Autonomic and Somatic Nervous System Flashcards Preview

RUSVM Pharmacology > Autonomic and Somatic Nervous System > Flashcards

Flashcards in Autonomic and Somatic Nervous System Deck (91):
1

Autonomic Nervous System

Innervates cardiac muscle, smooth muscle and secretory cells (glands)

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Sympathetic Nervous System

Fight or flight

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Parasympathetic Nervous System

Rest and Digest

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Somatic Nervous System

Innervates skeletal muscle 

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Parasympathetic Nervous System originates from

Craniosacral plexus

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Sympathetic Nevous System originates from

Thoracolumbar plexus

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Long preganglionic nuron, short post ganglionic neuron

Parasympathetic Nervous System

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Short preganglionic neuron, long post ganglionic neuron

Sympathetic Nervous System

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Neurotransmitters of the Autonomic Nervous System

Acetylcholine

Nor/epinephrine

Dopamine

Histamine

Serotonin

Nitric Oxide

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Acetylcholine

Released from presynaptic neuron and broken down by cholinesterases

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Norepinephrine is released from 

Synaptic nerve endings

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Epinephrine is released from the 

Adrenal Glands

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Types of cholinergic receptors

Nicotinic (Ionotropic)

Muscarinic (Metabotropic)

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Cholinergic receptors respond to

acetylcholine

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Types of adrenergic receptors

Alpha and Beta

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Adrenergic receptors respond to

Epinephrine, norepinephrine and dopamine

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SNS

Preganglionic Neuron → _____  → Postganglionic Neuron  → _______

SNS

Preganglionic Neuron → ACh  → Postganglionic Neuron  → Epinephrine/Norepinephine

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What type of receptor is found at the synapse between the pre and post ganglionic neurons of the SNS?

Nicotinic Receptor

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What type of receptor is found between the post ganglionic receptor and the target tissue of the SNS?

Adrenergic 

___________________

Alpha-1, Alpha-2, Beta-1, Beta-2

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PSNS

Preganglionic Neuron → _____  → Postganglionic Neuron  → _______

PSNS

Preganglionic Neuron → ACh  → Postganglionic Neuron  → ACh

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What type of receptor is found between the pre and post ganglionic neuron in the PSNS?

Nicotinic Receptor

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What type of receptor is found between the post ganglionic and target tissue in the PSNS?

Muscarinic Receptor 

_________________

M1 - M5

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Neurotransmitter released by the presynaptic neuron of the somatic nevous system?

ACh

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What type of receptor is fround between the neuron and target tissue in the somatic nervous system?

Nicotinic Receptor

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Autonomic Drugs

Mimetics

Lytics

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Mimetics 

Drugs that stimulate (mimic) autonomic effects

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Parasympathomimetics

Parasympathetic signs

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Sympathomimetics

Sympathetic signs

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Lytics

Drugs that block autonomic effects

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Parasympatholytic

Sympathetic signs

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Sympatholytic

Parasympathetic signs

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Effects of the SNS on the eye

Relaxation of ciliary muscle - far vision

Contraction of iris radial muscle

Decrease aqueous humor production

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Effects of the PSNS on the eye

Contraction of ciliary muscle - near vision

Contraction of the iris sphincter muscles

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Mydriasis

Contraction of the iris radial muscle

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Miosis

Contraction of the iris sphincter muscle

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Effects of the SNS (Beta-1) on the heart

Increased heart rate

Increased contractility

Increased automaticity and conduction of AV node

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Effect of PSNS on the heart

Decreased heart rate

Decreased contractility

Decreased AV node conduction

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Effect of alpha-1 SNS on vasculature

Vasoconstriction

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Effect of Beta-2 SNS on vasculature

Vasodilation

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Effect of Alpha 2 SNS receptor on vasculature

Either vasoconstriction or vasodilation

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Effect of PSNS on vasculature

Vasodilation through release of NO

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Effect of beta-2 SNS receptors on the lung

Bronchodilation

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Effect of alpha-2 receptors on the lung

Decreased secretion

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Effect of PSNS on the lungs

Bronchoconstriction

Increased respiratory secretions

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Effect of the SNS (alpha-1, beta-1 and beta-2 receptors) on the GI tract

Decrease motility

Close sphincters

Inhibit secretion

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Effect of the parasympathetic nervous system on the GI tract

Increase motility

Relax sphincters

Stimulate secretion

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Effect of the beta-2 receptor of the SNS on the urinary bladder

Relax detrusor muscle

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Effect of the alpha-1 receptor of the SNS on the urinary bladder

Contract sphincter

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Effect of the PSNS on the urinary bladder

Contract detrusor muscle

Relax sphincter

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Autonomic drugs can act in what ways

Direct and Indired

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Autonomic drugs that are direct acting act on

the receptor

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Autonomic drugs that are indirect acting act on

something other than the receptor

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Acetylcholine effects on the PNS

Bradycardia

Decreased blood pressure

Increased GI motility and secretion

Smooth muscle contraction

Increased secretions

Convulsions

Stimulation of autonomic ganglia and adrenal medulla

Skeletal muscle contraction

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Examples of direct acting parasympathomimetics

Acetylcholine

Bethanechol (PO)

Pilocarpine (opthalamic)

Carbachol

Muscarine (poisoning)

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Bethanechol

(Urecholine)

Direct acting parasympathomimic

Muscarinic agonist, some selectivity for M3

Minimal Nicotinic activity

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Indications of Bethanechol

Increase bladder contractility

Increase GI motility

Treat dysautonomia

Stimulate uterine contraction?

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Cautions of Bethanechol

  • Patent urethra and intact 
  • Do not use if GI obstruction present or if increased GI motility is contraindicated

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Signs of an overdose of Bethanechol

Excessive muscarinic effects - salivation, urination, defecation

Life threatening cholinergic signs - bradycardia, bronchospasm

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Examples of indirect acting parasympathomimetics

  • Reversible anticholineesterases
    • Neostigmine
    • Pyridostigmine
    • Edrophonium
    • Physostigmine (opthalmic)
    • Demecarium (Opthalmic)
    • Carbamate insecticides

 

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Neostigmine

(Prostigmin)

Indirect acting parasympathomimetic (reversible)

"Cholinergic", "Cholinesterase inhibitor", "Anticholinesterase"

Oral and Injectable

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Indications of Neostigmine

  • Treatment of rumen atony
  • Stimulating GI motility, bladder emptying
  • Reversal of competitive neuromuscular blockers (NMB)
  • Treatment of myasthenia gravis in dogs

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Cautions of Neostigmine

Contraindicated in peritonitis, GI obstruction, late pregnancy, presence of other cholinesterase inhibitors

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Pyridostigmine

(Mestinon)

Indirect acting parasympathetic - reversible

"Cholinergic", "Cholinesterase inhibitor", "Anticholinesterase"

Oral

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Pyridostigmin generally lasts (longer/shorter) than Neostigmine

Longer

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Indications for Pyridostigmine

Treatment of myasthenia gravis in dogs

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Cautions of Pyridostigmine

Anything contraindicating use of cholinergic agents

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Edrophonium

(Tensilon)

(Enlon)

Indirect acting parasympathomimic - reversible

"Cholinergic", "Cholinesterase inhibitor", "Anticholinesterase"

Injectable

 

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Onset and duration of Edrophonium

Onset - 1 minute

Duration - 10 minutes

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Onset of Pyridostigmine

1 hour after dosing

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Onset and duration of Neostigmine

Onset - 10-30 minutes

Duration - 4 hours

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Indications for Edrophonium

  • "Tensilon Test" for myasthenia gravis
  • Differentiate myasthenic crisis from cholinergic crisis
  • Reversal of nondepolarizing NMBs

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Cautions for Edrophonium

Cholinergic signs - mild urination defecation lacrimation

Severe Cholinergic Crisis - bronchoconstriction/secretions, bradycardia or tachycardia, hypotension, cardiac arrest

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Examples of Parasympathomimetics that are indirect acting

Echothiophate (ophthalmic)

Organophosphate insecticides (toxicity)

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Organophosphate Toxicity - Muscarinic Effects

Salivation

Lacrimation

Urination

Defecation

Dyspnea

Diarrhea

Urination

Miosis

Bronchospasm

Emesis

 

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Organophosphate toxicicty - Nicotinic Effects

Muscle Tremors

Muscle Weakness

Muscle Paralysis

CNS Effects

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Examples of Parasympatholytics that are direct acting

Atropine

Glycopyrrolate

Oxybutynin

Propantheline

Aminopentamine

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Effects of Atropine

Tachycardia

Mydriasis

Dries secretions

Reduces salivation

Slows gut

Bronchodilation

Blurred vision

Difficulty with urination

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Atropine Sulfate

(Atroject)

Direct acting parasympatholytic

"Anticholinergic" "Antimuscarinic"

Injectable, Oral, Opthlamic Drops

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Systemic Indications of Atropine

  • Treatment of bradyarrhythmias/bradycardia
  • Treatment of toxicity
  • Treatment of cholinergic crisis - anticholinesterase overdose

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Cautions of systemic Atopine

  • Contraindicated in glaucoma, tachycardia
  • Certain GI diseases, obstructive uropathy, myasthenia gravis
  • Rabbits have endogenous atropinases - break down rapidly

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Glycopyrrolate

(Robinul)

Direct acting parasympatholytic

"Anticholinergic" "Antimuscarinic"

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Onset and duration of Glycopyrrolate

Slower onset of action than Atropine- 30-40min

Longer duration than Atropine- hours

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Indications of Glycopyrrolate

  • Anywhere that atropine is indicated but the slower kinetics are favorable - bradyarrhythmias
  • Pre-Med in asesthesia
  • Reduce hypersialism

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Cautions of Glycopyrrolate

Same as atropine, lest likely to cause CNS effects

Less arrhythmogenic than Atropine

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Oxybutynin (Ditropan)

Propantheline (Pro-banthinine)

Direct acting parasympatholytic

"Anticholinergic" "Antimuscarinic"

Oral Tab, ER Tab, Syrup, Topical

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Effect of Oxybutynin or Propantheline

GI or urinary antispasmodic agent - relaxes the detrusor muscle and allows the bladder to better fill

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Distribution of Oxybutynin and Propantheline

Oxybutynin is widely distributed 

Propantheline does not readily cross the BBB

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Indication of Oxybutynin and Propantheline

Incontinence due to detrusor muscle instability - hyperactive bladder

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Cautions for oxybutynin and Propantheline

Potential to cause other parasympatholytic signs as for atropine.  

At normal doses bladder and GI tract appear to be most affected

90

Aminopenamine

(Centrine)

Direct acting parasympotholytic

Antispasmodic for GI indications

Approved in dogs and cats

91

N-Butylscopolammonium Bromide 

(Buscopan)

Direct acting parasympatholytic

Antispasmodic for colic in horses

Also used to treat bradycardia