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APEX > ANS Anatomy and Physiology > Flashcards

ANS Anatomy and Physiology Flashcards

1
Q

2 divisions of the Peripheral NS

A

Somatic and Autonomic (visceral)

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2
Q

Somatic nerves innervate?

A

Skeletal muscle and sensory skin

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3
Q

Autonomic Nerves Innervate?

A

Smooth muscle, cardiac muscle, glands

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4
Q

Afferent nerves transmit?

A

Sensory incoming

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5
Q

Efferent nerves transmit?

A

Motor outgoing

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6
Q

3 Divisions of the ANS

A

Sympathetic
Parasympathetic
Enteric

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7
Q

What is the big-picture function of the ANS?

A

Maintaining physiologic homeostasis

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8
Q

3 forms of extracellular signals and an example of each

A
  1. Chemical - hormones, neurotransmitters, drugs
  2. Electrical - membrane voltage
  3. Mechanical - pressure
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9
Q

3 Major categories of membrane-bound receptors

A
  1. ion channel
  2. G- protein-coupled
  3. Enzyme-linked
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10
Q

2 ways a G-protein coupled receptor works

A
  1. opens or closes ion-channel
  2. Activates or inhibits an enzyme inside the cell
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11
Q

What 2 compartments are intracellular receptors located?

A
  1. cytoplasm
  2. nucleoplasm
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12
Q

List the sequence of events of signaling through g-protein-coupled receptors

A

First messenger (Ligand)
GPCR
Effector
Second Messenger
Cellular Response

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13
Q

Name the three subunits of a GPCR

A

alpha beta gamma

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14
Q

What are the 5-second messengers we need to know

A
  1. cAMP
  2. cGMP
  3. DAG (diacylglycerolcerol)
  4. Inositol triphosphate (IP3)
  5. Calcium Ion
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15
Q

Which 2 G proteins turn on an effector?

A

Gs
Gq

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16
Q

Stimulation of which receptors increases phospholipase C activity?

A

Alpha-1
Vasopressin -1

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17
Q

How does the Gq-coupled protein affect its effector and second messenger?

A

Activates phospholipase C and activates IP3, DAG, Calcium

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18
Q

What is the effector for Gq-coupled proteins?

A

Phospholipase C

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19
Q

What is the effector for Gs and Gi-coupled proteins?

A

Adenylate Cyclase

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20
Q

How does the Gs-coupled protein affect its effector and second messenger?

A

Activates adenylate cyclase
Activates cAMP

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21
Q

How does the Gi-coupled protein affect its effector and second messenger?

A

Inhibits Adenylate Cyclase
Inhibits cAMP

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22
Q

What are the 6 Gq protein-coupled receptors

A

Alpha 1
Muscarinic 1
Muscarinic 3
Muscarinic 5
Vasopressin 1 (vasculature)
Histamine 1

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23
Q

What are the 4 Gi protein-coupled receptors?

A

Alpha 2
Muscarinic 2
Muscarinic 4
Dopamine 2 (presynaptic)

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24
Q

What are the 6 Gs protein-coupled receptors?

A

Beta 1
Beta 2
Beta 3
Dopamine 1 (post-synaptic)
Vasopressin 2 (renal-tubules)
Histamine 2

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25
Q

Nicotinic Receptors (ANS ganglia, NMJ & CBS) have what signal transduction?

A

Ion Channels

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26
Q

Sympathetic activation of the heart is caused by what receptor? What are the effects when that receptor is activated?

A

Beta 1
Positive Inotropic, Chronotropic, Dromotropic

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27
Q

What receptor causes the parasympathetic activation of the heart? What are the effects when that receptor is activated?

A

Muscarinic 2
Negative Inotropic, Chronotropic, Dromotropic

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28
Q

What receptor causes the sympathetic activation of the lungs? What are the effects when that receptor is activated?

A

Beta 2
Bronchodilation

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29
Q

What receptor causes the parasympathetic activation of the lungs? What are the effects when that receptor is activated?

A

Muscarinic 3
Bronchoconstriction
Increase in gland secretions

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30
Q

What receptor causes the sympathetic activation of the GI tract? What are the effects when that receptor is activated?

A

Alpha 1
Vasoconstriction
Sphincter Contraction

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31
Q

What receptor causes the parasympathetic activation of the GI tract? What are the effects when that receptor is activated?

A

Muscarinic 3
Increased Motility
Sphincter Relaxation
Increase Gland Secretion

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32
Q

What receptor causes the sympathetic activation of the Glands? What are the effects when that receptor is activated?

A

Alpha 1
Increased Sweating
Decreased Pancreatic Activity

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33
Q

What receptor causes the parasympathetic activation of the Glands? What are the effects when that receptor is activated?

A

M1, M3

Increased Salvation
Increased Lacrimation
Increase Pancreatic Activity

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34
Q

What receptor causes the sympathetic activation of the urinary tract? What are the effects when that receptor is activated?

A

Alpha 1, Beta 2

Bladder sphincter contraction
Increased Renin Secretion

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35
Q

What receptor causes the parasympathetic activation of the urinary tract? What are the effects when that receptor is activated?

A

M3

Bladder sphincter relaxation

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36
Q

What receptor causes the sympathetic activation of the skin? What are the effects when that receptor is activated?

A

Alpha 1
vasoconstriction

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37
Q

What receptor causes the sympathetic activation of the skeletal muscle? What are the effects when that receptor is activated?

A

Beta 2

Vasodilation

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38
Q

What receptor causes the sympathetic activation of the pupils? What are the effects when that receptor is activated?

A

Alpha 1
Dilation

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39
Q

What receptor causes the parasympathetic activation of the pupils? What are the effects when that receptor is activated?

A

M3
Constriction

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40
Q

What are 7 locations of alpha 1 receptors?

A

Nervous System
Vasculature
Renal Tubules
Pancreas
Platelets
Salivary Gland
GI Tract

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41
Q

Effects of alpha 2 stimulation on nervous System

A

decreased SNS tone
incresed PNS tone
- sedation, hypnosis, analgesia, antishivering

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42
Q

Effects of alpha 2 stimulation on vasculature

A

vasoconstriction

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43
Q

Effects of alpha 2 stimulation on renal tubules

A

inhibit ADH (diuresis)

44
Q

Effects of alpha 2 stimulation on pancreas

A

decreased insulin release

45
Q

Effects of alpha 2 stimulation on platelets

A

increased platelet aggregation

46
Q

Effects of alpha 2 stimulation on salivary glands

A

dry mouth

47
Q

Effects of alpha 2 stimulation on GI tract

A

decreased gut motility

48
Q

where in the CNS can you find alpha 2 receptors

A

medulla, locus coeruleus, spinal cord (dorsal horn)

49
Q

What G protein is coupled to presynaptic alpha 2 receptors

A

Gi
which means inhibition of adenylate cyclase which inhibits cAMP

50
Q

What three areas of a nerve are alpha 2 receptors found

A

presynaptic, post synaptic, and nonsynaptic (platelets)

51
Q

What occurs when alpha 2 on presynaptic nerves are stimulated (not rapid admin)

A

NE-releasing neurons in the CNS and PNS are inhibited by the Gi-coupled alpha 2 receptor

52
Q

What metabolizes cAMP to AMP

A

Phosphodiesterase 3 (PDE 3)

53
Q

cAMP is responsible for “turning on” a variety of?

A

protein kinases, that instruct cells to perform specific functions

54
Q

What is luistropy?

A

Rate of cardiac muscle relaxation

55
Q

How does cAMP augment myocardial performance?

A
  1. increases intracellular calcium and force of contraction
  2. Increased rate of relaxation. aka increased luistropy
56
Q

In vascular smooth muscle, cAMP produces?

A

Vasodilation and Decreased SVR

57
Q

What is a PDE3 Inhibitor we use?

A

Milrinone

58
Q

List 4 situations in which PDE 3 are useful:

A
  1. Beta blocker-induced myocardial depression
  2. Acute heart failure
  3. Unresponsiveness to IV catecholamines
  4. Anytime the combination of increased inotropy and reduced afterload is desired
59
Q

Which PDE is cAMP selective?

A

PDE 4

60
Q

Which PDE is cGMP selective

A

PDE 5

61
Q

Which PDE degrades both cAMP and cGMP

A

PDE 3

62
Q

3 endogenous catecholamines

A

norepi
epi
dopamine

63
Q

What amino acid is the main precursor for catecholamine synthesis

A

tyrosine

64
Q

NE inhibits its release by ?

A

stimulating the presynaptic alpha 2 receptor

65
Q

NE can augment its release by?

A

Stimulating the presynaptic beta 2 receptor

66
Q

How is 80% of NorEpi removed from the synaptic cleft?

A

Reuptake - which is an active processes requiring energy

67
Q

What is the primary neurotransmitter in the Parasympathetic NS

A

ACh

68
Q

Ach stimulates what receptors

A

cholinergic

69
Q

2 families of cholinergic receptors

A

nicotinic and muscarinic

70
Q

3 types of nicotinic receptors

A

Ganglionic (Nn)
Neuronal CNS (Nn)
Skeletal Muscle (Nm)

71
Q

Where are Nn types of ACh receptors found

A

PNS ganglia
SNS ganglia
CNS

72
Q

Where are Nm type Ach receptors found

A

Neuromuscular Junction

73
Q

What ion is an antagonist of Ach at the presynaptic nerve terminal?

A

Magnesium. explains why magnesium can cause muscle weakness and acts synergistically with neuromuscular. blockers

74
Q

How many paired sympathetic ganglia are there?

A

22

75
Q

Which rami are found at all levels of the spinal cord?

A

grey rami

76
Q

List the 4 abdominal prevertebral (peripheral) plexuses?

A

Celiac, Aortic, Superior hypogastric, inferior hypogastric

77
Q

What is horner syndrome

A

characterized by ipsilateral ptosis, miosis, anhydrosis, flushing of skin, nasal congestion, and enophthalmos

78
Q

What is the stellate ganglion (cervicothoracic)

A

confluence of the inferior cervical ganglion and T1 ganglion

79
Q

All preganglionic sympathetic neurons (B fibers) arise from?

A

T1-L2

80
Q

Stellate ganglion provides SNS innervation to?

A

the ipsilateral head, neck, and upper extremity

81
Q

The stellate ganglion is often blocked for treatment of?

A

upper extremity dystrophy, complex regional pain syndrome, to increase blood flow to the upper extremity, or to provide relief from intractable post-MI pain

82
Q

Stellate ganglion blockade is often an unintended consequence of?

A

brachial plexus block

83
Q

Autonomic innervation of the adrenal cortex

A

Preganglionic sympathetic nerves (T5-T9)

NO post ganglionic nerves

84
Q

How much epi is secreted by the adrenal medulla. what is the percent of total catecholamine output?

A

0.2 mcg/kg/min 80%

85
Q

Classic triad of symptoms for Pheochromocytoma

A

headache, tachycardia, diaphoresis

85
Q

How much norepi is secreted by the adrenal medulla. what is the percent of total catecholamine output?

A

0.05 mcg/kg/min 20%

85
Q

In the hemodynamic management for a patient with Pheochromocytoma, you must?

A

You must alpha block before you beta block or risk causing heart failure

86
Q

What medications should be avoided if there are suitable alternatives when caring for a Pheochromocytoma pt

A

Histamine - releasing agents: Succinylcholine, atracurium, mivacurium, morphine
Indirect-Acting Sympathomimetic Agents: Ephedrine
SNS activators: Desflurane, Ketamine, Pancuronium, Naloxone

87
Q

SNS activation stimulates hepatocytes to release?

A

Glucose and potassium into systemic circulation. it also increases insulin output from pancreatic beta cells (so we can use that glucose)

88
Q

2 phases of potassium response to following SNA stimulation of hepatocytes

A
  1. K released from liver. short term effect.
  2. SNS activation causes adrenal medulla to release catecholamines. Epi binds to Beta 2 receptors on skeletal muscle and erythrocytes, which activates the Na/K pump and shifts K into cells.
89
Q

4 factors that shift potassium into cells?

A
  1. Alkalosis
  2. Beta 2 Agonists (Epi, Albuterol)
  3. Theophyulline
  4. Insulin
    (temp???)
90
Q

4 factors that shift potassium out of cells?

A

Acidosis (H+/K+ exchanger)
Cell lysis
Hyperosmolarity
Succinylcholine

91
Q

Preganglionic nerves in the sympathetic NS are?

A

myelinated B fibers

92
Q

The efferent limb of the ANS pathway consists of 2 nerve fibers:

A

preganglionic fiber = myelinated B fiber
postganglionic fiber = nonmyelinated C fiber

93
Q

key points of integration between ANS and endocrine system

A

RAAS
Vasopressin (antidiuretic hormone)
Glucocorticoids
Insulin

94
Q

the ANS influences all tissues except?

A

skeletal muscle fibers

95
Q

central blood volume and arterial blood pressure are normally maintained within narrow limits by?

A

neural and hormonal mechanisms

96
Q

What are the 6 cardiac reflexes
Mnemonic “Three Bees in the CV … Ouch”

A

Baroreceptor
Bainbridge
Bezold-Jarisch
Chemoreceptor
Vasovagal
Oculocardiac

97
Q

Baroreceptor response to increased BP

A

Decreased HR, contractility, SVR

98
Q

Baroreceptor response to decreased BP

A

Increased HR, contractility, SVR

99
Q

What two locations are baroreceptors located in? What nerves correspond and transmit their action potentials?

A
  1. Tranverse Aortic Arch - Vagus N. (CN 10)
  2. Carotid Bifurcation - Carotid Sinus - Glossopharyngeal N. (CN 9)
100
Q

Name 2 procedures that may produce bradycardia by the baroreceptor reflex

A
  1. Carotid Endarterectomy
  2. Mediastinoscopy
101
Q

Activation of the Bezold-Jarisch reflex manifests as:

A

Bradycardia, hypotension, coronary artery vasodilation,

Slows the heart in the setting of profound hypovolemia. Idea is to slow to optimize filling

102
Q

What is the sensor for the Bezold-Jarisch reflex

A

Ventricle chemo and mechanoreceptors. Low preload. Slows the heart in the setting of profound hypovolemia.

Idea is to slow to optimize filling

103
Q

What is the sensor for the Bainbridge reflex?

A

preload too high. atrial mechanoreceptors.

Increase HR to not allow blood to pool

104
Q

What is the primary area for relay of afferent chemoreceptor and baroreceptor information from the vagus and glossopharyngeal nerves?

A

Nucleus Tractus Solitarius (in medulla)

105
Q

What is the primary neurotransmitter of the parasympathetic nervous system?

A

Ach

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