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B&B 2 (MM) > 3.10.14 Autonomics 1&2 > Flashcards

3.10.14 Autonomics 1&2 Flashcards

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1
Q

How many neurons exist between the CNS and skeletal muscle in somatic motor systems?
How many neurons exist between the CNS and smooth muscle/cardiac muscle/glands of autonomic motor systems?

A

ONE neuron for somatic (alpha motor neuron)

TWO neurons for autonomic (preganglionic and postganglionic)

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2
Q

What is the state of myelination for somatic motor neurons?

What is the state of myelination for autonomic motor neurons?

A

All are myelinated for somatic

The preganglionic neurons are myelinated; the postganglionic neurons are unmyelinated

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3
Q

What neurotransmitter is secreted by somatic motor neurons?

What neurotransmitter is secreted by autonomic motor neurons?

A

Somatic: acetylcholine (always)
Autonomic: preganglionic = acetylcholine; postsynaptic = acetylcholine (parasympathetic) and norepinephrine (sympathetic, except for neurons of thermoregulatory sweat glands)

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4
Q

What autonomic division is referred to as thoracolumbar? What region is this name associated with?

A

Sympathetic

T1-L2 spinal cord

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5
Q

What autonomic division is referred to as craniosacral? What region is this name associated with?

A

Parasympathetic
Brainstem
S2-S4 spinal cord

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6
Q

Where are second neurons of the sympathetic division located?

A

Body wall (prevertebral and paravertebral ganglia)
Viscera
Adrenal medulla

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7
Q

Where are second neurons of the parasympathetic division located?

A

Viscera (ganglia in the head; terminal ganglia on or near the target organ)

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8
Q

What are the two types of nicotinic receptors?

A

Nn (found in ANS ganglia; associated with neurons)

Nm (found in neuromuscular end plates)

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9
Q

Where are muscarinic receptors found?

What differentiates muscarinic receptors from one another? (Name the subtypes)

A

Muscarinics are found in all postsynaptic parasypathetics and in postsynaptic sympathetics that innervate thermoregulatory sweat glands
They are organized by different subtypes of G-coupled receptors and different target organs/tissues:

M1-M3, Q-I-Q
Gq –> increase IP3 and DAG
Gi –> inhibit/decrease cAMP, open K+ channels

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10
Q

What are the two types of adrenergic receptors?

A

Alpha (A1 = Gq, A2 = Gi –> inhibit/decrease cAMP)

Beta (B1,2 = Gs –> stimulate/increase cAMP)

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11
Q

Which adrenergic receptors is considered an autoreceptor? Why is this so flippin’ special?

A

Alpha-2 autoreceptors - regulation of NT release (negative feedback)
Important for autonomic drug effects: CNS effect may predominate over direct PNS effect

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12
Q

What does atropine do?

A

Muscarinic receptor blocker (postganglionic parasympathetics)

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13
Q

What does botulinum toxin do?

A

Blocks release of acetylcholine

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14
Q

What does cocaine do?

A

Blocks monoamine (dopamine, norepinephrine, epinephrine) re-uptake

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15
Q

What does curare do?

A

Nicotinic receptor blocker (skeletal muscle)

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16
Q

What does neostigmine do?

A

Inhibits acetylcholinesterase activity

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17
Q

What do organophosphates do?

A

Irreversibly inactivates acetylcholinesterase

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18
Q

What do tricyclic antidepressants do?

A

Blocks monoamine (dopamine, norepinephrine, epinephrine) re-uptake

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19
Q

What receptor contracts (mydriasis) dilator pupillae muscles (eye)? (What ANS division?)

A

A1 adrenergic receptors (sympathetic)

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20
Q

What receptor increases outflow of aqueous humor? What decreases secretion of aqueous humor? (What ANS division?)

A

A agonists increase outflow
B blockers decrease secretion
(sympathetic)

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21
Q

What receptor accelerates heart rate (SI node stimulus)? (What ANS division?)

A

B1 (B2) - Sympathetic

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22
Q

What receptor increases contractility of the heart? (What ANS division?)

A

B1 (B2) - Sympathetic

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23
Q

What receptor constricts skin/splanchnic blood vessels? (What ANS division?)

A

Alpha - Sympathetic

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24
Q

What receptor relaxes renal blood vessels? (What ANS division?)

A

D1 - Sympathetic

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25
What receptor relaxes blood vessels to skeletal muscle? (What ANS division?)
B2 - Sympathetic
26
What receptor relaxes bronchiolar smooth muscle? (What ANS division?)
B2 - Sympathetic
27
What receptor relaxes smooth muscle of the GI tract walls? (What ANS division?)
B2 - Sympathetic
28
What receptor contracts sphincters of the GI tract? (What ANS division?)
A1 - Sympathetic
29
What receptor inhibits secretions of the GI tract? (What ANS division?)
A2 - Sympathetic
30
What receptor relaxes the bladder wall detrusor muscles? (What ANS division?)
B2 - Sympathetic
31
What receptor contracts the sphincter of bladder? (What ANS division?)
A1 - Sympathetic
32
What receptor relaxes the uterus (pregnancy)? Contracts? (What ANS division?)
Relax: Beta - Sympathetic Contract: Alpha - Sympathetic; M - Parasympathetic
33
What receptor promotes ejaculation? (What ANS division?)
Alpha - Sympathetic
34
What receptor sustains an erection? (What ANS division?)
M - Parasympathetic
35
What receptor stimulates renin, gluconeogenesis, glycogenolysis, and lypolysis? (What ANS division?)
B1, B2, B2, B3 (respectively) - Sympathetic
36
What receptor stimulates pilomotor, eccrine sweat, and apocrine sweat? (What ANS division?)
Alpha - Sympathetic M - Sympathetic Alpha - Sympathetic
37
What receptor contracts (miosis) sphincter pupillae muscles (eye)? (What ANS division?)
M - Parasympathetic
38
What receptor contracts ciliary muscles of the eye? (What ANS division?)
M - Parasympathetic
39
Do parasympathetic neurons cause dilation of blood vessels?
Nope; lack of sympathetic innervation = relaxation
40
What receptor is associated with every parasympathetic postganglionic neuron, eliciting the effects of parasympathetic innervation in eyes, the heart, bronchiolar smooth muscle, GI tract, and GU smooth muscle?
M receptors (muscarinic)
41
What tissues are solely innervated by the sympathetic nervous system (as opposed to dual innervation with parasympathetics)? (Hint: there are 3)
Blood vessels Sweat glands (eccrine and apocrine) Piloerector muscles
42
What is the predominant ANS tone at rest for arterioles?
Sympathetic
43
What is the predominant ANS tone at rest for the iris?
Parasympathetic
44
What is the predominant ANS tone at rest for the GI tract?
Parasympathetic
45
What is the predominant ANS tone at rest for the heart?
Parasympathetic
46
What is the predominant ANS tone at rest for salivary glands?
Parasympathetic
47
What is the predominant ANS tone at rest for the urinary bladder?
Parasympathetic (contract detrusor, relax sphincter)
48
What is the predominant ANS tone at rest for sweat glands?
Sympathetic
49
Which structures of the eye fall under sympathetic regulation? Parasympathetic regulation?
Sympathetic: dilator pupillae muscle Parasympathetic: sphinctor pupillae muscle (pupil contraction; ciliary muscle (accomodation)
50
What structures are responsible for secretion and drainage of aqueous humour? How is this regulated (ANS division)?
Ciliary epithelium secretes Canal of Schlemm and trabecular network drain Contraction of the ciliary muscle puts tension on the trabecular network, opening pores and increasing drainage
51
What are the five CLASSES of autonomic drugs?
``` Direct-acting cholinomimetics Cholinoceptor blockers Indirect-acting cholinesterase inhibitors Sympathomimetics (direct/indirect) Adrenoceptor blockers ```
52
What are the five SITES OF ACTION for pharmacological manipulation of the ANS
``` Synthesis Storage Release Termination Receptor ```
53
What is the difference between direct and indirect effect?
Direct effect: act directly on autonomic receptors Indirect effect: act indirectly through changes in endogenous transmitter levels in the terminal or synaptic cleft
54
What are the two subtypes of direct-acting cholinomimetics? Uses?
``` Nicotinic agonists (skeletal muscle paralysis; smoking cessation) Muscarinic agonists (non-selective for M1-5; glaucoma, Sjogren's, bowel and bladder disorders) ```
55
What drug is a derivative of acetylcholine, useful because of its increased resistance to inactivation and its selectivity? What class of drug is this?
Bethanecol | Direct-acting cholinomimetic
56
What drugs are classified as "naturally occurring alkaloids"? What class of drug is this?
Muscarine; nicotine | Direct-acting cholinomimetics
57
What might be prescribed to treat glaucoma?
``` Muscarinic agonists (direct-acting cholinomimetics) They increase the constriction of ciliary muscles, opening pores of the trabecular network, increasing outflow ```
58
What clinical uses are there for muscarinic agonists?
Glaucoma Sjogren's (decreased salivary gland secretion) Bowel and bladder issues (decreased parasympathetic drive)
59
What toxic effects are specific to muscarinic agonists?
``` Increased parasympathetic drive (intuitive): Miosis Cycloplegia (spasm of accomodation) Bronchoconstriction Excessive GI/GU activity Secretions (sweat, GI, airway, lacrimal) ``` Some are less intuitive: Tachycardia (compensatory sympathetic discharge, baroreceptor reflex) Vasodilation (muscarinic receptors of endothelial cells cause release of nitric oxide; increases cGMP; relaxes vessels)
60
Why would sweat glands (sympathetic innervation) be affected by a drug that specifically cues parasympathetic receptors?
Postganglionic parasympathetics are muscarinic receptors; the drug would be a muscarinic agonist: sweat glands have muscarinic receptors (exception to the symp postganglionic adrenergic receptor rule)
61
What is the mnemonic for toxic effects of muscarinic agonists?
``` SLUDGE Salivation Lacrimation Urination Defecation GI upset (diarrhea) Emesis ```
62
What class of drug are anti-nicotinic drugs? What are they used for?
Cholinoceptor blocker | Historically used to treat hypertension; too many side effects (all ANS ganglia), so limited use today (acute use)
63
What class of drugs are anti-muscarinic drugs? Example? What are they used for?
Cholinoceptor blocker Atropine is the prototype; also scopolamine Block exogenous cholinomimetics more easily than endogenous parasympathetics ``` Clinical uses: Anti-motion sickness (note: remember the dry mouth story) Ophthalmological exam Bronchodilation Surgical adjunct Temporal control of diarrhea Anti-parkinsonism ```
64
What effects are predictable of anti-muscarinic drugs?
Mydriasis (dilation) Cycloplegia (same as muscarinic agonists) Tachycardia Bronchodilation, reduced secretions of lungs Dry mouth Reduced peristalsis Reduced sweating
65
What are contraindications of anti-muscarinic drugs?
Glaucoma Prostatic hyperplasia (urinary retention) Children (danger of hyperthermia, reduced sweating)
66
Atropine toxicity? Mnemonic?
Anti-muscarinic cholinoceptor blocker Constipation, blurred vision, dry mouth "Dry as a bone" (sweat, salivation, lacrimation) "Red as a beet" (dilation of blood vessels) "Mad as a hatter" (CNS effects, delirium and hallucinations)
67
What major non-cholinergic drugs have prominent anti-muscarinic effects due to similar chemical structure? What symptoms would you expect?
Tricyclic antidepressants | Dry as a bone, red as a beet, mad as a hatter; constipation, blurred vision, dry mouth
68
Name a couple examples of cholinesterase inhibitors. How do they work?
Neostigmine and organophosphates | Potentiate the effects of ACh by blocking the inactivating enzyme
69
What are the clinical uses of neostigmine and organophosphates?
``` Cholinesterase inhibitors: Postoperative and neurogenic ileus (disruption of bowel flow) Urinary retention Myasthenia gravis (diagnostic) Alzheimer's disease ```
70
What is the toxicity of cholinesterase inhibitors?
``` Similar to cholinomimetic toxicity: DUMBBELSS Diarrhea Urination Miosis Bronchoconstriction Bradycardia Exitation of CNS/NMJ Lacrimation Salivation Sweating ```
71
Name some direct acting sympathomimetics
Epinephrine, norepinephrine, phenylephrine, albuterol, dopamine
72
What are the effects of direct acting sympathomimetics on the eye?
Alpha-agonists (phenylephrine) --> mydriasis; accomodation unaffected; facilitates aqueous humour outflow
73
What are the effects of direct acting sympathomimetics on the heart?
Beta agonists (B1) --> increase rate and force of contraction
74
What are the effects of direct acting sympathomimetics on the bronchi?
B2 agonists (albuterol) --> relax smooth muscle; bronchodilation
75
What are the effects of direct acting sympathomimetics on the blood vessels?
Alpha agonists constrict cutaneous blood vessels | B2 agonists dilate skeletal vessels
76
What are the effects of direct acting sympathomimetics on the GI tract?
Alpha agonists contract sphincters | Beta agonists relax walls (decreased peristalsis)
77
What are the effects of direct acting sympathomimetics on the GU tract and uterus?
Alpha agonists mediate trigone and sphincter contraction A1 contracts prostatic smooth muscle B2 relaxes uterine muscle (premature contractions
78
What are the effects of direct acting sympathomimetics on metabolism?
Beta agonists increase gluconeogenesis, glycogenolysis, and lipolysis
79
What are the clinical uses of direct acting sympathomimetics?
Anaphylaxis (epi-pens) Local vasoconstriction (for administration of local anesthetics Asthma therapy (albuterol) Allergies (alpha agonists like phenylephrine) Cold medicine
80
Name some indirect acting sympathomimetics
Tyramine and amphetamine (induces release) | Cocaine and tricyclic antidepressants (block reuptake)
81
What suffix is associated with alpha blockers (adrenoceptor blockers)
"-zosin" (prazosin)
82
What suffix is associated with beta blockers (adrenoceptor blockers)
"-olol" (propranolol)
83
What are the clinical uses of adrenoceptor blockers?
``` Glaucoma (blocker decreases secretion of aqueous humour) Pheochromocytoma (neuroendocrine tumor, increased circulating levels of catecholamines) Cardioselective blockers (B1 advantageous to asthma patients) Benign prostatic hyperplasia (alpha blockers) ```

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