Autonomic Nervous System

Question 1

Define Autonomic Nervous System (ANS)

Answer 1

Functional division of nervous system that is not voluntarily controlled

Question 2

Define Somatic Nervous System

Answer 2

Functional division of nervous system that is voluntarily controlled

Question 3

Define Sympathetic Nervous system

Answer 3

Branch of autonomic nervous system that opposes effects of parasympathetic division

Question 4

Define parasympathetic nervous system

Answer 4

Branch of autonomic nervous system that opposes effects of sympathetic division

Question 5

Catecholamines are:

Answer 5

• Biogenic amines derived from tyramine including dopamine, epinephrine, norepinephrine
• Produced from tyrosine in adrenal medulla and postganglionic fibers of sympathetic nervous system

Question 6

Function of Autonomic nervous system

Answer 6

Deals primarily with control and visceral functions necessary for life (non-voluntary)

• cardiac output
• Blood flow and distribution
• Digestion

Question 7

Autonomic nervous system comprised of two branches:

Answer 7

Sympathetic nervous system(adrenergic) -Fight & flight

Parasympathetic (Cholinergic) - Res and digest

Question 8

Stimulation of Sympathetic and parasympathetic nervous system results in effect on:
eyes
salivation
skin
respiration
heart
digestion
adrenal glands

Answer 8

pic 2 parasympathetic

Question 9

What are the neurotransmitters of the SNS

Answer 9

Epinephrine, Norepinephrine, Dopamine

Question 10

Dopamine of a precursor of

Answer 10

Norepinephrine and ephedrine

Question 11

Where is most NE secreted

Answer 11

Synaptic clefts
NE is also found in bloodstream, normally exists in concentrations 3x greater than epinephrine

Question 12

Where is most epinephrine produced

Answer 12

Adrenal glands (80%), rest by brain

Question 13

What neurotransmitter is found in the PNS

Answer 13

Acetylcholine

Question 14

Receptors (alpha,beta and DA), where are they located and result of stimulation

Answer 14

pic receptor

Question 15

What effect will Beta2 stimulation have on the ciliary muscle

Answer 15

Relaxation (suppresses accomodation)
Increased aqueous production (IOP)
(alpha2 stimulation decreases IOP)

Question 16

Mydriasis results from stimulation of which receptor

Answer 16

Alpha 1

Question 17

Alpha1 receptors are more sensitive to NE or E?

Answer 17

NE (also stimulated by high doses of D)

Question 18

Alpha 2 receptors are more sensitive to NE or E

Answer 18

E more than or equal to NE

Question 19

Beta2 receptors more sensitive to NE or E

Answer 19

E is a lot morethan NE

Question 20

What is the t1/2 of catecholamines

Answer 20

1-3minutes
85% of synaptic NE is non-enzymatically inactivated by reuptake

Question 21

direct acting sympathomimetic drugs

Answer 21

Bind to and stimulate same receptor as the endogenous neurotransmitter eg phenylephrine

Question 22

Beta1 receptors more sensitive to NE or E

Answer 22

Equal (also stimulated by high doses of D)

Question 23

Indirect acting sympathomimetics

Answer 23

Stimulate release of neurotransmitter from a nerve terminal eg amphetamine
Block the reuptake of neurotransmitter from the synapse, prolonging effect eg cocaine

Question 24

Sympathomimetic adverse effects regarding CVS

Answer 24

Increased heart rate
Arrhythmia
Elevated blood pressure

Question 25

Ocular sympathomimetic side effects

Answer 25

Mydriasis & suppression of accommodation leading to light sensitivity Reduced depth of focus and near blur

Question 26

Sympathomimetic adverse effects regarding CNS

Answer 26

Hemorrhagic stroke Anxiety Fear Headache Tremor

Question 27

Hepatic sympathomimetic adverse effect

Answer 27

Elevated blood sugar

Question 28

Immune system and respiratory sympathomimetic adverse effect

Answer 28

Immunosuppression Pulmonary edema

Question 29

Effect of M3 stimulation on eyes

Answer 29

Miosis Cilliary muscle contraction and increased aqueous outflow Increase in ocular gland secretion

Question 30

Ocular anticholinergic side effects

Answer 30

Increased IOP Angle closure risk Alergy

Question 31

Systemic anticholinergic side effects

Answer 31

ABCDss -Anorexia -Blur -Constipation -Dryness -Sedation \_Stasis of urine Thirst, tachycardia. hypertension, decreased glandular secretions(sweat/bronchial/saliva) \> heart/smooth muscle \> GIT

Question 32

CNS anticholinergic side effects

Answer 32

Decreased parkinson tremor Decreased heart rate

Question 33

What is the anticholinergic toxidrome

Answer 33

Blind as a bat (blur) Hot as desert (hyperthermia) Mad as a hatter (Confusion) Dry as a bone (Dry mouth,urinary retention) Red as beet (flushed skin) Tachycardia absent bowel sounds shaking dilated pupils

Question 34

How do neuromuscular blocking agents work

Answer 34

Act on motor neurons where they block Acetylcholine-based contraction of muscle fibres (Nicotinic acid ACh receptors are ligand gated, stimulation leads to Na+ influx and generation of action potential that results in contraction

Question 35

How do botox and tetanus produce muscle paralysis

Answer 35

Inhibiting degranulation of ACh vesicles in the presynaptic neuron Blocking ACh release

Question 36

Acetylcholine is broken down into...

Answer 36

Acetate + choline by Acetylcholinesterase (AChE) and Butyrylcholinesterase (BChE) (enzymes)

Question 37

Activity of Depolarizing Neuromusclular blocking agents (NMBA) act

Answer 37

Initially depolarize the skeletal muscle fiber, desensitizing it to ACh stimulation These drugs are sustained by AChE/ BChE inhibitors (prolonged by AChE) Stimulates somatic nicotinic receptors at neuromuscular junctions resulting in initial phase of depolarization and short term paralysis Degraded slower than ACh by circulating BChE Commonly results in post-op pain eg Succinylcholine

Question 38

How is the effect of non-depolarizing NMBA's reversed

Answer 38

By AChE inhibitors

Question 39

Activity of Non-depolarizing NMBA's

Answer 39

Most common clinically used Reversable Competitive antagonists at ACh receptor Reversed by AChE inhibitors through ACh competition eg pancuronium

Question 40

Side effects of depolarizing NMBA'c

Answer 40

Elevated IOP common Respiratory depression Arrythmia Bradycardia Cardiac arrest

Question 41

Contraindications of depolarizing NMBA's

Answer 41

Angle closure glaucoma Penetrating eye injury

Question 42

Adverse effects of Nonpolarizing NMBA's

Answer 42

Elevated heart rate and BP Respratory depression

Question 43

Contraindications of nonpolarizing NMBA's

Answer 43

Angle closure glaucoma Penetrating eye injury (cation in Myasthenia Gravis and pulmonary disease)

Question 44

Atropine is an antidote to which receptor effects

Answer 44

Muscarinis, not the nicotinic(muscular) effects

Question 45

What medication is an antidote to all receptor effects regarding anticholinergic poisoning

Answer 45

Pralidoxime - cleaves bond formesby organophosphate and AChE

Question 46

Which drugs are used in anticholinergic poisoning and neurodegenerative disease therapy such as parkinsons and alzheimers

Answer 46

Acetylcholinesterase inhibitors eg Neostigmine Pyridostigmine Echothiophate (irreversable and used in glaucoma)

Question 47

Adverse effects of Neostigmine (Acetylcholinesterase inhibitor)

Answer 47

SLUDGE Salivation Lacrimation Urination Defecation GI distress Emesis Severe: Anaphylaxis, arrhythmias ,severe hypotension, respiratory arrest