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S5 - Anesthesia Pharm II - Test 2 > ANS > Flashcards

ANS Flashcards

1
Q

Does the ANS control voluntary or involuntary functions?

What is the term for this?

A

Involuntary (or visceral)

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2
Q

How does activation of ANS mainly occur?

A
  • Hypothalamus
  • Brainstem
  • Spinal cord
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3
Q

3 Divisions of the ANS

Which is independent of the other two divisions?

A
  1. Sympathetic
  2. Parasympathetic
  3. Enteric

Enteric (GI function) is independent from other two

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4
Q

Are most target organs innervated by either the sympathetic or parasympathetic branches?

A

No, most have innervation from both SNS and PNS and activity is a balance between the two

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5
Q

Effect of SNS and PNS on SA node?

A

SNS- increases HR

PNS - decreases HR

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6
Q

Effect of SNS and PNS on AV node

A

SNS- increases conduction velocity

PNS- decreases conduction velocity

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7
Q

Effect of SNS and PNS on His-Purkinje system

A

SNS- increases automaticity and conduction velocity

PNS- minimal effect

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8
Q

Effect of SNS and PNS on ventricles

A

SNS- Increases contractility, conduction velocity, and automaticity
PNS- minimal effects, slight decrease in contractility)

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9
Q

Effects of SNS and PNS on Bronchial smooth muscle

A

SNS- relaxation

PNS- contraction

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10
Q

Effect of SNS and PNS on GI motility

A

SNS- decreases motility

PNS- increases motility

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11
Q

Effect of SNS and PNS on GI secretions

A

SNS- decreased secretion

PNS- increased secretion

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12
Q

Effect of SNS and PNS on GI sphincters

A

SNS- contraction of sphincters

PNS- relaxation of sphincters

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13
Q

Effect of SNS and PNS on gallbladder

A

SNS- relaxation of gallbladder

PNS- contraction of gallbladder

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14
Q

Effect of SNS and PNS on bladder smooth muscle tone

A

SNS- Relaxation of bladder smooth muscle

PNS- Contraction of bladder smooth muscle

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15
Q

Effect of SNS and PNS on bladder sphincter tone

A

SNS- contraction of bladder sphincter

PNS- relaxation of bladder sphincter

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16
Q

Effect of SNS on radial muscle of eye

A

SNS- mydriasis (muscle contraction)

Pupil dilation

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17
Q

Effect of PNS on sphincter muscle of eye

A

PNS- miosis

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18
Q

Effect of SNS and PNS on ciliary muscle of eye

A

SNS- relaxation for far vision

PNS- contraction for near vision

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19
Q

Effect of SNS and PNS on liver

A

SNS- glucogenolysis and gluconeogensis

PNS- glycogen synthesis

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20
Q

Effect of SNS on pancreatic beta cell secretion

A

SNS- decreased pancreatic beta cell secretion

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21
Q

Effect of SNS and PNS on salivary gland secretion

A

SNS- increased salivary gland secretion

PNS- marked increase in salivary gland secretion

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22
Q

Effect of SNS on sweat glands

A

SNS- Increased secretion

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23
Q

Effect of SNS on apocrine glands

A

SNS- increased secretion

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24
Q

Effect of SNS and PNS on coronary arterioles

A

SNS- Constriction (alpha) and relaxation (beta)

PNS- Relaxation (?)

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25
Q

Effect of SNS and PNS on skin and mucosal arterioles

A

SNS- constriction

PNS- relaxation

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26
Q

Effect of SNS and PNS on skeletal muscle arterioles

A

SNS- constriction (alpha) and relaxation (beta)

PNS- relaxation

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27
Q

Effect of SNS and PNS on pulmonary arterioles

A

SNS- constriction

PNS- relaxation

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28
Q

Where do sympathetic nerves arise from?

A

T1-L2 segments of spinal cord

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29
Q

Where do parasympathetic nerves arise from?

A

Cranial nerves III, V, VII, IX, and X

Sacral spinal cord S2, S3 and sometimes S1, and S4

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30
Q

Where are sympathetic preganglionic neurons located?

A

Intermediolateral horn of spinal cord

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31
Q

Where do sympathetic preganglionic fibers leave from and go to?

A

Leave with the ventral nerve roots and go into one of the 22 pairs of ganglia in the paravertebral sympathetic chain

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32
Q

Where do preganglionic sympathetic neurons synapse? What may happen before this?

A

Synapse with cell bodies of postganglionic fibers at the paravertebral chain
Some may stay at the same level, but most travel cephalad or caudad prior to synapsing

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33
Q

Where do postganglionic fibers go to after exiting the paravertebral chain?

A

Target organs

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34
Q

Describe preganglionic fibers

A

Mostly myelineated
Fairly slow B-fibers
Coming out of the white ramus

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35
Q

Describe postganglionic fibers

A

Mostly unmyelinated C fibers

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36
Q

What cranial nerves supply the head?

A

Cranial Nerve III, V, VII, IX

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37
Q

What nerve supplies 75% of all parasympathetic nervous system fibers (particularly the thorax and abdomen)?

A

Cranial nerve X (Vagus)

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38
Q

What nerves supply the pelvis?

A

S2, S3

Sometimes S1 and S4

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39
Q

What is the difference in lengths of pre and postganglionic neurons between the PNS and SNS?

A
  • PNS: has longer preganglionic and very short postganglionic neurons
  • SNS: short preganglionic, long postganglionic
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40
Q

What neurotransmitter do all preganglionic neurons release?

What does it activate?

A

Acetylcholine

Activates both SNS and PNS postganglionic fibers

41
Q

What neurotransmitter do PNS postganglionic neurons release?

A

Acetycholine

42
Q

What neurotransmitter do most SNS postganglionic neurons release?
What is the exception?

A

Most release norepinephrine

Exceptions are sweat glands and some blood vessels release acetylcholine

43
Q

What are some other neurotransmitters of the ANS besides acetylcholine and norepinephrine?

A
  • Dopamine
  • Vasoactive Intestinal Polypeptide (VIP)
  • ATP
  • Neuropeptide Y
44
Q

How is norepinephrine synthesized?

A

Synthesized from phenylalanine and tyrosine by a series of enzymatic-controlled steps

45
Q

Progression from tyrosine to epinephrine

A

Tyrosine–> dopa –> dopamine –> norepinephrine –> epinephrine

46
Q

Which circulates longer, acetylcholine or norepinephrine?

A

Norepinephrine slightly longer

Circulating half-life of 2 minutes

47
Q

What happens to 80% of norephinephrine?

A

80% undergoes reuptake back into postganglionic sympathetic nerve endings where it can be reused

48
Q

What causes true termination of action of norepinephrine?

A

Dilution by diffusion from receptors
- Reuptake is what allows the concentration gradient for it to diffuse away

APEX says termination of effect is reuptake so its all very unclear

49
Q

What drugs can block reuptake of norepinephrine?

What can this cause?

A
  • Cocaine, amphetamines

- Can cause depletion of norepinephrine

50
Q

What two enzymes metabolize norepinephrine?

A

Monoamine oxidase (MAO) and Catechol-O- methyltransferase (COMT)

51
Q

Where is MAO located?

A

Intracellularly on the mitochondria of noradrenergic nerve endings

52
Q

Where is COMT located?

A

Extracelluarly in many tissues, mostly in the liver

53
Q

In a patient receiving ephedrine, what home medication could place the patient at risk for hypertensive crisis?

A

MAOIs

Ephedrine causes release of norepinephrine and MAOIs block the metabolism of norepi

54
Q

How is acetylcholine synthesized?

A

Choline and acetyl coenzyme A by enzyme choline acetyltransferase

55
Q

where is acetylcholine stored?

A

In synaptic vesicles

56
Q

How is acetylcholine metabolized?

A

Rapidly by acetylcholinesterase to metabolites choline and acetate

57
Q

T/F the enzyme that metabolizes acetylcholine is pseudocholinesterase

A

False

Acetylcholinesterase does

58
Q

Which metabolite of acetylcholine undergoes reuptake into the nerve ending?

A

Choline

59
Q

Does acetylcholine have short or long duration?

A

Short, due to highly efficient acetylcholinesterase

60
Q

Is acetylcholine’s effect local or widespread?

A

Highly localized

61
Q

Where are alpha1 receptors located?

A

Postsynaptic

In smooth muscle throughout blood vessels, GI tract, GU system, eye, lungs, and uterus

62
Q

Effects of stimulation of alpha1 receptors on vascular smooth muscle (skin, mucosa, hepatorenal)

A

Contraction- aka vasoconstriction

63
Q

Effects of stimulation of alpha1 receptors on heart, pupils and bronchial smooth muscle

A
  • Increases force of heart contraction slightly
  • Dilates pupils (contracts radial eye muscles)
  • Bronchoconstricts
64
Q

Effect of stimulation of alpha1 receptors on prostate and uterine smooth muscle, and sphincters of GI/GU tracts

A

Contractions

65
Q

Effect of stimulation of alpha1 receptors on salivary and sweat glands

A

Secretion

66
Q

Effect of stimulation of alpha1 receptors on insulin and lipolysis

A

Inhibits insulin secretion and lipolysis

67
Q

How does activation of alpha1 receptors lead to contraction of smooth muscles?

A

Increases intracellular calcium ion concentration

68
Q

General effect of alpha2 receptor stimulation?

Exception?

A

“Relaxation”

Exception is effect on postsynpatic receptors for vascular smooth muscle - causes contraction

69
Q

Presynaptic Alpha2 receptor stimulation inhibits release of what NT?

A

Norepinephrine

Via negative feedback loop

70
Q

Effects of postsynaptic alpha 2 receptor stimulation in CNS

A

Hyperpolarization

- Causes sedation, decreased MAC, decreased sympathetic outflow causing vasodilation and decreased BP

71
Q

Effects of alpha2 receptor stimulation on platelets and insulin

A

Causes platelet aggregation and and decreased insulin release

72
Q

Are alpha 2 receptors more pre or post synaptic?

How do they act?

A

Largely pre-synaptic, but both

Act via G protein subgroup Gi, inhibiting adenyl cyclase, reducing cAMP and calcium levels

73
Q

Where are beta1 receptors located?

A

Postsynaptic in the heart

74
Q

Stimulation of beta1 receptors produces what effect?

A

Inotropic, chronotropic and dromotropic effect

75
Q

Define inotropic

A

Increased force of contraction

76
Q

Define chronotropic

A

Affects heart rate

77
Q

Define dromotropic

A

affects conduction velocity

78
Q

Beta1 receptors effect on adenyl cyclase and cAMP

A
  • increased andenylate cyclase

- Increased cAMP

79
Q

Effect of beta1 receptors increasing cAMP

A

stimulation initiates cascading protein phosphorylation reaction and stimulates sodium-potassium pump

80
Q

Where are beta2 receptors located?

A

Smooth muscle and glands, postsynaptic

81
Q

Effect of beta2 stimulation on respiratory, uterine, and vascular smooth muscles

A

Relaxation

- Causes bronchodilation, vasodilation, relaxation of uterus and GI/GU

82
Q

Effect of beta2 stimulation on skeletal muscle

A

Vasodilation- better perfusion

83
Q

Effect of beta2 stimulation on ciliary muscle of eye

A

Relaxation allowing for far vision

84
Q

Effect of beta2 stimulation on metabolic processes

A
  • Gycogenolysis
  • Lipolysis
  • Gluconeogenesis
  • Increased insulin release

Results in hyperglycemia

85
Q

which dopamine receptors are presynaptic and which are post?

A 
D1= postsynaptic
D2= presynaptic
86
Q

Effect of stimulation of D1 receptors

A

Vasodilation of renal, mesenteric, coronary, and cerebral blood vessels

87
Q

Effect of stimulation of D2 receptors

A

Inhibit release of norepinephrine

Cause N/V

88
Q

Cholinergic receptors within an ANS ganglion and at the NMJ

A

Nicotinic

89
Q

Two types of cholinergic receptors

A

Nicotinic and muscarinic

90
Q

Where are M1 receptors?

A

Autonomic ganglia and the CNS

91
Q

Where are M2 receptors?

A

Principally in the heart and salivary glands

92
Q

Where are M3 receptors?

A

Bronchial tree

93
Q

What is unique about innervation of the adrenal medulla?

A

Innervated by preganglionic fibers that come directly from the spinal cord and bypass the paravertebral ganglia

94
Q

What is released when SNS stimulation of adrenal medulla occurs?

A

Epinephrine (80%) and Norepinephrine (20%) directly into circulation
This means they act as hormones instead of NTs
Allows stimulation of areas that aren’t directly innervated by the SNS

95
Q

Which branch of the ANS has more localized effects and which has more widespread effect?

A

PNS is more local

SNS is widespread (due to adrenalla medulla releasing hormones directly into circulation)

96
Q

Effects of stimulation of adrenal medulla

A

Prolonged (10-30 seconds)

?

97
Q

How does parasympathetic system effect MAP?

A

Chronotropic effects only (HR)

Practicing my vocab because TC says it matters

98
Q

How does SNS effect MAP?

A
  • PVR
  • HR
  • Contractility
  • Venous tone

S5 - Anesthesia Pharm II - Test 2 (7 decks)

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