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Spring '20/ L. A&P > The Autonomic Nervous System; and the Adrenal Medulla > Flashcards

The Autonomic Nervous System; and the Adrenal Medulla Flashcards

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1
Q

Autonomic Nervous System

A

A set of efferent pathways from the central nervous system that innervates and regulates smooth muscles ,cardiac muscles and glands.

Is different from somatic nervous system, which innervates skeletal muscle

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2
Q

3 divisions of the autonomic nervous system

A

Has three divisions : sympathetic, parasympathetic and enteric

Sympathetic for ‘flight or fight’ situations
Parasympathetic for ‘relax and digest’ situations

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3
Q

Parasympathetic ganglia are located close to

A

effector organs

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4
Q

Sympathetic ganglia are located in the

A

paravertebral chain

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5
Q

Preganglionic neurons

A

have their cell bodies in CNS and synapse in autonomic ganglia

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6
Q

Preganglionic sympathetic fibers originates from

A

thoracolumbar region.

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7
Q

Preganglionic parasympathetic fibers originates from

A

craniosacral region.

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8
Q

Postganglionic neurons

A

of both divisions have their cell bodies in autonomic ganglia and synapse on effector organs (heart , blood vessels, sweat glands)

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9
Q

Adrenal medulla

A

is a specialize ganglion of the sympathetic nervous system

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10
Q

chromaffin cells

A

Preganglionic fibers synapse directly on chromaffin cells in adrenal medulla

The chromaffin cells secrete epinephrine (80%) and norepinephrine (20%) into circulation.

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11
Q

Adrenergic neurons release

A

norepinephrine as the neurotransmitter

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12
Q

Cholinergic neurons release

A

whether in sympathetic or parasympathetic nervous system, release Acetylcholine

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13
Q

Non adrenergic , non cholinergic neurons include some postganglionic parasympathetic neurons of the GIT which release

A

Non adrenergic , non cholinergic neurons include some postganglionic parasympathetic neurons of the GIT which release substance-P, vasoactive intestinal peptide (VIP) and Nitric oxide

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14
Q

SYNTHESIS OF NOREPINEPHRINE

A

hydroxylation of tyrosine is the rate limiting step

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15
Q

UPTAKE INTO STORAGE VESICLES (NE)

A

Dopamine is synthesized to norepinephrine

Transport into vesicles inhibited by reserpine

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16
Q

RELEASE OF NEUROTRANSMITTER (NE)

A

Ca++ influx leads to fusion of vesicles to cell membrane

Release block by guanethidine and bretylium

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17
Q

BINDING TO RECEPTOR (NE)

A

Activation of adenylate cyclase
Opening of ion channel/ formation of cAMP
Contraction of arterial smooth muscles, increase HR, increase contractility

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18
Q

REMOVAL OF NOREPINEPHRINE

A

Reuptake is inhibited by cocaine and TCA

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19
Q

METABOLISM (NE)

A

By COMT (in plasma )and MAO (in synaptic cleft)

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20
Q

physiologic anatomy of the parasympathetic nervous system

A

Visceral motor neurons are located in discrete brain stem nuclei and in sacral s2-s4

Parasympathetic nerves originate from cranial nerves III, VII, IX, and X and the sacral spinal cord.

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21
Q

Occulomotor nerve (parasympathetic)

A

fibers to the pupillary sphincters and ciliary muscle

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22
Q

Facial nerve (parasympathetic)

A

fibers to nasal, lacrimal and submandibular gland

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23
Q

Glossopharyngeal nerve (parasympathetic)

A

fibers to parotid gland

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24
Q

Vagus nerve (parasympathetic)

A

Vagus nerve - motor inputs to visceral organs

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25
sacral segments
Sacral segments - fibers to descending colon, rectum, bladder and genitalia
26
SYNTHESIS OF ACETYLCHOLINE
Transport of choline is inhibited by hemicholinium
27
UPTAKE INTO STORAGE VESICALS (ACH)
Acetylcholine is protected from degradation in vesicles
28
RELEASE OF NEUROTRANSMITTER (ACH)
Release blocked by botulinum toxin | Black widow spider venom causes release of acetylcholine
29
BINDING TO RECEPTOR (ACH)
Postsynaptic receptor activated by binding of neurotransmitter
30
DEGRADATION OF ACETYLCHOLINE
Acetylcholine is hydrolyzed by Cholinesterase | Physostigmine inhibits acetyl cholinesterase (AChE)
31
RECYCLING OF CHOLINE
...
32
Heart Sympathetic action parasympathetic action sympathetic receptor
sympathetic action- increase heart rate increase contractility increase av node conduction B1B1B1 parasympathetic action decrease heart rate decrease contractility decrease av node conduction
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vascular smooth muscle sympathetic action parasympathetic action sympathetic receptor
sympathetic action constricts blood vessels in skin; splanchnic. dilates blood vessels in skeletal muscles A1B2 no parasympathetic action
34
GIT Sympathetic action parasympathetic action sympathetic receptor
sympathetic action decrease motility, constricts sphincters A2B2A1 increase motility relax sphincters
35
bronchioles Sympathetic action parasympathetic action sympathetic receptor
sympathetic action dilates bronchiolar smooth muscles, increase secretion B2 constrict bronchiolar smooth muscles
36
Male sex organ Sympathetic action parasympathetic action sympathetic receptor
sympathetic action ejaculation A1 parasympathetic erection Point and shoot
37
bladder Sympathetic action parasympathetic action sympathetic receptor
Sympathetic action Relax bladder wall Constricts sphincter B2 A1 parasympathetic action Contracts bladder wall Relax sphincter
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Kidney Sympathetic action parasympathetic action sympathetic receptor
Sympathetic action increase renin secretion parasympathetic action none sympathetic receptor B1
39
Sweat glands Sympathetic action parasympathetic action sympathetic receptor
Sympathetic action increases sweating parasympathetic action none sympathetic receptor muscarinic sympathetic cholinergic
40
Pupil Sympathetic action parasympathetic action sympathetic receptor
Sympathetic action dilation parasympathetic action constriction sympathetic receptor A1
41
Liver Sympathetic action parasympathetic action sympathetic receptor
Sympathetic action glycogenolysis gluconeogenesis parasympathetic action none sympathetic receptor B2
42
gallbladder Sympathetic action parasympathetic action sympathetic receptor
Sympathetic action relaxation parasympathetic action B2 sympathetic receptor contraction
43
Urinary Bladder Sympathetic action parasympathetic action sympathetic receptor
Sympathetic action relaxation parasympathetic action contraction of detrusor muscles sympathetic receptor B2
44
Pancreas Sympathetic action parasympathetic action sympathetic receptor
Sympathetic action increase insulin secretion parasympathetic action none sympathetic receptor B2
45
adipose Sympathetic action parasympathetic action sympathetic receptor
Sympathetic action increase lipolysis parasympathetic action none sympathetic receptor B1
46
uterus Sympathetic action parasympathetic action sympathetic receptor
Sympathetic action relaxation (tocolysis) parasympathetic action none sympathetic receptor B2
47
Na+/K+ Pump Sympathetic action parasympathetic action sympathetic receptor
Sympathetic action stimulation (decrease K) parasympathetic action none sympathetic receptor B2
48
Medulla
Medulla Vasomotor center Respiratory center Swallowing, coughing and vomiting center
49
pons
Pneumotaxic center
50
Midbrain
Micturition center
51
Hypothalamus
Temperature regulation center “thermostat” | Thirst and food intake regulatory center
52
Function of the Adrenal Medulla
Large sympathetic ganglion When stimulated releases epinephrine (80%) and norepinephrine (20%) into the blood Causes prolonged activity of the substances stimulation of cardiovascular function and metabolic rate Helps the body deal with stress Pheochromocytoma
53
Pheochromocytoma
Tumor of chromoffins cells of adrenal medulla in adults increase secretions of norepinephrine, epinephrine and dopamine from tumor cells increase Urinary VMA(Vanillyl mandalic acid), normetapinephrines, metanephrines Treatment : Surgery . Preoperatively  blockers (Phenoxybenzamine) to control BP  blockade without  blockade in patient with pheochromocytoma can cause heart failure “Block  receptors first”
54
Anesthetic Consideration(Pheochromocytoma)
Preoperative adrenergic blockade and volume replacement Intraoperative monitoring CVP ,PCWP and urine output Following anesthetic drugs or techniques are best avoided because they may precipitate hypertension Eephedrine, ketamine, hypoventilation stimulate sympathetic system Halothane potentiates the dysrhythmic effects of catecholamine Pancuronium inhibits the parasympathetic nervous system Atracurium and Morphine SO4 release histamine that enhances the effect of tumor.
55
Stress Response
Mass sympathetic discharge increase in arterial pressure, heart rate and contractility, blood flow to muscles, blood glucose, metabolic rate, muscle strength, mental activity, blood coagulation Prepares the body for vigorous activity need to deal with a life-threatening situation The fight or flight response
56
Adrenergic Receptors | a1 Receptors location?
Postsynaptic adrenergic | Located on vascular smooth muscle of skin and splanchnic regions , GIT, bladder sphincter ,and radial muscle of iris
57
a2 Receptors
Are located in presynaptic membrane. They are postsynaptic in brain stem platelets, fat cells and walls of GIT
58
b1 receptors location?
Located in the SA node, AV node ventricular muscle
59
b2 receptors location?
Are located on smooth muscle of skeletal muscle blood vessel, bronchial smooth muscle and walls of GIT and bladder
60
b3
Receptors located in gall bladder (unknown function) and adipose tissue
61
Cholinergic Receptors | Nicotinic Receptors
Located in the autonomic ganglia (NN) of the sympathetic and parasympathetic , neuromuscular junction (NM) and adrenal medulla (NN). The receptors at these locations are similar but not identical - Are activated by Ach or nicotine - Produce excitation - Ganglion blockers (hexamethonium , trimethaphan) block the nicotinic receptors for Ach in autonomic ganglia but NOT at the NMJ - M/A: opening of Na+ and K+ channels
62
B2 receptors produce what?
Produce relaxation ( dilation of vascular smooth muscle, dilation of bronchioles , relaxation of the pregnant uterus- tocolysis)
63
B2 Receptors do what to BG?
Glycogenolysis & gluconeogenesis increase BG , calorigenesis
64
B2 Receptors M/A
M/A : Gs protein, activation of adenylate cyclase and increase cAMP(same as B1)
65
B1 receptor produce
Produce EXCITATION (increase HR , increase conduction, increase contractility, increase CO)
66
B1 Receptor sensitive to?
Sensitive to both norepinephrine and epinephrine
67
B1 Receptor M/A?
M/A : GS PROTEIN, activation of adenylate cyclase and increase cAMP
68
Alpha 1 produce and sensitive to?
``` Produce excitation (contraction of vascular smooth muscles) Are equally sensitive to norepinephrine and epinephrine ```
69
Alpha 1 m/a
M/A: formation of IP3 and increase intra cellular calcium
70
alpha 1 | cardiac effects?
Arterial vasoconstriction increase SVR, LV afterload and BP Venous vasoconstriction increase venous return, increase SV, increase CO a1 stimulation inhibit insulin secretion and lipolysis
71
alpha 2 produce?
Produce inhibition of norepi release and synthesis (relaxation and dilatation); blocks Ca++ entry -ve feed back loop Inhibit sympathetic out flow in brain stem Sedation Promotes analgesia in substantia gelatinosa
72
alpha 2 ma
M/A: Gi protein, inhibition of adenylate cyclase, and decrease cAMP and decrease Ca++ entry
73
Clonidine (catapres)
a2 is inhibitory. Stimulation decrease release of epi and norepi. Provides negative feedback. Clonidine (Catapres) is a2 agonist – decrease BP Clonidine does not effectRBF or GFR decrease Sympathetic outflow by inhibiting VMC – central action decrease Release of substance P in substantia gelatinosa – analgesic action Prolong effect of regional anesthesia decrease MAC of inhalation anesthetics Treat opioid withdrawal Use to treat shivering Use to attenuate the hemodynamic effect of ketamine
74
clonidine s/e
S/E sedation, bradycardia, dry mouth and rebound (withdrawal) HTN due to  catecholamine, renin and angiotensin II Restart clonidine
75
Clonidine and beta blockers?
never give b-blocker WHY?
76
Adrenergic or sympathomimetic drugs act like
norepi and epi
77
Isoproterenol stimulates both
b1&b2 | Chemical pacemaker
78
Albuterol
only b2
79
Ritodrine (Yutopar)
stimulate only b2 receptors Use to relax uterus in premature contraction S/E hyperglycemia, hypokalemia and tachycardia
80
Phenylephrine
only alpha receptors
81
Some drugs have an indirect effect by increasing the release of norepi from its storage terminals examples...
ephedrine, tyramine, and amphetamine
82
Ganglionic blockers- Sympathetic ganglion | effect ne and epi release
hexamethonium
83
Beta blockers | decrease effect of ne and epi release
b1 and b2 - propranolol, b1 - metoprolol
84
Alpha blockers | block the effect of norepi and epi
phentolamine and phenoxybenzamine
85
Monoamine oxidase type A
(MAO-A) in nerve terminal
86
catechol-O-methyl trasnferase
(COMT) in liver and plasma metabolize epi and norepinephrine to inactive metabolites
87
Selegiline (deprenyl)
selectively inhibit MAO-B increase dopamine level in brain Use in Parkinson’s disease
88
What drug should be avoided in patient taking MAO inhibitor
(Meperidine and Ketamine) Hypertensive crisis with meperidine (Demerol) or ephedrine
89
Drug-food or drug-drug interactions | MAO inhibitors
Tyramine containing food Hypertension, arrhythmias, seizures , stroke “Serotonin syndrome” with SSRI’s Wash-out period of 2 weeks is required
90
Clinical uses MAO inhibitors
Atypical depression, anxiety
91
mao inhibitor drugs?
Phenelizine (Nardil), isocarboxazid (Marplan), tranylcypromine (Parnate)
92
MH Symptoms
Unexplained increase end-tidal CO2 (most sensitive indicator in OR) High grade fever; spontaneous combustion Skeletal muscle rigidity Lactic acidosis (hypermetabolism)
93
MH cause
Triggered by anesthetics (halothane) with Sux Familial tendency - can be tested for by muscle biopsy Constant leak of SR Ca++ through Ryanodine receptor Sustained contractions with increase metabolism
94
MH Treatement
Notify the surgeon as soon as a case of MH is suspected Stop triggering agents Hyperventilate patient with 100% O2 Finish or abort procedure I/ V Dentrolene (Dentrolene prevents the release of Ca++ from SR) 2.5 mg/kg Bicarb Cooling Insulin for hyperkalemia Continue to monitor core temp Monitor urinary output to prevent shock to kidneys or ATN
95
Ganglion Blocker- Trimethaphan (Arfonad)
Trimethaphan (Arfonad) is competitive antagonistic of nicotinic receptor at the autonomic ganglia (NN) Use to lower BP in emergency situation S/E due to histamine release Mydriasis, cycloplegia, ileus and bronchospasm
96
S/S of Atropine overdose: & treatment
increase temp, rapid pulse, dry mouth, flush skin, mydriasis, disorientation and constipation Tx: Physostigmine ``` Blind as bat Red as beet Mad as hatter Hot as hell Dry as bone ```
97
atropine and heart rate explain?
atropine completes with ACH for the binding sites on the SA and AV node. atropine binds instead of ACH and will speed up the heart rate.
98
Cholinergic drugs: | Cholinergic agonists
Decrease heart rate* and lower BP Nausea/vomiting Increased activity of gut increase cramping and diarrhea Excessive sweating/salivation Increase urination Blurred vision due to pupillary constriction (PPP) Shortness of breath due to bronchoconstriction Uncontrolled muscle twitching
99
*Acetylcholine applies breaks on heart but accelerates gut and bladder smooth muscles
*Acetylcholine applies breaks on heart but accelerates gut and bladder smooth muscles
100
Pyridostigmine
Myasthenia gravis, Block reversal increase endogenous increase Ach strength
101
Edrophonium
Dx of MG (short acting) Block reversal increase endogenous Ach
102
Physostigmine
Glaucoma and atropine overdose Block reversal increase endogenous Ach
103
Anti-cholinesterases) | Neostigmine
Post op ileus and urinary retention Myasthenia gravis, reversal of NMJ block increase endogenous Ach
104
Charbachol, Pilocarpine
Narrow angle glaucoma | Constricts pupil which facilitates drainage of AH and decrease IOP
105
Bethanechol
Post op paralytic ileus and urinary retention | Activates bowel and bladder smooth muscles
106
Adverse reactions of beta blockers
``` Adverse reactions of beta blockers Fatigue, hypotension Bronchospasm Bradycardia Peripheral vascular insufficiency Sexual dysfunction Arrhythmias ```
107
Pharmacotherapeutics/ Indications
``` Angina Hypertension Hyperthyroidism Hypertrophic cardiomyopathy Supraventricular arrhythmias Anxiety Migraine headaches Open-angle glaucoma Pheochromocytoma ```
108
Beta-adrenergic blockers
Actions Decreased blood pressure and force of heart’s contractions By depressing SA and AV node activities leads to bradycardia Increased peripheral vascular resistance* Peripheral resistance returns to normal or decreased after long term use of propranolol Reduced stimulation of the heart Bronchiole constriction
109
Adverse effects of alpha blocker
``` Adverse effects of alpha blocker Orthostatic hypotension (patient up; BP down) Reflex tachycardia leads to angina Vertigo Difficulty breathing Light-headedness Sexual dysfunction ```
110
Norepi
Acts on a and b1 No b2 activity Increase in systolic BP (b1 effect) Increase in diastolic BP (a1 mediated intense vasoconstriction leads increase in SVR Increase in mean arterial pressure Induces reflex bradycardia; increase vagal tone and baroreceptor reflex
111
Isoproterenol (b specific)
Both b1 and b2 activity , NO a activity Increase cardiac force and rate (b1 effect) Increase AV conduction Decrease the SVR (vasodilation of skeletal m. blood vessels (b2 effect which is unopposed ) Moderate increase in systolic BP and greatly decrease in diastolic BP. Mean arterial BP decreases
112
Epinephrine (Non-selective)
Increase rate and force of cardiac contraction (b1 stimulation of SA node) Decreases the SVR (vasodilation of skeletal m. blood vessels (b2 effect) Result; increase systolic BP and decrease diastolic BP. Mean arterial pressure may increase or decrease or not change depending upon alteration of systolic and diastolic BP At low dose, b effect(vasodilation) predominate; at high dose a effect (vasoconstriction) predominate
113
Interaction of anesthetics with b blocker Ketamine stimulates sympathetic NS , increase SVR . Heart failure may occur in b blocked heart Worst to bad
Ketamine (The worst) Enflurarne Halothane Opioids Isoflurane
114
ephedrine
``` Hypotension associated with regional or inhaled anesthetics Bronchial asthma Decongestant Antiemetic Vasopressor in OBS (does not  UBF) ```
115
Phenylephrine (Neosynephrine)
Stimulate a1 and a2 receptors leads to vasoconstriction increase SVR, increase MAP, reflex bradycardia is used to treat hypotension associated with regional or inhaled anesthetics Topical nasal decongestant Prolong the duration of spinal anesthesia when added to LA solution

Spring '20/ L. A&P (21 decks)

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