Autonomics- General information Flashcards Preview

Summer Pharm (2016) ** COPY > Autonomics- General information > Flashcards

Flashcards in Autonomics- General information Deck (24)
Loading flashcards...
1
Q

What are the endogenous catecholamines?

A

Epinephrine

Norepinephrine

Dopamine

2
Q

What are the synthetic catecholamines?

A

Isoproterenol

Dobutamine

3
Q

What are the two types of synthetic non-catecholamines?

What are some of these drugs?

A
  • Indirect acting- increases the endogenous NE release from post-ganglionic SNS nerves which then activate the GCPR
    • Ephedrine, mephentermine, amphetamines
  • Direct Acting- interact directly with the G-protein coupled receptor.
    • Phenylephrine, Methoxamine
4
Q

What are the selective Alpha-2 agonists?

A

Clonidine

dexmedetomidine

5
Q

What are the selective Beta-2 adrenergic agonists?

A

Albuterol

terbutaline

ritodrine

6
Q

When will you use sympathomimetic drugs as a CRNA?

A
  • to improve arterial blood pressure and contractility after administering an anesthetic with myocardial depressant/vasodilating properties
  • to improve bronchodilation in susceptible pts with bronchoconstriction caused by airway instrumentation
  • anaphylaxis treatment
  • ACLS protocols
  • as an additive to LAs
  • sedation and analgesia (alpha 2)
7
Q

What is a sympathomimetic?

What is the chemical makeup?

A
  • “mimics” the Sympathetic nervous system
  • Beta-phenylethylamine derivatives
    • an amine group side chain (NH2)
    • Hydroxyl group on the 3.4 carbons of a benzene ring (catechol)
    • catecol-amine……duh
8
Q

Sympathomimetic Mechanism of Action

A
  • Activates a G-protein, either directly or indirectly
  • G protein will either be Gq, Gi, or Gs coupled
    • usually this cascade with result in either increased or decreased intracellular Ca2+
  • Specific effect will depend on:
    • the type of receptor stimulated
    • receptor density in given tissue
    • what the second messenger activates at a molecular level
  • Receptors will up or down regulate based upon plasma concentrations of sympathomimetic
9
Q

How are Catecholamines terminated/metabolized?

A
  • Reuptake
    • Uptake 1- neuronal reuptake into presynaptic terminal
    • Uptake 2- extraneuronal uptake- into other cells in the area
  • MAO- Enzyme that catalyzes oxidation of monoamines. Found in lots of places.
  • COMT- Enzyme that degrades things with catechol structure. primarily in Liver.
  • Lungs ??
10
Q

How are Non-catecholamines terminated/metabolized?

A
  • MAO
  • urinary excretion (unchanged)
11
Q

What drug should you NOT give to a person on an MAOI?

Why?

A

Ephedrine

Ephedrine is indirectly acting, so it causes the release of all the stored NE. If somebody has been taking a medication the prevents the metabolism/breakdown of the NE, they will have a large amount stored and an abundant amount of NE would be released.

12
Q

Receptor selectivity for:

phenylephrine

A

a1 > a2 >>>>> B

13
Q

Receptor selectivity for:

Clonidine

A

a2 > a1 >>>>>B

14
Q

Receptor selectivity for:

Norepinephrine

A

a1 = a2; B1 >>>>> B2

15
Q

Receptor selectivity for

Epinephrine

A

a1 = a2; B1 = B2

16
Q

Receptor selectivity for:

Dobutamine

A

B1 >B2>>>>a

**can get alpha effects at higher end of dosing range

17
Q

Receptor selectivity for:

Fenoldopam

A

D1 >> D2

18
Q

In the peri-op period, do IDDM patients require more or less insulin? Why?

A

More, because they have increased glycogenolysis from B2 receptors

19
Q

Alpha 1 receptors effect _____

A
  1. Heart (increase contractility and HR)
  2. Vasoconstriction
  3. Iris- dilation
  4. pylomotor contraction
  5. prostate/uterus contraction
  6. pancrease (decreased insulin production)
20
Q

Alpha 2 receptors effect ______

A
  1. Inhibits adrenergic release *
  2. GI relaxation *
  3. CNS decrease*
  4. Vascular smooth muscle dilation*
  5. vascular smooth muscle contraction
  6. Platelet aggregation

* presynaptic

21
Q

Beta 1 receptors effect _______

A
  • Heart (increase HR and contraction)
  • Kidney (release renin)
22
Q

Beta 2 receptors effect_______

A
  1. Smooth muscle relaxation
  2. skeletal muscle increased contraction
  3. Mast cells decrease histamine release
  4. Liver increase glycogenolysis
  5. pancrease increase insulin secretion
  6. increase adrenergic NE release
23
Q

D1 receptor affects ______

A

Post synaptic; smooth muscle

dilates renal, mesenteric, coronary, cerebral blood vessels

24
Q

D2 receptor affects

A

Pre synaptic; nerve endings

modulates neurotransmitter release, N/V