Pharmacology Ch. 13 Ans Drugs

Front 1

Outline the Nervous System:

Back 1

Front 2

What are the basic functions of the nervous system?

Back 2

Processing perceptions.
Reacting to the internal/external environment.

Front 3

What are the 4 fundamental classes of autonomic drugs?

Back 3

Adrenergic agents, Adrenergic-blocking agents, Cholinergic agents, & Cholinergic-blocking agents.

Front 4

In the PNS, neurons either:

Back 4

recognize changes to the environment (sensory division), or respond to these changes by moving muscles or secreting chemicals (motor division).

Front 5

The Somatic nervous system controls:

Back 5

VOLUNTARY contraction of skeletal muscles.

Front 6

The Autonomic nervous system controls:

Back 6

INVOLUNTARY contraction of SMOOTH muscle , CARDIAC muscle, and glands.

Front 7

Organs and tissues under autonomic nervous system control:

Back 7

the heart & arteries; the respiratory, digestive, & reproductive tracts; the salivary glands, and portions of the eye.

Front 8

The Autonomic NS has two divisions:

Back 8

Sympathetic and Parasympathetic.

Front 9

With few exceptions, organs and glands receive nerves from ______ branch(s) of the Autonomic NS.

Back 9

Both

Front 10

What are the physiologic responses to Sympathetic activation?

Back 10

Increased HR and BP.
Increased Blood flow to muscles.
Bronchi and pupils dilate.
Liver produces glucose.

Front 11

What are the physiologic responses to Parasympathetic activation?

Back 11

Decreased HR and BP.
Bronchi constrict.
Digestion is promoted.

Front 12

HR can be increased by either:

Back 12

Increasing sympathetic stimulation or decreasing parasympathetic stimulation.

Front 13

Do the Sympathetic and Parasympathetic divisions always produce opposite effects?

Back 13

NO, some things are entirely controlled by one or the other. eg.. CONSTRICTION of arterioles is controlled entirely by the Sympathetic branch. Sympathetic stimulation causes constriction of arterioles, whereas VASODILATION is caused by lack of Sympathetic stimulation.

Front 14

What systems are controlled entirely by the Sympathetic system?

Back 14

Arterioles and sweat glands.

Front 15

In the Autonomic NS, communication involves the connection of:

Back 15

two neurons in series.

Front 16

In the Autonomic NS, as the action potential travels along the first nerve, it encounters the first ________. Because this occurs outside of the CNS it is called:

Back 16

Synapse; a Ganglionic synapse.

Front 17

Describe a nerve impulse sent from the CNS to the target tissue in the Autonomic NS:

Back 17

The impulse is sent from the spinal cord down the Preganglionic neuron, through the Ganglionic synapse, then down the Postganglionic neuron which then synapses at the target tissue.

Front 18

Are Autonomic drugs given to correct physiological defects in the autonomic nervous system?

Back 18

NO, they are given to STIMULATE or INHIBIT TARGET ORGANS of the Autonomic NS such as the heart, lungs, glands, or digestive tract.

Front 19

With few exceptions, disorders lies with the ____________, not the:

Back 19

target tissue, not the ANS, which itself is remarkable free from disease compared to other systems.

Front 20

When an Autonomic drug is administered, it does not correct an autonomic disorder, rather it:

Back 20

corrects dysfunction of that target organ naturally stimulated by the autonomic neurotransmitter.

Front 21

The two primary neurotransmitters of the Autonomic nervous system are:

Back 21

norepinephrine (NE) and acetylcholine (Ach).

Front 22

Parasympathetic division:
______________ pupils.
______________ salivation.
______________ HR.
______________bronchioles.
______________digestion.
______________gallbladder.
______________urinary bladder.
______________sex organs.

Back 22

CONSTRICTS pupils.
STIMULATES salivation.
DECREASES HR.
CONSTRICTS bronchioles.
STIMULATES digestion.
STIMULATES gallbladder.
CONTRACTS urinary bladder.
STIMULATES sex organs.

Front 23

Sympathetic Stimulation:
______________ pupils.
______________ salivation.
______________ HR.
______________bronchioles.
______________digestion.
______________ release of glucose.
______________urinary bladder.
______________sex organs.

Back 23

DILATES pupils.
INHIBITS salivation.
INCREASES HR.
DILATES bronchioles.
INHIBITS digestion.
STIMULATES release of glucose.
RELAXES urinary bladder.
INHIBITS sex organs.

Front 24

What transmitter is released at almost all Postganglionic nerves in the Sympathetic nervous system?
The exception is?

Back 24

NE; the exception is sweat glands, in which Ach is the neurotransmitter.

Front 25

NE belongs to a class of agents called ____________, all of which are involved in:

Back 25

natural Catecholamines; neurotransmission.

Front 26

Other natural Catecholamines include:
Examples of Synthetic Catecholamines include:

Back 26

Epinephrine (adrenaline) and Dopamine.
Isoproterenol and Dobutamine.

Front 27

What are some Noncatecholamines?
Structure?

Back 27

Ephedrine, phenylephrine, and terbutaline.
They have a slightly different chemical structure than the catecholamines

Front 28

All the Noncatecholamines bind to:

Back 28

adrenergic receptors

Front 29

Where are Adrenergic receptors located?

Back 29

At the ends of the Postganglionic Sympathetic neurons.

Front 30

What are the two types of Adrenergic receptors?

Back 30

Alpha and Beta.

Front 31

What are the different subtypes of Alpha and beta receptors?

Back 31

alpha₁, alpha₂ and beta₁, beta₂, & beta₃

Front 32

In drug receptor selectivity, can drugs activate one type of receptor at low doses and begin to affect other receptor subtypes as dosage increases?

Back 32

Yes.

Front 33

Five Mechanisms by Which Drugs Can Affect Synaptic Transmission?

Back 33

1) Affect the SYNTHESIS of the neurotransmitter in the
presynaptic nerve.
2) Prevent STORAGE of the neurotransmitter
within the presynaptic nerve.
3) Influence RELEASE of the neurotransmitter from the presynaptic nerve.
4) Prevent the normal REUPTAKE OR DESTRUCTION of the neurotransmitter.
5) Bind to the RECEPTOR site on the postsynaptic target tissue.

Front 34

1) Drugs that Affect the synthesis of the neurotransmitter in the presynaptic nerve:
Drugs that decrease neurotransmitter synthesis will:
Drugs that increase neurotransmitter synthesis will:

Back 34

Inhibit nervous system activity.
Promote nervous system activity.

Front 35

2) Drugs that Prevent storage of the neurotransmitter in vesicles within the presynaptic nerve:
Prevention of neurotransmitter storage will:

Back 35

inhibit nervous system activity.

Front 36

3) Drugs that Influence release of the neurotransmitter from the presynaptic nerve.
Promoting neurotransmitter release will:
Slowing neurotransmitter release will:

Back 36

stimulate nervous system activity.
inhibit nervous system activity.

Front 37

4) Drugs that Prevent the normal destruction or reuptake
of the neurotransmitter:
Drugs that cause the neurotransmitter to remain in the synapse for a longer time will:

Back 37

stimulate nervous system activity.

Front 38

5) Drugs that Bind to the receptor site on the postsynaptic target tissue:
Drugs that bind to the receptor site on the postsynaptic target tissue will:
Drugs that attach to the postsynaptic target tissue and prevent neurotransmitter receptor interaction will:

Back 38

increase nervous system activity.
inhibit nervous system activity.

Front 39

NE is synthesized in the nerve terminal through a series of steps that require that amino acids __________________. The final step of the synthesis involves the conversion of _______________ to _________________.

Back 39

phenylalanine and tyrosine; conversion of dopamine to NE.

Front 40

NE is stored in the vesicles until:

Back 40

an action potential triggers its release into the synaptic cleft. NE then diffuses across the cleft to alpha or beta receptors on the effector organ.

Front 41

What terminates NE action?

Back 41

The reuptake of NE back into the presynaptic neuron. Once reuptake occurs, NE may be returned to vesicles for future use or destroyed enzymatically by monoamine oxidase (MAO).

Front 42

______________ destroys NE after reuptake inside the presynaptic neuron:
____________destroys NE at the synaptic cleft:

Back 42

monoamine oxidase (MAO).
catecholamine-O-methyl transferase (COMT).

Front 43

The primary method for termination of NE action is through:

Back 43

reuptake.

Front 44

As part of the sympathetic NS, the preganglionic neuron from the spinal cord terminates at the _______________ and releases:

Back 44

Adrenal medulla and releases epinephrine directly into the blood.

Front 45

How is the action of epinephrine terminated?

Back 45

through hepatic metabolism, rather than reuptake.

Front 46

Primary locations of alpha₁ receptors:
Responses:

Back 46

All sympathetic target organs except the heart.
Blood vessel constriction, pupil dilation.

Front 47

Primary locations of alpha₂ receptors:
Responses:

Back 47

Postganglionic nerve terminals in the Sympathetic division.
Inhibits release of NE.

Front 48

Primary locations of beta₁ receptors:
Responses:

Back 48

Heart and kidneys.
Increased heart rate and force of contraction; release of renin.

Front 49

Primary locations of beta₂ receptors:
Responses:

Back 49

All sympathetic target organs except the heart.
Inhibit smooth muscle.

Front 50

Primary locations of Beta₃ receptors:
Responses:

Back 50

Adipose tissue.
Lipolysis.

Front 51

Nerves releasing Ach are called:

Back 51

Cholinergic nerves.

Front 52

What are the two types of Cholinergic receptors?

Back 52

Nicotinic and Muscarinic

Front 53

Where are nicotinic receptors located?

Back 53

at the Ganglionic synapse of both Sympathetic and Parasympathetic divisions of the Autonomic NS.

Front 54

Where are Muscarinic receptors located?

Back 54

On target tissues affected by Postganglionic neurons in the Parasympathetic NS.

Front 55

Receptors for Ach at the ganglia are called:

Back 55

Nicotinic receptors.

Front 56

Nicotinic receptors are also located where?

Back 56

In the Skeletal muscle, controlled by the Somatic NS.

Front 57

Primary locations of Nicotinic receptors:
Responses:

Back 57

Postganglionic neurons; Skeletal muscle.
Stimulates smooth muscle and glands.

Front 58

Primary locations of Muscarinic receptors:
Responses:

Back 58

Heart & other organs.
Response in the heart: Decreased HR and Force of Contraction.
Response in other organs: Stimulation of smooth muscle and gland secretion.

Front 59

What is the effect of drugs that act on Nicotinic receptors? Symptoms?

Back 59

There are profound effects on both the Somatic and Autonomic nervous systems. Symptoms: Tachycardia, hypertension, and increased tone and motility in the GI tract.

Front 60

Activation of Muscarinic receptors results in:

Back 60

Classic Parasympathetic NS symptoms.

Front 61

Ach is synthesized in:

Back 61

the Preganglionic neuron of the Sympathic nerves, and both the Pre/Post-Ganglionic nerves of the Parasympathetic nerves.

Front 62

Ach is synthesized from:

Back 62

Acetyl coenzyme A & choline.

Front 63

How is Ach action terminated?

Back 63

it is rapidly destroyed in the synaptic cleft by the enzyme acetylcholinesterase (AchE), and Choline is reused to make more Ach.

Front 64

How do drugs affect Ach?

Back 64

They affect the Synthesis, Release or Destruction, and Receptor activation of Ach.

Front 65

Autonomic drugs are classified based on:
What are they?

Back 65

one of 4 possible actions:
Stimulation/ Inhibition of the Sympathetic NS.
Stimulation/ Inhibition of the Parasympathetic NS.

Front 66

Drugs that stimulate the Sympathetic NS are called:
Effects?

Back 66

adrenergic agents or Sympathomimetics.
Effects are the classic fight/flight response.

Front 67

Drugs that Inhibit the Sympathetic NS are called:
Effects?

Back 67

adrenergic-blocking agents or Adrenergic Antagonists or Sympatholytics.
Effects are the OPPOSITE of Sympathomimetics.

Front 68

Drugs that stimulate the Parasympathetic NS are called:
Effects?

Back 68

cholinergic agents or Parasympathomimetics.
Effects are the classic rest/digest response.

Front 69

Drugs that Inhibit the Parasympathetic NS are called:
Effects?

Back 69

cholinergic-blocking agents or Anticholinergics or Parasympatholytics or Muscarine blockers.
Effects are the OPPOSITE of Parasympathomimetics.

Front 70

To generalize, Sympathomimetics have the same effects as _________________, and Parasympathomimetics have the same effects as ____________________.

Back 70

Sympathomimetics have the same effects as Parasympatholytics, and Parasympathomimetics have the same effects as Sympatholytics.

Front 71

Sympathomimetics have clinical applications in treating:

Back 71

shock and hypotension.

Front 72

How must catecholamines be administered?
Can non-catecholamines be administered orally?
What is their duration like?

Back 72

parenterally.
Yes, and they have a longer duration of action because they are not destroyed by MAO or COMT.

Front 73

What does it mean that Sympathomimetics act directly or indirectly?

Back 73

Sympathomimetics act directly by binding to and activating adrenergic receptors.
Sympathomimetics act Indirectly by causing the RELEASE of NE or by inhibiting the REUPTAKE or DESTRUCTION of NE.

Front 74

Sympathomimetics that act by indirect means, such as amphetamines or cocaine, are used for their ________________affects in the ______________:

Back 74

Central effects in the brain, rather than their autonomic effects. A few agents, such as ephedrine, act by both direct and indirect mechanisms.

Front 75

Adrenergic-blocking agents inhibit the sympathetic NS, and produce many of the same rest-and-digest symptoms as:

Back 75

the Parasympathomimetics.

Front 76

Adrenergic-blocking agents have wide therapeutic use in the treatment of:

Back 76

hypertension.

Front 77

All beta blockers are used therapeutically for their effects on:

Back 77

the CV system

Front 78

What do beta blockers do physiologically?

Back 78

They decrease the rate and force of contraction of the heart and slow conduction through the AV node.

Front 79

The primary use of beta blockers is the treatment of:

Back 79

hypertension

Front 80

What are the interventions for Adrenergic drugs:

Back 80

Check Pulse, BP, BG, & pt's sensitivity to light.

Front 81

What are the interventions for Adrenergic-blocking agents:

Back 81

Fluid bal: weigh pt daily and report weight gain or loss of 2 lbs daily.
Do not stop abruptly (must taper down).
CNS: monitor for dizziness, drowsiness, or light-headedness.
Cardio: monitor for bradycardia, hypotension, reflex tachycardia, seizures
Uro: monitor urinary hesitancy, incomplete bladder emptying, interrupted stream.

Front 82

What are the interventions for Parasympathomimetics:

Back 82

Frequent monitoring of vitals, bowel sounds, urinary output, mental status, musculoskeletal function.
Promptly report bradycardia, hypotension, dysrhythmias, tremors, change in mental status.
Monitor liver function tests.
Carefully calculate doses to avoid toxicity.

Front 83

What are the interventions for cholinesterase inhibitors:

Back 83

Monitor muscle strength and neuromuscular status; commonly ptosis, diplopia, and chewing and swallowing.
Schedule medication around mealtimes (unless specifically contraindicated).
Schedule activities to avoid fatigue.
Monitor for muscle weakness.

Front 84

What are the interventions for Anticholinergic drugs:
What is the mnemonic?

Back 84

Monitor Pulse, BP, & for Dysrhythmias.
Monitor urinary output.
Monitor bowel sounds & for ABD distension.
Strictly forbidden with acute glaucoma.

Can’t See
Can’t Pee
Can’t Spit
Can’t Sh*t

Front 85

Anticholinergics effect on strenuous exercise:

Back 85

they inhibit sweating, so overheating can occur.

Front 86

Drugs that inhibit AchE are called:

Back 86

cholinesterase inhibitors

Front 87

Direct acting Parasympathomimetics do this:
Indirect acting Parasympathomimetics do this:

Back 87

Bind to cholinergic receptors.
Inhibit the action of Acetylcholinesterase (AchE).

Front 88

What are some Anticholinergic drugs?

Back 88

atropine
benztropine

Front 89

What are some Adrenergic blocking agents?

Back 89

acebutolol
atenolol
carteolol