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Pharm Exam 1
Set 7: Cholinergic Pharmacology Intro
107
Pharmacology
Graduate
10/08/2011

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Cards

Term
What are the 2 major divisions of the efferent portion of the nervous system?
Definition
Somatic & Autonomic
Term
Function

Somatic nerves
Definition
skeletal muscle
Term
Function

Autonomic nerves
Definition
unconscious innervated structures of periphery
Term
Where does control of the somatic nervous system originate?
Definition
mortox cortex via corticospinal tracts
Term
Where do all synapses of the somatic nervous system occur?
Definition
within CNS (therefore motor neurons run from CNS to skeletal muscles uninterrupted)
Term
Are somatic motor neurons usually myelinated or unmyelinated?
Definition
myelinated
Term
That is the neurotransmitter for skeletal muscle?
Definition
Ach
Term
What happens to skeletal muscles if their innervation is lost?
Definition
atrophy
Term
Where does control of the autonomic nervous system originate?
Definition
hypothalamous, limbic system, & brain stem that integrate at the peripheral ganglia b/w CNS & neuroeffector junction.
Term
What happens to smooth muscles & glands in the absence of functional autonomic innervation?
Definition
spontaneous activity
Term
What are the 2 major portions of the autonomic nervous system?
Definition
Parasympathetic
Sympathetic
Term
What is the PS comprised of?
Definition
autonomic output of the cranial nerves & sacral portion of the SC
Term
What is the neurotransmitter at all ganglionic & neuroeffector junctions of the PS?
Definition
Ach
Term
What is the SS comprised of?
Definition
autonomic output of the thoracic & lumbar portions of the SC
Term
When is Ach the neurotransmitter in SS?
Definition
sympathetic ganglia, adrenal medulla, & few sympathetic neuroeffector junctions
Term
What is the neurotransmitter dominant at the neuroeffector junctions of the SS?
Definition
NE
Term
Which of the autonomic system is "rest & digest"?

"fight or flight"?
Definition
R&D: PS
F&F: SS
Term
What could be regarded at the 3rd component of the ANS?
Definition
enteric nervous system
Term
Where is the enteric nervous system found?
Definition
walls of GI tract
Term
What modulates the intrinsic activity of the enteric nervous system?
Definition
PS & SS inputs
Term
What outputs does the enteric nervous system have?
Definition
cholinergic & NANC (non-adrenergic, noncholinergic)
Term
What are the primary neurotransmitters of the enteric nervous system?
Definition
peptides, purines, & other substances (NO)
Term
What do peptides, purines, & other substances function as in cholinergic & adrenergic neurons?
Definition
co-transmitters
Term
def

cholinergic neuron
Definition
any neuron in CNS or periphery that liberates Ach as it's transmitter
Term
What is the primary signal for all neurons leaving the CNS?
Definition
Ach
Term
What receptor type do all Ach originating from CNS synapse on initially?
Definition
nictotinic
Term
When are muscarinic Ach receptors used?
Definition
In SS sweat glands & PS AFTER they initially synapse on a nictotinic Ach receptor
Term
Where is Ach synthesized?
Definition
cytoplasm of cholinergic nerve terminals
Term
What 2 substrates are used to form Ach?
Definition
choline & acetyl CoA
Term
What enzyme catalyzes Ach synthesis?
Definition
ChAT (choline acetyltransferase)
Term
Where is ChAT synthesized?
Definition
cell body of neuron & transported down axon
Term
Why is the rate of Ach synthesis dependent on choline?
Definition
aceytl CoA is produced via mitochondria in the nerve, choline is selectively pumped into the nerve.
Term
What amine type is choline?
Definition
quaternary
Term
def

quantum of Ach
Definition
contents of a single vesicle of Ach
Term
How does Ach end up in vesicles?
Definition
packaged into vesicles in nerve terminal
Term
What singals Ach vesicles to fuse with the membrane & be relesed to synapse?
Definition
Terminal becomes excited by action potential => Ca2+ channels activated => Ca2+ influx
Term
What can effect Ca2+-dependent Ach release?
Definition
Any Ca2+ antagonist interfering with permeability of Ca2+
Term
def

MEPP (mini end plate potential)
Definition
Sm. transient depolarization of the motor end plate via spontaneous release of individual quanta NOT cauing an AP
Term
Why are graded responses in Ach release needed in the heart, visceral organs, or glandular tissue?
Definition
1) Single AP doesn't provide maximal response
2) released Ach must diffuse more widely due to less organized neuromuscular junction
Term
What is the postsynaptic cholinoreceptor for Ach?
Definition
AchR
Term
What enzyme degrades Ach?
Definition
AChE (acetylcholinesterase)
Term
What does the cholinergic mediated response depend on?
Definition
Ach binding postsynaptic AchR
Term
How do presynaptic receptors play a role in neurotransmission?
Definition
feedback inhibiton
Term
How is AchR subdivided?
Definition
By effects of agonists (muscarine & nicotine) & effects of antagonists (atropine & s-tubocurarine)
Term
What does the flexibility of Ach allow it to bind to?
Definition
all cholinoreceptors
Term
What does the flexibility of Ach allow it to bind to?
Definition
all cholinoreceptors
Term
What on all cholinoreceptors allows the + charged Ach to orient over the binding site?
Definition
- charged area
Term
Why do Ach analogs tend to have preference over receptor type/subtype?
Definition
more rigid conformations
Term
What stimulates muscarinic receptors (mAch)?

What blocks mAch?
Definition
Stimulates: Ach
Blocks: atropine
Term
def

muscarine
Definition
alkaloid isolated from Amanita muscaria mushroom
Term
What 5 locations does muscarine mimic Ach?
Definition
1) visceral smooth muscle GI, LUT, uterus, bronchi
2) heart/vasculature
3) secondary glands
4) CNS
5) autonomic ganglia (primary cholinoreceptor is nicotinic, tho)
Term
def

atropine
Definition
an alkaloid from the leaves of atopine belladonna
Term
def

mAchR
Definition
all cholinoreceptors that are activated by muscarine & blocked by atropine. They traverse the membrane 7 times.
Term
def

M1
Definition
neuronal mAchR
Term
def

M2
Definition
mAchR predominant in the heart
Term
def

M3
Definition
mAchR predominant in secretory signals
Term
def

nicotine
Definition
a liquid alkalois isolated from tobacco
Term
What are the 4 cholinoreceptor sites where nicotine acts as an agonist?
Definition
1) Neuromuscular junction of somatic muscles
2) all autonomic ganglia on dendrites of post-ganglionic neurons
3) CNS
4) adrenal medulla
Term
What happens when nictotine binds to AchR in low concentrations?
Definition
stimulation followed by recovery
Term
What happens when nictotine binds to AchR in high concentrations?
Definition
stimulation followed by depression
Term
What causes the depression seen in high nicotine concentrations after stimulation?
Definition
sustained depolarization of receptor membrane due to ionic channels being kept open
Term
def

depolarization blockade
Definition
effect of large nicotine cocentrations
Term
What blocks the stimulatory action of nicotine?
Definition
d-turbocurarine
Term
def

d-turbocurarine
Definition
alkaloid
Term
def

nicotinic AchR (nAchR)
Definition
cholinoreceptor stimulated by nicotine & blocked by d-turbocurarine

They are pentameric complexes that span the membrane several times.
Term
What are mAchR coupled with to transduce signals & cellular responses?
Definition
heterotrimer G-proteins
Term
Which mAchR's are coupled through Gi?
Definition
Even mAchR's (M2 & M4)
Term
Effect mAchR binding Gi
Definition
increased K+ conductance => inhibitory to cellular activity decreased cAMP => decreased AC
Term
What are the 3 subunits of the G protein?
Definition
α, β, γ
Term
What subunit of G protein is responsible for it's function?
Definition
α
Term
When does the G protein α subunits dissociate from the βγ subunits?
Definition
When α is bound to GTP
Term
When does G protein α subunit rejoin βγ subunits?
Definition
After GTP hydolyzed to GDP by α subunit
Term
Which mAchR's are coupled through Gq?
Definition
Odd mAchR's (M1, M3, & M5)
Term
Effect mAchR binding Gq
Definition
increase cytosolic calcium => stimulatory to cellular activity (via phospolipase C activation => conversion of PIP2 to PIPG3 & DAG => intracellular stroage release of calcium)
Term
What is formed when nictotinic receptors are bound to agonists?
Definition
conformational change to a poor allowing Na+, K+, & Ca2+ permeability
Term
Why is it possible to selectively block nitotinic receptors either at autonomic ganglia or neuromuscular junction?
Definition
Though both nAchR's, there are subtle differences at the binding sites.
Term
Why does synaptically released Ach have a very short half life?
Definition
presence of cholinesterases
Term
Function

AchE
Definition
hydrolyze ester linkage of Ach => choline & acetic acid
Term
Where is AchE found?
Definition
cholinergic/effector cell membranes & RBC membranes
Term
Why is AchE so rapid to degrade Ach?
Definition
to limit duration of action of Ach at cholinergic junctions
Term
Where are pseudocholinesterases found?
Definition
plasma & liver
Term
Function

pseudocholinesterases
Definition
less selective hydrolyzation of esters
Term
Why is Ach relatively ineffective as a drug?
Definition
it's rapidly metabolized in plasma
Term
What are the 2 primary sites that Ach interacts contained on AchE?
Definition
anionic site & esteratic site
Term
What attracts the Ach to AchE?
Definition
the (-) charge of anionic site draws in the (+) charge of quaternary amine of Ach => orients Ach over esteratic site for ester link hydrolysis
Term
What releases choline from Ach in AchE?
Definition
enzyme transfer of acetyl group to serine residue
Term
What causes acetic acid release from AchE after choline leaves?
Definition
water hydrolysis
Term
What happens to the free choline after Ach breakdown by AchE?
Definition
pumped back into nerve terminal or diffused away
Term
What are the common pre-synaptic AchR's?
Definition
mAchR (usually M2)
Term
Function

presynaptic AchR
Definition
regulate evoked release of Ach (feedback inhibition) i.e. prevent excessive Ach release
Term
Why can low doses of atropine produce a paradoxical bradycardia?
Definition
presynaptic AchR's = mAchR's. mAchR's are blocked by atropine => less feedback inhibition of presynaptic Ach release
Term
Function

presynaptic nAchR at neuromuscular junction
Definition
stimulatory for Ach release to maintain Ach release during periods of intense neuromuscular transmission
Term

Pharmacologic sites of action at cholinergic synapses

[image]

 

Definition
1) Ach synthesis 2) Ach storage 3) Prevent nerve terminal activation 4) Interfer with Ca2+ influx to nerve terminal via Ca2+ antagonists (NOT Ca2+ channel blockers) 5) Exocytosis modification 6) AchR Action 7) AchE inhibition
Term
How do drugs affect Ach synthesis?
Definition
Inhibit the rate-limiting step (choline uptake to nerve terminal)
Term
How do drugs affect Ach storage?
Definition
Prevent Ach packaging into secretory vesicle
Term
def

hemicholinium
Definition
blocks rate-limiting step of Ach synthesis
Term
Function

Vesamicol
Definition
Inhibit Ach vesicle formation
Term
What can prevent activation of nerve terminal?
Definition
Local anaesthetics
Term
What interfers with Ca2+ influx to nerve terminal?
Definition
hypermagnesia (or other Ca2+ antagonists, NOT Ca2+ channel blockers)
Term
What inhibits Ach exocytosis?
Definition
botulinum toxin
Term
What activated Ach exocytosis?
Definition
Black Widow venom
Term
def

indirect Ach agonists
Definition
agents that occupy cholinesterase Ach binding sites
Term
def

reversible indirect Ach agonist
Definition
indirect Ach agonist agents metabolized or removed from binding site within minutes-hours

or they are simple, competitive inhibitors of Ach binding
Term
def

irreversible indirect Ach agonist
Definition
indirect Ach agonist agents that have stable covalent binding to esterases & remain on the AchE receptor for hours-days
Term
What is an example of an irreversible indirect Ach agonist?
Definition
Nerve gas
Term
Patient has primary axillary hyperhydrosis (excessive sweating) that has not responded to topical treatment. What agent may be appropriate for this patient.
Definition
Local botox injection
Term
When can botox be used pharmacologically?
Definition
strabismus, torticollis, wrinkles, possibly migranes
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