Physiology and pharmacology of the ANS Flashcards

(65 cards)

1
Q

What governs the pharmacology of parasympathetic and sympathetic neurones

A

Different neurotransmitters

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2
Q

What determines the state of that organ

A

The parasympathetic and sympathetic activity at that organ.

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3
Q

Summarise the autonomic nervous system

A

Along with the somatic nervous system, the autonomic nervous system constitutes the total neural output of the CNS.
It controls involuntary internal processes such as digestion and the regulation of blood flow.
It acts mainly on the heart, smooth muscle, metabolic processes and glandular structures.
Split into Sympathetic and parasympathetic.

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4
Q

List some actions of the PSNS

A
Constricts pupils
Constricts bronchi
Slows heart rate
Increases flow of saliva
Stimulates peristalsis and secretion
Stimulates bile release
Contracts bladder
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5
Q

List some actions of the SNS

A
Dilates pupils
Relaxes bronchi
Increases heart rate
Decreases flow of heart rate
Inhibits peristalsis and secretion
Secretion of adrenaline and noradrenaline 
Inhibits bladder contraction 
Stimulates orgasm
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6
Q

What. is the flight or flight response

A

An extreme example of the sympathetic nervous system- both SNS and PSNS are always working

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7
Q

Describe the outputs of the CNS

A

 Somatic Nervous System – Voluntary nervous system.
o Main innervated tissue is the skeletal muscle.
 Autonomic Nervous System (ANS) – Continually works to maintain homeostasis. Split into the:
o Sympathetic – Activated during exercise.
o Parasympathetic – Homeostasis during rest.
 Neuroendocrine System – Involves nerve fibres but the efferent way into the body is via hormones.
o Endo – Hormone released into circulation.
o Neuro – Neurotransmitter released NOT into the circulation.

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8
Q

What happens in the flight or flight response

A

pupil dilation, increased HR (better oxygen to muscles), increases diameter of bronchioles, stimulates glucose release (feed muscles), increases sweat production (prevents overheating); results from EXTREME activation of SNS - at work all time, just not to this level

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9
Q

Which structures does the ANS innervate

A
Secretory glands (salivary, sweat, tear and mucous-producing glands)
Smooth muscle
Cardiac muscle (to control heart rate in response to homeostatic changes).
	NOTE: You don’t need innervation to get an effect as certain tissues have receptors for blood bound hormones.
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10
Q

Describe the structure of the SNS

A

Column of cell bodies (intermediolateral column) in the lateral grey horn of the spinal cord
Runs from t1-L3
These ‘preganglionic’ neurones have axons that travel through the ventral roots of their segmental spinal nerves.
They contact a chain of ganglia outside the CNS lying along the vertebral column (paravertebral ganglia)

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11
Q

Describe the structure of the PSNS

A

III Oculomotor – pupil constriction
VII Facial nerve – Salivation
IX Glossopharyngeal – Salivation
X Vagus – bradycardia, gastric motility, digestion

S2-S4

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12
Q

Describe the ganglia associated with the SNS and PSNs

A

PSNS has no separate ganglia outside target organ so Vagus nerve emerges from brainstem to directly innervate the target organ (where ganglia do occur)
SNS GANGLIA OUTSIDE ORGAN, PSNS GANGLIA INSIDE ORGAN

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13
Q

What is meant by ganglia

A

*Ganglia – Structure outside CNS containing collection of neural cell bodies (somas)

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14
Q

Describe the anatomy of the SNS

A

3 neurones are involved OUTSIDE the brain
Presympathetic neurones run down the spinal cord until they reach the intermediolateral cell column which is present T1-L2/3, containing the cell bodies of pre-ganglionic neurones; here the presympathetic neurones synapse to the soma of pre-ganglionic neurones in a glutaminergic synapse in the lateral horn
The pre-ganglionic neurones exit the cord via the ventral root, passing up the lateral rami communicantes (white ramus) to enter the sympathetic chain, where they synapse to post-ganglionic neurones (cholinergic)
The post-ganglionic neurones exit the sympathetic chain using the more medial grey ramus if supplying blood vessels, sweat glands and erector pili muscles, or if innervating thoracic viscera they exit via nerves

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15
Q

Describe neurotransmission in the SNS

A

The transmitter released by preganglionic neurone at the ganglia is Ach- binds to postsynaptic nicotinic receptors
The transmitter released by postganglionc neurone is noradrenaline (norepinephrine)

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16
Q

What are the exceptions to neurotransmission in the SNS

A

In sweat glands- Ach is also the postganglionic neurotransmitter- binds to muscarinic receptors
Dopamine is the postganglionic neurotransmitter for SNS efferents to the renal vessels

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17
Q

Essentially, what is the neurotransmitter in SNS ganglia

A

Ach

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18
Q

What is special about the adrenal medulla

A

Some preganglionic fibres continue to the adrenal medulla (don’t synapse in ganglia)
Here, they are responsible for the glandular secretion of catecholamines from cells that are functionally similar to postganglionic sympathetic neurones (NA and A). the noradrenaline and adrenaline released into the blood stream affect target organs (blood vessels).
 The adrenal medulla only receives pre-ganglionic fibres and stimulates Chromaffin cells (instead of a post-ganglionic fibre) to release ACh.

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19
Q

Describe neurotransmission in the PSNS

A

Preganglionic neurone release Ach onto postganglionic nicotinic receptors
At target organs postganglionic neurons release Ach onto muscarinic receptors.

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20
Q

Describe the anatomy of the PSNS

A

Postganglionic neurone are found in target organs

OR Plexi near target organs (e.g pelvic plexus from sacral PS efferents).

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21
Q

Describe neurotransmission of the somatic nerves

A

Glutamate at synapse between nerve from CNS and cell body in ventral horn
Act from motor neurone to effector organ (skeletal muscle)

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22
Q

Describe noradrenaline biosynthesis

A

L-phenylalanine (diet) - L-tyrosine - L-DOPA - Dopamine (cytoplasm) then in vesicles converted to noradrenaline

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23
Q

Describe Ach biosynthesis

A

acetate + choline uses choline acetyltransferase to produce ACh, broken down by acetylcholinesterase

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24
Q

What happens in Alzheimer’s

A

Reduction in Ach
Give Ach inhibitors
Delay its breakdown- increasing the amount of Ach present in the system
Side effects of dry mouth

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25
Describe the intermediolateral cell column
found T1-L3 and target of presympathetic neurones; where sympathetic neurones eminate from, travelling to the sympathetic ganglia outside of the cord, synapsing to post-ganglionic neurones Degradation of the intermediolateral cell column is seen in disease
26
What do baroreceptors respond to
Respond to physical distension respond to mechanical pressure, transmitting beat-to-beat pressure information; rate of firing proportional to BP when threshold reache
27
Describe the baroreflex
blood pressure defined at set point and slight deviation will lead to significant change in firing ( sensitive to small changes in blood pressure) In hypertension, the set point is shifted to the right- set point higher- sensitivity unchanged
28
Where are the baroreceptors found
1 in the aorta 1 in each carotid artery Aorta has vagus nerve afferents Carotid arteries (glossopharyngeal nerves)
29
Describe the situation in the brain where this higher BP set point is defended
Congential abnormalities in the brain may caused impaired cerebral blood flow- brain defends higher BP to maintain cerebral blood flow Also the case in hypertension
30
Describe, simply, how the body responds to increased baroreceptor firing to reduce BP
Aortic baroreceptors send impulses down vagus afferents, to brain, causing impulses down vagus efferents to decrease stroke volume and hence output, while also causing vasodilation, all to decrease pressure
31
Describe the Cephalic response
Response to food before it is ingested sight, smell or taste of food leads to CNX impulses from hypothalamus to cause pancreas to release insulin in anticipation and stomach to secrete gastric juice Prepares the stomach for food
32
Describe the role of mechanoreceptors in GI function
in the stomach wall detect distension, sending CNX efferent signals to brainstem to reduce appetite, with increased stretching leading to proportional increase in firing More firing= more full you are
33
Describe the role of chemoreceptors in GI function
when hungry, satiety hormone receptors not expressed, but are when start eating; GI tract releases GLP-1, PYY and CCK to activate chemoreceptors and signal to the brain to stop eating via the Vagus nerve (receptors lost in obesity)
34
Describe the plasticity of the vagus nerve
Changes expression of receptors When hungry- less receptors for satiety hormones Lost in obese- no response to satiety hormones obese- more food to get satiety response form distension of stomach
35
Describe the central respiratory centre
Pontine respiratory centre- controls rate and pattern of breathing ventral group- controls ryhtmicity Dorsal group (Nucleus tractus solitarius)- Output to respiratory muscles (intercostal and diaphragm) All communicate bi-directionally with each other- but ventral group does not send signals to the dorsal group
36
Where is the central respiratory centre found
Medulla and pons of brain stem | Ventral and dorsal groups- medullary respiratory centre
37
Describe the role of mechanoreceptors in lung function
Lung mechanoreceptors are stretched, and transmit down vagus nerve, inhibiting respiration to prevent overexpansion in the Hering-Breuer reflex Mechanoreceptors communicate with the dorsal group of the medulla to decrease respiration
38
Describe the role of chemoreceptors in lung function
``` Aortic and carotid chemoreceptors- respond to decreased oxygen, decreased pH and increased CO2 to send impulses down vagus and glossopharyngeal afferents respectively to the dorsal group Central chemoreceptors (medulla oblongata) respond to decreased pH and increased carbon dioxide All chemoreceptors communicate with the dorsal group of the medulla to increase respiration ```
39
Describe the spinal levels for the control of respiration
``` C1-C3 = accessory muscles C3-C5 = diaphragm control T1-T11 = intercostals T6-L1 = abdominals ```
40
Where is the detrusor muscle found
External wall of bladder
41
Describe the innervation of the detrusor muscle
Afferent mechanoreceptors Sacral spinal cord (S2-S4) Parasympathetic innervation Sacral spinal cord (S2-4)
42
Describe the innervation of the external and internal sphincters
External: Motor nerves (voluntary control) Sacral spinal cord (S2-S4) Internal: Sympathetic innervation Thoracic spinal cord (T10-12)
43
Describe the regulation of micturition
Activation of: PSN = Contraction of detrusor muscle SNS = Contraction of internal sphincte Afferent signalling results in activation of PSN and inhibition of SNS. Overall control of voiding governed by voluntary control of external sphincter relaxation of internal sphincter opens it
44
Describe central regulation of the autonomic nervous system
The nucleus tractus solitarius (medulla) plays a role in autonomic control and communicated with the hypothalamus. The nucleus of the solitary tract integrates sensory information from the internal organs (via the vagus and glossopharyngeal nerves) and sends this to the hypothalamus returning signals to the dorsal motor nucleus of the vagus, controlling output (DMNX)- or directly to Intermediolateral cell columns; other brain regions can exert some control over ANS (e.g. Can hold breath)
45
What is the consequence of the brainstem being tiny
Infarct is catastrophic
46
Describe the post-synaptic receptors of the SNS
uses adrenoreceptors as post-synaptic receptors; alpha and beta subtypes, alpha has alpha1 (A/B/D) and alpha2 (A/B/C), beta has beta1 and beta2 Except sweat gland of course
47
Describe the post-synaptic receptors of the PSNS
uses cholinoceptors - nicotinic and muscarinic
48
Describe the difference between presynaptic and postsynaptic receptors
Postsynaptic receptors: acted on by the NTs released from presynaptic neurone to propagate impulse Presynaptic receptors: respond to released NT, controlling amount released to stop over-release
49
Describe the difference between ion channels and GPCRs
Ion channels- on/off | GPCR- can last for hours once activated (due to downstream responses)
50
Describe PSNS and SNS receptors
PSNS receptors: Synapse 1 = ACh in nicotinic Synapse 2 = ACh in muscarinic SNS receptors: Mostly NA/DA postganglionic All ganglionic synapses are nicotinic ACh receptors Sweat glands use ACh muscarinic receptors
51
Where are nicotinic receptors also found
The NMJ
52
Describe cholinergic drugs
Atropine: competitive muscarinic receptor antagonist (changes HR) used for cardiac arrest, sinus bradycardia after MI Tubocurarine: nicotinic receptor antagonist - also used as NMJ so would paralyse muscles
53
What is the effect of nicotinic receptor antagonists on HR
Increase HR | Inhibits both PSNS and SNS functions- intrinsic heart beat of 120 bpm and PSNS predominates at rest
54
Describe nicotinic receptors
Nicotinic Receptors Ionotropic receptors Situated at all autonomic gangli ACh binding = non-specific cation influx (Na+/K+) stimulating A.P
55
Describe muscarinic receptors
Muscarinic receptors GPCRs Stimulated by all postganglionic PNS neurons Also stimulated by SNS at selected site Stimulates a series of downstream reactions
56
Describe the adrenergic receptors
All adrenergic receptors are GPCRs Alpha1 receptors located on most effector organs to cause smooth muscle contraction (blood vessels, ureter, bronchioles) Alpha2 receptors present on presynaptic neurones to limit NA release to synapse ( Beta1 receptor exclusively found on the heart to increase cardiac output ( Beta2 receptors can relax smooth muscle in noradrenaline synapses (contract sphincters of GI tract)
57
Describe the adrenergic drugs
Doxazosin: Alpha1 receptor antagonist to cause smooth muscle dilation, hypertension Medetomidine: Alpha2 receptor agonist to decrease NA release Atenolol: Beta1 receptors antagonist to decrease HR - hypertension, acute coronary syndromes, tachyarrythmia Salbutamol: Beta2 receptor agonist to relax smooth muscle - asthma
58
What is Synucleinopathy
bnormal accumulation of alpha-synuclein protein in nerve fibres and glial cells leading to degeneration - three main types: Parkinson's, Dementia with Lewy Bodies and Multiple System Atrophy
59
Describe Shy-Drager syndrome/ Multiple System Atrophy
Synucleopathy – along with PD & Lewy body dementia Associated with loss of intermediolateral cell bodies and striatonigral brain areas Symptoms include: Orthostatic hypotension Impotence Hypohidrosis Dry mouth Urinary retention Incontinence Rare: 1:100,000 (although around 13% of Px with PD found to have MSA at post-mortem, so maybe underdiagnosed)
60
Describe hypertension
1O Hypertension: idiopathic 2O Hypertension: hormonal imbalance BP = CO x TPR TPR determined by SNS activity, so exaggerated SNS activity to renal bed and blood vessels increases TPR to increase BP Leads to increased circulating volume and vascular tone
61
Describe heart failure
Inability to pump sufficient blood to meet oxygen demand Associated with increased sympathetic nerve activity to renal bed Leads to hypervolaemia and hypernatraemia Increases strain on cardiac tissue
62
Describe Parkinson's
Early sign of PD is autonomic dysfunction (orthostatic hypotension, constipation) Emerging evidence that vagus nerve may be involved in aetiology Alpha synuclein first observed in vagus nuclei of brainstem- NTS is first place you see death- may originate in the vagus nerve GI derived virus????
63
Describe adrenomedullary catecholamines
The chromaffin cells can be considered as specialised sympathetic post-ganglionic fibres The catecholamines from the chromaffin cells are released directly into the blood stream- hence they are HORMONES In humans, ~80% of adrenomedullary hormone output is ADRENALINE, most of the rest being NORADRENALINE
64
What are the functions of the PSNS
Oppose some effects of the SNS (hear rate, gut motility, bronchiolar diameter) Controlling body functions under non-stressful conditions, working either alone or with the SNS (ciliary muscle for accommodation for near objects, GI secretions, nasal secretions, mouth and eye secretions, micturition, defection, erection
65
What is seen in patients with severed vagus nerve
less likely to develop Parkinson's