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

ANS Flashcards

(98 cards)

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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
Effect of SNS and PNS on skin and mucosal arterioles
SNS- constriction | PNS- relaxation
26
Effect of SNS and PNS on skeletal muscle arterioles
SNS- constriction (alpha) and relaxation (beta) | PNS- relaxation
27
Effect of SNS and PNS on pulmonary arterioles
SNS- constriction | PNS- relaxation
28
Where do sympathetic nerves arise from?
T1-L2 segments of spinal cord
29
Where do parasympathetic nerves arise from?
Cranial nerves III, V, VII, IX, and X | Sacral spinal cord S2, S3 and sometimes S1, and S4
30
Where are sympathetic preganglionic neurons located?
Intermediolateral horn of spinal cord
31
Where do sympathetic preganglionic fibers leave from and go to?
Leave with the ventral nerve roots and go into one of the 22 pairs of ganglia in the paravertebral sympathetic chain
32
Where do preganglionic sympathetic neurons synapse? What may happen before this?
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
33
Where do postganglionic fibers go to after exiting the paravertebral chain?
Target organs
34
Describe preganglionic fibers
Mostly myelineated Fairly slow B-fibers Coming out of the white ramus
35
Describe postganglionic fibers
Mostly unmyelinated C fibers
36
What cranial nerves supply the head?
Cranial Nerve III, V, VII, IX
37
What nerve supplies 75% of all parasympathetic nervous system fibers (particularly the thorax and abdomen)?
Cranial nerve X (Vagus)
38
What nerves supply the pelvis?
S2, S3 | Sometimes S1 and S4
39
What is the difference in lengths of pre and postganglionic neurons between the PNS and SNS?
- PNS: has longer preganglionic and very short postganglionic neurons - SNS: short preganglionic, long postganglionic
40
What neurotransmitter do all preganglionic neurons release? | What does it activate?
Acetylcholine Activates both SNS and PNS postganglionic fibers
41
What neurotransmitter do PNS postganglionic neurons release?
Acetycholine
42
What neurotransmitter do most SNS postganglionic neurons release? What is the exception?
Most release norepinephrine Exceptions are sweat glands and some blood vessels release acetylcholine
43
What are some other neurotransmitters of the ANS besides acetylcholine and norepinephrine?
- Dopamine - Vasoactive Intestinal Polypeptide (VIP) - ATP - Neuropeptide Y
44
How is norepinephrine synthesized?
Synthesized from phenylalanine and tyrosine by a series of enzymatic-controlled steps
45
Progression from tyrosine to epinephrine
Tyrosine--> dopa --> dopamine --> norepinephrine --> epinephrine
46
Which circulates longer, acetylcholine or norepinephrine?
Norepinephrine slightly longer | Circulating half-life of 2 minutes
47
What happens to 80% of norephinephrine?
80% undergoes reuptake back into postganglionic sympathetic nerve endings where it can be reused
48
What causes true termination of action of norepinephrine?
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
What drugs can block reuptake of norepinephrine? | What can this cause?
- Cocaine, amphetamines | - Can cause depletion of norepinephrine
50
What two enzymes metabolize norepinephrine?
Monoamine oxidase (MAO) and Catechol-O- methyltransferase (COMT)
51
Where is MAO located?
Intracellularly on the mitochondria of noradrenergic nerve endings
52
Where is COMT located?
Extracelluarly in many tissues, mostly in the liver
53
In a patient receiving ephedrine, what home medication could place the patient at risk for hypertensive crisis?
MAOIs | Ephedrine causes release of norepinephrine and MAOIs block the metabolism of norepi
54
How is acetylcholine synthesized?
Choline and acetyl coenzyme A by enzyme choline acetyltransferase
55
where is acetylcholine stored?
In synaptic vesicles
56
How is acetylcholine metabolized?
Rapidly by acetylcholinesterase to metabolites choline and acetate
57
T/F the enzyme that metabolizes acetylcholine is pseudocholinesterase
False | Acetylcholinesterase does
58
Which metabolite of acetylcholine undergoes reuptake into the nerve ending?
Choline
59
Does acetylcholine have short or long duration?
Short, due to highly efficient acetylcholinesterase
60
Is acetylcholine's effect local or widespread?
Highly localized
61
Where are alpha1 receptors located?
Postsynaptic | In smooth muscle throughout blood vessels, GI tract, GU system, eye, lungs, and uterus
62
Effects of stimulation of alpha1 receptors on vascular smooth muscle (skin, mucosa, hepatorenal)
Contraction- aka vasoconstriction
63
Effects of stimulation of alpha1 receptors on heart, pupils and bronchial smooth muscle
- Increases force of heart contraction slightly - Dilates pupils (contracts radial eye muscles) - Bronchoconstricts
64
Effect of stimulation of alpha1 receptors on prostate and uterine smooth muscle, and sphincters of GI/GU tracts
Contractions
65
Effect of stimulation of alpha1 receptors on salivary and sweat glands
Secretion
66
Effect of stimulation of alpha1 receptors on insulin and lipolysis
Inhibits insulin secretion and lipolysis
67
How does activation of alpha1 receptors lead to contraction of smooth muscles?
Increases intracellular calcium ion concentration
68
General effect of alpha2 receptor stimulation? | Exception?
"Relaxation" | Exception is effect on postsynpatic receptors for vascular smooth muscle - causes contraction
69
Presynaptic Alpha2 receptor stimulation inhibits release of what NT?
Norepinephrine | Via negative feedback loop
70
Effects of postsynaptic alpha 2 receptor stimulation in CNS
Hyperpolarization | - Causes sedation, decreased MAC, decreased sympathetic outflow causing vasodilation and decreased BP
71
Effects of alpha2 receptor stimulation on platelets and insulin
Causes platelet aggregation and and decreased insulin release
72
Are alpha 2 receptors more pre or post synaptic? | How do they act?
Largely pre-synaptic, but both | Act via G protein subgroup Gi, inhibiting adenyl cyclase, reducing cAMP and calcium levels
73
Where are beta1 receptors located?
Postsynaptic in the heart
74
Stimulation of beta1 receptors produces what effect?
Inotropic, chronotropic and dromotropic effect
75
Define inotropic
Increased force of contraction
76
Define chronotropic
Affects heart rate
77
Define dromotropic
affects conduction velocity
78
Beta1 receptors effect on adenyl cyclase and cAMP
- increased andenylate cyclase | - Increased cAMP
79
Effect of beta1 receptors increasing cAMP
stimulation initiates cascading protein phosphorylation reaction and stimulates sodium-potassium pump
80
Where are beta2 receptors located?
Smooth muscle and glands, postsynaptic
81
Effect of beta2 stimulation on respiratory, uterine, and vascular smooth muscles
Relaxation | - Causes bronchodilation, vasodilation, relaxation of uterus and GI/GU
82
Effect of beta2 stimulation on skeletal muscle
Vasodilation- better perfusion
83
Effect of beta2 stimulation on ciliary muscle of eye
Relaxation allowing for far vision
84
Effect of beta2 stimulation on metabolic processes
- Gycogenolysis - Lipolysis - Gluconeogenesis - Increased insulin release Results in hyperglycemia
85
which dopamine receptors are presynaptic and which are post?
``` D1= postsynaptic D2= presynaptic ```
86
Effect of stimulation of D1 receptors
Vasodilation of renal, mesenteric, coronary, and cerebral blood vessels
87
Effect of stimulation of D2 receptors
Inhibit release of norepinephrine | Cause N/V
88
Cholinergic receptors within an ANS ganglion and at the NMJ
Nicotinic
89
Two types of cholinergic receptors
Nicotinic and muscarinic
90
Where are M1 receptors?
Autonomic ganglia and the CNS
91
Where are M2 receptors?
Principally in the heart and salivary glands
92
Where are M3 receptors?
Bronchial tree
93
What is unique about innervation of the adrenal medulla?
Innervated by preganglionic fibers that come directly from the spinal cord and bypass the paravertebral ganglia
94
What is released when SNS stimulation of adrenal medulla occurs?
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
Which branch of the ANS has more localized effects and which has more widespread effect?
PNS is more local | SNS is widespread (due to adrenalla medulla releasing hormones directly into circulation)
96
Effects of stimulation of adrenal medulla
Prolonged (10-30 seconds) | ?
97
How does parasympathetic system effect MAP?
Chronotropic effects only (HR) | Practicing my vocab because TC says it matters
98
How does SNS effect MAP?
- PVR - HR - Contractility - Venous tone

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

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