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PHRM 100 – APPP > APPP 11: Peripheral Nervous System and Autonomic Nervous System > Flashcards

APPP 11: Peripheral Nervous System and Autonomic Nervous System Flashcards

1
Q

What is the nervous system divided into anatomically?

A
  • peripheral nervous system (PNS)
  • central nervous system (CNS)
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2
Q

What is the PNS divided into?

A
  • autonomic nervous system (involuntary)
  • somatic nervous system (voluntary)
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3
Q

What is the autonomic nervous system divided into?

A
  • parasympathetic nervous system
  • sympathetic nervous system
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4
Q

What is the somatic nervous system divided into?

A
  • sensory
  • motor
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5
Q

How many nerves does the PNS have?

A
  • 12 cranial nerves (ventral surface of the brain)
  • 31 spinal nerves
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6
Q

Are nerves of the PNS myelinated (formed by surrounding Schwann cells) or unmyelinated?

A

can be either

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7
Q

What type of information do spinal nerves of the PNS contain?

A

both afferent and efferent information

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8
Q

What type of information do cranial nerves of the PNS contain?

A

only afferent information

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9
Q

What does the somatic nervous system of the PNS innervate?

A

skeletal muscle

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10
Q

What does the autonomic nervous system of the PNS innervate?

A
  • glands
  • neurons of the gastrointestinal tract
  • cardiac and smooth muscles of glandular tissue
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11
Q

What is cranial nerve I?

A

olfactory nerve

  • smell
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12
Q

What is cranial nerve II?

A

optic nerve

  • vision
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13
Q

What is cranial nerve III?

A

oculomotor nerve

  • control of eye movement – precise movement
  • pupil constriction – focusing
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14
Q

What is cranial nerve IV?

A

trochlear nerve

  • control of eye movement – move down and out
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15
Q

What is cranial nerve V?

A

trigeminal nerve – 3 branches (V1, V2, V3)

  • touch, pain
  • muscles for chewing
  • V1: general sensory innervation to cornea, bridge of nose, scalp, and forehead
  • V2: sensory innervation to the nasal cavity, sinuses, and maxillary teeth
  • V3: sensory innervation of the lower part of the face (tongue, mandibular teeth, motor innervation of muscles of mastication)
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16
Q

What is cranial nerve VI?

A

abducens nerve

  • control of eye movement – directs pupil laterally
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17
Q

What is cranial nerve VII?

A

facial nerve

  • taste – anterior 2/3 of tongue
  • sound
  • facial expression, submandibular and sublingual salivary glands
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18
Q

What is cranial nerve VIII?

A

vestibulocochlear nerve

  • hearing
  • balance – equilibrium
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19
Q

What is cranial nerve IX?

A

glossopharyngeal nerve

  • taste – posterior 1/3 of tongue
  • gag reflex
  • swallowing
  • also motor innervation to parotid gland (saliva)
  • also somatosensory information from tongue, tonsils, pharynx
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20
Q

What are the 5 tastes?

A
  • sweet
  • sour
  • bitter
  • salty
  • umami (amino acid)
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21
Q

What is cranial nerve X?

A

vagus nerve

  • has the most extensive distribution in the body
  • supplies parasympathetic innervation (digestion, breathing, heart rate)
  • slows heart reate
  • increases secretions
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22
Q

What is cranial nerve XI?

A

spinal accessory nerve

  • head movement – head turning
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23
Q

What is cranial nerve XII?

A

hypoglossal nerve

  • tongue movement
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24
Q

What is the autonomic nervous system involve in?

A
  • arousal (fight or flight), sympathetic
  • calm (relax and digest), parasympathetic
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25
Q

What are the cranial nerves involved in the parasympathetic nervous system?

A
  • oculomotor (III)
  • facial (VII)
  • glossopharyngeal (IX)
  • vagus (X)
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26
Q

Which spinal nerves are involved in the sympathetic nervous system?

A
  • thoracic
  • lumbar
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27
Q

Describe the 2-neuron system of the autonomic nervous system.

A
  • cells of origin lie within the CNS
  • synapse occurs in the autonomic ganglia located outside the CNS
  • preganglionic fibre utilizes a neurotransmitter to signal the postganglionic fibre
  • postganglionic fibre uses a neurotransmitter to signal the effector organ
  • these two neurotransmitters are not always the same
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28
Q

Where is the ganglia and what is the major neurotransmitter of the parasympathetic division?

A
  • parasympathetic ganglia are usually located in or near target organs
  • major neurotransmitter is acetylcholine
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29
Q

What is a result of parasympathetic activation

A
  • slows heart rate
  • decreases blood pressure
  • constricts pupils
  • stimulates digestive system activity
  • promotes emptying of bladder and rectum
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30
Q

Where is the ganglia and what is the major neurotransmitter of the sympathetic division?

A
  • sympathetic ganglia are usually located in proximal ganglion
  • major neurotransmitter is acetylcholine and norepinephrine
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31
Q

What is a result of sympathetic activation?

A
  • increases heart rate
  • increases blood pressure
  • dilates pupils
  • decrease digestive system activity
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32
Q

What are the neurotransmitters of the ANS and what effect do they have?

A

acetylcholine and norepinephrine

  • both can have excitatory and inhibitory actions
  • mode of action depends on the receptor present on the target neuron or tissue
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33
Q

What are nicotinic receptors of the ANS and how do they work?

A
  • ligand-gated ion channels
  • responsive to ACh
  • activation always causes a rapid increase in cellular permeability to Na+ and Ca2+
  • depolarization and excitation
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34
Q

What are muscarinic receptors of the ANS and how do they work?

A
  • there are 5 distinct subtypes, each produced by a different gene – these variants have distinct anatomic locations in the periphery and CNS and differing chemical specificities
  • are metabotropic receptors (GPCRs) – can inhibit or excite postsynaptic neurons depending on their coupling to G-protein α-subunits
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35
Q

What happens when a signaling molecule binds to a G-Protein Coupled Receptor (GPCR)?

A

results in G protein activation, which in turn triggers the production of any number of second messengers

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36
Q

Is the Gs protein family excitatory or inhibitory?

A

excitatory

37
Q

Is the Gi protein family excitatory or inhibitory?

A

inhibitory

38
Q

Is the Gq protein family excitatory or inhibitory?

A

excitatory

39
Q

Is the G12 protein family excitatory or inhibitory?

A

excitatory

40
Q

Muscarinic Receptors

M1

  • location
  • postreceptor mechanism
A
  • location: nerves
  • postreceptor mechanism: IP3, DAG cascade
41
Q

Muscarinic Receptors

M2

  • location
  • postreceptor mechanism
A
  • location: heart, nerves, smooth muscle
  • postreceptor mechanism: inhibition of cAMP production, activation of K+ channels
42
Q

Muscarinic Receptors

M3

  • location
  • postreceptor mechanism
A
  • location: glands, smooth muscle, endothelium
  • postreceptor mechanism: IP3, DAG cascade
43
Q

Muscarinic Receptors

M4

  • location
  • postreceptor mechanism
A
  • location: CNS
  • postreceptor mechanism: inhibition of cAMP production
44
Q

Muscarinic Receptors

M5

  • location
  • postreceptor mechanism
A
  • location: CNS
  • postreceptor mechanism: IP3, DAG cascade
45
Q

Which muscarinic receptors are associated with acetylcholine?

A
  • M1
  • M4
46
Q

What is acetylcholine?

A

neurotransmitter released at both the target organs of primarily the parasympathetic system, but also the sympathetic system, that act on muscarinic receptors

47
Q

Which muscarinic receptors cause excitation?

A

M1, M3, and M4

  • phosphotidyl inositol
  • IP3, DAG
48
Q

Which muscarinic receptors cause inhibition?

A

M2 and M4

  • adenylyl cyclase
  • cAMP
49
Q

What is norepinephrine?

A

neurotransmitter released at most sympathetic postganglionic neuroeffector sites

50
Q

What receptors does norepinephrine act via?

A
  • alpha receptors – α1, α2
  • beta receptors – β1, β2, β3
51
Q

How do α1 receptors work?

A
  • increase 1,4,5-triphosphate (IP3) and diacylglycerol (DAG)
  • IP3 promotes release of Ca2+ from intracellular stores
  • DAG activates protein kinase C
  • EXCITATION
52
Q

How do α2 receptors work?

A
  • inhibit adenylyl cyclase
  • INHIBITION
53
Q

How do β receptors work?

A
  • β1 increases cAMP – ie. heart
  • β2 increases cAMP – ie. bronchial smooth muscle
  • β3 increases cAMP – ie. adipose tissue, bladder
  • tissue specific actions: heart, β receptor activation increases the influx of calcium across the cell membrane and its sequestration inside the cell – increases force of contraction
54
Q

Sympathetic vs. Parasympathetic Division

Cell of Origin (Pre-Ganglionic Neuron)

A
  • sympathetic: thoracic and upper lumbar spinal cord
  • parasympathetic: brainstem (cranial nerves) and sacral spinal cord
55
Q

Sympathetic vs. Parasympathetic Division

Number of Nerve Fibres

A
  • sympathetic: many
  • parasympathetic: few – vagus (X) nerve is the major nerve of this division
56
Q

Sympathetic vs. Parasympathetic Division

Cell of Origin

A
  • sympathetic: short axon
  • parasympathetic: long axon
57
Q

Sympathetic vs. Parasympathetic Division

Ganglion Location

A
  • sympathetic: near spinal cord
  • parasympathetic: near organ
58
Q

Sympathetic vs. Parasympathetic Division

Ganglion Neuron

A
  • sympathetic: long axon
  • parasympathetic: short axon
59
Q

Sympathetic vs. Parasympathetic Division

Major Neurotransmitter

A
  • sympathetic: acetylcholine and norepinephrine
  • parasympathetic: acetylcholine
60
Q

Sympathetic vs. Parasympathetic Division

Function

A
  • sympathetic: fight or flight, arousing
  • parasympathetic: rest and digest, calming
61
Q

Lung Function

What modulates airway tone?

A

vagus nerve

62
Q

Lung Function

What happens in patients with asthma, COPD, chronic cough?

A
  • in the airways, acetylcholine is released from efferent endings of the vagus nerve fibre
  • ACh acts on M3 receptors – stimulates muscle cells to contract
  • results in high constriction
  • muscarinic antagonists block this effect – less constriction
63
Q

What is syncope?

A

fainting or passing out, temporary and sudden loss of consciousness

  • caused by a temporary drop in blood pressure or drop in heart rate – temporary drop in the amount of blood that flows to the brain
64
Q

What are the causes of syncope?

A
  • age-related cardiovascular changes – prevalence of syncope increases with age (> 20% in ages above 75)
  • neural-mediated etiologies
65
Q

Who is at risk for syncope?

A
  • older adults that have reduced vascular tone
  • people who overreact to certain triggers such as the sight of blood or extreme emotional distress
  • sympathetic withdrawal and vagus nerve overstimulation, excess acetylcholine release
66
Q

Describe who syncope occurs.

A
  • sympathetic withdrawal and vagus nerve overstimulation, excess acetylcholine released
  • heart rate slows and blood vessels dilate, making it harder for blood to defeat gravity and be pumped to the brain
  • decrease in blood flow to the brain
  • brain is deprived of oxygen
  • loss of consciousness/fainting episode

(body is trying to restore blood pressure)

67
Q

Syncope has also been reported in people after vaccination.

A
  • fainting is more common in adolescents than in children or adults – thus is more common after vaccination with HPV, MCV4, and Tdap
  • immediate fainting episodes following vaccination procedures is triggered by pain or anxiety, not the contents of the vaccines
  • while not serious, falling is the primary concern
  • prevent falls by having patients lie down or sit during the procedure
  • clinicians can give patients drinks and snacks to prevent some fainting
  • patients who faint after vaccination will recover after a few minutes, and clinicians should observe patients for at last 15 minutes after vaccination (recommendation of the CDC)
68
Q

What drugs are commonly implicated in syncope?

A
  • agents that reduce blood pressure – ie. antihypertensives, diuretics, nitrates
  • serotonin agonists
69
Q

What are the treatments for syncope?

A
  • elderly: modifying or discontinuing medications known to cause syncope is often the only necessary intervention
  • serotonin antagonists (ie. fluoxetine) have been reported to be effective
70
Q

What is dopamine β hydroxylase deficiency?

A

a rare genetic syndrome characterized by the complete absence of norepinephrine in the peripheral and central nervous system

  • deficiency in the enzyme that converts dopamine to norepinephrine
  • results in progressive sympathetic denervation, but normal cholinergic innervation
71
Q

What is the only effective treatment for dopamine β hydroxylase deficiency?

A

involves administration of the drug L-threo-3,4-dihydroxyphenylserine (DOPS, droxidopa)

  • DOPS is converted directly into NE via a decarboxylase, thereby bypassing DβH
72
Q

What nerves does the somatic nervous system (voluntary nervous system) contain?

A
  • afferent nerves made of sensory neurons that inform the central nervous system about our 5 senses
  • efferent nerves which contain motor neurons responsible for voluntary movements, such as walking or lifting an object
73
Q

Where are cell bodies of the SNS located?

A

either in the brainstem or the spinal cord

  • extremely long course as they do not synapse after they leave the CNS until they are at their termination in skeletal muscle
74
Q

Autonomic Nervous System

Adenoreceptors

A
75
Q

What type of receptors does the SNS have?

A

nicotinic receptors

76
Q

SNS – Acetylcholine

A
  • influx of Na+ changes membrane potential
  • Ca2+ channels at the sarcoplasmic reticulum (SR) open and leads to an increase in cytoplasmic Ca2+
  • Ca2+ binds troponin, actin active site is exposed, myosin binds and pulls actin filaments
77
Q

What are the nerves in the sensory system?

A

afferent nerves made of sensory neurons inform the nervous system about our 5 senses

78
Q

Sensory System

What is the specificity theory?

A

sensory neurons are sensitive to only one form of stimulation and encode only one perceptual quality

79
Q

Sensory System

What do mechanoreceptors sense?

A

tactile or discriminative touch

80
Q

Sensory System

What do thermoreceptors sense?

A

thermal or temperature sense

81
Q

Sensory System

What do chemoreceptors sense?

A

itch (and other senses)

82
Q

Sensory System

What do nociceptors sense?

A

pain

83
Q

Sensory System

Describe sensory fibres

A

nerve fibres contain afferent fibres of varying conduction velocities that have specific sensory functions

84
Q

Sensory System

What are the 2 types of cutaneous mechanoreceptors?

A
  • hair follicle afferents
  • Merkel cells
85
Q

Sensory System

Describe hair follicle afferents.

A
  • detect light touch
  • rapidly adapting (send information related to changing stimuli)
86
Q

Sensory System

Describe Merkel cells.

A
  • slowly adapting (send information about ongoing stimulation)
  • important for spatial resolution, pressure sensation, and roughness
87
Q

Sensory System

Describe thermal sensitivity.

A
  • highest on face, more sensitive to cold than heat – cold fibres activated with very small change in temperature
  • cold-specific – mostly C-fibres in humans
  • cold allodynia – lower cold pain threshold – can be a symptom of peripheral neuropathies due to chemotherapy, a consequence of stroke
88
Q

Sensory System

Describe cold sensation

A
  • rare cold fibres are also activated by noxious heat (ie. severe burn) – paradoxical cold sensation produced by heat
  • menthol activates cold fibres
89
Q

Sensory System

Describe itch (pruritus).

A
  • frequently occurring, but poorly understood somatosensory experience
  • an actual or perceived disruption to the skin that produces a desire to scratch
  • scratching can often lessen or remove the itch sensation
  • itch is now considered an independent sensation from pain, although until recently it was felt to be part of the pain continuum
  • associated with numerous allergic diseases – ie. atopic eczema
  • itch is proposed to be transmitted from the skin to the spinal cord by C fibres (unmyelinated, < 2 m/s)
  • broadly categorized as having either a histamine-dependent (acute) or histamine-independent (chronic) pathogenesis
  • acute itch is responsive to typical antihistmaines, but chronic itch is not

PHRM 100 – APPP (22 decks)

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