central muscle relaxants

Answer 47

CNS sedation | high potential for abuse

Question 48

overdose of central acting muscle relaxants

Answer 48

CNS and vital signs depressed

Question 49

antidotes of central muscle relaxants

Answer 49

flumazenil for benzo OD