Lesson 4

Question 1

One of the major control systems in the body is the __________ comprising _________ nerves; ________ nerves; and the ___________, which is divided further into sympathetic and parasympathetic branches.

Answer 1

• nervous system
• sensory efferent
• motor efferent
• autonomic nervous system

Question 2

There are two major control systems in the body that can be manipulated by drug therapy, which either mimics or blocks the usual action of the control system, to produce or inhibit physiologic effects.

Answer 2

nervous system and the endocrine system

Question 3

The nervous system is divided into the ___________ and __________, both of which offer sites for drug action.

Answer 3

central nervous system (CNS) and the peripheral nervous system (PNS)

Question 4

Central nervous system is comprise of:

Answer 4

a. Brain
b. Spinal cord

Question 5

Peripheral nervous system is comprised of:

Answer 5

a. Sensory (afferent) neurons
b. Somatic (motor) neurons
c. Autonomic nervous system
- Parasympathetic branch
- Sympathetic branch

Question 6

the branch of the nervous system consists of afferent neurons from heat, light, pressure, and pain receptors in the periphery to the CNS.

Answer 6

Sensory branch

Question 7

This branch (or motor branch) of the nervous system is under voluntary, conscious control and innervates skeletal muscle for motor actions such as lifting, walking, or breathing.

This portion of the nervous system is manipulated by neuromuscular blocking agents, to induce paralysis in surgical procedures or during mechanical ventilation.

Answer 7

Somatic (motor branch)

Question 8

It is the involuntary, unconscious control mechanism of the body, sometimes said to control vegetative or visceral functions.

For example of this is it regulates the heart rate, pupillary dilation and contraction, glandular secretion such as salivation, and smooth muscle in blood vessels and the airway

Answer 8

Autonomic Nervous System

Question 9

This extends without the interruption from the CNS to the skeletal muscle, and its action is mediated by a neurotransmitter called ______.

Answer 9

• Motor neurons
• Acetylcholine

Question 10

When the peripheral nervous system (PNS) sends signals to the central nervous system (CNS).

Answer 10

• Afferent System

Question 11

When the central nervous sytem (CNS) respond to the peripheral nervous system (PNS) or to the specific parts of the body.

It is considered in autonomic system

Answer 11

• Efferent System

Question 12

1. This branch arises from the cranial and sacral portions of the spinal cord and consists of two types of neurons: _______ and _______.
2. a fiber leading from the vertebrae to the ganglionic synapse outside the cord.
3. a fiber ganglionic synapse to the gland or smooth muscles being innervated.
   - where the parasympathetic branch has good specificity where this fiber arise very near the effector site (ex. gland, or smooth muscle).

Answer 12

• Parasympathetic branch (preganglionic fiber and post ganglionic fiber)
• Preganglionic
• Postganglionic

Question 13

Stimulation of this neuron can cause activity limited to individual effector sites such as heart and eye.

Answer 13

Parasympathetic preganglionic neuron

Question 14

Leave the cord or arises primarily from the thoracic and lumbar regions or thoracolumbar of the spinal cord and consists of __________ and _________.

Answer 14

Sympathetic (short preganglionic fibers and long postganglionic fibers)

Question 15

these are conducted by electrical and chemical means. the chemical portion of nerve transmission is referred to as a _______.

Answer 15

• Nerve impulses
  Neurotransmitters

Question 16

The neurotransmitter is ___________ at the myoneural (neuromuscular) junction, at ganglia, and at parasympathetic end sites.

Answer 16

acetylcholine

Question 17

The neurotransmitter at sympathetic end sites is generally ________ except at sweat glands and the adrenal medulla, where acetylcholine is the neurotransmitter.

Answer 17

norepinephrine

Question 18

Sympathetic neurons from the spinal cord terminate in the _______ that lie on either side of the vertebral column.

In the ganglia, or ganglionic chain, the preganglionic fiber makes contact with postganglionic neurons. As a result, when one sympathetic preganglionic neuron is stimulated, the action passes to many or all of the postganglionic fibers. The effect of sympathetic activation is further widened because sympathetic fibers innervate the adrenal medulla and cause the release of epinephrine into the general circulation. Circulating epinephrine stimulates all receptors responding to norepinephrine, even if no sympathetic nerves are present. Where the parasympathetic system allows discrete control, the design of the sympathetic system causes a widespread reaction in the body.

Answer 18

Ganglia or ganglionic chain

Question 19

1. It is more essential to life to life and is considered a more, finely regulated system than sysmpathetic control.

Effects control the day-to-day bodily functions of digestion, bladder and rectal discharge, and basal secretion of bronchial mucus.

2. Overstimulation of this would render the body incapable of violent reaction, resulting in what is termed the SLUD syndrome: _____, ____, ____, ____

Answer 19

• Parasympathetic
• salivation, lacrimation, urination, and defecation

Question 20

It reacts as a general alarm system and does not exercise discrete controls.

The fight or flight system (where the heart rate and blood pressure increase, blood flow shifts from periphery to muscles and the heart, blood sugar rises, and bronchi dilate.

Not essential to life

Answer 20

Sympathetic

Question 21

It can survive but of course are not prepared to cope with violent stress.

Answer 21

Sympathectomized animal models

Question 22

This are widespread, mediated by norepinephrine at nerve endings, as well as by circulating epinephrine released from the adrenal medulla

Answer 22

Sympathetic effect

Question 23

Nerve propagation is both ______ and ______.

Note: A nerve signal is caried along a nerve fiber by electrical action potentials, caused by ion exchanges (sodium, potassium)

Answer 23

electrical and chemical

Question 24

It is the chemical transmission of the electrical impulse at the ganglionic synapses and at the end of the nerve fiber, termed as_____.

Answer 24

Neuroeffector site

Question 25

What are the usual neurotransmitters in the peripheral nervous system, including the ganglionic synapses and terminal sites in the autonomic branches.

Answer 25

Acetylcholine (ACh) and Norepinephrine (NE)

Question 26

The neurotransmitter conducting the nerve impulse at skeletal muscle sites is _______, and this site is referred to as the neuromuscular junction, or the myoneural junction.

Answer 26

- acetylcholine

Question 27

In the sympathetic branch, _________ is the neurotransmitter at the ganglionic synapse; however, _________ is the neurotransmitter at the neuroeffector site. There are two exceptions to this pattern, both in the sympathetic branch. Sympathetic fibers to sweat glands release _______ instead of norepinephrine, and preganglionic sympathetic fibers directly innervate the adrenal medulla, where the neurotransmitter is ______.

Answer 27

- acetylcholine - norepinephrine - acetylcholine - acetylcholine

Question 28

Sympathetic fibers that have Ach at the neuroeffector sites are _______ (for Ach) sympathetic fibers. “________” would be an apparent contradictory combination of terms if not for the exceptions to the rule of norepinephrine as the sympathetic neurotransmitter. ex: policarpine - medication for sweat glands

Answer 28

- cholinergic sympathetic fibers - Cholinergic sympathetic

Question 29

The neurotransmitter acetylcholine is terminated by the enzyme _________, and norepinephrine and sympathetic transmission are terminated by neurotransmitter reuptake into the presynaptic neuron ______ and by the enzymes ________ and _______.

Answer 29

- cholinesterase - (uptake-1), catechol O methyltransferase (COMT), monoamine oxidase (MAO)

Question 30

its effects on the cardiopulmonary system include increased heart rate and contractile force, increased blood pressure, bronchodilation, and probable increased secretion from mucous glands in the airway

Answer 30

Sympathetic effect

Question 31

Its effects on the cardiopulmonary system include decreased heart rate, lower blood pressure, bronchoconstriction, and mucus secretion in the airways

Answer 31

Parasympathetic

Question 32

The term _________ has also been used in place of neurotransmitter

Answer 32

neurohormone

Question 33

Ach is concentrated in the _________ (both at the ganglion and at the effector site).

Answer 33

presynaptic neuron

Question 34

Acetylcholine is being synthesized from ________, catalyzed by the enzyme choline acetyltransferase. Ach is stored in vesicles as quanta of 1000 to 50,000 molecules per vesicle.

Answer 34

acetyl-CoA and choline

Question 35

Acetylcholine is inactivated through ______ by cholinesterase enzymes, which split the Ach molecule into choline and acetate, terminating stimulation of the postsynaptic membrane.

Answer 35

hydrolysis

Question 36

Effects of the parasympathetic to the heart, bronchial smooth muscle, and exocrine glands.

Answer 36

Heart: Slows rate Bronchial smooth muscles: Constriction Exocrine glands: Increase secretions

Question 37

1. What are the two additional terms used to refer to stimulation of receptor sites for acetylcholine? 2. They are derived from the action in the body of two substances such as ______ and _____.

Answer 37

- Muscarinic and Nicotinic - alkaloids muscarine and nicotine

Question 38

It refers to cholinergic receptors at parasympathetic end sites. They are distinguished into subtypes M1 through M5, with M2 receptors in the heart and M3 receptors on airway smooth muscle, mediating bronchoconstriction

Answer 38

Muscarinic

Question 39

In general, a parasympathomimetic effect is the same as a muscarinic effect, and a parasympatholytic effect is referred to as an ____________.

Answer 39

antimuscarinic effect

Question 40

A muscarinic effect well known to respiratory care clinicians is the ___________ after administration of acetylcholine-like drugs such as neostigmine.

Answer 40

increase in airway secretions

Question 41

a substance in tobacco products, stimulates acetylcholine (cholinergic) receptors at autonomic ganglia (parasympathetic and sympathetic) and at skeletal muscle sites.

Answer 41

Nicotinic

Question 42

Practical effects of stimulating these nicotinic receptors include an___________ resulting from stimulation of sympathetic ganglia, causing vasoconstriction when the postganglionic fibers discharge, and muscle tremor caused by skeletal tissue stimulation.

Answer 42

increase in blood pressure

Question 43

It mimics the action of the acetylcholine at receptor sites in the parasympathetic system and neuromuscular junction. This agents can cause stimulation at the terminal nerve site by two distinct mechanisms, leading to their classification as direct acting or indirect acting.

Answer 43

Cholinergic drugs

Question 44

Are structurally similar to acetylcholine. They mimic acetylcholine, binding and activating muscarinic or nicotinic receptors directly. Ex: methacholine, carbachol, bethanechol, and pilocarpine.

Answer 44

Direct-acting Cholinergic Agents

Question 45

This drug has been used in bronchial challenges test by inhalation to assess the degree of airway reactivity in asthmatics and others. Its parasympathetic effect is bronchospasm. It is a useful diagnostic agent to detect differences in degree of airway reactivity between asthmatics with hyperreactive airways and Non asthmatic individuals.

Answer 45

Methacholine

Question 46

It inhibits the cholinesterase enzyme. Because cholinesterase usually inactivates the Ach neurotransmitter, inhibiting this enzyme results in accumulation of endogenous Ach at the neuroeffector junction of parasympathetic nerve endings or the neuromuscular junction. Ex: neostigmine

Answer 46

Indirect-acting cholinergic agonist

Question 47

It stimulates autonomic muscarinic receptors in the iris sphincter and ciliary muscle of the eye to produce pupillary constriction (miosis) and lens thickening.

Answer 47

Echothiophate (Phospholine)

Question 48

It useful in reversing neuromuscular blockade caused by paralyzing agents such as pancuronium or doxacurium

Answer 48

Neostigimine

Question 49

1. They are also useful in increasing muscle strength in a neuromuscular disease such as myasthenia gravis, in which the cholinergic receptor is blocked by autoantibodies 2. is used in the Tensilon test to determine whether muscle weakness is caused by overdosing with an indirect-acting cholinergic agent (causing ultimate receptor fatigue and blockade) or undertreatment with insufficient drug. Because edrophonium is short-acting (5 to 15 minutes, depending on the dose), it is useful as a diagnostic agent, rather than as a maintenance treatment in neuromuscular disease.

Answer 49

- Neostigmine and edrophonium - Edrophonium (tensilon)

Question 50

To terminate norepinephrine at the post synaptic membrane.

Answer 50

Uptake 1

Question 51

The neurotransmitter can be also ended by two other mechanisms: _________ uptake into the tissue sites around the nerve terminal. - to distinguish it from reuptake into the nerve terminal itself, and diffusion of excess norepinephrine away from the receptor site. - is a mediated uptake of exogenous amines (chemicals such as norepinephrine) in nonneuronal tissues. - low affinity but high capacity system - specific to chatecholamines

Answer 51

Uptake 2

Question 52

These are autoreceptors that can inhibit further neurotransmitter release.

Answer 52

a2 - receptor

Question 53

Chemicals structurally related to epinephrine are termed _________.

Answer 53

catecholamines

Question 54

1. Two enzymes are available that can inactivate catecholamines such as epinephrine: 2. ________ is responsible for ending the action of catecholamine bronchodilators.

Answer 54

- catechol O methyltransferase (COMT) and monoamine oxidase (MAO). - COMT

Question 55

The effect of adrenergic receptors are mediated by coupling with _______, and they are identified as _______ receptors.

Answer 55

- G protein, G protein like receptors

Question 56

- a sympathetic receptor mediating excitatory effects - generally excite, with the exception of the intestine and central nervous system receptors, where inhibition or relaxation occurs. (ex. vasoconstriction)

Answer 56

a receptor

Question 57

- a sympathetic receptor mediating inhibitory effects - generally inhibit or relax, with the exception of the heart, where stimulation occurs. (ex. smooth muscle relaxation)

Answer 57

b receptor

Question 58

1. is one of the purest a stimulant 2. is an almost pure b stimulant

Answer 58

- phenylephrine - isoproterenol

Question 59

1. this stimulates both a and b sites equally 2. Has more of an a than b effect

Answer 59

- Epinephrine - Norepinephrine

Question 60

1. receptors that are found in cardiac muscles. Increase the rate and force of cardiac contraction. 2. receptor (which encompass all other B receptors) include those found in bronchial, vascular and skeletal muscle. Relaxes bronchial smooth muscle and vascular beds of skeletal muscle. 3. a B receptor type found in lipocytes (fats) and whose stimulation results in lipolysis.

Answer 60

- B1 - B2 - B3