Autonomic Flashcards
Adrenergic Receptors Definition? Responsible nervous system? Responding neurotransmitters? Types?
Definition -Adrenergic receptors are autonomic receptors that bind to adrenaline and noradrenaline. Nervous System -Sympathetic Neurotransmitters -Adrenaline and noradrenaline Types -Alpha and beta receptors
Cholinergic Receptors Definition? Responsible nervous system? Responding neurotransmitters? Types?
Definition -Cholinergic receptors are autonomic receptors that bind to acetylcholine Nervous System -Parasympathetic Neurotransmitters -Acetlycholine Types -Nicotinic and Muscarinic receptors
Drugs that act on the alpha and beta receptors affect function of ________ nervous system
Sympathetic
Acetylcholine (ACh) is the neurotransmitter of what nervous system?
What receptors binds with ACh?
- Parasympathetic (PNS)
- Cholinergic receptors
What do cholinergic drugs do to the parasympathetic nervous system?
What do anticholinergic drugs do to it?
- Mimic the PNS
- Suppress the PNS
Norepinephrine is the neurotransmitter of what nervous system?
What receptors bind with Norepinephrine?
- Sympathetic (SNS)
- Adrenergic receptors
What do adrenergic agonists do to the sympathetic nervous system?
What do alpha and beta adrenergic blockers do?
- Mimic the SNS
- Suppress the SNS
The nervous system is diveded into _______ and ________.
CNS and PNS
The PNS is divided into ______ and ________.
Autonomic (ANS) and Somatic nervous (SNS) systems
ANS is divided into ______ and _______.
Sympathetic and Parasympathetic
Somatic is divided into _______ and _______.
Sensory (afferent)and Motor (efferent)
The somatic nervous system deals primarily with ________ control.
It also employs ________ neuron to reach effector tissue.
- voluntary
- a single
The cranio and sacral regions are for _______ while the thoracic and lumbar are for ________.
- parasympathetic
- sympathetic
How many neurons link the CNS to the effector organ in the autonomic nervous system?
Two neurons
-preganglionic fiber
-postganglionic fiber
(postganglion is linked to the effector organ)
What does the somatic nervous system act on?
What does the autonomic nervous system act on?
- Skeletal muscle
- Cardiac and smooth muscle, glands
Is the pre or post ganglionic fiber longer in the sympathetic division?
Parasympathetic division?
- Post
- Pre
Where do preganglionic fibers arise from?
-Brain or spinal cord
There are both ______ and ________ prevertebral ganglia.
Paired and unpaired
Where do postganglionic fibers arise and go?
extend from ganglia to the effector tissue
CN10 carries __% of efferent component of the entire parasympathetic division.
75%
3,7, and 9 also carry some parasympathetic ganglionic neurons
Where are terminal ganglia generally located?
In or near the innervated organ
There is minimal branching in _____ and extensive branching in the ___________
- Parasympathetic
- Sympathetic
Parasympathetic response is ________ while sympathetic is ___________
- localized
- dispersed
T or F. Virtually every tissue in the body is innervated by the ANS?
True
What does blocking beta 2 cause?
Bronchoconstriction
What synthesizes and secretes E and NE?
Adrenal gland
Adrenal glands are under ___________ control.
Sympathetic
An excitatory neurotransmitter causes what?
An inhibitory neurotransmitter causes what?
- Depolarization of the target cell
- Blocks depolarization of the target cell
Can neurotransmitters be both excitatory and inhibitory?
Yes, depending on the receptor they bind to.
If the receptor causes a more positive charge inside then it is _________.
Excitatory
All parasympathetic postganglionic neurons release what?
ACh
binds to cholinergic receptors
Most sympathetic postganglionic neurons release what?
NE
may also release Epi or ACh
What are the receptors for ACh?
What are the receptors for NE?
- Muscarinic, Nicotinic
- Alpha (1 or 2), Beta (1,2, or 3)
2 types of cholinergic receptors and their subtypes
Nicotinic -Nₘ=muscle tissue -Nₙ=nerves Muscarinic (M1-M5) -M₁= mainly CNS and GI tract -M₂= mainly heart -M₃= mainly glands and smooth muscle
In skeletal muscle, Ach binds to a nicotinic receptor to _____ ligand-gated ion channels. In the heart muscle it binds to muscarinic receptors to _______ G-protein coupled receptors.
- open
- close
2 types of adrenergic receptors and their subtypes
Alpha: -α1= mainly vascular smooth muscle α2= ppresynaptic junctions to influence NE release Beta: -B1= heart -B2= lungs -B3= adipose tissue
Remember
B1 ______
B2 ______
- heart
- lungs
What are some other neurotransmitters?
- Glutamine
- GABA
- Dopamine
- Serotonin (5-HT₃)
- Histamine
Dopamine is both an _____ and a _______
- agonist (parkinsons)
- antagonist (antipsychotics)
Setotonin is a ________ agonist, meaning it doesnt directly bind to receptor but increases circulating levels.
Indirect
What is MAP?
mean arterial pressure
Any lower than 75mmHg, organs are being profused with blood.
What increases MAP?
Epinephrine
Cholinergic Drugs:
- Is it associated with the sympathetic or parasympathetic nervous system?
- What neurotransmitter binds cholinergic receptors?
- What are the two types of cholinergic receptors?
- Parasympathetic
- ACh
- Nicotinic and Muscarinic
Uses of anticholinergic drugs?
- COPD
- Parkinsons
- Asthma
- Overactive Bladder
- Motion Sickness
- Decreasing Saliva/secretions pre surgery
- Treating Poisoning
- Ophthalmic Exams
Key AE of anticholinergic drugs?
Cant see, spit,pee or poop
- Agitation
- Blurred Vision
- Constipation
- Dry mouth
- Stasis of urine and sweat
When should these drugs be avoided?
Should we address vision changes?
- If history of urine retention, or narrow angle closure glaucoma
- Yes, address vision changes immediately
What does atropine come from and what does it treat?
- Comes from belladonna
- Used to decrease saliva and secretions pre-surgery and end-of-life care, also used to treat some types of poisoning
Inhaled anticholinergics primarily bind to __ in ______________.
M₃ in airway smooth muscle
What are inhaled anticholinergics used for?
What are their most common AE?
- Asthma and COPD
- Most common AE is dry mouth
What is an example of a SAMA (short acting muscarinic antagonist)?
Example of a LAMA (long acting muscarinic antagonist)
- ipratropium
- tiotropium (Spiriva)
Cholinergic receptors in the lungs cause what?
Anticholinergic receptors in the lungs cause what?
- bronchoconstriction
- bronchodilation
What is OAB (overactive bladder) caused by?
inappropriate contraction of detrusor muscle= a sense of urinary urgency
What do OAB medications do?
Meds antagonize muscarinic receptors on bladder smooth muscle= decrease contraction
What is the goal of Parkinson’s disease treatment?
reduce tremor in rigidity
What is drug-induced EPS (extrapyramidal symptoms)?
drug-induced movement disorders
Antihistamines are divided into what?
What are antihistamines used for?
- 1st and 2nd gen antihistamines
- allergies, sleep aid, motion sickness, N/V`
Whats different about 2nd generation antihistamines?
less muscarinic receptor binding
What do antidepressants treat?
What is their MOA?
- Depression, OCD, bulimia, neuropathy
- MOA- primarily act by increasing serotonin and NE;
What is the drug exception to TCAs?
Paroxetine (Paxil) is an SSRI with some anticholinergic properties (less than TCAs)
TCA can cause ___ prolongation.
QTc
What is the Beers list?
What should we be aware of?
- potentially inappropriate medications on older adults
- Be aware of elderly patients using anticholinergics
What is the difference between direct and indirect cholinergic drugs?
Direct- act directly on muscarinic receptors
Indirect- inhibit acetylcholinesterase (AChE) (breakdown of ACh) thereby increasing ACh levels.
Glaucoma meds act to decrease ____
IOP by helping the eyes fluid drain better
Cholinergic drugs also help treat _______________
- urinary retention
- alzheimer’s disease
- myasthenia gravis
Alzheimers disease is associated with a decrease level in what?
Drugs act to do what?
- ACh
- reversibly bind AChE so it does not break down ACh
What happens over time with alzheimer’s drugs?
They may become less effective due to disease progression = decrease in cholinergic receptors
What is myasthenia gravis and what is it caused by?
It is an abnormal weakness of certain muscles caused by antibodies binding to nicotinic ACh receptors in neuromuscular juction= inability to maintain muscular contractions
(progressive weakness until receptors reset)
What is a cholinergic drug administered for diagnosis of myasthenia gravis?
Edrophonium
-If muscle strength temporarily improves this assists diagnosis
What are the AE you would expect from cholinergic drugs?
Opposite of anticholinergic drugs (enhancing of the parasympathetic nervous system):
- increased secretions
- diarrhea
- increased urination
- lethargy
Cholinergic drugs AE memory aid:
D-Diarrhea U-Urination M-Miosis B-Bradycardia E-Emesis L-Lacrimation L-Lethargy S-Salivation/Sweating
Who should avoid cholinergic drugs?
- Historyr of COPD or asthma
- Urinary tract obstruction
- Parkinsons Disease
- Peptic Ulcer Disease
Direct and Indirect acting Muscarinic agents effects?
cholinergic
Significant cardiovascular effects:
-Bradycardia
-Decreased CO
(consult prescribing MD if HR<60bpm)
- Vasodilation=hypotension
- GI issues- abdominal pain, diarrhea
- Lungs- bronchoconstriction
- Frequent urination
- Increased secretions
Anticholinergic drugs effects?
Atropine:
- low doses cause dry mouth, higher doses cause blurred vision
- blocked vagal effects (tachycardia, decreased secretions)
- constipation, urinary retention
- high doses cause CNS effects
