Autonomic Flashcards

1
Q

What is the general set up of neurons in autonomic nervous system as far as myelination of pre/post-ganglionic axons and the transmitter/receptor types?

A

Preganglionic myelinated axons use acetylcholine as their transmitter via ganglion type **(a3/B4) nicotinic receptors **
Then post-ganglionic unmyelinated axons which use either Ach or NE on corresponding cholinergic or adrenergic receptors

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2
Q

Where are sympathetic preganglionic neurons located?

A

From T1-L2 segments in lamina VII (7) forming the intermediolateral column

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3
Q

Interruption of supraspinal descending autonomic pathways above what level results in massive unpatterned reflex actication of sympathetic preganglionic neurons

A

Above T5 (about midway between T1-L2)

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4
Q

Sympathetic
Paravertebral ganglia innervate______
Prevertebral ganglia innervate ____

A

Paravertebral ganglia innervate all tissues and organs except those in the abdomen, pelvis, and perineum; prevertebral ganglia innervate the viscera and blood vessels of the abdomen and pelvis.

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5
Q

What is the primary neurotransmitter from sympathetic postganglionic nerves? What is the exception?

A

Norephinephrine
The exception is sympathetic ganglion neurons innervating the** sweat glands** which are cholinergic

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6
Q

Describe the impacts of norepinephrine and epinephrine on the following adrenoceptors:
a1 =

A

a1 = α1 receptors mediate excitation of the smooth muscle in blood vessels, iris (pupil dilator), vas deferens, bladder neck, and internal sphincter of the rectum.

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7
Q

Describe the impacts of norepinephrine and epinephrine on the following adrenoceptors:
a2 =

A

α2 receptors are located mostly in presynaptic terminals, and their main effect is presynaptic inhibition of the release of norepinephrine from sympathetic terminals (inhibitory autoreceptors) or other neurotransmitters from parasympathetic or afferent terminals

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8
Q

Describe the impacts of norepinephrine and epinephrine on the following adrenoceptors:
b1 =

A

β1 receptors are present in the heart and stimulate automatism of the sinus node, excitability of the His-Purkinje system, and contractility of the myocardium.

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9
Q

Describe the impacts of norepinephrine and epinephrine on the following adrenoceptors:
b2 =

A

the β2 receptors elicit smooth muscle relaxation, including vasodilation, bronchodilation, and relaxation of smooth muscle in the bladder and uterus

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10
Q

Describe the location of preganglionic parasympathetic neurons?

A

General visceral efferent column of the brainstem and at the sacral spinal cord segments S2-S4

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11
Q

Discuss the functional division of the parasympathetic system output?

A

1) cranial effectors
2) outputs mediated by vagus n. to thoracic and abdominal viscera
3) sacral preganglionic outputs to bladder, rectum, and sexual organs

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12
Q

What is the parasympathetic function of CN III?

A

Pupillary constriction and accomodation reflexes

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13
Q

What is the parasympathetic function of CN VII?

A

Pterygopalatine aka sphenopalatine ganglion to elicit LACRIMATION and cranial VASODILATION and to submaxillary and submandibular ganglia to elicit SALIVATION

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14
Q

What is the parasympathetic function of CN IX?

A

The glossopharyngial nerve innervates otic ganglion that promotes parotid gland SECRETION

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15
Q

What is the parasympathetic function of CN X?

A

Vagus nerve provides preganglionic innervation to autonomic ganglia in thorax and abdomen

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16
Q

Describe the division between vagal preganglionic neurons from the:
Dorsal motor nucleus of the vagus vs nucleus ambiguus

A

Preganglionic neurons from
Dorsal motor nucleus - innervate ganglia of cardiac, pulmonary, and enteric nervous system plexuses

Nucleus ambiguus - vagal output to cardiac ganglion neurons controlling the sinus node

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17
Q

Describe ACh muscarinic receptors in target organs:
M1
M2
M3

A

M1 - excitatory
M3 - excitatory - MOST of the excitatory effects of Ach on the visceral targets of parasympathetic neurons including smooth muscle contraction, exocrine gland secretion, endothelial synthesis or NO, and sweat gland
M2 - inhibatory - (presynaptic) -decrease automatism of sinus note and AV conduction

18
Q

Besides ACh, what other neurotransmitters mediate the parasymathetic output?

A

Nitric oxide and vasoactive intestinal peptide

NO major mediator for cranial vasodilation and penile excretion

19
Q

Name the pupil
Sympathetic receptor __

Parasympathetic receptor __

A

Sympathetic - dilation - a1

Parasympathetic - constriction and accomodation - M3

20
Q

Salivary and lacrimal glands action/receptor:
Sympathetic
Parasympathetic

A

Sympathetic: inhibition via ?a2
Parasympathetic: stimulation via M3 and vasoactive intestinal polypeptide receptors

21
Q

Heart action/receptor:
Sympathetic
Parasympathetic

A

Sympathetic - stimulation B1
Parasympathetic - Inhibition M2

22
Q

Bronchi action/receptor:
Sympathetic
Parasympathetic

A

Sympathetic - dilation B2
Parasympathetic - Constriction M3

23
Q

What is the etymology of adrenergic?

A

1930s from adrenaline + Greek -ergon ‘work’ + -ic.
Adrenaline = epinephrine

24
Q

Describe skeletal muscle action/receptor
Sympathetic
Parasympathetic

A

Sympathetic - 2 actions -
constriction via a1
Dilation via b2

Parasympathetic - NA

25
Q

Describe skin vessel action/receptor
Sympathetic
Parasympathetic

A

Sympathetic
constriction via a1
dilation? via NO?

Parasympathetic NA

26
Q

Describe cranial nerve and visceral vessel action/receptor
Sympathetic
Parasympathetic

A

Sympathetic: constriction via a1
Parasympathetic: dilation via NO and vasoactive intestinal polypeptide

27
Q

Describe sweat gland action/receptor
Sympathetic
Parasympathetic

A

Sympathetic: stimulation via M3
(** remember that this is an exception to the rule, only cholinergic sympathetic neurons in the system)

Parasympathetic: NA

28
Q

GI motility action/receptor

A

Sympathetic: inhibition (B2)
Parasympathetic: contraction (M3) and relaxation (NO, VIP)

29
Q

GI secretion action/receptor

A

Sympathetic: inhibition a2
Parasympathetic: gastric acid secretion (M1), intestinal secretion (M3, VIP)

30
Q

Bladder detruser action/receptor
Sympathetic
Parasympathetic

A

Sympathetic: inhibition b2, b3
Parasympathetic: stimulation M3

31
Q

Bladder neck action/receptor

A

Sympathetic: stimulation a1
Parasympathetic: inhibition NO

32
Q

Rectal smooth muscle action/receptor

A

Sympathetic: inhibition b2
Parasympathetic: stimulation M3

33
Q

Erectile tissue action/receptor

A

Sympathetic: constriction a1
Parasympathetic: dilation NO

34
Q

Vas deferens action/receptor

A

Sympathetic: contraction a1
Parasympathetic: NA

35
Q

What is the receptor which forms the relay between central and peripheral components of the autonomic nervours system?

A

a3/b4 nicotinic ganglionic receptor

this is important as there can be conditions of autoimmunity targeting the nicotinic ganglionic acetylcholine receptor (autoantibody α3-AChR Ab) which causes autoimmune dysautonomia that is either subacute or insidious in onset

36
Q

What is the receptor which forms the relay between central and peripheral components of the autonomic nervours system?

A

a3/b4 nicotinic ganglionic receptor

this is important as there can be conditions of autoimmunity targeting the nicotinic ganglionic acetylcholine receptor (autoantibody α3-AChR Ab) which causes autoimmune dysautonomia that is either subacute or insidious in onset

37
Q

What is the normal SBP, DBP, and HR response to standing?

A

In rseponse to standing baroreflex is activated and:
Systolic blood pressure falls 5-10 mmHg
Diastolic blood pressure rises 5-10 mmHg
Heart rate rises 10-20 beats/min

38
Q

Definition of orthostatic blood hypotension

A

sustained drop in blood pressure of:
at least 20 mm Hg systolic and/or 10 mm Hg diastolic that occurs within 3 minutes of active standing or head-up tilt

during tilt table testing sometimes more strict criteria (30mmHg systolic or 15 mmHg diastolic) is used as the passive maneuver of tilt testing doesn’t activate lower limb “muscle pump” thus more blood pooling in lower limbs

39
Q

General definition of Postural Tachycardia Syndrome

A

a disorder in which patients frequently experience symptoms of orthostatic intolerance in response to postural stressors despite autonomic reflexes that are generally preserved

The hallmark of the disorder is an excessive rise in HEART RATE in response to standing; however, unlike in classic autonomic failure, blood pressure does not fall.

40
Q

Diagnostic criteria of POTS

A

POTS is defined as a symptomatic and sustained heart rate increment of 30 beats/min or more within 10 minutes of standing or head-up tilt in the absence of orthostatic hypotension; the standing heart rate is often 120 beats/min or higher.4 For individuals 12 to 19 years of age, the required increment is at least 40 beats/min.5

41
Q

Definition of orthostatic intolerance

A

Orthostatic intolerance, then, is the inability to tolerate upright posture because of symptoms of cerebral hypoperfusion or sympathetic activation, or both, which are relieved with recumbency.

42
Q

What is the ratio of women:men with POTS?

A

5:1