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curs 3 Flashcards

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1
Q

unde sunt sintetizati si depozitati neurotransmitatorii

A

sintetizati- terminatii axonale buton presinaptic
depozitati- vezicule sinaptice

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2
Q

ce se intampla in mom declansarii unui impuls nv

A
  1. depolarizare mb presinaptica
  2. deschidere canale Ca
  3. creste conc Ca intracelul
  4. activare calmodulina care activ o proteinkinaza calciu/ calmodulin dependenta
  5. fosforilare proteine asociate cu vezicule depozit ex sinaptotagmina
  6. initiere proces alipire vezicule de mb presinapt
  7. eliberare neurotransmitator in fanta sinaptica
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3
Q

cum se elibereaza neurotransmitator in fanta sinaptica

A

prin exocitoza/ difuziune

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4
Q

ce se intampla dupa eliberare neurotransmitator in fanta sinaptica

A
  1. declansare RC specific- inhibitor/ excitator
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5
Q

cum se face inactivarea neurotransmitatorului eliberat in fanta sinaptica

A
  • recaptare in term presinaptica cu depozitare in vezicule sinaptice= metabolizare intraneuronala
  • metabolizare in fanta sinaptica
  • difuziune extrasinaptica
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6
Q

prin ce componenta difera SN vegetativ de SN somatic

A

componenta eferenta
2 neuroni legati prin sinapse ganglionare in afara SNC

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7
Q

componenta eferenta din SN somatic?

A

fibre eferente cu orig in SNC
inerveaza cel musc striate printr o sinapsa periferica neuromusculara

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8
Q

origine fibre nv preggl sistem simpatic

A

radacini ventrale corpi neuronali T1-L3

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9
Q

origine fibre nv preggl sistem parasimpatic

A

nuclei nv cranieni 3, 7, 9, 10
neuroni mv spinala S2-S4

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10
Q

structura acetilcolina

A

ester hidrosolubil al acid acetic si colina
- struct cuaternara de amoniu

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11
Q

unde este sintetizata Ach

A

buton neuronal presinaptic colinergic

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12
Q

cum se sintetizeaza Ach

A

sub influenta:
- colinacetiltransferaza din colina
- acid acetic din acetil coA mitocondriala

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13
Q

unde se depoziteaza Ach

A

vezicule terminatii colinergice presinaptice

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14
Q

enzime care hidrolizeaza Ach

A

SPECIFIC:
- acetilcolinesteraza
NESPECIFIC: (actioneaza si pe alte molec cu struct esterica)
- pseudocolinesteraza
- butirilcolinesteraza

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15
Q

ce rezulta din hidroliza Ach

A
  • acid acetic
  • colina- recaptata in buton presinaptic pt sinteza noi molec Ach
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16
Q

chimie fixare Ach pe receptori postsinaptici

A

are o:
- extremitate cationica- fixare pe sediu anionic receptor
- extremitate esterofila- fixare pe sediu esterofil receptor

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17
Q

receptorii colinergici difera in ceea ce priveste…..

A

structura sterica situs receptor

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18
Q

tipuri de receptori colinergici

A
  • muscarinici- agonist muscarina
  • nicotinici- agonist nicotina
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19
Q

ce sunt receptorii muscarinici

A

receptori in serpentina cuplati cu proteina G
- 5 tipuri care difera in fct de a 3 a ansa intracelulara

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20
Q

receptori muscarinici cu efecte stimulante

A

M1, M3, M5
* se cupleaza cu prot Gq
* fixare Ach-> stim fosfolipaza C-> activare IP3+ DAG-> cresc conc Ca2+

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21
Q

receptori muscarinici cu efecte inhibitorii

A

M2 si M4
* cuplare cu prot Gi
* fixare Ach-> scade cant de AMPc intracelular

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22
Q

localizare receptori muscarinici

A
  • in principal- sinapse PS terminale( neuroefectorii)
  • SNC
  • ggl simp+ psimp
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23
Q

struct chimica receptori nicotinici

A

canale ionice pt sodiu din 5 subunitati polipeptidice (2 pt α, 3 pt β, γ, δ)
* fiecare subunit- 4 segmente transmb
* situs receptor ach- mereu pe α=> cuplare 2 molec ach simultan pe receptor

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24
Q

tipuri receptori nicotinici

A
  • ganglonari Nn
  • musculari Nm
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25
localizare recept nicotinici Nn
- ggl simp+ psim - SNC
26
localizare recept nicotinici Nm
jonctiune neuromusculara (placa motorie muschi striati)
27
ce fel de receptori muscarinici se gasesc in tub digestiv
M1+ M3
28
ce fel de receptori muscarinici se gasesc in gl exocrine
M3
29
ce fel de receptori muscarinici se afla in ochi
M3
30
ce receptori muscarinici se gasesc la nivel cardiovascular
M2 inima ig? M3 vasculari
31
efecte Ach pe tub digestiv
- fav peristaltism GI - creste secretii gastrice, biliare, pancreas, bila, intestin
32
ce receptori muscarinici se gasesc la nivel arbore traheobronsic
M3
33
efecte Ach pe arbore traheobronsic
-bronhoconstrictie -crestere secretie traheobronsica
34
efecte Ach pe vezica biliara+ uretere
- relaxare sfinctere -eliminare secretii biliare+ urina
35
efecte Ach la niv gl exocrine
crestere secretie lacrimala, salivara, sudorala
36
efecte Ach la nivel ocular
- mioza ( contractie sfincter iris) - contractie m ciliar - bombare cristalin - fixare vedere pt aproape - scade presiune intraoculara - poate aparea hiperemie conjunctivala tranzitorie
37
efecte Ach la nivel cardiovasc
mimeaza actiune nv vag: - deprima fct cardiace - scade frecventa - scade excitabilitate - scade viteza conducere atrio-ventric - scade contractilitate
38
efecte Ach la nivel vascular
- vasodilatatie - eliberare monoxid azot cel endoteliu vasc=> crestere conc GMP ciclic intracel
39
stimulare receptori Nn
efecte in general antagoniste- depinde de localizare?
40
efect stim receptori Nn ggl psimp
eliberare Ach efecte psimp
41
efect stim receptori Nn din ggl simpatici
elib NA in sinapse simp terminale efecte simpatice
42
efecte stim receptroi Nn din gl medulosuprarenala
eliberare adrenalina in circulatie efecte simpatice
43
efecte stim receptori Nm
contractia musc striata
44
unde exista si receptori muscarinici si nicotinici
SNC muscarinici- M1 si M4
45
efect stim colinergica SNC
efecte excitatorii pot aparea convulsii la doze toxice de Ach
46
tipuri de medicamente agoniste sistem colinergic
* parasimpatomimetice- efect asem crestere tonus SN psimp si vag * nicotinice- pe Nn din ggl si SNC
47
ce sunt parasimpaticomimetice indirecte
agonisti care actioneaza indirect - det crestere disponibil de Ach fanta sinaptica=> stim psimp
48
tipuri medicamente antagoniste sist colinergic
* parasimpatolitice- muscarinici * ganglioplegice- Nn din ganglioni * curarizante
49
de cate feluri pot fi curarizantele
* depolarizante- agonist pe Nm- intai stim placa motorie, apoi paralizie * anti depolarizante- antagonist pe Nm- produc de la inceput paralizie neuromusculara
50
dc Ach nu este avantajoasa ca medicament
actiune intensa, brutala, neselctiva si de scurta durata
51
avantaje compusi sinteza Ach
* absorbtie dupa adm orala * durata de actiune mai lunga * efecte predominant muscarinice
52
ce compusi de sinteza ai ach se folosesc in clinica
* metacolina * carbacol * betanecol
53
indicatii carbacol
tratament glaucom- instilatii conjunctivale
54
indicatii metacolina
vasodilatator in afectiuni vasculospastice -cale orala
55
indicatii betanecol
stim motilitate tub dig/ vezica urinara in atonii postop - adm orala/ inj
56
utilizare betanecol in stomatologie
creste secr salivara bolnavi xerostomie
57
parasimpaticomimetice
* metacolina * carbacol * betanecol * pilocarpina * cevimelina
58
mod actiune pilocarpina
act pe recept M din gl exocrine si ochi
59
indicatii pilocarpina
* glaucom- solutie oftalmica 0,5-4% * xerostomie * antidot intoxicatie atropina
60
pilocarpina ca tratament glaucom
sol oftalmica 0,5-4% instilatii conjunctivale * fav drenare umoare apoasa * scade presiune intraoc * dezavantaj- scurta durata, aplic la 3-6 ore
61
pilocarpina ca tratament xerostomie
adm orala 5-10 mg de 3 ori/zi * crestere secretii parotide, submandib, subling * putine r adverse cardiovasc * poate determina hipersudoratie, frisoane, greata, ameteala
62
actiune cevimelina
stim selectiv recept M1 si M3=> m putine reactii adverse decat pilocarpina - efecte similare pilocarpina
63
indicatii cevimelina
xerostomie doze 30 mg de 3 ori/ zi
64
la ce fel de pac trb sa ai grija cand adm parasimpatomimetice in tratament xerostomie
astmatici intoleranti tratamente care pot interactiona cu actiuni tip parasimpatomimetic
65
actiune anticolinesterazice
inhiba acetilcolinesteraza(= enzima care degradeaza Ach) => efecte stim receptori muscarinici si nicotinici
66
tipuri de anticolinesterazice
reversibile ireversibile
67
actiune anticolinesterazice reversibile
durata limitata actiune( 2-6 ore) - legarea de enzima form complex lent hidrolizabil
68
medicamente anticolinesterazice reversibile
* ezerina (fiziostigmina) * neostigmina * tacrina * donepezil
69
utilizari ezerina
local, intraocular pt glaucom
70
utilizari neostigmina
stim musc neteda G-I su vezicala in: - atonii digestive+ vezicale postop stim musc striata - miastenia gravis antidot intoxicatii cu subst blocante placa motorie ( curarizante antidepolarizante)
71
indicatii tacrina si donepezil
tratament Alzheimer -patrund in SNC si cresc nivel Ach sinapse
72
mod actiune anticolinesterazice ireversibile
form leg covalenta cu acetilcolinesteraza=> inactivare un timp ft lung, chiar sute de ore disparitie efect- prin sinteza molecule noi Ach
73
anticolinesterazice ireversibile
compusi organofosforici - insecticide- paration, malation - gaze toxice lupta- tabun, sarin, soman
74
intoxicatie acuta cu organofosforice
* acumulare excesiva Ach * efecte muscarinice+ colinergice intense= CRIZA COLINERGICA * liposolub mare-> absorbtie rapida aproape completa pe orice cale de adm
75
simtpome intoxicatie organofosforice
* hipersudoratie, hipersalivatie, hiperlacrimatie * bronhoree * greturi, varsaturi, diaree, colivi * hipotensiune cu bradicardie * mioza * fasciculatii musculare, chiar convulsii care pot evolua spre paralizie musc striata * confuzie mintala pana la coma
76
tratament intoxicatie cu organofosforice
atropina in doze ft mari - inj iv de 2 mg odata la 5-10 min pana la aparitie midriaza * adm de reactivatori colinesteraza- oxime * spalare tegumente, indepartare haine, spalaturi gastrice * aspiratie traheobronsica * respiratie asistata * tratament simptomatic cu anticonvulsivante, sedative
77
reactivatori de colinesteraza
OXIME - pralidoxima - obidoxima
78
ce sunt parasimpaticolitice
antagonisti competitivi receptori muscarinici
79

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