Pharmacology Unit 4

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Pharmacology Unit 4
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Pharmacology Unit 4
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  1. 1) What are preganglionic and postganglionic neurons and where are they found?
    • a) Part of involuntary nervous system of peripheral nervous system’s efferent neurons for both SNS & PNS: prior and after a ganglia:
    •   i) Preganglionic neuron – a neuron whose axon terminates in contact w/ another nerve cell located in a peripheral ganglion
    •   ii) Postganglionic neuron - neurons whose cell bodies lie in the autonomic ganglia and whose purpose is to relay impulses beyond the ganglia.
  2. 2) How many efferent neurons in the SNS, PNS, voluntary portion of the nervous system
    a) SNS & PNS: 2 efferent neuron

    b) Voluntary efferent neurons has 1 efferent neuron
  3. 3) What are the main receptors we talked about in the peripheral nervous system, where are they located, what neurotransmitter stimulates them, and what happens at targets when they are stimulated and inhibited
    • a) Adrenergic:
    •   i) ANS-SNS: CNS –(cholinergic: short preganglionic neuron) ACh + nACh –(adrenergic: long postganglionic neuron) NE+ adrenergic receptor (alpha, beta-1, or beta-2) to effector site
    •   ii) Alpha receptor
    •    (1) Peripheral blood vessel
    •    (2) GI tract
    •     (a) Salivary glands
    •     (b) Stomach and intestinal secretions
    •     (c) Sphincters
    •    (3) Urinary system
    •     (a) Sphincters
    •    (4) Eye Pupil
    •     (a) Radial muscle
    •   iii) Beta-1 receptor
    •    (1) Heart:
    •     (a) Rate
    •     (b) Strength
    •   iv) Beta-2 receptor
    •    (1) Bronchioles
    •     (a) Smooth muscles
    •     (b) Secretions
    •    (2) GI tract
    •     (a) Motility (contractions in walls)
    •    (3) Urinary System
    •     (a) Bladder walls
    •    (4) Metabolic rate
    •     (a)
    • b) Cholinergic
    •   i) Nicotine
    •    (1) ANS: CNS –(cholinergic: short preganglionic neuron) ACh + nACh of either
    •     (a) ANS-SNS:
    •      (i) –(adrenergic: long postganglionic neuron) NE+ adrenergic receptor (alpha, beta-1, or beta-2) to effector organ
    •     (b) ANS-PNS:
    •      (i) –(cholinergic: short postganglionic neuron) ACh+ mACh to effector organ
    •    (2) Or Somatic-NS: CNS –(cholinergic neuron of 1 efferent neuron) ACh + nACh to effector site
    •   ii) Muscarinic
    •    (1) ANS-PNS: CNS –(cholinergic: long preganglionic neuron) ACh + nACh –(cholinergic: short postganglionic neuron) ACh+ mACh to effector site
  4. 4) What neurotransmitter stimulated skeletal muscle and what is the receptor
    • a) Cholinergic: Muscarinic: ANS-PNS: CNS –(cholinergic: long preganglionic neuron) ACh + nACh –(cholinergic: short postganglionic neuron) ACh+ mACh to effector site
    • b) Neurotransmitter:
  5. 5) Adrenergic receptors…what are they, where are they and what do they do
    • a) By ANS-SNS postganglionic neurotransmitter NE (norepinephrine)
    •   i) Vasculature:
    •    (1) Alpha receptor
    •     (a) Contract smooth muscle (in peripheral blood vessels)
    •      (i) Mostly vasoconstrictor
    •   ii) Heart- Cardiac muscle:
    •    (1) Beta-1 receptor:
    •     (a) Stimulates: heart rate & strength (major place found)
    •   iii) Bronchioles- Smooth muscle wraps around it:
    •   (1) Beta-2 receptor:
    •     (a) Relaxes smooth muscle
    •     (b) Increase metabolic rate
    •     (c) Bronchi dilation
  6. 6) Muscarinic and nicotinic receptors…what are they, where are they and what do they do
    • a) Some Cholinergic locations: by ACh neurotransmitters
    •   i) Especially at smooth muscle of hollowed organs
    •   ii) Cholinergic receptors of the eye
    • b) Muscarinic: Cholinergic: ANS-PNS: postganglionic neurotransmitter ACh
    •   i) Contracts smooth muscle
    •    (1) Except: blood vessels & sphincters
    •    (2) Eye NOT an exception – not considered a sphincter
    •     (a) “sphincter” muscle contracts causing the pupil to constrict
    •   ii) Stimulates exocrine organs
    •   iii) Decrease heart rate & sometimes contractility
    •   iv) Note: peripheral blood vessels dilated w/ muscarinic
    •    (1) Compare w/ parasympathetic responses on chart
    • c) Nicotinic : Cholinergic: Somatic NS: single efferent neuron: ACh
    •   i) Stimulates both sympathetic and parasympathetic ganglia
    •   ii) Stimulates adrenal medulla
    •    (1) Sympathetic-like effect
    •  iii) Stimulates neuromuscular junction: stimulates skeletal muscle
    •    (1) Voluntary system
    •   iv) Note: seems to have many side effects – so why use at all as sit for drug therapy?
    •    (1) Only option: if you have to use peripheral nervous system drug to have some control over neuromuscular junction/skeletal muscle
  7. 7) What happens when you stimulate a nicotinic receptor? Why would you want to stimulate a nicotinic receptor?
    • a) Stimulates
    •   i) Sympathetic & parasympathetic ganglia
    •   ii) Adrenal medulla
    •  iii) Neuromuscular junction/skeletal muscle
    • b) Note: seems to have many side effects – so why use at all as sit for drug therapy?
    •   i) Only option: if you have to use peripheral nervous system drug to have some control over neuromuscular junction/skeletal muscle
  8. 8) Parasympathetic vs. Sympathetic stimulation of the eye, smooth muscle, GI, Sphincters, heart, urinary bladder.
    • a) SNS VS PNS dominates
    •   i) SNS dominates
    •    (1) Cardiovascular
    •     (a) Heart
    •      (i) Drug use to increase heart rate
    •       1. Beta-1: agonist
    •       2. Muscarinic: antagonist
    •      (ii) Drug use to decrease heart rate
    •       1. Beta-1: antagonist
    •       2. Muscarinic: agonist
    •     (b) Blood vessels
    •      (i) Drug best used to constrict Peripheral Blood Vessels
    •       1. Alpha agonist
    •    (2) Respiratory
    •    (3) Metabolic rate
    •   ii) PNS dominates
    •    (1) Gastrointestinal (GI tract)
    •     (a) Drug best used to decrease stomach secretions
    •      (i) Muscarinic Antagonist
    •    (2) Urinary
    •    (3) Eye Focus
    •     (a) Drug either increase or decrease pupil dilation
    •      (i) Nicotinic agonist
    •      (ii) Nicotinic antagonist
    •      (iii) Note: only nicotinic receptors can have such variable resutls
    •   iii) Nicotinic, Cholinergic drugs control:
    •    (1) Skeletal muscle
    • b) Eye pupil
    •   i) Radial muscle:
    •    (1) SNS: Alpha = contracted (dilated pupil)
    •    (2) PNS: -----
    •   ii) Eye pupil “Sphincter”
    •   (1) SNS: -----
    •    (2) PNS: contracted (constricted pupil) = contracted (can see near)
    •   iii) Eye focus (ciliary muscle)
    • c) Smooth muscle
    •   i) Bronchioles smooth muscles
    •    (1) SNS: Beta-2 = relax (dilate)
    •    (2) PNS: stimulate = (constrict)
    • d) GI
    •   i) Salivary glands
    •    (1) SNS: inhibited Alpha-1 = increase thick mucus
    •    (2) PNS: stimulated incr. = watery, dilute saliva
    •   ii) Stomach & intestinal secretions
    •    (1) SNS: inhibited “?” = moderate increase
    •    (2) PNS: stimulated incr. = increased
    •   iii) Motility (contraction in walls)
    •    (1) SNS: inhibited Beta-2 = decreased
    •    (2) PNS: stimulated incr. = increased (stimulation)
    •   iv) GI Sphincters
    •    (1) SNS: inhibited Alpha = constricted
    •    (2) PNS: stimulated incr. = relax
    • e) Sphincters
    •   i) GI sphincters
    •    (1) SNS: inhibited Alpha = constricted
    •    (2) PNS: stimulated incr. = relax
    •   ii) Eye pupil “sphincter”
    •    (1) SNS: -----
    •    (2) PNS: contracted (constricted pupil) = contracted (can see near)
    •   iii) Urinary sphincters
    •    (1) SNS: inhibited Alpha = constricted
    •    (2) PNS: stimulated = relaxed
    • f) Heart
    •   i) Rate
    •   (1) SNS: stimulates Beta-1 = increases
    •   (2) PNS: inhibits = decreases
    •  ii) Strength
    •   (1) SNS: stimulates Beta-1 = increases
    •   (2) PNS: inhibits = mild decrease
    • g) Urinary bladder
    •   i) Bladder walls
    •   (1) SNS: inhibited Beta-2 = relaxed
    •   (2) PNS: stimulated = stimulated
    •  ii) Urinary bladder’s Sphincters
    •   (1) SNS: inhibited Alpha = constricted
    •   (2) PNS: stimulated = relaxed
    • h) Metabolic rate
    •   i) SNS: Beta-2 = incr. blood sugar, fat mobilized, glycogenolysis
    •  ii) PNS: ------
    • i) Bronchioles secretions
    •   i) SNS: Beta-2 = decreased
    •   ii) PNS: increased
    • j) Peripheral blood vessels
    •   i) SNS: Alpha = constricts
    •   ii) PNS: none but Muscarinic can dilate
  9. 9) Main indications and contraindications for alpha & beta agonists/antagonists, muscarinic agonists/antagonists, nicotinic agonists/antagonists
    • a) Drugs w/ Adrenergic effects (Alpha, Beta-1, & Beta-2 agonists)
    •   i) Targets:
    •    (1) Cardiovascular
    •     (a) Alpha or Beta-1
    •    (2) Bronchiolar
    •     (a) Beta-2
    •    (3) Metabolic rate
    •     (a) Beta-2
    •   ii) Therapeutic Uses
    •    (1) Treat Allergic reactions
    •     (a) Can reverse bronchiolar constriction: Beta-2
    •     (b) Can cause vasoconstriction and reduce edema: Alpha
    •     (c) Can increase cardiac output: Beta-1
    •    (2) Chronic obstructive pulmonary disease (COPD)
    •     (a) Asthma, emphysema, chronic bronchitis: Beta-2
    •      (i) Inhalation causes fewer side effects (than oral or sublingual routes)
    •    (3) Hypotension – as w/ spinal anesthesia (Alpha)
    •     (a) (not same thing as shock: in hypotension, fluid remain inside blood vessel –not in tissue spaces– and w/ effort, body needs are met)
    •     (b) Treat w/ Alpha, as well as Beta-1
    •    (4) (Prolonged) Shock (Beta-1) – have sympathetic discharge
    •     (a) Caution w/ alpha (often avoid)
    •     (b) Beta-1 & -2 helpful
    •      (i) Beta-2 may help dilate critical blood vessels
    •     (c) (Too much vasoconstriction reduces circulating plasma volume and causes microclots contributing to shock. Body needs aren’t being met and some necrosis is likely; therefore, use vasodilator [Beta agonists].)
    •    (5) Local vasoconstriction:
    •     (a) Nasal congestion
    •      (i) Use as nose spray
    •       1. Fewer side effects (Alpha)
    •     (b) Local anesthetic adjuncts
    •      (i) Delay absorption (longer acting w/ fewer central side effects): (Alpha)
    •     (c) Topical hemostatic (Alpha)
    •      (i) Dentist, professional sports, nosebleeds
    •    (d) Dilate pupil (Alpha) for eye exam
    •      (i) (drops dilates pupil, of radial muscle)
    •   iii) Adrenergic: Side Effects
    •    (1) Anxiety, tremulousness(/restless) (CNS effect)
    •   (2) Awareness of rapid heart beat
    •   iv) Adrenergic: Toxic Effects
    •    (1) Photophobia
    •    (2) Headache
    •    (3) Substernal(/chest) pain
    •    (4) Serious arrhythmias (Beta-1)
    •    (5) Fatal cases- acute pulmonary edema
    •     (a) (increased BP = heart failure) (Alpha)
    •   v) Adrenergic: Local Toxicity
    •    (1) Tissue Necrosis (Alpha)
    •     (a) (i.e. if infused into vein w/ insufficient blood flow)
    •    (b) (cut off blood supply = dead tissue)
    •   vi) Adrenergic: Contraindications
    •    (1) Angina (Beta-1 and Alpha stimulation increases heart workload)
    •    (2) Hypertension (Alpha stimulation increase BP dramatically, Betha-1 to lesser extent)
    •    (3) Hyperthyroidism
    •     (a) (Beta-2 stimulation increases metabolism more,
    •    (b) Beta-1 increase heart palpitations and makes symptoms worse)
    •   vii) Adrenergic: Drug Interactions
    •    (1) Inhalation anesthetics
    •     (a) Causes arrhythmias (irregular heart rates)
    •    (2) MAO inhibitors, tricyclics
    •     (a) Increases BP
    •    (3) Oxytocic drugs
    •     (a) Persistent hypertension
    •     (b) Sometimes cerebral hemorrhage
    • b) Drugs Inhibiting Adrenergic Effects (antagonists: blocking or inhibiting agents or Sympatholytic drugs)
    •   i) Therapeutic Uses: Alpha Blocking Agents
    •    (1) Locally:
    •     (a) Prevent local necrosis: Norepi overdose
    •    (2) Shock
    •     (a) (Patient in shock or w/ severe hypotension in which there is sympathetic discharge)
    •     (b) Fluid reenters circulation
    •    (3) Pheochromocytoma (tumor of adrenal gland)
    •     (a) Tumor adrenal medulla
    •      (i) Diagnosis – see if this is cause of hypertension
    •      (ii) Preoperative treatment – used to gradually remove stimulation
    •       1. (otherwise a drastic decrease in BP will occur when tumor removed)
    •    (4) Treat Hypertension
    •     (a) (Alpha blockers : dilate vessels)
    •   ii) Therapeutic Uses: Beta Blocking Agents
    •   (1) Cardiac arrhythmias
    •    (a) Suppress ectopic pacemakers
    •    (b) Especially good at slowing ventricles & correcting digitalis induced arrhythmias
    •   (2) Prevention of angina pain (decreases cardiac work)
    •   (3) Hypertension (lower heart rate)
    •   (4) Controlling signs of thyrotoxicosis
    •     (a) Counteracts symptoms
    •      (i) Tachycardia (heart rate exceed normal range), high BP
    •      (ii) Increased metabolism, increased body temperature
    •      (iii) Tremulousness
    •    (5) Prophylaxis migraine headaches
    •     (a) Mechanism unknown – perhaps blocks vasodilation
    •   iii) Side Effects: Adrenergic Blocking Agents
    •    (1) Asthmatic wheezing
    •     (a) Beta blocker
    •    (2) Dizziness
    •     (a) Alpha blocker
    •    (3) Tiredness and depression
    •     (a) Alpha & Beta blocker, as well as CNS effect
    •     (b) Nausea and diarrhea
    •      (i) Chiefly Beta blocker (that stops inhibition of gastrointestinal walls but also Alpha blocker that stop sphincter contraction)
    •     (ii) = (both) Parasympathetic (stimulation) unbalanced
    •  iv) Toxicity: Adrenergic Blocking Agents
    •    (1) Severe bronchiolar constriction
    •     (a) Beta blocking
    •    (2) Hypotension
    •     (a) Alpha & Beta blockers
    •    (3) Congestive heart failure, A-V block
    •     (a) Beta block
    •    (4) Hypoglycemia in diabetic receiving treatments
    •     (a) Beta blocker
    •  v) Contraindications: Adrenergic Blocking Agents
    •    (1) Asthma
    •    (2) Hypotension
    •     (a) Unless w/ arrhythmia requiring treatment
    •    (3) Congestive heart failure, heart block
    •     (a) Caution: Diabetes
    • c) Drugs with Cholinergic Effects (both muscarinic and nicotinic agonists)
    •   i) Targets include:
    •    (1) Muscarinic receptors
    •     (a) GI
    •     (b) Urinary
    •     (c) Eye pupil and focus
    •    (2) Nicotinic Receptors
    •     (a) Skeletal muscle
    •   ii) Therapeutic Uses: Cholinergic Agonists
    •    (1) Muscarinic
    •     (a) Helps treat postoperative ileus retention
    •      (i) (bowel not moving up, plugged: thus increase motility)
    •     (b) Helps treat postoperative urinary retention
    •     (c) Glaucoma
    •    (2) Nicotinic
    •     (a) Termination of curare action
    •      (i) Cholinesterase inhibitors –edrophonium (Tensilon®)
    •     (b) Myasthenia Gravis (autoimmune disease)
    •      (i) Caution: Take medicine early AM
    •   iii) Side Effects: Cholinergic Agonists
    •    (1) Muscarinic
    •     (a) GI
    •      (i) Cramps &/or diarrhea, nausea, excess salivation
    •     (b) Urinary urgency
    •     (c) Vasodilation
    •       (i) Feeling of warmth, faintness, nausea
    •     (d) Sweating
    •   iv) Toxicity: Cholinergic Agonists
    •    (1) Muscarinic
    •     (a) Eye-blurred far vision, ciliary spasm
    •     (b) Tearing and nose running
    •     (c) Bronchiole constriction and hypersecretion
    •    (2) Nicotinic
    •     (a) Autonomic = Elevated BP
    •      (i) Note: Check BP, pulse, and respirator routinely
    •     (b) Voluntary muscle twitching
    •      (i) Especially in muscles of face
    •    (3) CNS – Contraindication/Caution: Extreme Stimulation (Not PNS ~ not muscarinic nor nicotinic; but CNS)
    •     (a) Dreams and nightmares
    •     (b) Restless and anxiety
    •     (c) Convulsions, coma, respiratory failure
    • d) Drugs Inhibiting Cholinergic Effects (Antagonists) (e.g. Atropine, Scopolamine)
    •   i) Therapeutic Uses (antimuscarinic):
    •    (1) GI (antimuscarinic)
    •     (a) Peptic ulcer
    •     (b) Decreasing cramps or diarrhea
    •     (c) Acute pancreatitis
    •    (2) Relaxation of bladder (relieves pain of inflammation) (antimuscarinic)
    •    (3) Ophthalmic uses (antimuscarinic) – (not Glaucoma)
    •     (a) Dilation for eye examination (adrenergic safer), (or to prevent adhesion to lens)
    •     (b) Inhibits accommodation for near vision (- eye exam w/out focusing interference)
    •    (4) Treatment of cholinergic toxicity
    •     (a) May give anti-muscarinic drug w/ nicotinic agonist (in order to stimulate skeletal muscle but block parasympathetic side effects)
    •    (5) Preanesthetic medication
    •     (a) Sedation (CNS effect) (True of scopolamine more, than atropine – may be in OTC sleep aids)
    •     (b) Reduced secretions (antimuscarinic effect)
    •      (i) (not for asthma [because secretions become too dry and obstructive]- but note exception [however, ipratropium <Atrovent®> an anti-cholinergic agent is being used as a bronchodilator w/ encouraging results especially when used w/ a beta-2 agonist)
    •   ii) Side Effects: Cholinergic Antagonists (e.g. Atropine, Scopolamine) (Chiefly Antimuscarinic Intent from medication)
    •    (1) Dry mouth (antimuscarinic)
    •    (2) Urinary retention (antimuscarinic)
    •     (a) Especially in older men
    •    (3) Blurred vision (antimuscarinic)
    •    (4) Dizziness and fatigue
    •     (a) CNS effect
    •  iii) Toxicity: Side Effects: Cholinergic Antagonists (e.g. Atropine, Scopolamine) (Chiefly Antimuscarinic Intent from medication)
    •    (1) Uncommon- dangerous toxic effects
    •     (a) Pupillary dilation (antimuscarinic) – photophobia
    •     (b) Dry mouth, constipation (antimuscarinic)
    •     (c) Increased body temperature (decreased sweating) (antimuscarinic)
    •      (i) Caution: exercise w/out conditioning can cause hyperthermia
    •     (d) Palpitations
    •     (e) Behavioral changes (CNS effect)
    •      (i) Sedation; confusion, especially in elderly patients; hallucinations; coma; convulsions
    •     (f) Respiratory depression (antinicotinic)
    •   iv) Contraindications: Side Effects: Cholinergic Antagonists (e.g. Atropine, Scopolamine) (Chiefly Antimuscarinic Intent from medication)
    •   (1) Glaucoma (antimuscarinic)
    •   (2) Gastric Retention (antimuscarinic)
    •   (3) Urinary Retention (antimuscarinic)
  10. 10) Drugs Inhibiting Cholinergic Effects (Antagonists: antinicotinic) (e.g. Atropine, Scopolamine)
    • a) Skeletal muscle relaxants- Those acting on the PNS are antinicotinic neuromuscular blocking agents – (see 53 for non-PNS agents)
    •   i) Competitive agents (curare)
    •    (1) Compete w/ acetylcholine
    •    (2) Can be counteracted by cholinesterase inhibitors
    •   ii) Depolarizing agents (succinylcholine, decamethonium)
    •   (1) Initially depolarize the membrane (as does ACh)
    •   (2) Antagonists do no decrease their effect
    • b) Therapeutic uses (Note: these are not chronic)
    •   i) Facilitate surgery
    •   ii) Facilitate electroconvulsive therapy
    •   iii) Facilitate endotracheal intubation
    •   iv) Treat tetanus
    • c) Cautions
    •   i) May cause respiratory paralysis
    •   ii) May cause cardiac collapse (antinicotinic)
    •   iii) Interactions alter neuromuscular blocking
    •    (1) + w/ acidosis, some antibiotics (streptomycin), quinidine
    •    (2) – w/ low serum potassium
    •  iv) Slower GI motility – better absorption of other drugs
    •   (1) Toxicities possible w/ many drugs
  11. 11) How is neurotransmitter action stopped? Which neurotransmitter is degraded at the receptor? Which is recycled back into the presynaptic neuron?
    • a) Stopped by the:
    •   i) Use of an enzyme to destroy the transmitter (Acetylcholine destroyed by cholinesterase –important) (less significant clinically: norepinephrine destroyed by MAO in presynaptic terminal and by COMT in postsynaptic cell)
    •   ii) Reuptake of the transmitter into postsynaptic neuron (norepinephrine’s most important removal mechanism) (much less significant for acetylcholine)

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