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Anesthesia-phar > Adrenergic Agonist Patho and Receptors > Flashcards

Adrenergic Agonist Patho and Receptors Flashcards

1
Q

The sympathetic outflow is also called ___

A

the thoracolumbar outflow

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2
Q

The sympathetic, or thoracolumbar, outflow arises from ____.

A

segments T1–L2 or segments T1–L3

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3
Q

Most sympathetic preganglionic neurons synapse with ____

A

postganglionic fibers in the paravertebral ganglia

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4
Q

Sympathetic cardiac accelerator fibers arise from ___.

A

T1–T4

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5
Q

The stellate ganglion is formed by ___.

A

the inferior cervical and first thoracic ganglia

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6
Q

The effects of the sympathetic nervous system on the body’s physiology are designed to ____.

A

facilitate the fight-or-flight response

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7
Q

The sympathetic nervous system is anatomically and functionally more ____.

A

systemic in its effects when compared to the PNS

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8
Q

A massive sympathetic response would lead to ____

A

tachycardia, dry mouth, bronchodilation and diaphoresis.

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9
Q

Effects of the Sympathetic Nervous System on organs in the body system

A

Eye - The pupil dilation (mydriasis)

Heart - Increased heart rate

Secretions - Decreased salivary and bronchial secretions

Smooth Muscle - Bronchodilation, and decreased motility and tone of the stomach and intestines and relaxation of the bladder (detrusor muscle)

Pancreas – Increased blood glucose

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10
Q

What are the main endogenous neurotransmitters for adrenergic receptors?

A

Norepinephrine and epinephrine

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11
Q

The major subtypes of adrenergic receptors are ___.

A

alpha-1, alpha-2, beta-1, and beta-2

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12
Q

Preganglionic SNS fibers are ____.

A

short, myelinated and release Acetylcholine

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13
Q

Postganglionic SNS fibers are ____.

A

long, unmyelinated, have nicotinic receptors at the ganglia and release either NE or Ach onto target adrenergic receptors

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14
Q

The adrenal medulla is directly stimulated by ___.

A

a preganglionic SNS fiber to release NE and Epi into systemic circulation

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15
Q

What is a ganglia?

A

a group of cell bodies in the periphery, and in the SNS, sympathetic ganglia are where many preganglionic dendrites synapse on postganglionic cell bodies

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16
Q

The preganglionic SNS fibers exit the spinal cord through ____.

A

the ventral nerve root

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17
Q

All preganglionic SNS fibers pass through the ___.

A

white ramus (myelinated) in route to the paravertebral ganglia

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18
Q

Where do some preganglionic SNS fibers synapse in?

A

the paravertebral ganglia

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19
Q

Where do the postganglionic SNS fibers pass through?

A

the grey ramus (unmyelinated), and travel to effector organ

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20
Q

some preganglionic fibers ascend or descend in the ___.

A

paravertebral ganglia before synapsing with postganglionic neurons

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21
Q

some preganglionic neurons pass through the paravertebral ganglia without _____.

A

synapsing; these fibers synapse with postganglionic neurons in peripheral ganglia

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22
Q

In addition to the collateral ganglion, another example of a peripheral ganglia is ____.

A

the stellate ganglion

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23
Q

A stellate ganglion block is ___.

A

an injection of medication into these nerves that can help relieve pain in the head, neck, upper arm and upper chest.

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24
Q

A stellate ganglion block is also an unintentional consequence of ___.

A

a brachial plexus block

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25
Horner’s syndrome is common side effect of \_\_\_\_.
a stellate ganglion block
26
Signs and symptoms of Horner’s Syndrome
Ipsilateral miosis, ptosis, enophthalmos, flushing, increased skin temperature, anhydrosis, and nasal congestion (stuffiness) **Very Homely PAM**: **V**asodilation, **H**orner, **P**tosis, **A**nhydrosis, **M**iosis Ipsilateral miosis = lazy eye Enophthalmos = posterior displacement of the eye Anhydrosis = inability to sweat normally.
27
In the adrenal medulla, norepinephrine is converted to \_\_\_.
epinephrine, the catecholamine pool is comprised 20% NE and 80% epinephrine.
28
Describe the steps of the synthesis of norepinephrine
1. Tyrosine transported into nerve terminal from bloodstream. 2. Tyrosine converted to dopa. 3. Dopa converted to dopamine. 4. Dopamine transported into presynaptic vesicle. 5. Dopamine converted to norepinephrine. 6. Norepinephrine stored in presynaptic vesicles
29
Describe the steps of the release of norepinephrine
1. An action potential travels along the axon of sympathetic postganglionic neuron. 2. Depolarization opens voltage-gated Ca+ channels. 3. Ca+ diffuses through channels into nerve terminal down electrochemical gradient 4. Ca+ unites with calmodulin, and this second messenger system initiates a series of reactions leading to exocytosis. 5. Norepinephrine spills into the synaptic cleft.
30
First, norepinephrine combines with adrenergic receptors of postsynaptic membrane. Then what happens?
2.Norepinephrine-receptor complex causes: * ion channels to open, or * activation of adenylate cyclase and subsequent intracellular production of cAMP 3.The cell responds in a characteristic way to the opening of ion channels or the activation of adenylate cyclase (second messengers have tissue-specific actions). •Ex: cAMP relaxes vascular smooth muscle but stimulates contraction of the myocardium
31
Termination of norepinephrine
Diffusion of norepinephrine away from receptors is the first step in the termination of action of norepinephrine. 1. Norepinephrine is actively transported back into the presynaptic nerve terminal; most (80%) of the released norepinephrine is returned to the nerve terminal by this reuptake mechanism. 2. Small amounts of norepinephrine are metabolized in the synaptic cleft by monoamine oxidase (MAO); MAO is found on the surface of mitochondria; some MAO leaks from the nerve terminal into the synaptic cleft. 3. Small amounts of norepinephrine diffuse into the bloodstream; once in the vascular compartment, norepinephrine is metabolized by catechol-O-methyl transferase (COMT).
32
Indirect-acting sympathomimetics work in part by \_\_\_.
**displacing norepinephrine from sympathetic nerve terminals**. Ephedrine is the most frequently used indirect-acting sympathomimetic. Ephedrine also stimulates adrenergic receptors directly, so it also is a direct-acting agent.
33
What agents should be avoided in the patient taking an MAO inhibitor?
**indirect-acting sympathomimetic agents** (ephedrine) and **meperidine**; meperidine, like ephedrine, triggers the release of norepinephrine. When either ephedrine or meperidine is administered to a patient taking an MAO inhibitor, **the release of excess amounts of norepinephrine may cause a hypertensive crisis.** This hypertension is generally worse with meperidine.
34
α1 (alpha 1) receptors are \_\_\_
postsynaptic adrenoceptors located in smooth muscle throughout the body (in the eyes, lungs, blood vessels, uterus, gut, and genitourinary system)
35
α1(alpha 1) agonists are associated with \_\_\_.
mydriasis, bronchoconstriction, vasoconstriction, uterine contraction, constriction of GI/GU sphincters and inhibits insulin secretion. mydriasis = pupils dilate
36
The most important cardiovascular effect of α1 stimulation is \_\_\_.
vasoconstriction, which increases peripheral vascular resistance, left ventricular afterload, and arterial blood pressure.
37
α2 (alpha 2) receptors are located primarily on \_\_\_.
the presynaptic nerve terminals, in addition to tissues on postsynaptic membranes in the brainstem and in peripheral tissues
38
stimulation of alpha-2 receptors on sympathetic postganglionic, presynaptic nerves produces \_\_\_\_.
**inhibition of norepinephrine** synthesis and release this is a **negative feedback system.**
39
stimulation of postsynaptic alpha-2 receptors in the brainstem causes \_\_\_\_.
**sedation** and inhibits outflow of the sympathetic nervous system, which leads to peripheral vasodilation and lower blood pressure
40
stimulation of alpha-2 receptors in the substantia gelatinosa of the spinal cord promotes \_\_\_\_.
analgesia
41
Where are beta 1 receptors located?
heart and kidney
42
Stimulation of beta 1 receptors is __ and produces \_\_\_.
excitatory and produces positive chronotropic (increased heart rate), dromotropic (increased conduction), inotropic (increased contractility) effects and increase renin release
43
β2 (Beta 2) Receptors are primarily ___ and located \_\_\_\_.
primarily postsynaptic adrenoceptors located in smooth muscle and gland cells; but are also located in ventricular myocytes.
44
β2 (Beta 2) stimulation causes \_\_\_.
smooth muscle relaxation, resulting in bronchodilation, vasodilation, and relaxation of the uterus (tocolysis), bladder, and gut.
45
Glycogenolysis, lipolysis, gluconeogenesis, and insulin release are stimulated by \_\_\_\_.
β2-receptor activation.
46
β3 (Beta 3) Receptors are found in \_\_\_.
adipose tissue and play a role in lipolysis and thermogenesis in brown fat.
47
Stimulation of alpha 1 receptor on the pupil causes \_\_\_.
mydriasis (pupil dilates)
48
Stimulation of beta 1 receptor on the SA Node causes \_\_\_.
increased heart rate
49
Stimulation of beta 1 receptor on the AV Node causes \_\_\_.
increased conduction speed
50
Stimulation of beta 1 receptor on muscle fibers causes \_\_\_.
increased contractility
51
Stimulation of alpha 1 receptor on most arterial systemic vessels causes \_\_\_.
vasocontriction (increased SVR)
52
Stimulation of beta 2 receptor on artieral skeletal muscle vessels causes \_\_\_.
vasodilation (decreased SVR)
53
Stimulation of alpha 1 receptor on veins causes \_\_\_.
vasocontriction (increased preload)
54
Stimulation of beta 2 receptor on the bronchiolar muscle of the lung causes \_\_\_.
bronchodilation
55
Stimulation of beta 2 receptor on the secretory glands of the lung causes \_\_\_.
increased secretions
56
Stimulation of alpha 1 receptor on the spleen causes \_\_\_.
release of RBCs
57
Stimulation of beta 1 receptor on the kideny causes \_\_\_.
increased renin release
58
Stimulation of alpha 1 receptor on the kidney causes \_\_\_.
decreased renin release
59
Stimulation of beta 2 receptor on the liver causes \_\_\_.
Glycogenolysis & Gluconeogenesis
60
Stimulation of beta 2 receptor on the gallbladder causes \_\_\_.
relaxation
61
Stimulation of alpha 1 receptor on the stomach and intestines causes \_\_\_.
relaxation
62
Stimulation of beta 2 receptor on the urinary bladder wall causes \_\_\_.
relaxation
63
Stimulation of beta 2 receptor on the pancreas causes \_\_\_.
increased insulin secretion
64
Stimulation of alpha 2 receptor on the pancreas causes \_\_\_.
decreased insulin secretion
65
Stimulation of alpha 1 receptor on adipose tissue causes \_\_\_.
increased glucagon secretion
66
Stimulation of beta 1 receptor on adipose tissue causes \_\_\_.
Lipolysis
67
Stimulation of beta 2 receptor on the uterus causes \_\_\_.
relaxation
68
Stimulation of alpha 1 receptor on the uterus causes \_\_\_.
contraction
69
Stimulation of beta 2 receptor on the the sodium potassium pump causes \_\_\_.
the stimulation of the Na-K pump which causes decreased plasma potassium
70
Dopamine (DA) receptors are \_\_\_\_.
a group of adrenergic receptors that are activated by dopamine; these receptors are classified as D1 and D2 receptors.
71
Activation of D1 receptors \_\_\_\_.
mediates vasodilation in the kidney, intestine, and heart.
72
D2 receptors are believed to play a role in \_\_\_\_.
antiemetic action

Anesthesia-phar (18 decks)

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