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Autonomic Nervous System Flashcards

1
Q

Adrenergic stimulation of the eye effects what two structures, via what receptor

A

Pupil (dilated) via A1

Cliary muscle (relaxation-far vision) via B2

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2
Q

Cholinergic stimulation of the eye effects what two structures, via what receptor

A

Pupil Miosis (constriction) via M3,M2

Ciliary body (contraction-near vision) via M3,M2

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3
Q

Adrenergic stimulation of the heart effects what structures of the heart, what effect via what receptor

A

SA node (increased HR) via B1

AV node and conduction system (increased conduction velocity) via B1

Ventricles (increased force of contraction) via B1

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4
Q

Cholinergic stimulation of the heart effects what structures of the heart, what effect via what receptor

A

SA node (decreased HR) via M2

AV node and conduction syst. (decreased conduction velocity-AV block) via M2

Ventricles (decreased force of contraction) via M2

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5
Q

Adrenergic stimulation of blood vessels effect what specific structures, what effect via what receptor

A

Most arteries & veins (constriction) via *A1/a2

Arteries of skeletal muscle (constriction) via A1

Arteries of skeletal muscle (relaxation) via B2

*A1 vasoconstriction counters SM arteries vasodilation in fight or flight situation

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6
Q
  • Cholinergic stimulation of blood vessels effect what specific structures, what effect via what receptor
A

Sympathetic cholinergic fibers cause arteries and veins (dilation) NO receptor

Arteries of skeletal muscle (dilation) via M3 SYMPATHETIC CHOLINERGIC fibers

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7
Q

Adrenergic stimulation of lungs effect what specific structures, what effect via what receptor

A 
Muscles of the Trachea and Bronchials, (relaxation) via B2
Bronchial glands (secretion) B2
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8
Q

Cholinergic stimulation of lungs effect what specific structures, what effect via what receptor

A 
Muscles of the Trachea and Bronchials (constriction) M2=M3
Bronchial glands (stimulation) M3
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9
Q

Adrenergic stimulation of stomach/intestines effect what specific function, what effect via what receptor

A

Motility and tone (decreased) via A1/A2

Smooth muscle sphinters (contraction) via A1

Secretion (inhibited) A2

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10
Q

Cholinergic stimulation of stomach/intestines effect what specific function, what effect via what receptor

A

Motility and tone (increased) via M2=M3

Smooth muscle sphinters (relaxation) via M3

Secretion (stimulated) via M3

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11
Q

Adrenergic stimulation of kidney effect what specific function, what effect via what receptor

A

Renin secretion (increased) via B1

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12
Q

Cholinergic stimulation of kidney effect what specific function, what effect via what receptor

A

trick quesiton, there is no cholinergic stimulation of kidney

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13
Q

Adrenergic stimulation of adrenal gland effect what specific function, what effect via what receptor

A

trick question, there is no adrenergic stimulation of adrenal gland

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14
Q
  • Cholinergic stimulation of adrenal gland effect what specific function, what effect via what receptor
A

release of Epi/NE via SYPATHETIC CHOLINERGIC fibers

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15
Q

Adrenergic stimulation of bladder effect what specific structures, what effect via what receptor

A 
Detrusor muscle (bladder relaxation) via B2
Trigone & sphincter (contraction) via A1
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16
Q

Cholinergic stimulation of bladder effect what specific structures, what effect via what receptor

A 
Detrusor muscle (bladder contraction) via M3
Trigone & sphincter (relaxation) via M3
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17
Q

Adrenergic stimulation of gravid uterus effect what specific function, what effect via what receptor

A

relaxation via B2

contraction via A1

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18
Q

Cholinergic stimulation of gravid uterus effect what specific function, what effect via what receptor

A

trick question, there is no cholinergic effect on uterus

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19
Q

Adrenergic stimulation of Penis & seminal vesicles effect what specific function, what effect via what receptor

A

Ejaculation via A1

  • Remember adrenergic “shoot”
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20
Q

Cholinergic stimulation of Penis & seminal vesicles effect what specific function, what effect via what receptor

A

Erection via M3

  • Remember cholinergic “point”
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21
Q

Adrenergic stimulation of sweat glands effect what specific function, what effect via what receptor

A

Palm of hand (minimal secretion) via A1

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22
Q

Cholinergic stimulation of sweat glands effect what specific function, what effect via what receptor

A

Generalized secretion via SYMPATHETIC CHOLINERGIC fibers M1

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23
Q

Adrenergic stimulation of liver effect what specific function, what effect via what receptor

A

Glycogenolysis & Gluconeogenesis via A1/B2

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24
Q

Cholinergic stimulation of liver effect what specific function, what effect via what receptor

A

trick quesiton, there is no cholinergic stimulation of liver

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25
Adrenergic stimulation of beta cells of pancreas effect what specific function, what effect via what receptor
Insulin increase via B2 Insulin inhibition via A2
26
Cholinergic stimulation of beta cells of pancreas effect what specific function, what effect via what receptor
trick question, there is no cholinergic stimulation of beta pancreas cells
27
Adrenergic stimulation of fat cells effect what specific function, what effect via what receptor
lipolysis via B1,B3
28
Cholinergic stimulation of fat cells effect what specific function, what effect via what receptor
No innervation
29
The PSNS has neuronal fibers in what where
cranium and sacrum
30
What are the 4 cranial nerves assoc. with PSNS
cranial nerves III, VII, IX, and X
31
What are the sacral levels assoc. with PSNS
S2 thru S4
32
The sympathetic's (thoracolumbar) nervous system is spans what levels of the vertebral column
T1-L2
33
What are the major differences between the somatic and autonomic systems
somatic system needs external neural stimulation to effect a response ANS, organs and glands are regulated within ANS and can function without external control somatic system, all reflexes are mediated in CNS ANS, visceral reflexes can occur in periphery (autonomic dysreflexia)
34
Is the somatic nervous system a one or two neuron systems?
One
35
Is PSNS and SNS a one or two neuron system
parasymp-always two Sympath- mostly two, but one with adrenal medulla (relases ACh directly on gland, gland then releases Epi to target organs)
36
the postganglionic SNS release what neurotransmitter mainly, and what exceptions
postganglionic SNS contains mostly adrenergic nerve fibers that release NORepi; however, it also contains cholinergic nerve fibers that secrete ACh (sweet glands, smooth muscle of skeletal muscle arteries, and adrenal gland) * the SNS uses only a single neuron to communicate with adrenal cortex
37
What are the characteristics of the autonomic innervation of effector organs
No recognizable end-plate (like in skeletal muscle) nerve fibers run along membrane of effector cells branches are beaded by varicosities (enlargements) - not covered with Schwann cells - contain synaptic vesicles - approx. 20,000 per neuron
38
What are the three types of autonomic sensory receptors found throughout the body
Mechanoreptors Chemoreceptors Visceral Nociceptors
39
Mechanoreceptors respond to what three types of physical stimuli
Tension- baroreceptors Stretch- volume receptors Pressure- pressoreceptors/ baroreceptors
40
Carotid Sinus and Aortic Arch contain
Mechanoreceptors-Baroreceptors
41
Chemoreceptors respond to what
changes in the chemical environment such as, osmolality, pH, O2, and CO2 changes AKA Osmoreceptors * located throughout body atria, pulmonary vascu, kidney, GI tract
42
Carotid Body and Aortic Body contains
Chemoreceptors-osmoreceptors *located throughout the body GI tract, brain, etc
43
Visceral Nociceptors respond to what
Pain in visceral organs which may initiate both autonomic and somatic reflexes
44
Referred pain is
pain felt at another location as a result of noxious stimuli to visceral organs
45
What are the two types of cholinergic receptors
Nicotinic Muscarinic
46
What are the two types of Nicotinic receptors, where are they located, and when activated, what response is triggered
Nm (N2) receptors-Neuromuscular junction. Causes end-plate depolorization which leads to skeletal muscle contraction Nn(N1) receptors-Autonomic Ganglia when stimulated, leads to depolorizing & firing of postganglionic neurons
47
What are the five types of muscuranic receptors
M1, M2, M3, M4, M5
48
what three Muscuranic receptors are well known
M1, M2, M3
49
Describe the biosynthesis pathway of epinephrine
Tyrosine transported into noradrenergic varicosity by carrier-linked sodium uptake Then, tyrosine is hydroxylated into DOPA via tyrosine hydroxlase Then, DOPA is decarboxylated into Dopamine via DOPA decarboxylase Then, Dopamine is transported into a vesicle by a carrier (blocked by reserpine) Then, Dopamine converted to Norepi by dopamine beta-hydroxylase Then, Norepi is converted to Epi by Phenylethanolamine N-methyltransferase
50
List the epi precursors and their respective enzymes
Tyrosine>LDOPA>Dopamine>Norepi>Epi Tyrosine hydroxylase>L-aa decarboxylase>Dopamine-hydroxylase> Phenylethanolamine N-methyl-transferase
51
What are the four fates of Norepi
1. interacts with pre/post-synaptic adrenoreceptors 2. diffuses out of cleft into circulation 3. uptaken back into varicosity via H ions, and degraded by Monoamine Oxidase (MAO) 4. Degraded post-synaptically by hepatic "CATECHOL-O-METHYL TRANSFERASE. Extrajunctionally * Epi and Norepi share same degradation pathway. MAO>COMT * Dopamine degradation will start with MAO or COMT
52
What is the degradation product of Epi/NorEpi
Methoxy-hydroxy-Mandelic Acid (VMA) *measured in urine for patients suspected of pheochromocytomas. Will be high
53
What is the degradation product of Dopamine
Homovanillic Acid
54
What are the different types of adrenergic receptors
a1, a2, b1, b2, b3, Dopamine: da1-vasodilation of smooth muscle of renal & mesentery da2- presynpathic adrenergic receptors- inhibits release of NE
55
Binding to beta receptors activates what adrenergic G-protein family
Gs
56
Binding to alpha2 receptors activate what adrenergic G-protein family
Gi
57
Binding to alpha1 receptors activate what adrenergic G-protein family
Gq
58
Cholinergic agonist are classified as
Direct acting or Indirect acting (anticholinesterases) Cholinesterase resistant or NOT
59
Direct cholinergic agonists include
Bethanochol, Carbachol, Muscurine, and Pilocarpine *cholinesterase resistant
60
Indirect cholinergic agonists include
Reversible- Neostigmine, pyridostigmine, edrophonium, physostigmine (crosses BBB) Irreversible-Echothiphate (antagonizes succs), insectisides (Malathione, Parathion), nerve gases (Sarine, Tabun, Soman, DFP)
61
Bethanochol is used for
GI/GU tract Stimulates gastric motility Increased detrusor muscle initiating micturition *Postop/Postpartum nonobstructive urinary retention, and neurogenic bladder with retention.
62
Dont use Bethanochol concurrently with
beta blockers
63
Carbachol is used for
decrease intraocular pressure | Nicotinic and Muscarinic activity
64
Pilocarpine is used for
to decrease IOP via stimulating ciliary muscles and produces miosis via contracton of muscles surrounding iris
65
Pilocarpine can worsen
retinal detachment
66
Echothiophate, irreversible anticholinesterase, is indicated for
open-angle glaucoma, closed-angle, cross eyed
67
echothiophate prolongs the effects of
succinylcholine and may cause CV collapse
68
What two agents are given as an antidote for insecticide, or chemical poisioning
Atropine 1st, quickly followed by 2-PAM (cholinesterase reactivator)
69
Alzheimer and Dementia anticholinesterases exert its effect by
increasing ACh concentration in CNS *ACh is an excitatory NT
70
Cholinergic Antagonists are subdivided into antimuscarinics and antinicotinics, name each
antimuscarinics: Atropine, Scopalomine, Glycopyrrolate, Ipratropium, cogentin, artane Antinicotinics: NMBA, depolorizing succinylcholine and decamethonium
71
What racemic mixture of atropine is active
Levo-rotary
72
Atropine is used
``` antisialogogue to restore cardiac rate/arterial pressure Lessen severity of AV block Asystole ingestion of muscarinic mushrooms ```
73
Atropine is contraindicated in
glucoma pyloric stenosis prostate hypertrophy
74
what is the antidote for atropine overdose
physostigmine
75
what is the antidote of physostigmine overdose
atropine
76
Scopalomine is used to treat
motion sickness * greater effect on iris, ciliary body and secretory glands * Don't give in patients with Glaucoma
77
Glycopyrrolate is used to treat
non-emergent decrease in HR secretions (better than atropine) *Does not cross BBB
78
Ipratropium bromide (antimuscarinic) used to
treat bronchospasms Not a first line therapy for bronchospasms * 1st give albuterol (B2 agonist), then ipratropium (M3 antagonist), then theophyline (phosphodiesterase inhibitor), then cromyln (mast cell stabilizer), ect.....
79
Contraindications for Ipratropium/Propantheline Bromide
``` Glaucoma GI obstruction Obstructive uropathy Intestinal atony ulcerative colitis myasthenia gravis ```
80
NMBA and Depolorizing muscle blockers are antinicotinics and include
Panc, Vecu, Pipe, Roc, Atra, Doxa, Miva, Cisatr. Succinylcholine, Decamethonium
81
Adrenergic AGONISTS include
``` Nonselective B1 and B2 Isoproterenol B1-Dobutamine B2- Terbutaline, Albuterol, Salmeterol, Ritodrine Mixed alpha and beta- Norepi, Epi, D1-Fenoldopam D2-Bromocritine A1- Phenylephrine A2-Clonidine, Dexmedetomidine Mixed a1 and a2- Cocaine, Ephedrine, Amphetamines, MAO Inhibitors ``` *Clonidine is a centrally acting vasoconstrictor but peripherally acting vasodilator
82
Adrenergic Antagonists include
Non-selective B-blockers-propranolol, sotalol, nadolol, timolol B1 antagonists- Metoprolol, Esmolol,atenolol, bebivolol, betaxolol Beta/Alpha 1 antagonists- *Labetalol, Carvedilol Nonselective alpha antagonists- Phenooxybenzamine, phentolamine A1 antagonists- prazosin, terazosin, doxazosin, tamsulosin A2 antagonists- Yohimbine
83
Direct-acting sympathomimetics include
Nor, Epi, Dopamine, Isoproterenol, Dobutamine Non-catecholamines-Phenylephrine
84
Indirect-acting Sympathomimetics that cause release of Norepi include
Ephedrine & Tyramine Amphetamine
85
Indirect-acting Sympathomimetics that inhibit reuptake on Norepi include
Cocaine
86
Indirect-acting sympathomimetics that inhibit the metabolism of Norepi include
MAO inhibitors, Parnate, Marplan, etc. * stop two weeks before anesthetic * Tyramine-containing foods (beer, cheese)>>HTN crisis
87
Phenylephrine primarly agonizes
alpha 1 receptors *sign. MAP and PVR increase with decrease in HR, CO, and renal blood flow
88
Epineprine primarily agonizes
B1, but equally agonizes a1,a2, b2 receptors * Increased HR, CO, and MAP * Decreased Renal blood flow * Bronchodilation
89
Ephedrine and Norepinephrine are similar and primarily agonizes
a1, a2, b1, b2 * increased HR, MAP, CO, PVR * Norepi>>>PVR * bronchodilaton (not Norepi) * decreased renal blood flow
90
Dopamine primarily agonize
a1,a2, b1 equally * increased HR, MAP, CO, PVR, and Renal blood flow * No effect of bronchioles
91
Isoproterenol primarily agonizes
B1, B2 receptors * significant increases in HR, CO, Bronchodilation * decreases in MAP and PVR
92
Dobutamine primarily agonizes
B1 and B2 * significat increase in CO * increase in HR and MAP, renal blood flow * decreases PVR
93
Phenoxybenzamine is a Alpha antagonists used to manage
``` pheochromocytoma a1>a2 Decreased BP with reflex tachycardia No direct effect on heart miosis ```
94
Prazosin, Doxazosin, Tamsulosin are both alpha1 agonists that
decrease BP without reflex tachycardia *tamsulosin used to tx BPH
95
Labetalol is a mixed alpha/beta(nonselective) antagonist used to
decrease BP, HR, & SVR * No effect on CO * Labetalol IV 1:7 blocade, 1 alpha, 7 beta * Labetalol PO 1: 4 blocade, 1 alpha, 4 beta, so alpha effects greater due to less b-effect
96
Beta antagonists are classified
as selective vs. non-selective
97
Name the b1 selective antagonists
``` Atenolol Acebutolol Betaxolol Bisoprolol Celiprolol Esmolol Nebivolol ``` * All other b-blockers are nonselective
98
What are the effects of beta blockers
decrease hr and contractility with smaller doses, but increased contractility with higher doses hypotension, bronchoconstriction, inhibition of epi-induced glycogenolyisi & lipolysis * avoid rapid withdrawl * NPO status uneffected by patient's on alpha/beta blockers

Pharmacology (27 decks)

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