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Medical Ethno > 2a Autonomic Nervous System > Flashcards

2a Autonomic Nervous System Flashcards

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USMLE® Step 1 flashcards
1
Q

Agonist vs antagonist actions

A
  • Agonist : substance that enhances a receptor

- Antagonist : substance that directly or indirectly blocks a receptor

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2
Q

Endogenous v. exogenous molecules

A
  • Endogenous : molecule produced by human body

- Exogenous : molecule that originates outside of the human body

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3
Q

Nervous System

A

Central Nervous System
•Brain
•Spinal cord

Peripheral Nervous System
•Sensory
•Somatic (voluntary) motor innervates skeletal muscle •Autonomic (involuntary) motor innervates sympathetic & parasympathetic

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4
Q

Anatomical Differences in Sympathetic and Parasympathetic Divisions

A

•Issue from different regions of the CNS
–Sympathetic—also called the thoracolumbar division
–Parasympathetic—also called the craniosacral division

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5
Q

definition of
neuron
nerve fiber
nerve

A
  • Neuron: nerve cell
  • Nerve fiber: long axon
  • Nerve: collection of nerve fibers in the PNS
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6
Q

Neuron structure

A
  • Dendrites
  • Cell body
  • Axon
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7
Q

Two neurons connected by synapse

A
  • Axon terminal of pre-synaptic neuron
  • Presynaptic membrane
  • Synaptic cleft
  • Postsynaptic membrane on post-ganglionic axon or on receptor of end organ
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8
Q

AUTONOMIC NERVOUS SYSTEM TERMINOLOGY

A
  • Acetylcholine: Neurotransmitter released from preganglionic nerve fibers of parasympathetic NS and sympathetic NS, and postganglionic nerve fibers of parasympathetic NS and non-muscarinic exocrine/sweat glands
  • Acetylcholinesterase: enzyme that breaks down acetylcholine into choline and acetic acid
  • Anticholinesterase: compounds (e.g., physostigmine) that inhibit acetylcholinesterase resulting in an accumulation of acetylcholine in synapse
  • Cholinergic: Related to effects on nerve cells or fibers that use acetylcholine as their neurotransmitter. Nicotinic receptors, muscarinic receptors, and non-muscarinic exocrine/sweat gland receptors are all stimulated by cholinergic nerve fibers.
  • Cholinomimetic: Having action similar to acetylcholine in cholinergic nerve fibers.
  • Parasympathomimetic: Compounds (e.g, muscarine, pilocarpine, arecoline, physostigmine) whose actions have an effect that is similar to the stimulation of the parasympathetic nervous system. Similar to cholinomimetic.
  • Muscarinic effects:producing effects that resembles postganglionic parasympathetic receptor stimulation
  • Cholinergic blockers:Compounds (e.g., atropine, scopolamine) that inhibit the action of parasympathetic and/or other cholinergic fibers.
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9
Q

AUTONOMIC NERVOUS SYSTEM TERMOLOGY

A
  • Sympathomimetic:compounds (e.g., exogenous epinephrine, ephedrine, or cocaine) whose actions have a physiological effect that is similar to the stimulation of the sympathetic nervous system
  • Adrenergic:related to effects on nerve cells or fibers in the autonomic nervous system that use norepinephrine as their neurotransmitter. Molecules whose actions mimic the stimulation of the sympathetic nervous system.
  • Epinephrine (= adrenaline):similar effects as norepinephrine.
  • Norepinephrine:similar effects as epinephrine. A postganglionic adrenergic neurohormone.
  • Adrenomimetic:compounds e.g., ephedrine and cocaine that have effects similar to epinephrine or norepinephrine
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10
Q

PERIPHERAL NERVOUS SYSTEM

A

NICOTINIC EFFECT:-The subset of actions normally produced by endogenousacetylcholine on nicotinic receptors that can also be produced by exogenous nicotine

MUSCARINIC EFFECT:-The effect that resembles the postganglionic parasympathetic receptor stimulation by acetylcholine; an effect that resembles the muscarinic effect can be caused by exogenous muscarine, pilocarpine, arecoline, and physostigmine.

ADRENERGIC EFFECT:-Related to effects on nerve cells or fibers in the sympathetic nervous system that use norepinephrine as their neurotransmitter. An effect that resembles the adrenergic effect can be produced by exogenous ephedrine or cocaine.

NICOTINIC RECEPTORS IN AUTONOMIC GANGLIA: -nicotine stimulates receptors and, in very high doses, blocks receptors-D-tubocurarine blocks these receptors

NICOTINIC SOMATIC MOTOR RECEPTORS IN STRIATED MUSCLE: -D-tubocurarine, toxiferine, and botoxhave antagonistic effects on somatic motor nicotinic receptors resulting in the blockage of receptors causing muscle paralysis

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11
Q

AUTONOMIC NERVOUS SYSTEM NEUROTRANSMITTERS

A

-Parasympathetic Nervous System (PNS) neurotransmitters
Acetylcholine transmits impulses
in:
-autonomic ganglia
-post-ganglionic cholinergic nerve ending receptors in end-organs
-Sympathetic Nervous System (SNS) neurotransmitters Norepinephrineis main chemical transmitter at:-post-ganglionic adrenergic nerve fiber endings in end-organs
Acetylcholine transmits impulses in:-autonomic ganglia-cholinergic receptors of sweat glands28

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12
Q

Autonomic Nervous System (ANS)

A

Controls involuntary processes
-smooth muscle, glands, cardiac muscle and other organs.

Sympathetic nervous system (SNS) & Parasympathetic nervous system (PNS) usually work antagonistically
-inhibition of one system results in physiological effects that resemble the stimulation of the other system

SNS & PNS may also function independently or synergistically, e.g., in extreme fear

Pre-ganglionic fibers of the ANS originate in the CNS

Post-ganglionic fibers originate in autonomic ganglia and extend to end-organs

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13
Q

Parasympathetic Nervous System (PNS)

A
  • Anabolic system that conserves energy
  • Nerves originate from cranial-sacral regions
  • Promotes the absorption and digestion of food
  • Normal heart rate
  • Normal bronchial diameter
  • Miotic constricted pupils
  • Acetylcholine transmits impulses in ganglia and at post-ganglionic cholinergic nerve endings in end-organs
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14
Q

Parasympathemimetic Agents

A

MODES OF ACTION:

  • Direct agonistic action on the receptor
  • Inactivation of acetylcholinesterase(enzyme that breaks down acetylcholine) resulting in accumulation of acetylcholine at the synapse which enhances the receptor
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15
Q

Parasympathomimetic Agents

A

Muscarinic Cholinergic Receptor Agonists Acetylcholine

Synthetic choline esters(methacholine, carbachol, betanechol)

Cholinomimetic plant alkaloids

  • muscarine: stimulates muscarinic receptors
  • pilocarpine: stimulates muscarinic & ganglionic receptors
  • arecoline:stimulates muscarinic & ganglionic receptors
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16
Q

MUSCARINE

A

Compound isolated from different fungi species:Amanita muscaria, Amanita spp., Inocybe,&Clitocybe

Common names: amanita, fly agaric mushroom

Geography: Siberia, North America,

Habit: mushroom with red, orange, yellow or cream colored cap with white spots grows on forest floor

Ethnomedical Cultural background:

  • mushroom eaten by Siberian indigenous people as hallucinogen
  • dried mushrooms repel flies

Compounds in mushroom with hallucinogenic activity:
-ibotenic acid, muscimole, muscazone

Parasympathomimetic active compound: muscarine

17
Q

MUSCARINE

A
  • Chemical class: quanternary ammonium alkaloid
  • MUSCARINE:powerful parasympathomimetic agent: diaphoretic, salivation, lacrimation, vision problems, nausea, vomiting, diarrhea, hypotension, bradycardia, and bronchospasm.
  • MODERN MEDICAL USE(S):Understanding of muscarinic receptors and neurohumoral theory
  • Antedote: 1 -2 mg of atropineIM every 30 minutes
18
Q

PILOCARPINE

A

Isolated fromPilocarpus jaborandi, P. m i c r o p h y l l u s

Plant family: Rutaceae

Common Name: jaborandi (means slobber mouth plant in Tupi language)

Geography: Wet forests of Trop . A m erica, West In d ies

Ethnomedical uses: Tu p i c u l t u re i n B r a z i lchew leaves to induce salivation and sweating

Pharmaceutical: pilocarpine(first isolated in 1875)

Chemical class: tertiary amine alkaloid

19
Q

PILOCARPINE MECHANISMS OF ACTION

A

parasympathomimetic agentwith

  • strong postganglionic agonist at muscarinic receptors
  • mild nicotonic ganglionic receptor agonist

muscarinic receptor agonist resulting in stimulation of

  • salivation
  • intestinal motility
  • pupil constriction

smooth muscle stimulation resulting in

  • pupillary constriction
  • reduction in intraocular pressure

Sweat gland & non-muscarinic exocrine gland stimulation:
-10-15 mg of pilocarpine given subcutaneously causes secretion of 2 -3 liters of sweat

20
Q

PILOCARPINE THERAPEUTIC USES

A

To p i c a l a p p l i c a t i o n t o e y e c o n s t r i c t s p u p i l s

  • tx open-angle glaucoma (by reducing intraocular pressure)
  • tx mydriasis (dilated pupils) caused by atropine

Oral administration as medicine:Treats dry mouth (xerostoma)caused by

  • Sjogren’s disease
  • patients with head and neck radiation

Reduce morphine treatment side-effects of

  • dry mouth
  • constipation
  • urinary retention

Overdose may cause cardiovascular collapse
Antidote is atropine

21
Q

Areca catechuin Arecaceae

A

Common names: betelnut, betel, areca nut

Geography: Tree in wet forests of South Asia, Indomalasia, Oceania, probably originated in Sulawesi

Plant Part Used/Ethnopharmacology:

  • seed mixed with leaves of Piper betle& shell lime (calcium carbonate) as a masticory
  • Carotenoids from Piper betlemake the saliva red when chewed

Ethnomedical uses:

  • digestive by increasing salivary & intestinal secretions
  • energizer/euphoretic
  • antihelminthic (treats intestinal worms)
22
Q

Areca catechuCompounds & Derivatives

A

ACTIVE COMPOUNDS: alkaloidsarecoline (alkaloid): arecoline HB animal anthelminthicnipecotic acid(first isolated from betel nut in 1923)

CHEMICAL DERIVATIVES arecoline ®aceclidine(treatment for glaucoma)nipecotic acid ®gabitril(treatment for seizures)

23
Q

Areca catechuCompounds & DerivativesMechanisms of Action/Therapeutic Uses

A

MECHANISM OF ACTION of arecoline Parasympathomimetic/agonist at muscarinic receptors Agonist at nicotinic ganglionic receptors

MECHANISM OF ACTION of aceclidine Parasympathomimetic/agonist at muscarinic receptorsTreatment for glaucoma

MECHANISM OF ACTION of gabitril GABA re-uptake inhibitor in CNS ®­GABA levels at receptorTrea t men t f o r s ei zu res

Medical Ethno (3 decks)

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