Module 5- PNS Flashcards by Megan Manasco

Fibers responsible for proprioception

A-alpha and A-beta

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Sensation of throbbing pain, touch, and temperature

Type C

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Fibers carrying sensations of sharp, prickling pain and temperature

A-delta

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Sympathetic and parasympathetic pre ganglionic fibers are what type

Type B

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Post ganglionic sympathetic fibers are what type

Type B

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Sympathetic outflow arises where

T1-L3

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Cardioaccelerator fibers arise where

T1-T4

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Signs and symptoms of Horner’s syndrome

Miosis
Ptosis
Anhydrosis
Enophthalamos
Flushing
Increased skin temperature
Nasal congestion

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Horners syndrome is caused by

Block at stellate ganglion

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Sympathetic preganglionic neurons arise where in SC

Intermediolateral horn

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All SNS preganglionic fibers pass through what rami

White rami communicans in route to paravertebral ganglia

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Some SNS preganglionic fibers pass through what additional rami. Significance

Gray ramus

Distributed to all spinal nerves from the ganglia
Allow coordinated, mass discharge of SNS

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Stimulation of presynaptic A2 receptors what happens

NE synthesis and release is decreased

NEGATIVE FEEDBACK

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Synthesis of epi

Tyrosine - L dopa - dopamine - NE - epi

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NE receptor complex causes activation of what

Adenylate cyclase = increased production of cAMP

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Termination of acts of NE

1- 80% reuptake
2- metabolism by MAO in synaptic cleft
3- metabolized by COMT in plasma

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Patient taking MAOI should avoid

Ephedrine and Demerol

Both trigger release of NE

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Adrenergic receptor found on presynaptic nerve terminals of sympathetic postganglionic neurons and in tissues on postsynaptic membranes in brainstem and peripheral tissues.

Inhibitory

Alpha 2

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Adrenergic receptors found peripherally in a variety of tissues innervated by sympathetic postganglionic neurons

Excitatory response generally

Arterial and venous vasoconstriction

Alpha 1

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Adrenergic receptors found in heart, kidney, and adipose tissue

Excitatory

Beta 1

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Adrenergic receptor found in smooth muscle and glandular tissue

Inhibitory- dilation

Glycogenolysis and gluconeogenesis

Beta 2

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Stimulation results in increased insulin secretion

Beta 2

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Stimulation results in decreased insulin secretion

Alpha 1&2

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Stimulates Na-K pump

Beta 2

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Uterine relaxation Contraction

Relax beta 2 Contract alpha 1

Increased renin release

Beta 1

2 important stimuli for aldosterone release

Angiotensin II and high serum potassium

Increases potassium secretion and increases sodium reabsorption

Aldosterone

Renin release occurs in response to

Decreased renal blood pressure and increased SNS activity, and Chloride

Ritrodine is a beta 2 agonist used to treat preterm labor side effects

Hyperglycemia Hypokalemia Tachycardia It does cross the placenta so fetal effects may be seen

Long acting non selective alpha adrenergic agonist used to control BP in pt with pheochromocytoma

Phenoxybenzamine

Selective alpha 2 adrenergic antagonist used to treat impotence

Yohimbe

Selective alpha 1 adrenergic antagonist that lowers BP without increaseing release of NE (because does not. Block alpha 2)

Prazosin

Non selective beta 2 agonists Avoid in pt with irritable airway bc B2 block can cause bronchoconstriction

``` Propanolol Timolol Esmolol Nadolol Pindolol ```

Mixed alpha and beta adrenergic antagonists

Labetalol | Carvedilol

Which receipt depresses activity of Na-K pump

Beta 2

Chronic exposure to agonist results in what

Down regulation of receptors

Chronic exposure to antagonist results in

Up regulation

Parasympathetic outflow arises from

CN III, VII, IX, X and sacral cord S2-S4

Drug class Xanthines Example MOA

Theophylline and aminophylline Non specific inhibition of PDE = accumulation of cAMP = bronchodilation

Drug class mast cell inhibitors

Cromolyn

Respiratory stimulant agent used to reverse respiratory depression

Doxapram

Drug class leukotriene antagonists Ex MOA

Montekukast and Zafirlukast Impair conversion of arachidonic acid to leukotrienes

Cholinergic crisis is treated with

Atropine

Anticholinergic syndrome is treated with

Phyostigmine

``` Which agonist listed is devoid of beta 2 adrenergic activity Isoprel Terbutaline Epi NE ```

3 common glutamate receptors in CNS

NMDA AMPA Kainate

What is the rate limiting step in synthesis of catecholamines

Tyrosine to DOPA by tyrosine hydroxylase

Where does the SC end in adults? Neonates?

L1 in adults L3 in neonates

In supine position what is the highest point of the spinal column? Lowest?

Highest L3 Lowest T6

What is the major inhibitory NTS in spinal cord? CNS?

Spinal cord- glycine CNS- GABA

The epidural space is bound by what cranially, causally, anteriorly, and posteriorly

Top- foramen magnum Bottom- sacrococcygeal ligament Anterior- posterior longitudinal ligament Posterior- ligamentum flavum

Type of fiber that serves touch and pressure

Myelinated A- beta fibers Also proprioception

Which nerve fibers carry only motor information

B C A gamma

Which fibers carry sensory and motor information

A alpha A beta

What higher center regulates the SNS

Hypothalamus

Pelvic pain caused by inflammatory disease or CA can be relieved with what block

Superior hypogastric plexus block

Sympathetic nerves innervating organs in the abdomen arise where

T5-T12

Sympathetic nerves innervating bladder, colon, and rectum arise wehre

L1-L2

What class of drugs interrupt muscarinic transmission peripherally

Antimuscarinic aka anticholinergic

Nicotinic receptors are found where

Cell bodies of SNS and PNS postganglionic neurons, chromaffin cells of adrenal medulla, motor end plate of skeletal NMJ

3 drugs that block nicotinic receptors at autonomic ganglion

Trimethaphan D-tubocurarine Metocurine

NE stimulates what adrenergic receptors

alpha 1 Alpha 2 Beta 1

What adrenergic receptors are stimulated by epi Which are most sensitive

Alpha 1 Alpha 2 Beta 1 Beta2 Beta receptors are more sensitive to epi

At lower doses of epi which receptors effects predominate

Beta

How does cocaine alter sympathetic function

By blocking reuptake of NE

What should you avoid in treating hypotension in a cocaine addict

Indirect acting agents such as ephedrine

Phenylephrine produces which more arterial or veno constriction

Venoconstriction more than arterial constriction

Tachyphylaxis to ephedrine develops why

Depletion of NE from sympathetic post ganglionic nerve terminals

Dobutamine acts on what receptors

Primarily Beta 1 Some Neta 2 and alpha Increases contractility more than HR

Where in cardiovascular system are Beta 2 receptors mostly located

Smooth muscle of vasculature of skeletal muscle

Low dose dopamine stimulates what

Dopamine 1 receptors of renal vasculature = renal vasodilation

Intermediate doses of dopamine stimulate

Dopamine receptors and beta 1 receptors

High doses of dopamine stimulate

Dopamine, beta 1, and vascular alpha 1

What drugs and contradictions associated with increased resistance to NDNMB

Antiepileptic drugs Burns

MOA of gabapentinoids analgesic effect

Reduce hyperexcitaility of dorsal horn neurons caused by tissue damage

What drugs should be avoided in patient taking L-DOPA. Why

Any drug that antagonizes dopamine- doperidol, reglan, comparing, alfentanil Bc dopamine is deficient in Parkinson’s patient

Diphenhydramine interacts with what receptors

H1 blocking histamine Also has anticholinergic activity so can treat Parkinson’s crisis

What drug can be used to treat extrapyramidal symptoms

Diphenhydramine

What drugs are prohibited in patient taking MAOI for depression

TCA Opioids (especially Demerol) Indirect sympathomimetics Fluoxetine

How many days before surgery should MAOI be stopped

14-21 days

St Johns Wort effect

Induces cytochrome P450 Increases metabolism of drugs

In addition to lithium level what lab values are concerning for a patient taking lithium

Sodium (sodium depletion = decreased renal excretion of lithium) Avoid fluid restriction and excessive diuresis

Caffeine stimulant effect MOA

Antagonist at adenosine receptor Inhibit PDE

Position for patient with VAE

Left lateral decubitus with slight trendelenburg

Location of appropriate placement of doppler for detecting VAE

Over RA

Does alkalosis increase or decrease the seizure threshold

Decreases the threshold. Seizures are more likely

4 electrolyte disorders that lower the seizure threshold

Hypocalcemia Hypomagnesemia Hyponatremia Hypernatremia

Combination of aminophylline and ketamine can cause what

Seizures