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

3.10.14 Autonomics 1&2 Flashcards

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
Q

What receptor relaxes blood vessels to skeletal muscle? (What ANS division?)

A

B2 - Sympathetic

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26
Q

What receptor relaxes bronchiolar smooth muscle? (What ANS division?)

A

B2 - Sympathetic

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27
Q

What receptor relaxes smooth muscle of the GI tract walls? (What ANS division?)

A

B2 - Sympathetic

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28
Q

What receptor contracts sphincters of the GI tract? (What ANS division?)

A

A1 - Sympathetic

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29
Q

What receptor inhibits secretions of the GI tract? (What ANS division?)

A

A2 - Sympathetic

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30
Q

What receptor relaxes the bladder wall detrusor muscles? (What ANS division?)

A

B2 - Sympathetic

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31
Q

What receptor contracts the sphincter of bladder? (What ANS division?)

A

A1 - Sympathetic

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32
Q

What receptor relaxes the uterus (pregnancy)? Contracts? (What ANS division?)

A

Relax: Beta - Sympathetic
Contract: Alpha - Sympathetic; M - Parasympathetic

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33
Q

What receptor promotes ejaculation? (What ANS division?)

A

Alpha - Sympathetic

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34
Q

What receptor sustains an erection? (What ANS division?)

A

M - Parasympathetic

35
Q

What receptor stimulates renin, gluconeogenesis, glycogenolysis, and lypolysis? (What ANS division?)

A

B1, B2, B2, B3 (respectively) - Sympathetic

36
Q

What receptor stimulates pilomotor, eccrine sweat, and apocrine sweat? (What ANS division?)

A

Alpha - Sympathetic
M - Sympathetic
Alpha - Sympathetic

37
Q

What receptor contracts (miosis) sphincter pupillae muscles (eye)? (What ANS division?)

A

M - Parasympathetic

38
Q

What receptor contracts ciliary muscles of the eye? (What ANS division?)

A

M - Parasympathetic

39
Q

Do parasympathetic neurons cause dilation of blood vessels?

A

Nope; lack of sympathetic innervation = relaxation

40
Q

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?

A

M receptors (muscarinic)

41
Q

What tissues are solely innervated by the sympathetic nervous system (as opposed to dual innervation with parasympathetics)? (Hint: there are 3)

A

Blood vessels
Sweat glands (eccrine and apocrine)
Piloerector muscles

42
Q

What is the predominant ANS tone at rest for arterioles?

A

Sympathetic

43
Q

What is the predominant ANS tone at rest for the iris?

A

Parasympathetic

44
Q

What is the predominant ANS tone at rest for the GI tract?

A

Parasympathetic

45
Q

What is the predominant ANS tone at rest for the heart?

A

Parasympathetic

46
Q

What is the predominant ANS tone at rest for salivary glands?

A

Parasympathetic

47
Q

What is the predominant ANS tone at rest for the urinary bladder?

A

Parasympathetic (contract detrusor, relax sphincter)

48
Q

What is the predominant ANS tone at rest for sweat glands?

A

Sympathetic

49
Q

Which structures of the eye fall under sympathetic regulation? Parasympathetic regulation?

A

Sympathetic: dilator pupillae muscle
Parasympathetic: sphinctor pupillae muscle (pupil contraction; ciliary muscle (accomodation)

50
Q

What structures are responsible for secretion and drainage of aqueous humour? How is this regulated (ANS division)?

A

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
Q

What are the five CLASSES of autonomic drugs?

A 
Direct-acting cholinomimetics
Cholinoceptor blockers
Indirect-acting cholinesterase inhibitors
Sympathomimetics (direct/indirect)
Adrenoceptor blockers
52
Q

What are the five SITES OF ACTION for pharmacological manipulation of the ANS

A 
Synthesis
Storage
Release
Termination
Receptor
53
Q

What is the difference between direct and indirect effect?

A

Direct effect: act directly on autonomic receptors

Indirect effect: act indirectly through changes in endogenous transmitter levels in the terminal or synaptic cleft

54
Q

What are the two subtypes of direct-acting cholinomimetics? Uses?

A 
Nicotinic agonists (skeletal muscle paralysis; smoking cessation)
Muscarinic agonists (non-selective for M1-5; glaucoma, Sjogren's, bowel and bladder disorders)
55
Q

What drug is a derivative of acetylcholine, useful because of its increased resistance to inactivation and its selectivity? What class of drug is this?

A

Bethanecol

Direct-acting cholinomimetic

56
Q

What drugs are classified as “naturally occurring alkaloids”? What class of drug is this?

A

Muscarine; nicotine

Direct-acting cholinomimetics

57
Q

What might be prescribed to treat glaucoma?

A 
Muscarinic agonists (direct-acting cholinomimetics)
They increase the constriction of ciliary muscles, opening pores of the trabecular network, increasing outflow
58
Q

What clinical uses are there for muscarinic agonists?

A

Glaucoma
Sjogren’s (decreased salivary gland secretion)
Bowel and bladder issues (decreased parasympathetic drive)

59
Q

What toxic effects are specific to muscarinic agonists?

A 
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
Q

Why would sweat glands (sympathetic innervation) be affected by a drug that specifically cues parasympathetic receptors?

A

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
Q

What is the mnemonic for toxic effects of muscarinic agonists?

A 
SLUDGE
Salivation
Lacrimation
Urination
Defecation 
GI upset (diarrhea)
Emesis
62
Q

What class of drug are anti-nicotinic drugs? What are they used for?

A

Cholinoceptor blocker

Historically used to treat hypertension; too many side effects (all ANS ganglia), so limited use today (acute use)

63
Q

What class of drugs are anti-muscarinic drugs? Example? What are they used for?

A

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
Q

What effects are predictable of anti-muscarinic drugs?

A

Mydriasis (dilation)
Cycloplegia (same as muscarinic agonists)
Tachycardia
Bronchodilation, reduced secretions of lungs
Dry mouth
Reduced peristalsis
Reduced sweating

65
Q

What are contraindications of anti-muscarinic drugs?

A

Glaucoma
Prostatic hyperplasia (urinary retention)
Children (danger of hyperthermia, reduced sweating)

66
Q

Atropine toxicity? Mnemonic?

A

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
Q

What major non-cholinergic drugs have prominent anti-muscarinic effects due to similar chemical structure? What symptoms would you expect?

A

Tricyclic antidepressants

Dry as a bone, red as a beet, mad as a hatter; constipation, blurred vision, dry mouth

68
Q

Name a couple examples of cholinesterase inhibitors. How do they work?

A

Neostigmine and organophosphates

Potentiate the effects of ACh by blocking the inactivating enzyme

69
Q

What are the clinical uses of neostigmine and organophosphates?

A 
Cholinesterase inhibitors:
Postoperative and neurogenic ileus (disruption of bowel flow)
Urinary retention
Myasthenia gravis (diagnostic)
Alzheimer's disease
70
Q

What is the toxicity of cholinesterase inhibitors?

A 
Similar to cholinomimetic toxicity:
DUMBBELSS
Diarrhea
Urination
Miosis
Bronchoconstriction
Bradycardia
Exitation of CNS/NMJ
Lacrimation
Salivation
Sweating
71
Q

Name some direct acting sympathomimetics

A

Epinephrine, norepinephrine, phenylephrine, albuterol, dopamine

72
Q

What are the effects of direct acting sympathomimetics on the eye?

A

Alpha-agonists (phenylephrine) –> mydriasis; accomodation unaffected; facilitates aqueous humour outflow

73
Q

What are the effects of direct acting sympathomimetics on the heart?

A

Beta agonists (B1) –> increase rate and force of contraction

74
Q

What are the effects of direct acting sympathomimetics on the bronchi?

A

B2 agonists (albuterol) –> relax smooth muscle; bronchodilation

75
Q

What are the effects of direct acting sympathomimetics on the blood vessels?

A

Alpha agonists constrict cutaneous blood vessels

B2 agonists dilate skeletal vessels

76
Q

What are the effects of direct acting sympathomimetics on the GI tract?

A

Alpha agonists contract sphincters

Beta agonists relax walls (decreased peristalsis)

77
Q

What are the effects of direct acting sympathomimetics on the GU tract and uterus?

A

Alpha agonists mediate trigone and sphincter contraction
A1 contracts prostatic smooth muscle
B2 relaxes uterine muscle (premature contractions

78
Q

What are the effects of direct acting sympathomimetics on metabolism?

A

Beta agonists increase gluconeogenesis, glycogenolysis, and lipolysis

79
Q

What are the clinical uses of direct acting sympathomimetics?

A

Anaphylaxis (epi-pens)
Local vasoconstriction (for administration of local anesthetics
Asthma therapy (albuterol)
Allergies (alpha agonists like phenylephrine)
Cold medicine

80
Q

Name some indirect acting sympathomimetics

A

Tyramine and amphetamine (induces release)

Cocaine and tricyclic antidepressants (block reuptake)

81
Q

What suffix is associated with alpha blockers (adrenoceptor blockers)

A

“-zosin” (prazosin)

82
Q

What suffix is associated with beta blockers (adrenoceptor blockers)

A

“-olol” (propranolol)

83
Q

What are the clinical uses of adrenoceptor blockers?

A 
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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