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Apex > ANS Anatomy And Phys > Flashcards

ANS Anatomy And Phys Flashcards

1
Q

What 3 forms can an extracellular signal take form?

A

Chemical
Electrical
Mechanical

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2
Q

What are the 3 categories of membrane bound receptors?

A

Ion channel
G-protein couple receptor (GPCR)
Enzyme linked receptor

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3
Q

What are the two ways a GPCR works?

A

Opens/closes a channel
Activates/inactivates an enzyme inside the cell

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4
Q

Where are intracellular receptors located?

A

In the cytoplasm or nucleoplasm

(Steroids)

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5
Q

What are the 3 subunits in a g-protein receptor?

A

Alpha, beta, and gamma

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6
Q

What do Gs and Gq proteins do?

A

STIMULATE (turn ON am effector)

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7
Q

What do Gi proteins do?

A

INHIBIT (turn OFF an effector)

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8
Q

What are the main second messengers?

A

cAMP
cGMP
IP3
DAG
Calcium

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9
Q

What is the receptor, signal transduction, effector and second messenger for alpha 1?

A

Signal transduction: Gq

Effector: ^ phospholipase C

Second messenger: ^ IP3, DAG, Ca

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10
Q

What is the receptor, signal transduction, effector and second messenger for alpha 2?

A

Signal transduction: Gi

Effector: decreased adenylate cyclase

Second messenger: decrease cAMp

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11
Q

What is the receptor, signal transduction, effector and second messenger for Beta 1?

A

Signal transduction: Gs

Effector: ^ Adenylate Cyclase

Second messenger: ^ cAMP

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12
Q

What is the receptor, signal transduction, effector and second messenger for Beta 2?

A

Signal transduction: Gs

Effector: ^ adenylate cyclase

Second messenger: cAMP

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13
Q

What is the receptor, signal transduction, effector and second messenger for beta 3?

A

Signal transduction: Gs

Effector: ^ adenylate cyclase

Second messenger: ^cAMP

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14
Q

What is the receptor, signal transduction, effector and second messenger for nicotinic (ANS, NMJ, CNS)?

A

Ion channels

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15
Q

What is the receptor, signal transduction, effector and second messenger for M1, M3, and M5?

A

Signal transduction: Gq

Effector: ^ Phospholipase C

Second messenger: ^ IP3, DAG, Ca

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16
Q

What is the receptor, signal transduction, effector and second messenger for M2 and M4?

A

Signal transduction: Gi

Effector: decreased adenylate cyclase

Second messenger: decreased cAMP

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17
Q

What is the receptor, signal transduction, effector and second messenger for dopamine 1?

A

Signal transduction: Gs

Effector: ^ adenylate cyclase

Second messenger: ^ cAMP

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18
Q

What is the receptor, signal transduction, effector and second messenger for dopamine 2

A

Signal transduction: Gi

Effector: decreased adenylate cyclase

Second messenger: decrease cAMP

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19
Q

What is the receptor, signal transduction, effector and second messenger for vasopressin 1

A

Signal transduction: Gq

Effector: ^ phospholipase C

Second messenger: ^ IP3, DAG, Ca

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20
Q

What is the receptor, signal transduction, effector and second messenger for vasopressin 2?

A

Signal transduction: Gs

Effector: ^ adenylate cyclase

Second messenger: ^ cAMP

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21
Q

What is the receptor, signal transduction, effector and second messenger for histamine 1?

A

Signal transduction: Gq

Effector: ^ phospholipase C

Second messenger: ^ IP3, DAG, Ca

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22
Q

What is the receptor, signal transduction, effector and second messenger for histamine 2?

A

Signal transduction: Gs

Effector: ^ adenylate cyclase

Second messenger: ^ cAMP

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23
Q

What does Beta 1 affect the heart?

A

> Positive Inotrope
positive chronotropy
positive dromotropy

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24
Q

What does Beta 2 do to the lungs?

A

Bronchodilation

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25
Q

What does a1 do to the GI tract?

A

Vasoconstriction sphincter contraction

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26
Q

What does alpha 1 do to the glands?

A

> Increased sweating
decreased pancreatic activity

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27
Q

What does a1 and Beta 2 do to the urinary tract?

A

Bladder sphincter contraction
^ renin secretion (I’m almost positive this is actually Beta 1 stimulation)

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28
Q

What does alpha 1 do to the skin?

A

Vasoconstriction

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29
Q

What does beta 2 do the skeletal muscle?

A

Vasodilation

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30
Q

What does alpha 1 cause in the pupils?

A

Dilation

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31
Q

What does M2 do in the heart?

A

> negative inotropy
negative chronotropy
negative dromotropy

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32
Q

What does M3 do in the lungs?

A

Bronchoconstriction
Increased gland secretions

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33
Q

What does M3 do in the GI system?

A

> increased motility
sphincter relaxation
increased gland secretion

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34
Q

What does M1 and M3 do to the glands?

A

> ^ salivation
^ lacrimination
^ pancreatic activity

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35
Q

What does M3 do to the urinary tract?

A

Bladder sphincter relaxation

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36
Q

What does M3 do to the pupils?

A

Constriction

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37
Q

How does alpha 2 affect beta cells?

A

Decrease insulin release

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38
Q

How does Beta 2 affect the uterus?

A

Relaxes uterus

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39
Q

How does the SNS system affect the pupil?

A

SNS activity > alpha 1 stimulation > radial muscle contraction > MYDRIASIS (pupil dilation)

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40
Q

How does the PNS system affect the pupil?

A

PNS activity > muscarinic stimulation > sphincter muscle contraction > MIOSIS (pupil constriction)

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41
Q

Where is the alpha 2 receptor present?

A

Presynaptic in the CNS and peripheral nervous system (this is a negative feedback mechanism that reduces NE release)

Post synaptic: smooth muscle and several organs

Nonsynaptic: platelets

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42
Q

How does alpha 2 affect the nervous system?

A

Decreases SNS tone
Increases PNS tone
Sedation
Analgesia
Anti-shivering

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43
Q

How does alpha 2 affect the vasculature?

A

Vasoconstriction

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44
Q

How does alpha 2 affect the renal tubules?

A

Inhibits ADH (diuresis)

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45
Q

How does alpha 2 affect the pancreas?

A

Decreased insulin release

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46
Q

How does alpha 2 affect the platelets?

A

Increases platelet aggregation

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47
Q

How does alpha 2 affect the salivary glands and GI tract?

A

Salivary glands: dry mouth
GI tract: decreased gut motility

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48
Q

How does rapid administration of precedex cause vasoconstriction and hypertension?

A

Stimulates postsynaptic alpha 2 receptors in the arterial and venous circulations.

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49
Q

How many moles of ATP can be produced with 1 mole of glucose?

A

38!

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50
Q

What metabolizes cAMP to AMP?

A

Phosphodiesterase 3 (PDE 3)

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51
Q

What is one of the main PDE 3 Inhibitors?

A

MILRINONE!! ~ it’s an inodilator.

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52
Q

What are PDE 3 inhibitors useful in?

A

Beta blocker myocardial depression
Acute heart failure
Unresponsiveness to IV catecholamines
Any time a combo of increased inotropy and decreased SVR would be desirable!

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53
Q

What is the prototype nonselective phosphodiesterase inhibitor?

A

Theophylline

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54
Q

In vascular smooth muscle, what does cAMP inhibit?

A

Myosin light chain kinase

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55
Q

What is the primary neurotransmitter of the SNS?

A

NE

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56
Q

What are the 3 ways catecholamines are removed from the synaptic cleft?

A

Reuptake (main)
Diffusion
MAO and COMT

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57
Q

Which local anesthetic blocks reuptake of NE at the synapse?

A

Cocaine

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58
Q

What is the end-product of catacholamine metabolism?

A

Vanillylmandelic acid

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59
Q

What is the primary transmitter in the parasympathetic nervous system?

A

Ach

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60
Q

Where are Type N cholinergic receptors located?

A

PNS ganglia
SNS ganglia
Central nervous system

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61
Q

Where are Type M cholinergic (nicotinic) receptors located?

A

Neuromuscular junction

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62
Q

Where are muscarinic receptors (cholinergic) located?

A

Post ganglionic PNS effector organs
CNS

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63
Q

What is an antagonist of Ca at the presynaptic nerve terminal?

A

Magnesium!

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64
Q

What is the primary mechanism for ACh removal?

A

Metabolism by Acetylcholinesterase

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65
Q

What is the rate-limiting factor for ACh synthesis?

A

The availability of substrates, choline, and acetyl-CoA

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66
Q

What are the two locations for neurotrasmitter release in the ANS?

A

Ganglia and effectors (organs)

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67
Q

What are some traits about the SNS?

A

Origin: thoracolumbar (T1-L3)
Ganglia: near spinal cord (sympathetic chain)
Post-to-preganglionic ratio: 30:1 (postsynaptic amplification for mass effect)
Preganglionic fiber: short myelinated B fiber
Post ganglionic fiber: long unmyelinated C fiber
Neurotransmitter at the ganglia: ACh
Receptor at ganglia: Nicotinic type N
Neurotransmitter from POSTganglionic fiber: NE (ACh at the sweat glands and piloerector muscles)
Receptor at effector organ: Adrenergic (Alpha, Beta, Dopamine) and muscarinic

68
Q

What are some traits about the PNS system?

A

Origin: cranial (nerves: 1973 ~ 10,9,7,2) sacral (S2-S4)
Ganglia: near in inside effector tissue/organ
Post-to-preganglionic ratio: 1:1 or 3:1
Preganglionic fiber: long myelinated B fiber
Post ganglionic fiber: short, unmyelinated C fiber
Neurotransmitter at the ganglia: ACh
Receptor at ganglia: Nicotinic (N)
Neurotransmitter from POSTganglionic fiber: ACh
Receptor at effector organ: muscarinic

69
Q

How many paired symapathetic ganglia are there and what are they called?

A

22 paired called the sympathetic chain (sympathetic trunk or paravertebral ganglia)

70
Q

What is the path for a SNS nerve? Think ganglia…

A

Lateral horn > ventral root > white ramus (more distal) > grey ramus

71
Q

When would you use a celiac plexus nerve block?

A

Acute or chronic pancreatitis

72
Q

When would you use a nerve block of the lower intercostal nerves?

A

Intraabdominal surgery

73
Q

Where do the cell bodies is the preganglionic sympathetic fibers lie?

A

The interomediolateral (IML) horn of the spinal cord, also known as the lateral horn and Rexed lamina 7

74
Q

What is often an unintended consequence of a brachial plexus block? (Not lung related)

A

Horner syndrome

75
Q

What is Horner’s syndrome?

A

Very Homely PAM

V: vasodilation (flushing)
H: Horner’s
P: ptosis
A: anhidrosis
M: miosis

***horner’s is ALWAYs ipsilateral! Never contralateral.

76
Q

What’s another name for the stellar ganglion block?

A

Cervicothoracic ganglion

77
Q

How is the autonomic innervation of the adrenal gland unique?

A

It’s innervated by preganglionic sympathetic nerves (T5-T9) but there are no postganglionic nerves

78
Q

What is pheochromocytoma?

A

It’s a catecholamine-secreting rumor that usually arises from the adrenal gland or extra chromaffin tissue

79
Q

What is the classic triad of symptoms with pheochromocytoma?

A

Headache
Diaphoresis
Tachycardia

80
Q

What must you block in a patient with pheochromocytoma?

A

Must block alpha BEFORE you block beta (A before B)

81
Q

What are the common alpha antagonists used In pheochromocytoma?

A

Non-selective: phenoxybenzamine and phentolamine

Alpha 1 selective: doxazosin and prazosin

82
Q

What happens if you block beta receptors first in pheochromocytoma?

A

You can cause heart failure!

Beta 1 reduces inotropy and can precipitate CHF in a patient with an increased SVR

83
Q

What should you anticipate prior to removal of the catecholamine-secreting tumor In pheochromocytoma?

A

HTN, tachycardia, and hyperglycemia

***use nitro, clevidipine, nicardipine for HTN and short acting BB for tachycardia

84
Q

What should you anticipate following the removal of a pheochromocytoma tumor removal

A

After removal, no catecholamines are being released.

***expect hypotension and hypoglycemia

Choose NEO, NE, vaso

85
Q

What drugs should you avoid in pheochromocytoma?

A

> Histamine releasing agents: sux, Atracurium, morphine, Mivacurium

> indirect-acting sympathomimetics (ephedrine)

> SNS activators: desflurane, ketamine, pancuronium, and naloxone

86
Q

Stimulation of which receptor results in a transcellular potassium shift?

A

Beta-2

87
Q

How does SNS activation affect glucose?

A

Increases glucose

**stimulates hepatocytes to release glucose and potassium into the circulation.

***it also increases insulin from beta cells (to utilize glucose, you must have insulin)

88
Q

How does the SNS system affect potassium?

A

Initially, the liver causes an increase in serum potassium ~ this is short lived

*** when epi binds to beta 2 receptors on skeletal muscle and erythrocytes, it activated the Na/K pump and shifts potassium into the cells

89
Q

What are some things that push K+ into the cell?

A

Alkalosis
Beta-2 agonists
Theophylline
Insulin

90
Q

What are some things that shift K+ out of the cell (increase serum K)?

A

Acidosis
Cell lysis
Hyperosmolarity
Succinylcholine

91
Q

What does the efferent limb of the SNS pathway consist of?

A

Preganglionic ~ myelinated B fiber
POSTganglionic ~ nonmyelinated C fiber

92
Q

What are the five components to biological feedback loops?

A

> Sensor (monitors the environment and informs CNS of changes)
Afferent pathway (links the sensor to the CNS)
Control center (CNS ~ subcortical structures: hypothalamus, brainstem, spinal cord)
Efferent pathway (links the control center to the effector organ/tissue ~ usually a pre/post ganglionic fiber)
Effector organ/tissue (elicits a response to restore homeostasis; smooth muscle, cardiac muscle, glands)

93
Q

The ANS influences all tissues except what?

A

Skeletal tissue

94
Q

Which component of the feedback control arc compares and multiplies signals?

A

Control center

95
Q

Which control mechanism regulates short-term BP control?

A

Neural

**seconds to minutes
(ANS reflexes ~ mechanoreceptors respond to stretch)

96
Q

Which control mechanism regulates longer-term BP control?

A

Hormonal

Minutes, hours, even days!!
(RAAS, vasopressin, natriuretic peptides)

97
Q

What are the 6 cardiac reflexes?

A

“Big Booty Babes Choose Violence Only”

B: Bainbridge
B: Barorecptor
B: Bezold-Jarisch
C: Chemoreceptor
V: Vasovagal
O: Oculocardiac

98
Q

What is the best way to think about the baroreceptor reflex?

A

High-pressure arterial baroreceptor reflex

^ BP ~> decreased HR, contractility, and SVR

Decreased BP ~> ^ HR, contractility, and SVR

99
Q

How does chronic HTN affect the baroreceptor loop?

A

Increases the BP set point
**takes 1-3 days

100
Q

What are the two afferent pathways in the baroreceptor reflex?

A

Transverse aortic arch ~ VAGUS n. 10

Carotid bifurcation ~ carotid sinus (Hering’s n.) ~ GLOSSOPHARYNGEAL n. 9

101
Q

In the baroreceptor reflex arch, what is considered the “control center,” where sensory information is interpreted and an integrated response is formed?

A

Nucleus tract is solitaries (NTS) in the medulla

102
Q

What are two surgical procedures that affect the baroreceptor reflex arch?

A

> Carotid endarectomy ~ manipulation of the carotid bifurcation causes bradycardia
Mediastinoscopy ~ pressure from the scope causes bradycardia

103
Q

What is the spinal cord region of cardioaccerator fibers.

A

T1-T4

104
Q

How do volatile anesthetics affect the baroreceptor reflex?

A

Impair! ~ in dose-dependent fashion

**iso had mild B1 agonist properties so it impairs the reflex the LEAST

105
Q

How do IV anesthetic agents affect the baroreceptor reflex?

A

Propofol: impairs ~ Bradycardia
Ketamine: activates SNS ~ ^ HR (but it does have DIRECT myocardial depressant effects)
Etomidate: usually unchanged with a small decrease in SVR

106
Q

Which IV anesthetic preserves the baroreceptor reflex?

A

Thiopental

**causes a decrease in SVR with compensatory rise in HR

107
Q

How do vasodilator affect the baroreceptor reflex?

A

Hydralazine ~ preserves (decreased SVR with increase HR)

Nitroglycerin ~ preserves

108
Q

What do beta blockers affect the baroreceptor reflex?

A

May impair reflex! ~ may present a compensatory increase in HR in the setting of hypotension

109
Q

How do catecholamines affect the baroreceptor reflex?

A

> NE: preserved
Epi/dopamine/isuprel: NOT preserved
NEO: preserved ~ causes a compensatory bradycardia

110
Q

What other types of medications may impair the bark EP toe reflex arch?

A

CCB
Ace inhibitors
PDE inhibitors

111
Q

Which cardiac reflex is considered a “low-pressure cardiopulmonary baroreceptor reflex?”

A

Bainbridge reflex

112
Q

What does the Bainbridge reflex do?

A

Increases in HR caused by an increase in venous return

113
Q

During VOLUME LOADING, which reflex dominates?

A

Bainbridge prevails

114
Q

During VOLUME DEPLETION, which reflex prevails?

A

High-pressure Baroreceptor reflex dominates

115
Q

Which nerve is the afferent pathway in the Bainbridge reflex?

A

Vagus n.

116
Q

What is the CURRENT triad of the bezold-Jarisch reflex?

A

Brady cardia
Hypotension
Coronary dilation

117
Q

Where are the receptors in the Bezold-Jarisch reflex?

A

Chemo and mechanoreceptors in the LV wall

118
Q

What is the control center in the Bezold Jarish reflex?

A

NTS and medullary cardiovascular nuclei and centers

119
Q

What two instances can anesthetic providers elicit/see the Bezold-Jerisch reflex?

A

Spinal or epidural block

Shoulder surgery with regional anesthesia in sitting position

120
Q

The Bainbridge reflex does what?

A

Increases HR in the setting of venous congestion (preload is too high)

121
Q

What Bezold-Jarisch Reflex does what?

A

Slows the heart rate in the setting of profound hypovolemia (preload is too low)

122
Q

What is the strongest drive (stimulus) at the peripheral chemoreceptors is what?

A

Hypoxia

123
Q

What is the ACUTE CV response to hypoxemia?

A

Activation of the PNS ~ decreased HR, decreased Inotropy

124
Q

What is the CV response to persistent hypoxemia?

A

Sympathetic activation
Increased HR/inotropy ~ increased CO

125
Q

How does volatile anesthetic affect the chemoreceptor reflex?

A

Even subanesthetic (< 0.1 MAC) blunt the reflex

**opioids and nitrous oxide also affect this receptor in a dose-dependent fashion

126
Q

What is the vasovagal response?

A

Vasovagal syncope or Neurocardiogenic syncope ~ transient fall in perfusion pressure to the brain.

**basically autonomic nuclei cause massive stimulation of the parasympathetic system and abolition of SNS tone

127
Q

What can the Vasovagal reflex be triggered by?

A

Psychological stress
Peritoneal stretching or dissension

128
Q

Following a Vasovagal response, what may a person notice?

A

Oliguria ~ d/t the high levels of ADH

129
Q

What is the Oculocardiac reflex?

A

Traction on the extraocular muscles (especially medial rectus) ~ stimulate a pathway which leads to Bradycardia

130
Q

What is the afferent and efferent limb in the Oculocardiac reflex?

A

“5 and dime store”

Afferent: Trigeminal CN 5
Efferent: Vagus CN 10

131
Q

What is some common causes of the Oculocardiac reflex?

A

Strabismus surgery
Pressure on the globe
Ocular trauma
**retrobulbar block can cause or prevent the Oculocardiac reflex

132
Q

What is the clinical presentation of the Oculocardiac reflex?

A

Bradycardia
Hypotension
Junctional rhythm
AV block
Asystole

133
Q

What are some factors that worsen the Oculocardiac reflex?

A

Hypoxia
Hypercarbia
Light anesthesia

134
Q

How do you treat the Oculocardiac reflex?

A

Ask surgeon to remove stimulus
Administer 100% O2
Deepen anesthetic
Administer anticholinergic

135
Q

What happens when blood flow to the medullary vasomotor centers decreases enough to cause cerebral ischemia?

A

Massive SNS activation occurs

> immense vasoconstriction
profound increase in BP, often as high as the heart can possible create

136
Q

at what MAP does the CNS ischemic response become significant?

A

MAP < 50 mmHg

**it reaches its greatest degree of stimulation at a pressure of 15-20 mmHg

137
Q

What is Cushing reflex and Cushing triad?

A

Cushing reflex is a specialty type of CNS ischemic response that results from increased ICP

138
Q

What is Cushing triad?

A

Bradycardiac
Hypertension
Irregular resps (d/t brain stem compression)

139
Q

What is the thermogenesis reflex?

A

temperature reflex to maintain a homeothermic environment

140
Q

What area in the brian receives information regarding thermal signals?

A

Preoptic area (hypothalamus) ~ serves as control center

141
Q

Is piloerection effective in humans?

A

No! It’s effective in animals with fur.

142
Q

What is sweating controlled by?

A

Cholinergic fibers ~ these can be blocked by anticholinergics (remember the atropine acronym of being hot)

143
Q

How do general anesthetics affect thermogenesis reflex?

A

All of them impair reflex!

This can lead to hypothermia!

144
Q

What is another name for “max reflex?”

A

Synonymous with autonomic hyperreflexia

145
Q

Which cranial nerves are purely sensory?

A

1, 2, and 8

146
Q

Which cranial nerves are purely motor?

A

3, 4, 6, 11, and 12

147
Q

What are the 4 mixed sensory and motor nerves?

A

5, 7, 9, and 10

148
Q

What type of reflex is the bezold-jarisch?

A

Cardio-inhibitory!

**may play a cardioprotective reflex in response to noxious stimuli

149
Q

What does Beta 3 do?

A

Lipolysis

150
Q

Which receptor causes cerebral vasoconstriction?

A

M1

151
Q

What are examples of adrenergic agonists?

A

Epi, NE, dopamine

152
Q

what are examples synthetic catecholamines?

A

Isoproterenol, dobutamine

153
Q

What are examples of synthetic noncatecholamines?

A

Ephedrine, phenylephrine

154
Q

what are examples of selective beta-adrenergic agonists?

A

Albuterol, salmeterol

155
Q

What are examples alpha-2 agonists?

A

Clonidine and dexmedetomidine.

156
Q

What are examples of beta-1 and beta-2 antagonists?

A

Propranolol, esmolol

157
Q

What are examples of mixed function alpha and beta antagonists?

A

Labetalol, carvedilol

158
Q

What are examples of cholinergic agonists?

A

Nicotine, bethanechol, and physostigmine

159
Q

What are examples of antimuscarinics?

A

Atropine, scopolamine, glycopyrrolate

160
Q

What are examples of calcium channel blockers?

A

Verapamil and diltiazem

161
Q

What are examples of phosphodiesterase inhibitors?

A

MILRINONE and sildenafil

162
Q

What is an example of arginine vasopressin?

A

Vasopressin.

163
Q

What are direct vasodilators/nitro dilators?

A

Nitro/nitroglycerin/hydralazine

164
Q

What are examples of ace inhibitors?

A

Lisinopril, captopril, enalopril

165
Q

What are examples of ARBs?

A

Valsartan, olmesartan, losartan

166
Q

What are examples of anesthetic agents?

A

Volatile agents, propofol, and local anesthetics

Apex (47 decks)

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