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Principles of Therapy > Theme 5 - Nervous System > Flashcards

Theme 5 - Nervous System Flashcards

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1
Q

What are the main functions of the autonomic nervous system?

A

Cause consistency of internal environment (homeostasis)
Includes all involuntary efferent neurons
Controls subconscious effectors

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2
Q

What are the 3 divisions of the autonomic nervous system?

A

enteric
parasympathetic
sympathetic

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3
Q

What is the difference between sympathetic and parasympathetic nervous system?

A

Sympathetic - fight or flight

Parasympathetic - rest and digest

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4
Q

What are the neurotransmitters in the sympathetic nervous system?

A

Adrenergic: noradrenaline

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5
Q

What are the neurotransmitters in the parasympathetic nervous system?

A

Cholinergic: acetylcholine

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6
Q

What are the receptors involved in cholinergic neurotransmission?

A

Nicotinic and muscarinic

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7
Q

What are the 2 types of nicotinic receptors and where are they located?

A

NN - autonomic ganglia

NM - skeletal muscle

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8
Q

What are the 3 types of muscarinic receptors and where are they located?

A

M1 - gastric parietal (secretes gastric acid)
M2 - heart
M3 - glands/smooth muscle

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9
Q

What are the receptors involved in adrenergic neurotransmission?

A

Alpha and beta

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10
Q

What are the 2 types of alpha receptors and where are they located?

A

alpha-1: postsynaptic neurons (esp. smooth muscle)

alpha-2: presynaptic neurons (autoreceptors)

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11
Q

What are the 2 main types of beta receptors and where are they located?

A

beta-1: intestinal smooth muscle and heart

beta-2: bronchial, uterine, vascular smooth muscle

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12
Q

What is the effect of alpha receptor stimulation

A

excitatory, except smooth muscle in gut and eye constriction

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13
Q

What is the effect of beta receptor stimulation

A

inhibitory, except in heart

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14
Q

What is the response of the parasympathetic and sympathetic nervous system on the EYES?

A

Parasympathetic: constricts pupils
Sympathetic: dilates pupile

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15
Q

What is the response of the parasympathetic and sympathetic nervous system on the HEART?

A

Parasympathetic: beats slowly
Sympathetic: beats faster and stronger

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16
Q

What is the response of the parasympathetic and sympathetic nervous system on the LUNGS?

A

Parasympathetic: constricts airways
Sympathetic: relaxes airways, deep breathing

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17
Q

What is the response of the parasympathetic and sympathetic nervous system on the DIGESTION?

A

Parasympathetic: stimulates
Sympathetic: inhibits

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18
Q

What is the response of the parasympathetic and sympathetic nervous system on the MUSCLES?

A

Parasympathetic: reduces blood flow to skeletal muscle
Sympathetic: increases blood flow to skeletal muscles

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19
Q

How does glucose and choline enter the neuron?

A

facilitated transport

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20
Q

With which ion is choline uptake associated with?

A

Na+

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21
Q

What is glucose converted into in the mitochondria?

A

Acetyl-CoA

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22
Q

What 2 components combine in the cytoplasm to form acetylcholine and what enzyme is it catalysed by?

A

Acetyl-CoA and choline

enzyme: choline acetyltransferase

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23
Q

What transports ACh into vesicles for storage?

A

VAT - vesicle-associated transporter

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24
Q

What activates VAMPS and SNAPS?

A

influx of Ca2+ into neuron

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25
What do activated VAMPS and SNAPS cause?
exocytosis of ACh, dopamine, noradrenaline into synaptic cleft (vesicle contents)
26
What happens to ACh in axonal cleft?
binds to receptors and depolarisation occurs
27
How does the concentration of ACh in synaptic cleft decrease?
Enzyme acetylcholineesterase hydrolyses ACh to choline and acetate
28
What happens to choline and acetate after it has been hydrolysed?
Choline recycled back to neuron (becomes ACh again) | Acetate used for metabolic purposes
29
How much ACh reaches circulation
Virtually none, plasmaesterases in blood deactivate ACh immediately
30
What does tyrosine transform into?
dopa, then dopamine
31
Which enzyme transforms tyrosine into dopamine?
Tyrosine hydroxylase
32
What transports dopamine into vesicles for storage?
VMAT - vesicle monoamine transporter
33
Which enzyme turns dopamine into noradrenaline?
b-hydroxylase
34
Which enzyme converts noradrenaline into adrenaline
Phenylethanolamine N-methyl transferase (only in adrenal medulla)
35
How is NA removed from synaptic cleft?
Binds to adenoceptors of target cell Noradrenaline transporter There is no enzyme in synaptic cleft like acetylcholineesterase
36
What are the 3 ways NA is deactivated?
- Reuptake by adrenergic neuron (like choline) - Removal by circulation (like plasmaesterases) and degradation in liver - Reuptake 2 = active transport in effector cells followed by enzymatic degradation
37
Which 2 enzymes degrade catecholamines?
COMT (Catechol – oxygen – methyltransferase) | MAO (Mono aminoxidase)
38
What are the 3 clinical uses of sympathomimetic Drugs (adrenergic agonists)?
Increase blood pressure | Cause constriction of blood vessels in mucosa
39
Name the catecholamines
Isoprenaline, adrenaline, noradrenaline, dopamine
40
Name a β1-adrenergic agonist
Dobutamine
41
``` What type of drugs are these: Salbutamol Orciprenaline Salmeterol Formoterol ```
β2-adrenergic agonists
42
Name an α-receptor agonist
Phenylephrine
43
``` What type of drugs are these: Ephedrine Phenylpropanolamine Amphetamine Naphazoline and Oxymetazoline ```
Indirect/Mixed action adrenergic agonists
44
List 3 α-antagonists
Phenoxybenzamine (α1 >>>> α2) Phentolamine (α1=α2) Prazosin (α1)
45
``` What type of drugs are these? Propanalol Timolol Pindolol Metaprolol Atenolol ```
β-antagonists (non- selective)
46
Name a α and β-antagonist
Labetolol
47
Name 2 direct acting muscarinic agonists
Muscarin and Pilocarpine
48
What is the collective name for indirect acting muscarinic agonists?
Cholinesterase inhibitors (stop the breakdown of ACh)
49
``` What type of drugs are these? Edrophonium Neostigmine Physostigmine Pyridostigmine bromide ```
cholinesterase inhibitors
50
Which drug is also a nicotonic agonist?
Neostigmine
51
What is the antidote for atropine poisoning?
Physiostigmine
52
``` What type of drugs are these? Atropine Scopolamine Ipratropium Cyclopentolate Propantheline ```
muscarinic antagonists/blockers
53
Which receptors do neuromuscular blockers block?
nicotinic cholinergic receptors (NM>NN)
54
Which Non-polarising muscle relaxant is no longer used?
d-Tubocurarine (curare)
55
List 6 Non-polarising muscle relaxants
1. Pancuronium chloride 2. Vecuronium bromide 3. Atracurium besilate 4. Cisatracurium besilate 5. Mivacurium chloride 6. Rocuronium bromide
56
What are the 2 types of neuromuscular blockers?
Non-polarising muscle relaxants | Depolarising muscle relaxants
57
What is the main function of neuromuscular blockers?
General anaesthetics
58
What type of drugs are Non-polarising muscle relaxants
Nicotinic receptor agonists
59
How do Non-polarising muscle relaxants work?
They compete with ACh for NM receptors, cause skeletal muscle relaxation
60
What reverses the effect of Non-polarising muscle relaxants?
cholinesterase inhibitors
61
What must be added to cholinesterase inhibitors when reversing the effects of Non-polarising muscle relaxants?
antimuscarinic drug (atropine)
62
Name a Depolarising muscle relaxant
Succinylcholine
63
What happens in a Phase I block of a Depolarising muscle relaxant?
Drug binds to NM receptor and occupies for 3-5mins, this prevents repolarisation of membrane
64
What happens in a Phase II block of a Depolarising muscle relaxant?
After repeated doses (bad) | Repolarisation takes place slowly while receptors remain occupied, receptor becomes desensitised to effect of ACh
65
What are the Disadvantages/dangers of Depolarising muscle relaxants?
Some patients are abnormally sensitive
66
What are local anaesthetics?
Drugs used to prevent pain by causing a reversible block of conduction along nerve fibres
67
Where are local anaesthetics administered?
Locally where pharmacological action is desired
68
Which part of a local anaesthetic penetrates the interior of the axon?
lipophilic base
69
What happens to local anaesthetic once it reaches the axon?
It becomes protonated
70
What do local anaesthetics bind to?
receptors in Na+ channel
71
What happens when local anaesthetics bind to Na+ channel?
It inactivates the channel at resting potential, so depolarisation does not occur and a nerve block occurs
72
What is the Rate of absorption of local anaesthetics dependant on?
Site of administration Dose Specific drug
73
What is often added to LA solutions?
vasoconctrictors (adrenaline, noradrenaline, felipressin)
74
Why are vasoconctrictors added to LA solutions?
Reduces systemic absorption
75
Where do the main side effects of LA occur?
Cardiovascular system and CNS
76
Name 3 ester local anaesthetics
cocaine, benzocaine, oxybuprocaine
77
Name 4 amine local anaesthetics
lignocaine, lidocaine, prilocaine, bupivacaine

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