fight or flight division of the autonomic nervous system
sympathetic
rest and digest division of the autonomic nervous system
parasympathetic
ANS controls what 3 tissue types
cardiac muscle, smooth muscle, glands. controlled automatically
primary neurotransmitter for sympathetic division
norepinephrine (and epinephrine from adrenal)
primary neurotransmitter for parasympathetic division
acetylcholine
number of neurons in sympathetic/parasympathetic divisions
2 except adrenal gland (sympathetic) - 1 neuron directly stimulates adrenal medulla to secrete epinephrine and norepinephrine directly into the blood
steps by which a drug modifies physiology
drug binds receptor on target tissueorgan physiology is changedorganisms physiology is changed
drugs can be either __ or __
agonists or antagonists
cell drug-receptor types
a1, a2, B1, B2, M2, M3
what can a drug physiologically induce in an organ
contract, rate of contraction, relax, or secrete
a drug induces 1 of 2 physiologic reactions: __ or __
fight/flight or rest/digest
what happens to lungs - parasympathtic
bronchioles constrict
what happens to lungs - sympathetic
bronchioles dilate
what happens to salivary glands - sympathetic
stop secretion
what happens to salivary glands - parasympathetic
increase secretion
what happens to eye - sympathetic
mydriasis
what happens to eye - parasympathetic
miosis
what happens to heart - sympathetic
increase rate
what happens to heart - parasympathetic
decrease rate
what happens to stomach - sympathetic
inactive
what happens to stomach - parasympathetic
active
what happens to bladder - sympathetic
inactive
what happens to bladder - parasympathetic
active
symp or parasymp - stimulate secretion
parasymp
symp or parasymp - stimulate smooth muscle contraction
either
symp or parasymp - stimulate smooth muscle relaxation
sympathetic
symp or parasymp - inhibit heart rate (SA/AV node)
parasymp
symp or parasymp - stimulate heart rate (SA/AV node)
symp
symp or parasymp - a1 receptor
sympathetic
symp or parasymp - B1 receptor
sympathetic
symp or parasymp - B2 receptor
sympathetic
symp or parasymp - M2 receptor
parasympathetic
symp or parasymp - M3 receptor
parasympathetic
what receptor - parasympathetic - eye
M3
what receptor - parasympathetic - salivary glands
M3
what receptor - parasympathetic - heart
M2
what receptor - parasympathetic - lungs
M3
what receptor - parasympathetic - stomach
M3
what receptor - parasympathetic - bladder
M3
what receptor - sympathetic - eye
a1, B2
what receptor - sympathetic - salivary glands
B2
what receptor - sympathetic - lungs
B2
what receptor - sympathetic - heart
B1
what receptor - sympathetic - stomach
B2
what receptor - sympathetic - bladder
a1, B2
which organ has M2 receptor
heart - parasympathetic
which organ has B1 receptor
heart - sympathetic
M2 receptor causes
inhibition of SA/AV node (decrease HR)
M3 receptor causes
secretion or SM contraction
a1 receptor causes
SM contraction
a2 receptor causes
SM contraction
B1 receptor causes
SA/AV node stimulation (increase HR)
B2 receptor causes
SM relaxation
Sympathetic stimulation of B2 receptor causes
SM relaxation
most autonomic drugs used in clinic are
sympathetic (because less off target toxicity)
which is selective/non-selective - sympathetic or parasympathetic drugs
sympathetic selective, parasympathetic non-selective
receptor type(s) in the heart
M2, B1
cardiovascular indications for atropine
bradyarrhythmia
organophosphate poisoning may be treated with __
atropine
indications for dobutamine
heart failure, hypovolemic shock
hypovolemic shock may be treated with __
dobutamine
indications for metoprolol
hypertension, angina
heart failure may be treated with __
dobutamine
hypertension may be treated with __
metoprolol
angina may be treated with __
metoprolol
receptor type(s) in the lungs
B2, M3
indications for methacholine
respiratory challenge - asthma TEST, not therapeutic
indications for ipratropium
COPD
indications for albuterol
asthma, COPD
receptor type(s) in the detrusor of bladder
M3, B2
receptor type(s) in the urethra
a1
sympathetic response of detrusor is to __ and urethra __
detrusor relaxes, urethra contracts
indications for bethanechol
urinary retention
urinary retention may be treated with __
bethanechol
indications for oxybutynin
overactive bladder
indications for tamsulosin
urinary retention
indications for dicyclomine
IBS
receptor type(s) in GI tract
M3, B2Focus on M3; B2 drugs not clinically relevant
receptor type(s) in salivary glands
M3, B2Focus on M3, B2 drugs not clinically relevant
sympathetic stimulation of salivary glands causes
thick saliva (protein rich), B2 receptor
parasympathetic stimulation of salivary glands causes
watery saliva, M3 receptor
indications for pilocarpine
Sjogren's syndrome, people with low salivary flow
pilocarpine __ salivary flow
increases
glycopyrrolate __ salivary flow
decreases
B2 receptor can additionally cause
secretion of thick saliva - salivary glands. Can cause dry mouth
receptor type(s) in the dilator muscle of the eye
a1
receptor type(s) in the constrictor muscle of the eye
M3
parasympathetic stimulation of the eye causes
constriction - M3 stimulation
sympathetic stimulation of the eye causes
dilation - a1 stimulation
mydriasis
pupil dilation
miosis
pupil constriction
ocular indications for atropine
inhibits pupil contractioncauses mydriasis (dilation)ex. in eye exam to open pupils
receptor type(s) in the uterus
M3, B2
parasympathetic stimulation of the uterus
contraction
sympathetic stimulations of the uterus
relaxation
indications for terbutaline
premature labor(stops contractions, causes relaxation)
receptor types in the vascular system
a1, B2
vasculature is directly innervated by __ and is not directly innervated by __
directly innervated by sympathetic, not directly innervated by parasympathetic
vascular smooth muscle is only innervated by __
sympathetic
what receptor is more numerous in vascular smooth muscle
more a1, less B2
the __ receptor dominates control of vascular smooth muscle
a1
indications for phenylephrine
hypotension, nasal congestion, hemorrhoids
indications for prazosin
hypertension
epinephrine causes vaso__ in a1 receptors
vasoconstriction
epinephrine causes vaso__ in B2 receptors
vasodilation
epinephrine causes overall vaso__
vasoconstriction (moderate)
if a patient is taking a non-selective beta blocker, epinephrine causes overall vaso__
vasoconstriction (extreme). Can cause hypertensive crisisExtreme because B2 receptors (dilators) repressed
alpha 2 receptor is located on the __-synaptic side of the end of the neuron releasing the neurotransmitter.
pre-synaptic
a2 receptor has anti-sympathetic effects by blocking signals through the synapse. opposite of expected effect
...
clonidine is a receptor __
agonist
clonidine inhibits __ response
sympathetic
does clonidine increase or decrease blood pressure
decreases blood pressure
indications for clonidine
hypertension
what drug is a sympathetic agonist with anti-sympathetic activity
Clonidine. a2 receptor.
on-target toxicity
toxic effect due to the drug interacting with the INTENDED target
off-target toxicity
...
example of tamsulosin on-target toxicity
tamsulosin is an a1 antagonist, meant to cause urethra to relax to allow urination. Taking tamsulosin causes inhibition of other a1 receptors as well, including vascular smooth muscle, leading to hypotension. Also can cause pupil constriction, and therefore loss of night vision
what are 2 on-target toxicities of tamsulosin
hypotension, pupil constriction (loss of night vision)
Pilocarpine on-target toxicities
Intended to increase salivation. Causes pupil constriction and increased GI motility. So "side effects" are diarrhea and loss of night vision.
Nadolol off-target toxicities
Non-selective B blocker. Intended to reduce blood pressure by antagonizing B1 in heart. Also antagonizes B2 because non-selective. Can cause bronchoconstriction, so can't use for patients with asthma or COPD.
Atropine off-target toxicities
Intended to raise heart rate and BP by antagonizing M2. Can also antagonize M3 in the stomach, causing constipation. Inhibit M3 in eye, causing pupil dilation
epinephrine is primarily a __
hormone
norepinephrine is primarily a __
neurotransmitter
epinephrine mostly released by __ directly into the bloodstream
adrenal gland
what receptors does epinephrine agonize?
a1, B1, B2
what receptors does norepinephrine agonize?
a1, B1
effects of epinephrine vs norepinephrine
BOTH increase HR, cardiac output, increase BP, vasoconstriction.Only epinephrine causes bronchodilation
initial, high concentration of epinephrine (injections)
vasoconstriction, less bleeding, stimulates a1 receptors primarily
later, lower concentration of epinephrine (injections)
vasorelaxation, more bleeding, stimulates B2 receptors primarily. Rebound bleeding after a procedure.