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ANS Flashcards

1
Q

divisions of nervous system

A

-Central Nervous System (CNS):
-Includes brain and spinal cord
-integrates all body activities

-Peripheral Nervous System:
-Somatic Nervous System
-Autonomic Nervous System (ANS):
-Parasympathetic nervous system
(PNS)
-Sympathetic nervous system (SNS)

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2
Q

somatic nervous system

A

-Activates skeletal muscle contraction
-Consists of motor neurons/sensory
neurons
-Sensory (afferent) – go TO CNS
-Motor (efferent) - go FROM CNS to
skeletal muscle
-Adjusts to external environment
-VOLUNTARY

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3
Q

ANS

A

-Further subdivided into PNS and SNS
-Regulates activity of smooth muscle,
exocrine glands, cardiac tissue and
certain metabolic activities
-Sensory neurons go from smooth
muscle & cardiac muscle TO CNS
-Motor neurons go to glands, smooth & cardiac muscle FROM CNS
-Adjust to internal environment
-INVOLUNTARY

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4
Q

enteric nervous system

A

-Aka 3rd division of ANS
-Network of autonomic nerves in
gut wall
-Receives innervation from SNS &
PNS and regulates gi motility and
secretion
-Responds to Neurotransmitters –
peptides and nitric oxide

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5
Q

neurotransmission of ANS

A

-Preganglionic neuron – cell body in CNS, axon extends out of CNS
-Postganglionic neuron – innervate an
effector outside the CNS
-Ganglion – Small mass of nerve tissue containing the cell bodies of neurons
-Synapse – space b/w pre & post neurons or space b/w post neuron & effector where Neurotransmitter (NT) is released
-SNS – primary NT is Norepinephrine (NE) – may also be referred to as noradrenaline (NA)
-PNS- primary NT is ACh

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6
Q

neurotransmitters of the ANS

A

-Acetylcholine (ACH)– Primary NT of PNS. Released at ALL autonomic ganglia (PNS & SNS), at PNS neuroeffector junction (nej), somatic neuromuscular junction (nmj), and some SNS nej
-Norepinephrine/Noradrenaline (NE/NA) – Primary NT of SNS. Released at most SNS nej
-Epinephrine (Epi) – released from adrenal medulla in response to activation of SNS
-Dopamine (DA)- important NT in CNS, and released at several peripheral SNS fibers

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7
Q

other neurotransmitters

A

-Found in ANS nerves but they are nonadrenergic noncholinergic neurons (NANC)
-Primarily found in enteric nervous system of GI tract, genitourinary tract, airways and some blood vessels
-Includes peptides, ATP, GABA, substance P, nitric oxide, serotonin
-viagra- #1 drug that affects nitric oxide

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8
Q

ANS: general effects of PNS

A

-Responses are specific
-Rest & digest
-Miosis
-increase gi motility/salivation
-increase urination/defaction
-decrease HR
-Bronchoconstriction
-Erection

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9
Q

ANS: general effects SNS

A

-Responses are diffuse
-Fight or flight
-Mydriasis
-decrease gi motility/salivation
-decrease urination/defaction
-increase heart rate
-Bronchodilation
-Ejaculation

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10
Q

alpha 1 adrenergic receptor

A

-pupils mydriasis
-arteries/veins- constriction
-salivary secretion- inhibits
-liver- glycogenolysis
-just alpha -> pancreas secretion- inhibits

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11
Q

beta 1 adrenergic receptor

A

-HR- increase
-just beta -> gastric secretion- inhibit
-just beta -> salivary secretion - inhibits

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12
Q

beta 2 adrenergic receptor

A

-arteries/veins- dilation
-smooth muscle- decrease motility
-liver- gluconeogenesis

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13
Q

cholinergic (PNS) receptor effects

A

-PNS
-muscarinic
-pupil miosis
-HR decrease
-arteries/vein- dilation
-smooth muscles- increase motility
-gastric secretion- stimulate
-pancreas secretion- stimulate
-salivary secretion- stimulate
-liver- glycogenesis
-SLUDGE

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14
Q

cholinergic receptors (just know there are diff ones)

A

-muscarinic 1
-muscarinic 2
-muscarinic 3
-nicotinic N
-nicotinic M

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15
Q

adrenergic receptors (just know they exist)

A

-alpha 1
-alpha 2
-beta 1
-beta 2
-beta 3

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16
Q

dopamine receptors (just know they exist)

A

-D1
-D2
-D3
-D4

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17
Q

cholinergic receptors (ACh): muscarinic

A

-Located at PNS nej, some SNS nej (sweat glands), CNS, and autonomic ganglia
-Activated by ACh and muscarine
-Found in body in greater numbers than nicotinic receptors
-SLUDGE- salivation, lacrimation, urination, defecation, GI motility, erection
-Mediate smooth muscle contraction (except sphincter contraction)
-Stimulates gland secretion
-Decrease HR and conduction
-Bronchoconstriction
-Peripheral vasodilation
-Miosis

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18
Q

cholinergic receptors (ACh): nicotinic

A

-activated by ACh and nicotine
-Located on autonomic ganglia and when activated will excite neurotransmission
-Located at somatic neuromuscular junction and when activated will mediate muscle contraction
-Nicotinic have some opposing effects of muscarinic (tachycardia, HTN)

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19
Q

adrenergic receptors (NE and epi): alpha 1

A

-constricts vascular smooth muscle
-constricts blood vessels
-Increase basal metabolic rate
-Located at SNS nej effector (primarily smooth muscle)

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20
Q

adrenergic receptors (NE and epi): alpha 2

A

-Inhibition of NE release from nerve endings at pre synaptic post ganglionic neuron (negative feedback)
-Also located on some postsynaptic tissue & blood platelets

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21
Q

adrenergic receptors (NE and epi): beta 1

A

-HEART muscle
-Mediates cardiac stimulation (increase HR & contractility)
-Located on SNS effector (cardiac muscle, vascular smooth muscle, renal cells - increase renin release)
-Increased lipolysis

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22
Q

adrenergic receptors (NE and epi): beta 2

A

-Mediates smooth muscle relaxation
-located on SNS effector (bronchioles in lung, uterine smooth muscle and vascular smooth muscle)
-In liver and muscle – mediate glycogenolysis

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23
Q

non specific beta blocker

A

-works on beta 1 and 2
-ex. propanolol
-contraindicated in pts with asthma

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24
Q

drugs affecting autonomic transmission

A

-Can exert effects at any step in neurotransmission process depending on classification of drug
-PNS & SNS agonist- Direct or Indirect acting
-PNS & SNS antagonist- Direct or Indirect acting

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25
direct/indirect agonist and antagonists
-Direct agonists - Activate postsynaptic receptors -Indirect agonists: -Stimulate release of NT -Inhibit reuptake of NT -Inhibit metabolism of NT -Direct antagonists- Block postsynaptic receptors -Indirect antagonists: -Inhibit synthesis of NT -Prevent vesicular storage of NT -Inhibit release of NT
26
cholinergic agonists
-Direct agonists – bind and activate cholinergic receptors: -Choline esters -Plant alkaloids -Indirect agonists – increase synaptic concentrations of ACH: -Cholinesterase inhibitors
27
direct cholinergic agonists (choline esters)
-ACH and Carbachol – activate both nicotinic and muscarinic. ACH has limited clinical indications -Lack of specificity for muscarinic subtypes, therefore have a wide range of effects on many organ systems -Bethanechol** and methacholine**– activates only muscarinic -Methacholine not commercially available -> main ones used are bethanechol and carbachol
28
direct cholinergic agonists: bethanechol (urecholine)
-acts at muscarinic only -Stimulates bladder w/o significant effects on HR or BP -TX of urinary retention post-op & post partum
29
direct cholinergic agonists (choline esters): carbachol (isoptocarbachol, miostat)
-For chronic open-angle glaucoma -Produce miosis during ophthalmic surgery -not really used anymore
30
direct cholinergic agonists (plant alkaloids)
-1. muscarine – no current medical use -2. nicotine – smoking cessation -3. Pilocarpine (Isoptocarpine, Ocusert, Salagen) -Higher affinity for muscarinic receptor -Treats glaucoma: stimulate contraction of ciliary muscle fibers -> increase aqueous humor outflow -> decrease IOP -4. Cevimeline (Exovac)- To treat dry mouth associated with Sjogren’s syndrome
31
indirect agonist: cholinesterase inhibitors
-MOA- Inhibit breakdown of ACH at all cholinergic synapses -> increase ACH concentration -Reversible vs Irreversible
32
cholinesterase inhibitors: reversible agents
-tx for pts with issues with ACh -can be muscle relaxor, prior to intubation, OD -Donepezil (Aricept)– Tx of Alzheimer's Disease -Edrophonium (Enlon) - very short DOA. Used in Dx of Myasthenia gravis -Neostigmine (Prostigmin) - Tx of Myasthenia gravis, antidote for skeletal muscle relaxants -Physostigmine (Eserine) - Tx for Overdoses of drugs with anticholinergic effects (like atropine, TCAs) -Pyridostigmine (Mestinon) – Tx of Myasthenia gravis
33
cholinesterase inhibitors: irreversible agents
-organophosphates -Ecothiophate (Phospholine) – Tx of chronic refractory glaucoma. DOA of up to one week -Pesticides (palathion and malathion)- parasites -Soman (chemical warfare agent)
34
organophosphate poisoning
-SLUGE -Augmented cholinergic neurotransmission at central and peripheral synapses -Produces all effects of muscarinic activation -> SLUDGE, spasm, bronchoconstriction, decrease HR & CO, etc -Cholinergic activation in CNS – seizures, respiratory depression, coma -Excessive activation of nicotinic receptors- Neuromuscular blockade & muscle paralysis -Treatment: -Symptomatic - maintain VS -Decontamination -Antidotes – Use Atropine to counteract ACH and pralidoxime (2-PAM) to regenerate cholinesterase
35
cholinergic antagonists
-1. muscarinic receptor antagonists: -plant alkaloids- atropine, scopalamine -semi synthetic - several -2. nicotinic receptor antagonists: -ganglionic blockers -neuromuscular blockers- "curium" -depolarizing neuromuscular blocker- succinylcholine -anesthesia
36
muscarinic receptor antagonists
-belladonna alkaloids- atropine, scopolamine, hyoscyamine (antispasmodic used for IBD) -synthetic/semi synthetic- ipratropium, tolterodine, oxybutynin, propantheline, dicyclomine, benztropine, etc -Both types inhibit effects of PNS stimulation: -Smooth muscle relaxation, increase HR & cardiac conduction and inhibit exocrine gland secretion
37
muscarinic receptor antagonist: ocular effects
-Relax iris sphincter -> mydriasis -Inhibits lacrimal gland –> dry eyes -Therapeutic uses – mydriatic to facilitate eye exams (atropine, tropicamide, scopolamine) -belladonna (pupil dilation) alkaloids- people used to look pretty
38
muscarinic receptor antagonist: cardiac effects
-increase HR and AV conduction -Therapeutic Uses: Sinus bradycardia & AV block (atropine)
39
muscarinic receptor antagonist: respiratory effects
-increase Bronchodilation -Therapeutic Uses: COPD, emphysema, bronchitis: -ipratropium (Atrovent)- mainly COPD -tiotropium (Spiriva)
40
muscarinic receptor antagonist: GI and urinary tract effects
-Relax gi muscle, reduce intestinal motility, inhibit gastric acid secretion and urinary retention -Therapeutic Uses: -TX of intestinal spasms/pain – Hysosamine, Donnatal, Dicyclomine -TX of dysuria & urinary incontinence – oxybutynin, tolterodine, darifenacin, solifenacin
41
muscarinic receptor antagonist: CNS effects
-TX of motion sickness by blocking cholinergic transmission from vestibular apparatus to vomiting center (Scopolamine patch) -TX of Parkinson’s Disease – reduce tremor (benztropine & trihexyphenidyl) -CNS side effects include: sedation*, confusion, altered mental status
42
nicotinic receptor antagonists
-1. ganglionic blockers -limited use due to adverse effects -trimethaphan- used rarely for hypertensive emergency -2. neuromuscular blocking agents -nondepolarizing -depolarizing
43
nicotinic receptor antagonists: nondepolarizing neuromuscular blocking agent
-aka curariforms -Atracurium, pancuronium, vecuronium, rocuronium -Competitive antagonist of ACH at nicotinic muscle receptors -Causes muscle relaxation and paralysis -Effects reversed by cholinesterase inhibitors* -Used for surgery, intubation, ventilators -sedation -> paralysis but conscious
44
atropine poisoning
-dry as a bone -red as a beat -mad as a hatter
45
nicotinic receptor antagonists: depolarizing neuromuscular blocking agent
-Succinylcholine -Causes “persistent” depolarization -Used for surgery, RSI kits -Effects not reversed by cholinesterase inhibitors therefore no antidote** if an overdose, short duration of action -good for rapid emergency situation
46
adrenergic agonists
-1. Direct Acting Agonists: -Catecholamines (epi, NE, isoproterenol, dopamine and dobutamine) -Non-catecholamines (albuterol, clonidine, phenylephrine) -2. Indirect Agonists: -Amphetamine, cocaine, tyramine -3.Mixed direct/indirect agonists: -pseudoephedrine
47
nasal decongestant
-dont need to know -afrin - great vasoconstrictor- used for nasal surgery -sudafed is good for decongestant -> not phenylephrine
48
direct adrenergic agonists: catecholamines
-Rapidly metabolized by monoamine oxidase (MAO) and catechol-O-methyltransferase (COMT) enzymes in gut, liver and other tissues – must give parenterally -Effects depend on affinity and specificity for type of Adrenergic receptor
49
direct adrenergic agonists: catecholamines: epinephrine and norepinephrine
-Epinephrine – can bind to ALL the adrenergic receptors: -Vasoconstriction & increase BP (alpha1) -Cardiac stimulation (beta1) -Bronchodilation & skeletal muscle vasodilation (beta2) -Used in anaphylactic shock and cardiac arrest -Norepinephrine: -Vasoconstriction & increase BP (alpha1) -Cardiac stimulation (beta1) -Used in hypotension and shock -no lung involvement
50
direct adrenergic agonists: catecholamines: isoproterenol, dopamine, dobutamine
-Isoproterenol (Isoprel) -Cardiac stimulation (beta1) & Bronchodilation (beta2) -Used to TX asthma, AV block and bradycardia -Dopamine - precursor to epi, NE -Renal vasodilation (D1)- at a low dose -> at a long term dose it will cause kidney constriction -Cardiac stimulation (beta1) -increase BP (alpha1) -Used to TX cardiogenc shock, septic shock, heart failure and adjunct to fluid administration in hypovolemic shock -Dobutamine -Highest affinity for beta1 receptor -Less activity at alpha1 receptor -Used to Tx cardiogenic shock, cardiac arrest and heart failure -no affect on kidney -> better for a longer term dose
51
direct adrenergic agonists: non-catecholamines
-Phenylephrine (Neosynephrine) -Vasoconstriction, increase BP and mydriasis (alpha1) -Used as nasal decongestant, ocular decongestant and maintenance of BP during surgery -given IV or topical -Albuterol (Proventil) -Bronchodilation (beta2) -Used in asthma -has alpha1 affect -> increase HR -> doesnt last though -Clonidine (Catapres) -Inhibits NE release from nerve terminal of postganglionic neuron (feedback inhibition: alpha2) -Used to treat chronic hypertension -Can have effects in CNS (sedation) - not a good drug bc of this -Terbutaline (Brethine) -Bronchodilation and uterine relaxation (beta2) -Used to TX asthma and premature labor (tocolytic) -great for children -case reports for learning disability for premature labor use -> not proven
52
indirect adrenergic agonists: amphetamine
-Increase the release of NE & dopamine (DA) from SNS neurons -Vasoconstriction, cardiac stimulation and increase BP -Penetrates CNS - CNS stimulation (increases mood and alertness (but decreases appetite)
53
indirect adrenergic agonists: cocaine
-Local anesthetic -Simulates SNS by blocking reuptake of NE & DA in the PNS & SNS – similar effects as amphetamine
54
indirect adrenergic agonists: tyramine
-Normal by-product of tyrosine metabolism in body -Found in high concentrations in fermented foods such as certain cheeses, beers, red wine, certain cured meats (salami & pepperoni) -Indirect sympathomimetic b/c it causes the release of stored catecholamines. -Normally metabolized bymonoamine oxidase (MAO). So if taking an MAO inhibitor must avoid tyramine-containing foods
55
mixed acting adrenergic agents
-Cause vasoconstriction by binding to alpha1 -Increase release of NE from SNS neurons -Nasal decongestants – Pseudoephedrine (sedofed) -> cant take it long term
56
adrenergic antagonists
-alpha adrenergic receptor antagonists: -Nonselective -blockers -Selective 1-blockers (“azosin”) -beta adrenergic receptor antagonists (“olol”): -Nonselective  blockers -Selective 1 blockers -Mixed  and  adrenergic receptor antagonists
57
nonselective alpha-blockers
-Block alpha1 and alpha2 receptors -Phenoxybenzamine (Dibenzyline) -Noncompetitive, irreversible* -TX hypertensive episodes associated w/ pheochromocytoma (tumor in adrenal medulla that secretes Catecholamines) -Phentolamine (Regitine) -Competitive, reversible* -DX and TX hypertensive episodes from pheochromocytoma -Tx necrosis and ischemia from extravasations of epinephrine
58
selective alpha1-blockers ("azosin")
-relax vascular smooth muscle and smooth muscle in bladder and prostate. -Produce vasodilation and decrease BP -Used to treat hypertension and urinary retention due to benign prostatic hyperplasia (BPH) -Agents include: -Doxazosin (Cardura), Prazosin (Minipress), Terazosin (Hytrinon) -Tamsulosin (Flomax) Alfuzosin (Uroxatral)– only for BPH not for HTN -not really our go to drug for HTN -can cause phantom ejaculation
59
nonselective beta-blockers
-Block beta1 receptors in heart and beta2 in smooth muscle, liver and other tissues -beta1 blockade - decrease BP , decrease cardiac output, decrease renin release and decrease aqueous humor secretion -beta 2 blockade – bronchoconstriction, decrease glycogenolysis (dont give to pts with diabetes), mask signs of hypoglycemia -TX HTN, angina, arrhythmias, MI, migraine, glaucoma -Agents include: Propranolol (Inderal), Nadolol (Corgard), Timolol (Timoptic)
60
selective beta1-blockers
-Selective for beta1 receptors (primarily in cardiac tissue) -Produce less bronchoconstriction and other beta2 receptor mediated effects -Aka cardioselective beta-blockers -TX HTN, angina, MI -Agents include: Atenolol (Tenormin), Metoprolol (Lopressor)
61
mixed alpha and beta receptor antagonists
-Block both alpha and beta receptors -Carvedilol (Coreg) – Tx HTN and CHF -Labetalol (Trandate) – Tx HTN -> this can be used IV in emergency -not reaching their goals with just beta blocker

Pharmacology (16 decks)

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