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What neurotransmitter is secreted by the preganglionic neuron in the parasympathetic nervous system?
ACh
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What neurotransmitter is secreted by the postganglionic neuron of the parasympathetic nervous system?
ACh
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Which ANS increases heart rate?
Sympathetic
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Which ANS decreases heart rate?
Parasympathetic
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Which ANS dilates the broncioles?
Sympathetic
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Which ANS dilates the pupils?
Sympathetic
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Which ANS conserves energy?
Parasympathetic
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Which ANS empties the bowels and the bladder?
Parasympathetic
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Which ANS constricts the pupils?
Parasympathetic
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Which ANS increases gastric secretion and motility?
Parasympatheric
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What are the three patterns of innervation by the ANS?
- Opposed
- Complementary
- Singular
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What type of receptor is on the postganglionic neuron of the ANS?
Nicotinic N receptors
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What receptor is found on the effector organ of the parasympathetic nervous system?
Muscarinic cholinergic
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What receptor is found on most of the effector organs of the sympathetic nervous system?
Adrenergic
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What are the four adrenergic receptor types?
- Alpha 1
- Alpha 2
- Beta 1
- Beta 2
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Which effector is the exception in the sympathetic nervous system receptors?
Sweat glands (muscarinic cholinergic)
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What organ acts as a postganglionic neuron in the sympathetic nervous system?
Adrenal medulla
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What neurotransmitter is excreted by the adrenal medulla?
Epinephrine
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From what portion of the spinal cord do sympathetic preganglionic neurons originate?
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What cells of the adrenal medulla are innervated by the pregangltionic neuron of the sympathetic nervous system.?
enterochromaffin cells
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What receptors are activated when the adrenal medulla secretes epinephrine into the synapse at an effector organ?
Beta 2
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Which ANS is known as the thoracolumbar nervous system?
Sympathetic
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What receptor is found at the neuromuscular junction?
Nicotinic M
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Which ANS is known as the craniosacral nervous system?
Parasympathetic
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From where do the preganglionic neurons of the parasympathetic nervous system originate?
- Cranial Nerves 3, 7, 9 and 10
- Sacral Spinal Nerves S2 - S4
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Which ANS has a general function that is catabolic?
Sympathetic
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Which ANS has a general function that is anabolic?
Parasympathetic
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What is the nature of the peripheral response in the sympathetic nervous system?
Generalized
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What is the nature of the peripheral response in the parasympathetic nervous system?
localized
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What is the response of alpha 1 receptors to neurotransmitter or agonist?
Constriction of the bladder, arteries and veins
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What is the response of alpha 2 receptors to neurotransmitter or agonist?
Inhibits sympathetic outflow in the CNS
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What is the response of beta 1 receptors to neurotransmitter or agonist?
- Increase in heart rate, speed of conduction and contractility of the heart
- Release of renin by the kindey
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What is the response of beta 2 receptors to neurotransmitter or agonist?
- Dilation of the bronchioles
- Dilation of the arterioles in skeletal muscle
- Relaxation of the uterus
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What is a pressor?
Raises BP
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What class of drugs will increase BP?
Alpha 1 agonists
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What class of drugs are used for urinary retention or hypertension?
- Alpha 1 antagonists
- (block constriction of arteries/veins, block constriction of the bladder)
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What is benign prostatic hypertrophy?
When the prostate becomes enlarged and puts pressure on the urethra, making it hard to urinate.
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What is pheochromacytoma?
A catecholamine producing tumor in the adrenal medulla that produces large amounts of epinephrine and NE causing extremely high BP.
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What can be used to treat pheochromocytoma?
- Alpha 1 antagonist
- and Beta-1 blocker (to lower HR)
(will block constriction of arteries and veins, which will lower BP)
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Adverse effects of alpha-1 blocker
- Orthostatic hypotension (peripheral veins cannot constrict to increase venous return)
- Reflex tachycardia (heart compensates for decreased BP)
- Ejaculation inhibition (alpha-1 receptors cannot produce ejaculation)
- Nasal congestion (vessels in nose are dilated)
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What are three examples of alpha-1 agonists?
Phenylephrine (Neo-synephrine®)
Oxymetazoline (Afrin®)
Pseudoephedrine (Sudafed®)
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What are three examples of Alpha-1 Antagonists?
Prazosin (Minipres®)
Terazosin (Hytrin®)
Doxazosin (Cardura®)
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What is the therapeutic effect of beta 1 agonists?
Increasing heart rate or strength of contraction
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What are two examples of beta 1 agonists?
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What are therapeutic effects of beta 2 agonists?
- Bronchodilation
- Stop preterm labor
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What are three examples of beta-2 agonists?
- albuterol
- terbutaline
- ritrodine
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What are four categories of beta blockers?
- Cardioselective (Beta 1 specific)
- Nonspecific Beta blockers
- Beta blockers with ISA
- Alpha/Beta Blockers
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What is an example of a cardioselective beta blocker?
metoprolol
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What is an example of a Nonselective Beta Blocker?
Propranolol
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Examples of alpha/beta blockers?
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Which class of antagonist drugs are really partial agonists having little effect on resting heart rate or cardiac output?
Beta blockers with ISA
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What are six therapeutic uses for Beta blockers?
•Angina: (Decrease the workload on the heart by lowering HR and contractility)
•Hypertension: (Reduce peripheral vascular resistance)
•Cardiac Dysrrhythmias: (Have been shown to prevent sudden death in post-MI patients)
•Myocardial Infarction: (reduce infarct size and risk of 2nd heart attack/re-infarction).
•Stage fright: (prevent tremulousness)
•Glaucoma: (given topically for this indication)
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Adverse effects of beta 1 blockade
- Bradycardia
- Exacerbation of heart failure, reduced CO
- A/V heart block
- Rebound cardiac excitation if stopped abruptly (leads to MI)
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Adverse effects of beta 2 blocker
- Brochoconstriction
- Hypoglycemia (r/t inhibition of glycogen breakdown)
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What is the effect of ACh on the nicotinic N receptors?
- 1. Transmission of postganglionic neuron in both sympathetic and parasympathetic nervous system?
- 2. release of epinephrine and NE from the adrenal medulla
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What is the effect of ACh on Nicotinic M receptors?
Contraction of the skeletal muscle
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What is the effect of ACh on muscarinic receptors?
- Slowed heart rate and speed of conduction
- Bronchoconstriction and increased secretions
- Bladder contraction
- Increased GI motility and secretions
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What muscarinic agonist is used for glaucoma?
Pilocarpine
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Why are muscarinic agonists not used often?
They have multiple unpleasant effects (SLUDGE)
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What muscarinic agonist is used for urinary retention?
bethanecol (not very often though)
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What muscarinic agonist is used for dry mouth?
Bethanecol (topically)
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What class of drugs are also referred to as anti-cholinergic?
Muscarinic Antagonists
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What are some adverse effects of muscarinic antagonists/anticholinergic drugs?
- Inhibits contraction of bladder (can't pee)
- Dilation of pupils (can't see)
- Decreases GI secretions (can't spit)
- Decreases GI motility (can't sh__)
- Confusion/delirium
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What are some uses for Muscarinic Antagonists?
- Dry up secretions pre-operatively
- Dilate pupils
- Speed up heart or improve heart block
- Anti-diarrheal (not anymore)
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What are some examples of muscarinic antagonists?
Atropine
Scopolamine
Glycopyrolate
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What does SLUDGE stand for?
- salivation
- lacrimation
- urination
- defecation
- GI distress
- emesis
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What causes SLUDGE?
Excess of ACh
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What are the symptoms of cholinergic crises?
- SLUDGE
- CNS depression
- Muscle fasciculation, fatique, spasm
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What can be used to treat cholinergic crisis?
Atropine
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What can atropine be used to treat?
- Cholinergic crisis
- Bradycardia (if parasympathetic stimulation is cause)
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What class of drugs can be used to treat urinary incontinence?
Muscarinic antagonists
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What are two examples of muscarinic antagonists that are marketed to treat incontinence?
Ditropan (oxybutynin)
Detrol (tolterodine)
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How does a non-depolarizing neuromuscular blocker work?
It blocks ACh from binding to the nicotinic M receptor at the NMJ, thereby inhibiting muscle contraction.
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What is an example of a nondepolarizing neuromuscular blocker?
tubocarine
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What is tubocurarine used for?
- Intubation
- Conservation of energy for mechanically ventilated patients
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What is an example of a depolarizing neuromuscular blocker?
Succinylcholine
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Which is easily reversible using acetylcholinesterase inhibitors?
Tubocurarine
Succynylcholine
Tubocurarine
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Reversible acetylcholinesterase inhbitor
Neostigmine
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What class of drugs are irreversible acetylcholinesterase inhibitors?
Nerve Agents
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What is an example of long term use acetylcholinesterase inhibitors?
Treatment of myasthenia gravis or Alzheimers
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What are some examples of acetylcholinesterase inhibitors?
- Neostigmine,
- edrophonium,
- physostigmine,
- pyridostigmine,
- tacrine,
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What are some adverse effects of Neostigmine?
SLUDGE
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What is short term use of Neostigmine or other AChesterase inhibitors
reversal of nondepolarizing neuromuscular blockers
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What are the adverse effects of Nerve Agents?
- Respiratory Arrest
- SLUDGE
- Twitching/convulsing
- Multi-organ involvement
- GI effects
- Coma/stupor
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What is the antidote to Nerve AGents?
- Atropine (stops SLUDGE)
- 2-PAM Chloride (reactivates AChesterase at NMJ for respiration)
- Lorazepam (anticonvulsant)
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What is the mechanism of action for CNS stimulants?
- (1) Increase catecholamine release and (2) inhibit reuptake of catecholamines
- thus increasing concentration of neurotransmitters in synapse.
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What are three common CNS stimulants?
- Methylphenidate
- Methylxanthines
- Theobromine
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What is methylphenidate?
Ritalin
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What is a common methylxanthine?
caffeine
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What is theobromine?
chocolate
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What are the effects of abrubtly discontinuing methylphenidate?
- extreme fatigue
- depression
-
What is the mechanism of action of caffeine?
It is unclear.
*most likely, it is an adenosine receptor antagonist
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