Dr. Diaz Test 2

Front 1

regulation of biological process

Back 1

1. hormones

2. nt

3. histamine prostaglandins

Front 2

Brain and Spinal Cord

Back 2

CNS, incased in bondy strucutre

Front 3

Peripheral

Back 3

that comes out from CNS nerves (what extends from the brain)

Front 4

Cranial nerve, optic nerve, vagus nerve

Back 4

controll all function of body while at rest

Front 5

peripheray

Back 5

afferent sensory ex: posture, , unconsicioulsy sending signals from outside to inside

Front 6

afferent neurons

Back 6

sensory

Front 7

efferent neurons

Back 7

motor

Front 8

autonomic nerrvous system

Back 8

homeostasis

1. parasympathetic

2. sympathetic

3. enteric

Front 9

somatic nervous system

Back 9

skeletal muscle

Front 10

sympathetic

Back 10

anatomically designed to produce widespread physiological activity

thoraco-lumbar division

Front 11

parasympathetic

Back 11

anatomically designed to produce response on an organ basis

cranio-sacral divisoin

Front 12

nt 2

Back 12

sympathetic neuron= norepinephrine

cholinergic neuron= acetylcholine

Front 13

neurotransmission

Back 13

1. preganglionic synapse

2. postganglionic synapse

3. somatic motor end plates

Front 14

norepinephrine

Back 14

sympathetic,

adrenaline, produced by adrenal gland

WIDE SPREAD EFFECT

Front 15

acetylcholin

Back 15

cholinergic neuron, stimulate skeletal muscle tissue, targets motors

Front 16

receptors

Back 16

1.coupled to ion channels

2. coupled to adenyly cyclase

3. coupled to diaclyglycerol

Front 17

indirectt

Back 17

hormones like ADH, bind as surface receptor and secondary messenger regulate vasopressins

Front 18

innervation

Back 18

most visceral organs receive dual innervation

both working in opposition (balanced) the one exerting the greater function will prevail

Front 19

specific effects of blood vessels:

Back 19

innervated by sympathetic, maintains smooth muscle tone

Front 20

innervation specific effects: heart and cardiovascular reflex

Back 20

2- Heart
Sympathetic system
Positive chronotropic (heart rate)
Positive inotropic (force of contraction)
Positive dromotropic (conductivity)
Parasympathetic system
Negative inotropic
Negative dronotropic
3- Cardiovascular reflex
Mainly due to stretch receptors (carotid body) effects on cardiovsacular center at Medulla oblongata

Front 21

innervation specific effects: eye

Back 21

4- Eye
Pupil
Lens)
Sympathetic system (mydriasis)
Dilator pupillae (radial fibers)

Parasympatheic system (miosis)
Constrictor pupillae (circular fibers
At rest the suspensory ligaments of cilliary body exerts tension flattening the lens
Under parasympathetic stimuli the cilliary body contracts decreasing tension on the lens thickening the lens due to elasticity accommodating for near vision

Front 22

innervation specific effects: lung and GI tract

Back 22

5- Lung
Bronchial tree is dually innervated
Sympathetic system
Bronchodilation
Parasympatehtic system
Bronchoconstriction
6- Gastrointestinal tract
Dual effects but act on local neural regulators
Enkephalins
Substance P
Vasoactive intestinal peptide

Front 23

innervation specific effects: salivary glands and adrenal medulla

Back 23

7- Salivary glands
Dual stimulation produce secretion with different characteristics
Sympathetic stimuli
Thick and mucinous
Parasympathetic stimuli
Watery
8- Adrenal medulla
Behaves as a sympathetic ganglion producing primarily epinephrine, then norerpinephrine

Front 24

chemical synapses

Back 24

1. one way transmission

2. promotes a response in post-synaptic target

Front 25

cholingeric neuron

Back 25

actylcholine

produced by modification of acetylco-A Krebs cycle

Front 26

muscarinic receptors

Back 26

wider effects than acetylcholine,

have mild nicotine rxns

Front 27

nicotinic receptors

Back 27

stronger response to nicotine than acetylcholine

have mild effect to muscarine

Front 28

adrenergic neuron

Back 28

tyrosine is the building block for pigment of skin, IS RATE LIMITING STEP

Dopamine- is nt in brain, regulates and counteracts balance of brain

parkinson's disease: lose dopa, lose control over skeletal muscle tissue

Dopamine make norepinephrine

Front 29

presynaptic cleft

Back 29

3 outcomes:

1. binding to post syn receptor

2. catabolism of excess inside cleft by COMT and MAO

3. may be recycled back to presynaptic neuron

Front 30

adrenrergic drugs

Back 30

adrenergic neuron

release norepinephrine in CNS

drugs act on receptors stimulated by:

epinephrine and norepinephrine

Front 31

biotransformation

Back 31

COMT

MAO

enzymes that degrade excess in synaptic cleft MAO (metanphrine and VMA) measured in urine

Front 32

adrenergic receptors alpha

Back 32

have higher affinity for epinephrine

Front 33

adrenergic receptors beta

Back 33

have stronger affinity for isoproternol (synthetic) will not be destroyed

Front 34

alpha 1 adrenoreceptor

Back 34

vasoconstriction

increase peripheral resistance

increased blood pressure

mydriasis

increased closure of internal urinary bladder sphincter

Front 35

alpha 2 adrenoreceptor

Back 35

inhibition of norepinphrine rlease

inhibition of insulin release

Front 36

beta 1 adrenoreceptor

Back 36

tachycardia

increased myocardial contractility

increased lipolysis

Front 37

beta 2 adrenoreceptor

Back 37

vasodilation

slight decrease in peripheral resistance

bronchodilation

increased glycogenolysis (liver and muscle)

increased glucagon release

relaxation of uterine smooth muscle

Front 38

adrenergic receptor desensitization

Back 38

prolonged exposure to catecholamines reduces responsiveness of receptor

receptor sequestration (less # of receptors on surface)

down regulation (respond with lesser strength, but same # of receptors on surface, receptors are LESS SENSITIVE)

inability to couple w protein G

Front 39

adrenergic agonists

Back 39

drugs used to replace normal endogenous compound, drugs that mimic resemble in outcome of normal nt

Front 40

adrenergic agonist

Back 40

either indirect

direct

mixed action

Front 41

direct acting adrenergic agonists

Back 41

as a group are widely used catecholamines

Front 42

catecholamines

Back 42

high potency

rapid inactivation

MAO & COMT

Poor penetration into CNS

Front 43

Catecholamines Naturally Occuring

Back 43

epinephrine

norepinephrine

dopamine

Front 44

Catecholamines synthetic compounds

Back 44

dobutamine

isoproterenol

Front 45

indirect acting adrenergic agents

Back 45

As a group causes release of norepinephrine from presynaptic terminals
Amphetamines (“ups’ ”)
central stimulation
(A) & (B)
 Blood pressure and heart rate
Tyramine
Not a clinically useful drug found in cheese and Chianti wine

Cocaine

Front 46

cocaine

Back 46

local anesthetic that blocks Na/K pump required for reuptake of norepinephrine enhancing its sympathetic activity--> so too much nt in synaptic cleft

Front 47

mixed-action adrenergic agents

Back 47

induce norepinephrine release from presynaptic terminals and activate receptors in postsynaptic membranes

Front 48

mixed action adrenergic agents 2

Back 48

ephedrine

enhance contractility and improve motor function in Myasthenia gravis

metaraminol

alternative drug for shock treatment, may be used to treat acute hypotenstion

Front 49

adrenerrgic agonists side effects: 6

Back 49

arrhtythmias

headache

hyperactivity

insomnia

nausea

tremors

Front 50

epinephrine

Back 50

interacts with alpha and beta receptors

Front 51

epinephrine low and high dose

Back 51

low dose- beta receptor activity predominates (vasodilation)

high dose- alpha receptor predominates (vasoconstrictor)

Front 52

actions

Back 52

ACTIONS

Cardiovascular system

(+) inotropic and chronotropic (B1)
peripheral vasoconstriction with decrease renal blood flow (A)
dilation of hepatic and muscle vasculature (B2)

Front 53

actions

Back 53

Respiratory system
Bronchodilation (B2).

Hyperglycemia
Glycogenolysis (B2)
decrease Insulin (A2)

Lypolysis (B)

Front 54

therapeutic use

Back 54

Thearpeutic use

Bronchospasm (SC)
Anaphylactic shock
Type I hypersensitivity reactions
(Anaphylaxis)

Glaucoma open angle (2% sol)
decrease intraocular pressure

Anesthetics
increase duration of local anesthetics due to vasoconstiction

Front 55

pharmacokinetics

Back 55

Pharmacokinetics
rapid onset but brief duration: IV, SC, endotracheal tube
orally ineffective
metabolites excreted in urine (metanephrine & VMA)
Adverse effects
CNS disturbances
Intracerebral hemorrhage
cardiac arrythmias (digitalis)
pulmonary edema
Interactions
hyprethyroidism
cocaine

Front 56

norepinephrine

Back 56

affects mostly alpha receptors

actions: cardiovascular

vasoconstriction

baroreceptor reflex

atropine preteratment

if given after atropin it will cause tachycardia

Front 57

therapeutic use for norepinephrine

Back 57

shock (levarterenol)

dopamine is better because it doesn't decrease renal blood flow

Front 58

isoproterenol

Back 58

stimulates b1 and b2

actions:

cardiovascular

(+) inotropic (+) chronotropic

decrease peripheral resistance

pulmonar

bronchodilation

Front 59

isopreterenol therapeutic use

Back 59

asthma

heart block or cardiac arrest

pharmacokinetics

absorbed systemically by sublingual or aerosols

Front 60

dopamine

Back 60

activates a and b receptors

in addition D1 and D2 (mesenteric and renal beds)
Actions
cardiovascular (B1)
(+) inotropic (+)chronotropic
vasoconstriction (A)
renal and visceral
dilation of renal and splachnic beds
Therapeutic use
Shock (DRUG OF CHOICE)
adverse effects
short lived arrhythmias and nausea

Front 61

other direct acting agents

Back 61

1- Fenlodopan (D1 and A2)
Rapid vasodilation for severe hypertension in hospitalized patients.

2- Dobutamine (B1)
Use in congestive heart failure to  C.O.

Front 62

other direct acting agents

Back 62

3- Phenylephrine (A1)

4- Oxymetazoline
Use as nasal decongestant
Mydriasis

5- Methoxamine (A1 > A2)
Overcome hypotension during anesthesia with halothane

6- Clonidine (A2)
Essential hypertension due to CNS action
(diminish central adrenergic outflow)

Front 63

Fenlodopan

other direct acting agent

Back 63

D1 and A2

dopamine agent, which may be implied in hypertension pts that are hospitalized, can increase profusion

Front 64

Dobutamine

Back 64

b1 agonist

synthetic agent used to improve cardiac activity in heart failure

Front 65

phenylephrine

Back 65

A1, vasoconstriction, reduces histamine release

Front 66

oxymetazoline

Back 66

nasomucousa,

reducing glucosecretions, watery dischage (reduce the discharge), mydriasis, topically

Front 67

methoxamine

Back 67

A1>A2

parernterally, works by modulating the vasculature, smooth muscle contraction

Front 68

Clonidine

Back 68

A2

HYPERTENSIVE AGENT, slows down function of heart pump, vasodilation

Front 69

b2 agonist are employed for asthma aerosols for b2 rescue agent

Back 69

have effects produce smooth muscle

Front 70

metaproterenol

albuterol, pributerol,

salmetrol, formetrol

-----------

Terbutaline

Back 70

used for bronchodilation

--------

bronchodilator, decreases uterine contractions in premature labor

Front 71

rescue agents bc

Back 71

immediate

Front 72

alpha adrenergic blockers

Back 72

decrease sympathetic tone of blood vessels

decrease peripheral vascular resistance with reflex tachycardia

Front 73

as a group act as equilibrium competitors

3 families

compete in supply and demand

commonly employed for hypertension

begins with first making diagnosis from increased blood pressure 130/90

Back 73

1. haloalkylamines

2. imidazolines

3. quinazolines

Front 74

first step in hypertension

Back 74

weightloss, second step is drug

Front 75

equilibrium competitors

haloalkylamine

Back 75

phenoxybenzamine

(Dibenzyline)

Front 76

equilibrium competitors

Imidazolines

Back 76

phentolamine (Regitine)

Front 77

Equilibrium competitors

Quinazolines

Back 77

prazosin (Minipress®)
yohimbine (Yocon ®)
terazosin (Hytrin ®)
doxazosin (Cardura ®)
tamsulosin (Flomax ®)
afluzosin (Uroxatal ®)

Front 78

phenoxybenzamine

Back 78

Phenoxybenzamine
Irreversible and noncompetitive block overcome by synthesis of new receptors.
Used in treatment of pheochromocytoma prior to surgery.
Associated with postural hypotension

Front 79

phentolamine

Back 79

Phentolamine
(Only used for diagnosis of pheochromocytoma)
Competitive blocker (duration of 4 hrs.)

Front 80

Quinazolines

Prazosin, terazosin and doxazosin

Back 80

(Post synaptic alpha 1 receptors blockers)
used as antihypertensive agents (first dose effect) ( VASO – VAGAL reflex)

Front 81

w 3 families halo, imi, quin side effects

Back 81

hypotension, tachycardia, vertigo, sexual dysfunction

Front 82

drugs affecting nt release or uptake

Back 82

Reserpine

Guanethidine

Front 83

Reserpine

Back 83

Reserpine (Serprasil ®)
Blocks transport and storage of biogenic amines causing depletion of norepinephrine.

Front 84

Guanethidine

Back 84

(Ismelin®)
Blocks release of storage norepinephrine

Front 85

alpha and beta antagonist

Back 85

Alpha and Beta antagonist

Reversible Beta blockers with concurrent Alpha blocking
Labetolol
Carvelidol

Front 86

beta blockers

Back 86

Propranolo

Nadolol

Timolol

Acebutolol

Atenolol

Esmolol

Metaprolol

Carvelidol

Labetalol

Front 87

B1 and B2 blockers

Back 87

Propranolol

Nadolol

Timolol

Front 88

B1 Selective ***ISA***

Back 88

Acebutolol

Atenolol

Esmolol

Metaprolol

Front 89

ISA

Back 89

Intrinsic sympathetic activity (binds to receptor, but effect has lower strength)

Front 90

A1, B1, B2

Back 90

Carvelidol

Labetalol

Front 91

Selective

Back 91

Acebutolol

Atenolol

Esmolol

Metaprolol

Front 92

Non-selective

Back 92

Propranolol

Nadolol

Timolol

Carvelidol

Labetalol

Front 93

What happens w insulin secretion?

Back 93

beta blockers, beta cells create insulin, may decrease production from pancreas, don't take into consideration

Front 94

Clinical Use

Back 94

CLINICAL USE
Arrythmia prophylaxis after a myocardial infaction
propranolol, metropolol and timolol reduce cardiac output and renin secretion.

Supraventricular tachycardias
propranolol, esmolol and acebutolol slow AV conduction velocity.

Front 95

Clinical Use

Back 95

Angina pectoris
propranolol nadolol and other B blockers reduce heart rate and force of contraction
Hypertension
propranolol, metropolol, timolol and other B blockers reduce cardiac output and renin secretion.
Glaucoma
timolol and other B blockers reduce secretion of aqueous humor.

Front 96

Clinical Use

Back 96

Migrane
propranolo provides prophylactic effect.

Thyrotoxicosis
propranolol reduces cardiac rate and potential for arrythmias

Front 97

Side effects w beta blockers

Back 97

arrhythmias,

bronchoconstriction

sexual dysfunction

Front 98

Regulation of Biological Process

Back 98

Hormones, Neurotransmitters, Histamine (prostaglandins)inn

Front 99

innveration

Back 99

blood vessels, heart, cardiovascular, eye, lung, GI tract, Salivary Glands, Adrenal Medulla

Front 100

Cholinergic neuron uses what for a nt?

Back 100

acetylcholin

Front 101

name the 2 receptors of a cholinergic neuron

Back 101

muscarinic and nicotinic

Front 102

adrenergic neuron uses what for nt's?

Back 102

epinephrine and dopamine

Front 103

CNS

Back 103

is composed of brain and spinal cored

Front 104

PNS

Back 104

neurons located outside spinal cord

Front 105

efferent division

Back 105

EXIT- carry info (signals) AWAY from brain and spinal cord

Front 106

afferent

Back 106

bring information from PNS to CNS

Front 107

efferent division divided into

Back 107

somatic and autonomic

Front 108

autonomic divided into

Back 108

para

symp

enteric (endocrine and exocrine), GI tract

Front 109

sympathetic region

Back 109

thoracic and lumbar

Front 110

parasympathetic region

Back 110

cranium and sacral areas

Front 111

effects of stimulation from sympathetic

Back 111

flight or fight

increase heart rate, dilation of pupils and bronchioles

increase blood pressure

Front 112

effects of stimulation from sympathetic

Back 112

adrenal medulla release epinephrine and less neorephinephrine

Front 113

parasympathetic

Back 113

opposes sympathetic, and dominates over "rest and digest"

TO SPECIFIC ORGANS

Front 114

Hypothalmus, medulla oblongata, and spinal cord

Back 114

respond to stimuli by sending out efferent reflex impulses via autonomic nervous system

Front 115

emotion: rage, fear, pleasure

Back 115

can modify autonomic nervous system

Front 116

dual innervation

Back 116

by both para and sum, but one will predominate

Front 117

controlling heart rate dual innervation

Back 117

VAGUS NERVE predominate factor

Front 118

Organs receiving only sympathetic innveration

Back 118

adrenalla medulla, kidney, pilomotor muscles, and sweat glands

and basically control of blood pressure

Front 119

somatic nervous system

Back 119

single myelinated motor neuron, originating in the CNS

Front 120

Local mediators

Back 120

not distributed throughout body, only act locally

Histamine and prostaglandins!!**

Front 121

hormones

Back 121

specialized endocrine cells secrete hormones into the bloodstream

Front 122

2 main nts in autonomic nervous system

Back 122

acetylcholine and norepinephrine

Front 123

cholernergic neurons use

Back 123

acetylcholine

Front 124

adernergic neurons use

Back 124

ADRENALINE, epinephrine or norepinephrine

Front 125

acetylcholine does:

Back 125

decrease heart rate and cardiac output

decrease blood pressure

Front 126

acetylcholine has 2 receptors:

Back 126

1. muscarinic

2. nicotinic

Front 127

M2

Back 127

HEART, brain, autonomic ganglia, and smooth muscle

Front 128

acetylcholine is not therapeutically important

Back 128

because has so many actions

Front 129

bethanecol

Back 129

synthetically related to acetylcholine but not destroyed by acetylcholineterase

strong muscarinic action

increases intestinal motility and tone

stimulate detrussor muscle of bladder promoting urination

Front 130

carbachol

Back 130

muscarinic and nicotinic actions may last up to an 1 hr.

Front 131

carbachol

Back 131

because of its potency and long duration is rarely used except for the eye where causes mitosis ( decrease intraocular pressure)

can avoid systemic effects is applied topically

Front 132

pilocarpine

Back 132

for acute angle glaucoma

Front 133

pilocarpine

Back 133

miosis, also stimulates sweat, tears, and saliva production

Front 134

pilocarpine

Back 134

drug of choice for decreasing IOP in emergency treatment of glaucoma

Front 135

Cholinergic adverse effects

Back 135

diarrhea, diaphoresis,miosis, nausea, urinary urgency

Front 136

reversible: pyridostigmine

Back 136

both muscarinic and nicotinic receptors,

duration 2-4 hours

Front 137

pyridostigmine therapeutic use:

Back 137

promotes motility in bladder, decrease IOP topically, antidote for overdose of atropine, phenotiazine, Tricyclic antidepressants

USE IN MYASTHENIA GRAVIS

Front 138

pyridostigmine adverse effects

Back 138

convulsions, bradychardia

Front 139

Neostigmine

Back 139

doesn't cross the blood brain barrier, but has greater effect in skeletal muscle. used in myasthenia gravis and antidote for tobocurarine and neuromuscular blockers

Front 140

Demecarium

Back 140

similar action as Neostigmine but used for open angle glaucoma

Front 141

Edrophonium

Back 141

similar to neostigmine but shorter duration

USE IV IN DIAGNOSIS OF MYASTEHNIA

Front 142

Tarcrine, Donazepil, Rivastigmine, and Galantamine,

Back 142

used in treatment of alzheimer's disease

Front 143

irreversible

Back 143

extremely toxic

Front 144

ecchothiophate

irreversible

Back 144

covalently binds to active site of acetylcholinesterase and permanently activates. With "age" (loosing of isopropyl group) make is unavailable for activation

Front 145

ecchothiophate

irreversible

Back 145

one application lasts up to one week

misosis

Front 146

pralidoxime

Back 146

reactivation of acetylcholinesterase but be used before aging

Front 147

cholinergic agonists

Back 147

contraction of visceral smooth muscle

miosis

hypotension

bradycardia

Front 148

atropine

anti muscarinic

Back 148

mydriasis

cyclopegia

used for examination of funds, if pt suffers from glaucoma, might not be used

Front 149

atropine

antimuscarinic

Back 149

GI system: antipasmodic

CV: low dose--> bradycardia (block M1 receptors)

high dose--> tachycardia

xerostomia (dry mouth and eye)

antidote for insecticides

Front 150

atropine

Back 150

if too much, hallucinations

Front 151

scoplamine

Back 151

"scuba" used for motion sickness

blocks short term memory

can cross blood brain barrier and can produce hallucinations

Front 152

ipratropium/ tiotropium

Back 152

inhalation in asthma and COPD, decrease mucouse production

Topically: Topicamine and Cycopentolate - cyclopegia

Front 153

benztripine/ trihexyphenidyl

Back 153

parkinson disesase

Front 154

Darifenacin/ Fesoterodine, Oxybutyin/ Solifenacin, Tolterodine

Back 154

sythenitch atropin

used for over active bladders

these drugs reduce hypersensitivity to sensation of having to pee

Front 155

Cholinergic antagonist side effects

Back 155

blurred vision

confusion

mydriasis

constipation

urinary retention