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Pharmacology for Anesthesia > 08 - Autonomic Nervous System 1, Cholinergic System > Flashcards

08 - Autonomic Nervous System 1, Cholinergic System Flashcards

1
Q

The ANS is the part of the nervous system that regulates ______ muscle, _____ and _____ function.

A

cardiac/smooth
visceral
gland

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2
Q

The ANS controls _____ functions and reflexes

A

involuntary

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3
Q

The ANS influences homeostasis of every tissue and organ system using

A

only 3 substances

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4
Q

The sympathetic nervous system is also known as the

A

adrenergic system (adrenaline = epinephrine)

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5
Q

The parasympathetic nervous system is also known as the

A

cholinergic system (acetylcholine)

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6
Q

The principle site of organization of the CNS is found in the

A

brainstem and hypothalamus

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7
Q

The _____ is the main nerve of the CNS. It transmots sensory input from the ____ and ____ organs

A

Vagus (CN X)

throracic, abdominal

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8
Q

HR, BP, GI, temp, hunger, thirst, osmolarity, and gland secretions are regulated by the

A

CNS

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9
Q

Emotional responses (blushing, fainting, anxiety) are controlled by the CNS in the

A

cortex

limbic system

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10
Q

The peripheral nervous system is the ______ component of the CNS

A

efferent (motor)

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11
Q

What is the difference between autonomic and somatic nerves?

A

Autonomic - two neuron unit: 1. myelinated neuron from CNS to ganglion, 2. unmyelinated neuron from ganglion to target organ

Somatic - single myelinated axon with cell body in spinal cord

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12
Q

Both SNS and PNS are

A

tonically active - have baseline activity that can increase or decrease -> more than one way to accomplish effect

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13
Q

The SNS is also known as the

A

thoraco-lumbar system

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14
Q

In the SNS, ____ preganglionic fibers originate from the spinal cord at ______ and synapse at the

A

short
T1-L3
paravertebral sympathetic ganglionic chain

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15
Q

The preganglionic fibers of the SNS can synapse with the postganglionic neuron at the _____ or

A

same level

course of and down the ganglionic chain and synapse at another level

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16
Q

The paravertebral sympathetic ganglionic chain is

A

paired

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17
Q

The sympathetic collateral ganglia are

A

unpaired

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18
Q

Examples of the sympathetic collateral ganglia

A

celiac plexus

inferior mesenteric plexus

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19
Q

Special paired ganglia of the SNS are formed at _____. Examples?

A

T1-T4

Superior cervical, middle cervical, stellate

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20
Q

SNS ganglia are closer to the _____ than the

A

spinal cord

target organ

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21
Q

Some preganglionic fibers of the SNS go directly to _____ where ______ take the place of postganglionic neurons

A

adrenal gland

adrenal chromaffin cells

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22
Q

Adrenal stimulation releases ____ epi and ____ NE into circulation

A

80%

20%

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23
Q

Postganglionic fibers of the SNS originate at the sympathetic ganglion and synapse at effector tissues. They travel within

A

spinal nerves

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24
Q

Postganglionic fibers of the SNS outnumber preganglionic fibers by

A

20-30:1

Concurrent stimulation of many organs at once = mass sympathetic discharge

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25
Q

Postganglionic fibers of the SNS release ______ at the effector tissues. Exceptions are the

A

NE
sweat glands - Ach
adrenal medulla - NE + Epi

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26
Q

CNS neurotransmitter

A

Dopamine

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27
Q

Synthesized/stored in postganglionic neurons and adrenal medulla

A

Norepinephrine

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28
Q

Synthesized/stored in adrenal medulla

A

Epinephrine

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29
Q

Phenylalanine -> Tyrosine -*-> DOPA -> DA -> NE -> Epi

  • represents
A

tyrosine hydroxylase - the rate limiting step

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30
Q

NE causes _____ at the point of tyrosine hydroxylase

A

negative feedback

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31
Q

Almost all endogenous NE undergoes ____ into the presynaptic terminal and is metabolized by

A 
reuptake
monoamine oxidase (MAO)
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32
Q

Reuptake of NE is inhibited by

A 
tricyclic antidepressants (TCA)
cocaine
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33
Q

Circulating catecholamines (NE + Epi) are metabolized in the ______ by

A

liver and kidneys

Catechol-O-methyltransferase (COMT)

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34
Q

What is the metabolite of NE and epi? It is used in the diagnosis of

A

Vanillylmandelic acid

Pheochromocytoma

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35
Q

Systemic catecholamines ____ cross the blood brain barrier

A

do NOT

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36
Q

Sympathomimetics are

A

drugs that act like catecholamines but have a different structure

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37
Q

The PNS is also known as the ______. Preganglionic fibers originate in

A

cranio-sacral system

bainstem or sacral segments (S2-S4) of the spinal cord

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38
Q

The Vagus Nerve (CN X) accounts for ____ of all parasympathetic fibers

A

> 75%

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39
Q

PNS ganglia are near the

A

target organ

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40
Q

Unlike the SNS, there is ______ of pre to post ganglionic fibers in the PNS

A 
little divergence (1:1)
PNS effects are more discrete and localized
41
Q

What is released at the effector tissues of the PNS?

A

Ach

42
Q

How long does it take Ach to be removed by acetylcholinesterase?

A

<1 msec

43
Q

What are the two types of cholinergic receptors?

A

Nicotinic and muscarinic

but both respond to Ach

44
Q

Nicotinic (n-Ach-r) receptors are found on cell bodies of

A

all postganglionic neurons

within ganglia of both SNS and PNS

45
Q

Ach (nicotine) excites

A

the PNS and SNS

46
Q

A low dose of Ach ->

A

adrenal medulla -> Epi, NE -> HTN, tachy

47
Q

A high dose of Ach ->

A

ganglionic blocker -> hypotension, weakness

48
Q

Ach in the NMJ is blocked by

A

nondepolarizing neuromuscular blocking agents

49
Q

Muscarinic (m-Ach-r) receptors are found on

A

cell membranes of effector tissues

50
Q

Ach (muscarine) will ______ and be ________, depending on the target tissue

A

mimic the PNS

excitatory or inhibitory

51
Q

Stimulation of muscarinic receptors on the presynaptic membrane of the SNS nerve terminals

A

inhibits the release of NE

52
Q

Anticholinergic drugs act specifically at the

A

muscarinic receptor

53
Q

What is a prototype muscarinic blocker that causes sympathomimetic activity?

A

Atropine

54
Q

Anticholinergic drugs are ______ that competitively bind to _______ and block activity by Ach

A

aromatic acid esters

muscarinic receptors

55
Q

CV effects of anticholinergics

A

reversing brady due to vagal reflexes
transient slowing of HR at low doses
block vagal activity in SA node
facilitate conduction through AV node

56
Q

Pulmonary effects of anticholinergics

A

relaxation of bronchial smooth muscle

57
Q

Ophthalmic effects of anticholinergics

A

mydriasis (pupillary dilation)

58
Q

GU effects of anticholinergics

A

urinary retention

59
Q

Which anticholinergic is the first choice for bradyarrhthmias? It has the side effect of

A

atropine

tachycardia

60
Q

Why should atropine be used with caution in CAD?

A

It causes an increased O2 demand

61
Q

The inhaled derivative of atropine is called ________. It has minimal systemic absorption due to its

A

ipratropium (atrovent)

quaternary ammonium structure

62
Q

Does atropine cross the BBB? It can cause

A

Yes
memory deficits, CNS excitement
central anticholinergic syndrome

usually minimal effect

63
Q

Central anticholinergic syndrome caused by atropine can be treated with

A

physostigmine (also crosses the BBB)

64
Q

What is an antisialagogue?

A

a substance that prevents the production of saliva

65
Q

Which anticholinergic is the strongest antisialagogue?

A

scopalamine

66
Q

Which anticholinergic is a good premedication for antisialagogue?

A

Glycopyrrolate

67
Q

Atropine should be used with CAUTION in

A

narrow angle glaucoma

benign prostate hyperplasia (BPH)

68
Q

Usual adult dose of atropine

A

0.4-.06 mg IV

1-2 mg/kg for total vagal blockade

69
Q

Duration of action for atropine?

A

30 min

70
Q

Scopalamine has ____ CNS effects than atropine

A

greater: sedation, amnesia

71
Q

Which anticholinergic is an antiemetic?

A

scopolamine (patch commonly used for PONV)

72
Q

Scopalamine should be used with CAUTION in

A

closed angle glaucoma

73
Q

Why doesn’t glyco cause CNS/ophthalmic activity?

A

It does not cross the BBB due to its charged quaternary ammonium structure

Atropine and scopolamine are tertiary amines

74
Q

The concentration and dose of glycopyrrolate is

A

half of atropine

75
Q

Duration of action of glyco?

A

2-4 hours

76
Q

Adrenergic receptors are subdivided into

A 
alpha and beta
and DA (dopaminergic)
77
Q

Which adrenergic receptor is the most abundant? Where are they found?

A

a1
only found on post synaptic membrane
smooth muscles of coronary arteries, skin, uterus, intestines, renal/splanchnic beds

78
Q

a1 receptors are _____ and cause

A

excitatory

increased intracellular Ca++

79
Q

The effect of a1 receptors

A

vasoconstriction and GI relaxation

cardiac contractility

80
Q

a2 receptors are ___ that cause

A

inhibitory

decrease in cAMP

81
Q

Presynaptic effects of a2 receptors

A

inhibit NE release -> reduce sympathetic outflow; vasodilation; sedation

82
Q

Postsynaptic effects of a2 receptors

A

arterial/venous vasoconstriction, platelet aggrgation, inhibiton of insulin release and gut motility, inhibition of ADH

83
Q

b receptors cause

A

increased cAMP

84
Q

b1 receptors are only

A

postsynaptic

85
Q

b1 receptors are found mostly in the ____, causing

A

heart
increased HR and contractility
renin release
coronary dilation

86
Q

How does the affinity for epi compare with NE in b1 receptores?

A

Equal

87
Q

b2 receptors are primarily ____ and tend to be

A

postsynaptic

inhibitory

88
Q

b2 receptors cause

A

vasodilation
brochodilation
renal vessel relaxation

89
Q

b2 receptor affinity is greater for

A

Epi than NE

It is stimulated by circulating epi instead of direct sympathetic activity

90
Q

Cardiac effects of b2 receptors

A

increased HR and contractility

91
Q

Presynaptic b2 receptors cause

A

accelerated NE release

vasoconstriction

92
Q

The resting HR of a person who has had a heart transplant is

A

90-100 bpm

93
Q

Pt with heart transplants cannot respond to drugs that _____ because

A

block the parasympathetic system

connections are severed during the transplant

94
Q

Heart transplant patients do not have

A

baseline parasympathetic innervation and therefore lack vagal tone

95
Q

Patients who have had heart transplants need to have adequate intravascular volume because

A

they lack normal tachycardia and contractility response to hypotension/hypovolemia

96
Q

What drugs can treat bradycardia in pt with heart transplant?

A

Isoproterenol and glucagon

They directly affect the heart

97
Q

Epi/NE may have _______ in pt with heart transplant

A

exaggerated beta mimetic effects on HR

98
Q

Increased BP will _____ reflex slowing of HR in pt with heart transplant

A

not lead to

Pharmacology for Anesthesia (9 decks)

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