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APEX > ANS > Flashcards

ANS Flashcards

1
Q

What second messenger system is associated with the alpha-1 receptor?

A

Gq = Phosopholipase C = IP3/DAG

-other receptors that share this pathway are Histamine1 and Muscarinic 1, 3, 5
-Vasopressin 1

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2
Q

What second messenger system is associated with the alpha 2 receptor? Name other receptors.

A

Gi = decreased AC = decreased cAMP

M2
DA2

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3
Q

What second messenger system is associated with beta 1 and beta 2 receptor? Other receptors?

A

Gs = increased Ac = increased cAMP

DA-1
VA- 2 (renal)
Histamine 2

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4
Q

Describe PSNS heart innervation

A

M2 decreased contractility and heart rate

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5
Q

Describe the autonomic innervation of vasculature

A

v/c ARTERIES = a1 > a2
v/c VEINS = a2 > a1

myocardium, sk. muscle B2 vasodilation

renal & mesenteric DA vasodilation

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6
Q

describe the autonomic innervation of the bronchial tree

A

B2 = bronchodilation respond to catechols in the systemic circulation b/c not innervated

M3 = bronchoconstriction

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7
Q

Autonomic innervation of the kideny

A

renal tubules = a2 (diuresis)
renin release = b1

a1/a2 = vasoconstriction
b2/da1 = vasodilation

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8
Q

describe autonomic innervation of the eye

A

SPHINCTER MUSCLE (IRIS) = M = contraction = miosis

RADIAL MUSCLE (IRIS) = A1 = contraction (mydriasis)

CILIARY MUSCLE =
B2 = relaxation (far vision)
Muscarinic = contraction (near vision)

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9
Q

Describe autonomic innervation of pancreas

A

alpha 2 = decreased insulin release
beta 2 = increased insulin release

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10
Q

Bladder autonomic innervation

A

sphincter = a1 contraction
detrusor = b2 relaxation

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11
Q

List the steps of NE synthesis. What is the rate-limiting step?

A

Tyrosine
via Tyrosine hydroxylase –> L-dopa
via Dopa decarboxylase –> Dopamine
via Dopamine B-hydroxylase –> NE
via Phenylethanolamine N methytransferase in the adrenal medulla –> EPI

**rate limiting is tyrosine hydroxylase

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12
Q

Three ways that NE can be removed from synaptic cleft?

A
  1. Reuptake (80%)
  2. Diffusion into bloodstream
  3. Reuptake by extraneural tissue
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13
Q

What enzymes metabolism NE and epi? Final metabolic byproduct?

A

MAO and COMT (monoamine oxidase and catechol-O-methyltransferase)
VMA (VANILLYLMANDELIC ACID = 2-4-methoxy-4hydroxymandelic acid)

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14
Q

Describe synthesis of Ach

A

Choline is transferred into neuron.
Mitochondria produces Acetyl CoA.
ChAT converts Choline + Acetyl CoA into Ach

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15
Q

Where is Ach released for SNS postganglionic

A

Sweat glands, piloerector muscles, some vessels

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16
Q

Where is the origin of the efferent SNS pathways?

A

T1 - L3 (THORACOLUMBAR)
via intermediolateral region of the spinal cord and axons exit via ventral nerve roots.

22 paired sympathetic ganglia**

17
Q

What is ShyDrager

A

-Multiple system atrophy (aka)
-causes autonomic dysfunction and degeneration at the locus coeruleus, intermediolateral column of spinal cord, and peripheral autonomic nerves.

s/s reflect autonomic dysfunction - orthoHoTn, urinary retention, bowel dysfunction, cerebral hypoperfusion

HD instability!! use direct acting sympathomimetics

18
Q

What is the ratio of epi to NE from chromaffin cells?

A

80% and 20%

19
Q

Describe the HD management of a patient with pheochromocytoma?

A

ALPHA block before BETA (A before B)

alpha antagonist: phenoxybenzamine, phentolamine (non-selective) or doxazosin and prazosin (selective)

20
Q

Name four things that shift K+ intracellularly

A

alkalosis
beta 2 agonism
theophylline
insulin

21
Q

Name 4 things that shift K+ out

A

-acidosis
-cell lysis
-hyperosmolar
-sux

22
Q

What are the sensors in the baroreceptor reflex?

A

Carotid body = GPN
Aortic arch = Vagus N.

23
Q

Describe the reflex arc of Bainbridge

A

-Sensor = SA node, RV, pulmonary veins
-Afferent = Vagus
CONTROL = VASOMOTOR CENTER IN MEDULLA
-Efferent: Vagus
-Effector: SA node increases HR

*only reflex still present in denervated heart
*ex = autotransfusion during childbirth

24
Q

Describe the reflex arc of the Bezold-Jarisch reflex

A

sensor = cardiac mechanoreceptors and chemoreceptors
afferent = vagus
control center = vasomotor center in medulla
efferent = vagus
effector = SA node decreases HR and AV node decreases conduction velocity

25
Q

Describe the reflex arc of the OCR

A

afferent = long & short ciliary n. > ciliary ganglion > ophthalmic division V1 of CN 5 > gasserion ganglion
control = vasomotor center in medulla
efferent = vagus

26
Q

Primary concerns for glomus tumor removal

A

-VAE (grow close to carotid artery, aorta, middle ear)
-Aspiration (d/t GPN involvement, vagus, hypoglossal)
-Serotonin & Kallikrein release (bronchoconstriction, HTN, diarrhea)
-Histamine & Bradykinin (Bronchoconstriction & hOTN)

27
Q

Low, Intermediate, High dose Epi

A

Low = 0.01 - 0.03 mcg/kg/m - B1 & B2 (increased CO, decreased SVR, increased pulse pressure)
Intermediate = 0.03 - 0.15 mcg/kg/m - beta & alpha
High dose = > 0.15 mcg/kg/m (alpha)

28
Q

Isoproteronol

A

Synthetic catecholamine that stimulates B1&B2
-may reduce CPP by reducing DBP
-clinical indications: pacemaker, heart transplant, bronchoconstriction, cor pulmonale

29
Q

When should ephedrine NOT be used to treat hypotension

A

-Patient on MAOIs, cocaine
-Denervated heart
-Sepsis

30
Q

6 drugs selective for beta-1

A

Betaxolol
Bisoprolol
Atenolol
Acebutolol
Esmolol
Metoprolol

31
Q

6 drugs non-selective for beta blockers

A

-Carvedilol
-Labetalol (has ISA)
-Nadolol
-Pindolol
-Propanolol (MSA)
-Timolol

32
Q

What is the primary site of metabolism of the commonly used beta blockers?

A

-Liver
-The two exceptions are atenolol (kidneys) and esmolol (nonspecific plasma esterases)

33
Q

Which beta blockers have local anesthetic properties? What is another name for this?

A

Membrane stabilizing properties (MSA)
-Propanolol and Acebutolol

34
Q

What is intrinsic sympathomimetic activity? Which drugs exert this effect?

A

-BB that exert a partial agonist effect while simultaneously blocking other agnoistss that have a higher affinity for beta receptors

-Labetalol
-Pimolol
-Acebutolol

35
Q

List 3 alpha antagonists. What is the MOA for each?

A
  1. Phenoxybenzamine (noncompetitive) & Phentolamine (short acting) - alpha 1&2
  2. Yohimbe - alpha 2
  3. Prazosin - alpha 1

APEX (18 decks)

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