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Neurology > Physiology and Pharmacology of the Autonomic Nervous System > Flashcards

Physiology and Pharmacology of the Autonomic Nervous System Flashcards

1
Q

What is the autonomic nervous system split into

A

Sympathetic and parasympathetic

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2
Q

What is the effect of the sympathetic and parasympathetic systems on the eyes, lungs, heart and liver

A

eyes - dilate pupils, constricts pupils
lungs - dilates bronchi, constricts bronchi
heart - accelerates heart rate, decreases heart rate
liver - stimulates glucose production + release, stimulates bile release

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3
Q

What controls the autonomic nervous system

A

Nucleus tractus solitarius

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4
Q

Where does the sympathetic nervous system emanate from

A

T1-L3 on the spinal cord

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5
Q

Describe the sympathetic short pre-ganglionic neurone

A

Arises from the lateral horn of grey matter
Emerges from the ventral root of the spinal cord
Enters the ventral rami of T1-L3
Detours via white rami communicans to enter the sympathetic ganglion

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6
Q

Describe the sympathetic ganglia

A

Exists as sympathetic trunks
Contains cell bodies of post ganglionic neurones
Short pre ganglionic neurone synapses with the longer post-ganglionic neurones
ACh is the NT for pre-ganglionic neurones

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7
Q

Describe the sympathetic long post-ganglionic neurone

A

Exits via the grey ramus communicans and innervates the effector

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8
Q

What are the roles of the sympathetic system

A 
Fight or flight
Constrict/dilate the blood vessels
Heart beat harder and faster
Dilation of pupils
Dilation of the trachea
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9
Q

Which nerves make up the parasympathetic system

A

Sacral splanchnic nerves S2-S4

Cranial nerves III, VII, IX, X

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10
Q

Which nerves are involved in the following processes: pupil constriction, salivation, bradycardia and gastric motility

A

Pupil constriction - III oculomotor
Salivation - VII facial nerve & IX glossopharyngeal
Brady cardia and gastric motility - X vagus

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11
Q

How does the sympathetic and parasympathetic differ in ganglion

A

Sympathetic - Ganglia is outside the target organ

Parasympathetic - Ganglia is inside the target organ

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12
Q

Describe the parasympathetic long pre-ganglionic neurone

A

Arises from the brainstem and lateral horn of grey matter in the sacral spinal cord segments
brainstem: pre-ganglionic neurone travels with cranial nerves 3,7,9,10
sacral spinal cord: Pre-ganglionic neurone enters ventral rami of S2-S4 spinal nerves and branch off to form pelvic splanchnic nerves
Synapse with short post ganglionic neurones

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13
Q

Which parasympathetic ganglia associate with the cranial nerves

A

Ciliary
Pterygopalatine
Submandibular
Otic

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14
Q

What are the functions of the parasympathetic nervous system

A 
Rest and digest
Heart beats slower
Constrict the pupils
Constricts the trachea
Increased motility tone, secretions and contraction
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15
Q

Compare the sympathetic to parasympathetic pathway

A

sympathetic - short (nicotinic ACh) to long (Adrenoreceptors NA)
parasympathetic- long (nicotinic ACh) to short (muscarinic ACh)

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16
Q

What are the two exceptions to the general structure of (para)sympathetic pathways

A
  1. Short pre-ganglionic neurone to the adrenal medulla
  2. Nicotinic ACh receptor
  3. Chromaffin cells in adrenal medulla release catecholamines
  4. Adrenoreceptors
  5. Short pre-ganglionic neurone to the sympathetic trunk
  6. Nicotinic ACh receptor
  7. Long post-ganglionic neurone releasing ACh
  8. Muscarinic ACh receptor
17
Q

What is the excitatory neurotransmitter for the pre-symapthetic neurones

A

Glutamate

18
Q

Where is acetylcholine used as a neurotransmitter for the postganglionic neurones

A

heart kidney, vessels, sweat glands

19
Q

What neurotransmitter is used for the post ganglionic neurones in the renal vessels

A

Dopamine

20
Q

Describe the biosynthesis of acetylcholine

A 
1. Acetyl CoA
Choline acetyl transferase
2. AcetylCholine + CoA
acetylcholinesterase
3. Acetate + Choline
21
Q

Describe the biosynthesis of noradrenaline

A 
1. Tyrosine
	Tyrosine hydroxylase
2. DOPA
	DOPA decarboxylase
3. Dopamine 
Dopamine hydroxylase in the vesicle
4. Noradrenaline
a. Uptake into the pre-synaptic bulb -> MAO-A
b. Postsynaptic uptake+ peripheral uptake -> COMT
5. Metabolites
22
Q

Describe nicotinic receptors

A

Ionotropic receptors type 1
Present at all autonomic ganglia (both sympathetic and parasympathetic) hence why tubocurarine increases heart rate
Allows action potential generation
ACh

23
Q

Describe muscarinic receptors

A

G-protein coupled type 2
Effector organs with parasympathetic innervation
Stimulated by all postganglionic PNS neurons also stimulated by SNS at selected sites
ACh

24
Q

Describe adrenergic receptors

A

All adrenergic receptors are G-protein coupled type 2
Effector organs with sympathetic innervation
Majority uses noradrenaline
A1 & A2 = Smooth muscle contraction (e.g. blood vessels, ureter, bronchioles)
B1 = Heart
B2 = Relax smooth muscle, contract sphincters of GI tract

25
Q

Explain bladder control

A

When bladder fills this stimulates the micturition reflex where there is activation of the PNS and inhibition of the SNS
PNS causes contraction of the detrusor muscle and relaxation of the internal sphincter
Sympathetic control causes contraction of the internal sphincter
There is also somatic control over the external sphincter

26
Q

Where are the baroreceptors located

A

Aorta and carotid
aorta -> IX glossopharyngeal
carotid -> X vagus

27
Q

Describe the response to a small increase in blood pressure

A

Great increase in baroreceptor firing rate

Hypertensive patients will have a greater set point that blood pressure is controlled at

28
Q

Describe the regulation of GI function

A

Innervation by the vagus nerve
Sight, smell, and taste of food causes saliva production
Release of acid into the stomach
Cephalic response (response before digestion) where insulin is produced

29
Q

What are the sensing mechanisms of the GI tract

A

Stomach - Mechanoreceptors that sends information to the brain via the vagus nerve
The intestines release GLP-1, PYY and CCK which sends signals via the vagus nerve to the brain stem

30
Q

What are the sensing mechanisms of the respiratory system

A

Central chemoreceptors exist on the brainstem which recognise a change in pH (CO2)
Mechanoreceptors exist in the lungs which are involved in the hering-breuer reflex to to prevent over-inflating the lungs. Connected to the vagus nerve.

31
Q

How is the respiratory system innervated (accessory muscles, diaphragm, intercostal muscles, abdominal muscles)

A

C1-C3 = accessory muscles
C3-C5 = diaphragm
T1-T11 = intercostal muscles
T6-L1 - abdominal muscles

32
Q

What are the types of sympathetic adrenoreceptors

A

alpha 1 - A, B, D
alpha 2 - A, B, C
beta 1
beta 2

33
Q

What does atropine do

A

Targets the organ receptor acting as a competitive muscarinic receptor antagonist
Increases heart rate
Decreases sweat production
Dry mouth

34
Q

What does tubocurarine do

A

Nicotinic receptor antagonist (rarely used as it causes paralysis due to NMJs)
Decreases respiration rate
Increases heart rate

35
Q

What is shy-drager syndrome

A 
Synucleopathy, PD and lew body dementia
Associated with loss of intermediolateral cell bodies and striatonigral brain areas
Symptoms:
	Orthostatic hypotension
	Impotence
	Hypohidrosis
	Dry mouth 
	Urinary retention 
	Incontinence
36
Q

What is primary hypertension caused by

A

Exaggerated sympathetic nerve activity to blood vessels and renal bed
Leads to increased circulating volume and vascular tone

37
Q

What is heart failure

A

Inability to pump sufficient blood to meet oxygen demand
Associated with increased sympathetic nerve activity to the renal bed
Leads to hypervolemia and hypernatraemia
Increased strain on cardiac tissue

38
Q

Describe Parkinsons

A

Early signs is autonomic dysfunction (see above)

Emerging evidence that vagus nerve may be involved

39
Q

Explain the process of adrenaline synthesis

A 
1. Tyrosine
Tyrosine hydroxylase
2. DOPA
DOPA decarboxylase
2. Dopamine
Dopamine hydroxylase
3. Noradrenaline
PNMT
4. Adrenaline

Neurology (12 decks)

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