2 ANS Flashcards
Transduction pathway G protein coupled receptors
1st messenger, GPCR, effector, 2nd messenger, cellular response
Receptors that activate Gq, their effector and 2nd messenger
A1, M1/3/5, V1, H1. Phos C. IP3, CA, DAG
Receptors that activ Gi. Their effector and 2nd messenger
A2, M2/4, D2. Inhib Adenylate cyclase so ATP wont lead to camp
Receptors that activ Gs. Their effector and second messenger
B1/2, D1, V2, H2. Adenylate cyclase, ATP to CAMP
Myocardium SNS vs PNS receptor, what they effect
B1. M2. Contractility
Heart conduction SNS vs PNS, effects
B1- HR and conduc speed. M2- dec hr and cv
Arteries SNS receptor and action
A1>A2, NO pns. Vasoconstrict
Vein sns receptor and action
A2>a1, constrict, no pns
Myocardium sns receptor and action
B2 vasodilation
Renal and mesenteric sns receptor, action
DA, dilation
Bronchus: sns and pns receptors and actions
B2 dilation M3 constriction
Kidney: renal tubules sns receptor and renin release sns receptor, actions
Tubules: A2, diuresis/adh inhib. Renin: B1, inc renin release
Eye sphincter muscle: pns receptor and action
M, miosis
Eye radial muscle sns receptor and action
A1, mydriasis
Eye ciliary muscle sns vs pns and actions
SNS B2, relax for far vision.pns M, contract for near vision
GI: sphincter sns vs pns
A1 contract M relax
GI: motility and tone sns vs pns
SNS: a1-2, b1-2, decrease. PNS M inc
GI salivary glands sns vs pns
A2 decrease M increase
Gallbladder and duct sns vs pns
B2 relax, m contract
Pancreas beta cells sns receptors and actions
A2 dec insulin, B2 inc insulin release
Liver sns receptor and action
A1 and B2, inc BG
Uterus sns receptors and actions
A1 contract B2 relax
Bladder sns
A1 contract sphincter B2 relax detrusor
Bladder pns
M relax sphincter m contract detrusor
Sweat gland sns vs pns
A1 and M inc secretion
Locations of A2 receptor
Pre synaptic (NE releasing), postsynaptic (smooth muscle/organs), non synaptic (plt)
A2 actions in CNS
Dec sns in medulla, inc pns in vagus, sedation in locus, analgesia SC dorsal horn, antishivering
A2 actions in vessels, kidney, pancreas
Constriction, inhib ADH—> diuresis, dec insulin release
A2 Actions: plt, salivary glands, GI
Aggregation, dry mouth, dec motility
What metabolizes camp, result
PD3, turns off protein kinases and cell told not to do action anymore
What inhib of PD3 leads to
Inc cAMP and protein kinases maintained in on state
Inhib PD3 in heart leads to what
Inc ca and force of contraction, inc rate of relaxation (lusitropy)
Inhib pd3 in vascular muscle leads to
Inhib myosin, leads to vasodilation and dec SVR
Rate limiting step of tyrosine to dopa
Tyrosine hydroxylase
Steps from tyrosine to epi
Tyro - tyro hydroxylase - dopa - dopa decarboxylase - dopamine - dopa b hydroxylase - NE - PNM- epi
NT release from adrenal medulla
80% epi 20% NE
How NE inhib or augment release
Stim pre-synaptic A2 receptor inhibits, augment by stim pre synaptic B2 receptor
How NE metabolized
Kidneys and liver, only 5% excreted unchanged in kidneys
Nicotinic receptors are what, muscarinic receptors are what
Nicotinic- ion ch. muscarinic- G protein linked
Ach synthesis
Choline to blood from cytoplasm. Acetyl co a made in mitochondria. Choline and acetyl co a joined by choline acetyltransferase.
How mag effects ach release
Mag antagonizes calcium, can cause muscle weakness and synergizes NMB
ACH metabolism
Acetyl cholinesterase hydrolizes ach, choline goes to nerve terminal by reuptake. Acetate diffuses away
Control center of ans in body
Hypothalamus, brain stem, sc
Preganglionic neuron fiber type, postganglionic type
Pre: myelinated B. Post: unmyelinated c
SNS: origin, ganglia where, post to preganglionic ratio
T1-L3. Near SC. 30:1
SNS: Pre vs post ganglionic fiber
Pre= short post= long
PNS: origin, ganglia location, post to pre ganglionic ratio
S2-4 and CN 3/7/9/10. Near/in effector organ. 1-3:1.
PNS pre vs post ganglionic fibers
Pre= long, post= short
In sns where preganglionic fibers exit sc and enter the chain
Exit ventral roots and enter white communicating rami
What stellate ganglion innervates
SNS to same upper extremity and pt of head and neck
Consequence of blockade of stellate ganglion
Hornets syndrome: vasodilation, ptosis, anhidrosis, miosis
Adrenal gland parts and their functions
Medulla sec catecholamines. Cortex sec glucocorticoids, mineralcorticoids, and androgens
Preganglionic fibers release what onto adrenal medulla. There are no what here. What stim leads to
Ach. Postganglionic fibers. Chromaffin cells release epi and norepi
Pheochromocytoma must do what
Alpha before beta block
Alpha antagonists used in pheo
Non selec: phenoxybenzamine and phentolamine. Selec a1: doxazosin and prazosin
Why its bad to beta before alpha block
Blocking B2 inc SVR b1 dec inotropy, can lead to CHF
SNS stim causes hepatocytes to release what, in turn pancreas does what
K and glucose. Pancreas inc insulin output
Things that shift k into the cell (hypokalemia)
Alkalosis, B2 agonists, theophylline, insulin
Things that shift k out of cell and inc concentration in blood
Acidosis, cell lysis, sux
Baroreceptor reflex: where sensors are for stretch, nerves there
Carotid sinus (nerve of hering - cn 9), transverse aortic arch (vagus). Both go to tractus solitarus in medulla
Surgeries with baroreceptor reflex
Endarterectomy, mediastinoscopy
What it means to preserve vs maintain BRR
Preserve= dec bp and inc hr. Impair= dec bp and hr
Drugs that impair BRR
Va (iso least), propofol, BB
Behold Jarisch reflex effects
Slows hr in hypovolemia: bradycardia, hypotension, CA vasodilation to allow filling
Bainbridge reflex
Full heart sensed- leads to inc in HR
Sensors: bezold, Bain
Bezold: LV. Bain: sa node, RV, pulm veins
Afferrent, control, and efferent in bezold v bain
Both afferrent unmyelinated c vagus, control medulla, efferent vagal stim v inhib
Tx of bezold reflex
IVF, tburg, inc hr
Oculocardiac reflex limbs
Afferrent: CN V, efferent CN X
Presentation of oculocardiac reflex, worsened by what
Low hr/bp, av block. Hypoxemia hypercarbia light anesthesia
Cushing reflex: presentation, when it happens
Happens w IC htn. Htn, bradycardia, irreg resp,
Celiac reflex
Traction on abd, mediated by vagus, causes bradycardia and hypotension
Chemoreceptor reflex
Stim by hypoxia and hypercarbia. In min vent and sns tone
Heart transplant: co dependent on what. Only reflex what is preserved
Preload. Bainbridge
Glomus tumors: what they release and where
NE, serotonin, histamine, bradykinin on carotid artery, aorta, cn 9, middle ear
Glomus tumor manifestations:
exag hypo or hypertension, flushing, bronchoconstriction
Tx glomus tumor effects
Octreotide
Mult sys atrophy: causes what, s/s
Degeneration of locus coeruleus, sc where sns lies, peripheral ans nerves. Ortho hypo, urinary retention, impotence, bowel issues
How to treat autonomic dysfunc from mult sys atrophy
Volume, direct acting agents. Indirect acting not used bc exag response
NE: receptors, dose
A1-2, B1. 0.02-0.4 mcg/kg/min. Low dose b1 selec, hi dose stim all
Avoid NE when, tx for extravasation
Cardiogenic shock. Phentolamine 2.5-10 mg diluted
Epi: low intermediate and hi dose fx
Low (<0.03) b1 and 2. Interned 0.03-0.15 a and b fx. High: >0.15 alpha mainly
Dopamine: low intermediate and high doses and dx
Low 1-2 renal vasodil/inc rbf. Intermediate 2-10, cardiac stim. High 10-20 vasopressor fx, alpha
Isuprel: receptor stim dose, fx
B1 and B2. 0.02-0.5 mcg/kg/min. Inc hr, dec scr.
Isuprel: impairs what, poor choice when, good uses
Impairs CPP. Bad in septic shock. Cor pulm/heart trans
Dobutamine fx and dose
0.5-15 mcg/kg/min, inc hr and co. B1 mainly, some B2
Heart conditions where phenylephrine is useful
HOCM, tet of fallot
Ephedrine: receptors, when it doesnt work
A1-2 b1-2. Sepsis and heart transplant or if mult doses given
Vaso: made by what, released where, receptor stim
Made by hypothalamus, released by posterior pituitary. V1= constriction. V2= aquaporins in collecting ducts, water reabsorption
OD of vaso van lead to what
Sz and hyponatremia
B1 selective BB
MABE AB. Metop, aten, betax, esmolol, acet, biso
Nonselective bb
Carved, labetolol, nadolol, pindolol, propranolol, timolol
BB that depends on kidney elim
Atenolol
Labetolol and carvedilol b:a ratio.
Labetolol: 7:1. Carvedilol: 10:1
How to tx bb overdose
Glucagon, calcium, pde3 inhib, epi, isuprel
What membrane stabilizing means, drugs that do this
Bb. Has local anesthetic like effects, reduces rate of rise of cardiac action potential. Propranolol and acebutolol
How BB have intrinsic sympathomimetic fx, which ones
Partial agonists while blocking other agonists. Labetolol and pindolol
Phenoxybenzamine: what it does/acts on, role
Non selec non compet alpha antagonist. Reflex tachy. Manage htn in pheo.
Phentolamine: what it is, uses
Non selec, compet antagonist. Reflex tachy. Tx in pheo or autonomic hyperreflexia, or infiltration
Prazosin: drug type, uses
A1 selec. No reflex tachy. Essential htn, bph
Yohimbine: drug type, uses, od leads to
A2 antagonist. Tx ortho hypo. Od= tachycardia and htn
