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Autonomic Nervous System... Don't be nervous!

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bananas's version from 2015-07-04 17:30

Sympathetic basics

Question Answer
VasoconstrictAlpha 1
Mydriasis (dilate eyes)Alpha 1
Increase bladder sphincter toneAlpha 1
Increase BP (vasculature)Alpha 1
Increase peripheral vascular resistance (PVR)Alpha 1
Inhibit NEAlpha 2
Increase heart rateBeta 1
Increase contractilityBeta 1
Increase BP (heart)Beta 1
Increase reninBeta 1
VasodilateBeta 2
BronchodilateBeta 2 **don't give beta 2 blockade to asthmatics
DECREASE uterine toneBeta 2
Increase HR (baroreflex)Beta 2
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Cholinergic droogz

Question Answer
BethanecolDirect muscarinic agonist: Bladder and Bowel (ileus) (post op.) [Bethany calls on your Bowels and Bladder]
CarbacholDirect muscarinic agonist: Glaucoma
PilocarpineDirect muscarinic agonist: Open angle glaucoma (contracts ciliary), Closed angle glaucoma (contracts pupillary sphincter), Increases saliva (Xerostomia caused by radiation or Sjögren's) [Drool, cry and sweat on your Pillow]
NeostigmineIndirect muscarinic agonist: Myasthenia Gravis, Ileus (post op. and neurogenic), Reverse NMJ blockade (after anesthesia)
**does NOT penetrate CNS**
PyridastigmineIndirect muscarinic agonist: Long term Myasthenia Gravis
**does NOT penetrate CNS**
EdrophoniumIndirect muscarinic agonist: "Tensilon Test" to Dx Myasthenia Gravis treatment -- short-acting
**Does NOT penetrate CNS**
PhysostigimineIndirect muscarinic agonis: Glaucoma; Atropine overdose [Physo Phyxes Atropine]
**Penetrates CNS
DonepezilIndirect muscarinic agonist: Alzheimer's [Galant Donnie forgets his Rivals]
GalantamineIndirect muscarinic agonist: Alzheimer's [Galant Donnie forgets his Rivals]
RivastigmineIndirect muscarinic agonist: Alzheimer's [Galant Donnie forgets his Rivals]
AtropineMuscarinic antagonist: Organophosphate poisoning, Bradycardia, Dilates pupil
HomatropineMuscarinic antagonist: Pupil dilation -- short acting
TropicamideMuscarinic antagonist: Pupil dilation -- short acting
CyclopentolateMuscarinic antagonist: Pupil dilation -- short acting
BenztropineMuscarinic antagonist: Parkinson's, lessens side effects of antipsychotics [Park my Benz]
ScopolamineMuscarinic antagonist: Decrease secretions (on ventilator), Motion sickness [Scope down your throat and on a boat]
IpratropiumMuscarinic antagonist: COPD and asthma [I Pray for Tio jim to breathe]
TiotropiumMuscarinic antagonist: COPD and asthma [I Pray for Tio jim to breathe]
OxybutyninMuscarinic antagonist: Urge incontinence [On The Darn Toilet]
TolterodineMuscarinic antagonist: Urge incontinence [On The Darn Toilet]
DarifenacinMuscarinic antagonist: Urge incontinence [On The Darn Toilet]
SolifenacinMuscarinic antagonist: Urge incontinence [On The Darn Shitter]
TrospiumMuscarinic antagonist: Urge incontinence [On The Darn Toilet]
DiphenylhydramineH1 blocker with anticholinergic side effects.
**NOT a muscarinic antagonist**
DoxylamineH1 blocker with anticholinergic side effects.
**NOT a muscarinic antagonist**
AmantadineStimulates dopamine release and blocks dopamine reuptake with anticholinergic side effects.
**NOT a muscarinic antagonist**
TCAsCholinergic side effects
**NOT a muscarinic antagonist**
EchothiophateIndirect muscarinic agonist: Glaucoma
HemicholiniumCholine uptake inhibitor
*Research only*
VesamicolAntagonizes the packaging of ACh into secretory vesicle
*Research only*
Black widow toxinInduces release of ACh into synapse >> spastic paralysis
Botulinum toxinInhibits ACh release into synapse >> flaccid paralysis
Choline acetylransferaseEnzyme that converts Acetyl CoA+Choline >> ACh from Acetyl CoA and choline. Deficient in Alzheimer's.
PralidoximeIndirect Muscarinic antagonist (Reactivates AchE): Organophosphate poisoning
memorize

Sympathetic Droogz

Question Answer
Epinephrinea1, a2, ß1, ß2 agonist: Anaphylaxis, Croup, Hypotension
Norepinephrinea2 > a1, ß1 agonist: Hypotension, Septic shock
DopamineAgonist.
Low: DA
Medium: ß1+ß2
High: a1+a2: HF, Unstable bradycardia, Shock
Dobutamineß1 > ß2 agonist
- Cardiac stress test
- Cardiogenic shock
Isoproterenolß1, ß2 agonist
- Evaluate tachyarrhythimas. Not used clinically.
Phenylephrinea1 > a2 agonist
- Dilates pupils
- Rhinitis
- Hypotension
Albuterolß2 > ß1 agonist: Asthma
Levalbuterolß2 > ß1 agonist: Asthma
Salmeterolß2 > ß1 agonist: Asthma longterm or COPD
Terbutalineß2 > ß1 agonist:
- Stops premature uterine contractions
- Treats bronchospasm

[TerButaline B2 keeps the Baby]
Clonidinea2 agonist (which inhibits NE)
- Malignant HTN
*Beware of rebound HTN*
Methyldopaa2 agonist, inhibits DOPA decarboxylase:
- HTN in pregnancy (Pre-eclampsia)
PrazosinSelective a1 blocker: BPH [-azosin = a1 blockers]
*can cause hypotension + reflex tachycardia*
DoxazosinSelective a1 blocker: BPH
[ZOSIN = a1 blockers]
*can cause hypotension + reflex tachycardia*
TerazosinSelective a1 blocker: BPH [-azosin = a1 blockade]
*can cause hypotension + reflex tachycardia*
TamsulosinVery selective a1 blocker in prostate: BPH
* does NOT cause hypotension/reflex tachycardia *
Phenoxybenzamine*Irreversible* Nonselective a-blocker
- Pheochromocytoma
PhentolamineNonselective a-blocker: Pheochromocytoma
*Irreversible*
PropanololNonselective ß-blocker: HTN
TimololNonselective ß-blocker: Glaucoma
NadololNonselective ß-blocker: Glaucoma
MetoprololSelective ß1-blocker: HTN
AtenololSelective ß1-blocker: HTN
EsmololSelective ß1-blocker: Arrhythmia
PindololWeak ß1 and ß2 partial agonist, Competitively inhibits epi+NE:
- HTN with bradycardia
[PACEs epi]
AcebutololWeak ß1 and ß2 partial agonist, Competitively inhibits epi+NE
- HTN with bradycardia [PACEs epi]
AmphetamineIndirect sympathomimetic (Stimulates release of stored catecholamines)
- Narcolepsy
- ADHD
- Obesity
EphedrineIndirect sympathetic agonist (Stimulates release of stored catecholamines)
- Urinary incontinence
- Nasal decongestant
CocaineIndirect sympathomimetic (Inhibits re-uptake of NE): Nasal decongestant, Anesthesia
ReserpineBlocks VMAT, inhibiting NE release
TyramineStimulates release of NE: nonpyschoactive sympathomimetic effects
**Does NOT cross the BBB**
BretyliumBlocks NE release from presynaptic cell: Anti-arrhythmic
TCAsBlock NE reuptake
Catechol-O-methyl transferase (COMT)Methylates catecholamines rendering them inactive
Monoamine oxidase (MAO)Oxidizes monoamines such as catecholamines, rendering them inactive
MetyrosineInhibits NE synthesis via Tyrosine hydroxylase (Tyrosine >> DOPA)
Angiotensin IIStimulates VMAT, stimulating release of NE
GuanethidineInhibits release of NE
How do M2 receptors regulate NE?Inhibit NE release (makes sense... don't want redundant signals)
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