the autonomic nervous system is comprised of which 2 neurons in a chain?
- pre-ganglionic (ganglion = a collection of cell bodies)
most organs are dually innervated by both the ___ and ___ nervous system, and the two tend to have ___ effects on the organs innervated
- sympathetic and parasympathetic
which are the two tissues innervated by the sympathetic nervous system that have muscarinic receptors?
sweat glands and salivary glands
pre-ganglionic cell bodies of the sympathetic nervous system are associated with the ___ region
pre-ganglionic sympathetic nervous system axons extend to ___ and ___ ganglia (hence, they tend to be ___)
- para- and pre-vertebral
in the ganglia of the sympathetic nervous system, axon terminals of the sympathetic pre-ganglionic neurons synapse onto ___
sympathetic post-ganglionic neurons
post-ganglionic cell bodies of the sympathetic nervous system are in ___ and ___ ganglia
para- and pre-vertebral
post-ganglionic axons/fibers of the sympathetic nervous system extend to ___
sympathetic pre-ganglionic also innervate the ___, which has what effect?
- adrenal medulla
- adrenal cells release epinephrine and norepinephrine into the bloodstream
pre-ganglionic cell bodies of the parasympathetic nervous system are located in the ___ region
pre-ganglionic axons of the parasympathetic nervous system extend to ganglia located ___
near or in effector tissues/organs
in the ganglia, axon terminals of the parasympathetic pre-ganglionic neurons synapse onto ___
parasympathetic post-ganglionic neurons
post-ganglionic cell bodies of the parasympathetic nervous system are in the ___
parasympathetic ganglia near or in effector tissue/organs
axons of parasympathetic post-ganglionic tissues innervate the ___
what are two classes of neuromuscular blockers?
depolarizing (non-competitive) and non-depolarizing
what is succinylcholine?
- a depolarizing (non-competitive) neuromuscular blocker that acts as a nicotinic agonist and depolarizes/desensitizes the neuromuscular endplate
- it opens the NIC channels and keeps these open such that the neuron is depolarized and unresponsive to another ACh challenge
what is tubocurare (aka tubocurarine)?
a non-depolarizing neuromuscular blocker that competes with ACh at nicotinic receptors
what 3 things can happen of AChE is blocked?
- affects BOTH sympathetic and parasympathetic systems
- affects tissues innervated by post-ganglionic fibers
- affects signaling at the neuromuscular junction
what is sarin?
a cholinesterase inhibitor
what are some effects of sarin on the body?
main effect is an increase in acetylcholine, which causes:
- increase in HR
- stimulates skeletal muscle = tetani and eventually you will stop breathing
- increase in salivation
- watery eyes
- blurred vision
- increase in perspiration
what can be used to reverse the effects of sarin?
botulinim toxin prevents the release of ___, which causes what?
- relax intraocular muscles, treats muscle dystonia (spasms), removes wrinkles
what are two cholinergic agents used in dentistry?
- cevimeline (evoxac)
- pilocarpine (salagen)
___ is a cholinergic agonist used to treat xerostomia in sjogrens syndrome
___ is a cholinergic agonist used to treat xerostomia after radiotherapy
what are 4 cholinomimetic agents?
- cholinesterase inhibitors (donepezil)
what are some uses of cholinomimetic agents?
- myasthenia gravis
- alzheimer's disease
- smoking cessation
what is bethanechol (urecholine) indicated for?
increases urine output to treat urinary retention
what is pilocarpine indicated for?
increases saliva secretions and treats glaucoma
what is succinylcholine indicated for?
used in surgeries to relax muscles
what is mecamylamine indicated for?
ganglionic blocker, used originally to treat hypertension (now only used for very significant cases of HTN - never used as a first choice)
what is carbachol (miostat) indicated for?
what is edrophonium indicated for?
reversible acetylcholinesterase inhibitor used to diagnose myasthenia gravis
describe closed angle glaucoma
- caused by blocked drainage, resulting in a sudden rise in intraocular pressure
- has a closed or narrow angle between the iris and cornea
- develops very quickly and requires immediate medical attention
- has symptoms and damage that are usually very noticeable
- treat with pilocarpine to contract (miosis) and pull iris to open trabecular meshwork
what are two examples of antimuscarinic agents?
atropine and scopolamine
what are antimuscarinic agents used for?
parkinson's disease (adjunctive therapy), motion sickness, COPD, urinary urgency
what are side effects of antimuscarinic agents?
- dry mouth
- blurred vision
- urinary retention
what are drugs that have anticholinergic effects?
- herbal medicines
what is pralidoxime indicated for?
treatment of organophosphate poisoning (ex. pesticide poisoning)
what are 4 synthetic anticholinergic drugs?
- glycopyrrolate (robinul)
- benztropine mesylate (cogentin)
- propantheline bromide (pro-banthine)
- trihyxphenidyl HCl (artane)
what is glycopyrrolate (robinul) used for?
inhibits salivation pre-operatively; controls upper airway secretions
what is benztropine mesylate (cogentin) used for?
what is propantheline bromide (pro-banthine) used for?
what is trihyxphenidyl HCl (artane) used for?
dopamine is released from ___ in the ___
sympathetic nerve terminals in the kidney
at high doses, dopamine activates ___ and ___
alpha and beta receptors