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Semester 2 Year 1 > Autonomic Nervous System 2 > Flashcards

Autonomic Nervous System 2 Flashcards

1
Q

Describe sympathetic innervation of the adrenal gland

A

Preganglionic sympathetic fibers synapse on chromaffin cells
Chromaffin cells release adrenaline (~80%) and noradrenaline (~20%) into systemic circulation
-> widespread tissue response

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2
Q

Where are the locations of all acetylcholine receptors in ANS?

A 
Eye
Lacrimal gland
Salivary gland
Heart
Lungs
Upper GI tract
Lower GI tract
Genitalia 
Adrenal medulla
Sweat glands
All ganglia including pelvic ganglia to lower GI tract and paravertabral sympathetic chain
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3
Q

What are the two types of acetylcholine receptors?

A

Nicotinic (Inotropic) and Muscarinic (G-protein linked receptor)

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4
Q

Can we differentiate muscle from ganglion NAChr?

A

Kinda:

Differences in subunits may allow for some specificity

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5
Q

Therapeutically, what’s the benefit of differentiating muscle NAChr from ganglion NAChr?

A

What would the effect of stimulating or blocking all ganglia be?
Tissues innervated by both branches of the ANS generally have a predominate tone

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6
Q

What is predominate tone?

A

In “most” organ systems, the parasympathetic nervous system displays a “predominant tone”, meaning it has a stronger influence on tissue function when the body is at rest, as compared to the sympathetic nervous system

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7
Q

What kind of drugs act on ACh with implications for the ANS?

A

Presynaptic toxins like botulinum

Anticholinesterases like neostigmine

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8
Q

What are the effects of anticholinesterases?

A 
SLUDGE
– Salivation
– Lacrimation
– Urination
– Defecation
– Gastrointestinal upset 
– Emesis
– Bradycardia
– Hypotension
– Bronchoconstriction
– Pupillary constriction (miosis)
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9
Q

Where are the predominate locations of nicotinic ACh receptors?

A

Neuromuscular junction Sympathetic ganglia Parasympathetic ganglia
Central nervous system

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10
Q

Where are the predominate locations of muscarinic ACh receptors?

A

Parasympathetic target organs Sweat glands (sympathetic) Vascular smooth muscle
Central nervous system

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11
Q

What complication may the presence of nicotinic ACh receptors being present at the neuromuscular junction cause?

A

Differences in the receptor types or subtypes may allow for specificity of drug action
Drugs that affect ACh at the NMJ may affect the ANS! Side effects of suxamethonium? Anticholinesterases?

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12
Q

How are muscarinic and nicotinic ACh receptors differentiated?

A

Nicotinic andmuscarinicAChreceptorsshare some agonists, but can be differentiated by others

Drugs that affect the synthesis, storage, release and termination of ACh will affect both receptor types
Drugs that affect ACh at the Sk. NMJ may affect the ANS

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13
Q

What drugs affect both muscarinic and nicotinic ACh receptors?

A

Acetylcholine

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14
Q

What drugs affect only muscarinic and not nicotinic ACh receptors?

A

Muscarine
Bethanechol
Pilocarpine

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15
Q

What drugs affect only nicotinic and not muscarinic ACh receptors?

A

Nicotine

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16
Q

How are muscarinic ACh receptors classified?

A

Muscarinic receptors can be classified by their tissue distribution and their cellular response.

17
Q

What are the classifications of muscarinic ACh receptors?

A

M1 (neural)
M2 (cardiac)
M3 (glandular/smooth muscle)

18
Q

Where are the main locations of the M1 (neural) muscarinic ACh receptors?

A

Autonomic ganglia Glands: gastric, salivary, lacrimal, etc.

19
Q

What are the functions of M1 (neural) muscarinic ACh receptors?

A

↑ IP3, DAG
Which leads to
Gastric secretion

20
Q

Where are the main locations of the M2 (cardiac) muscarinic ACh receptors?

A

Heart: atria

21
Q

What are the functions of M2 (cardiac) muscarinic ACh receptors?

A

↓ cAMP
Which leads to
Cardiac inhibition

22
Q

Where are the main locations of the M3 (glandular/smooth muscle) muscarinic ACh receptors?

A

Exocrine glands: gastric, salivary, etc. Smooth muscle: GI tract, eye, airways, bladder
Blood vessels: endothelium

23
Q

What are the functions of M3 (glandular/smooth muscle) muscarinic ACh receptors?

A

↑ IP3, DAG
Gastric, salivary secretion
GI smooth muscle contraction Ocular accommodation Vasodilation

24
Q

Are all muscarinic receptors found in the ANS?

A

Not all muscarinic receptors are in the ANS
– M1, M2, M4 and M5 also found in CNS
– M3 found on vascular endothelial and smooth muscle cells

25
Q

What factors should be considered when discussing parasympathetic directed therapies?

A

There are several types of muscarinic ACh receptors
– Some are excitatory
– Some are inhibitory

Can differences be exploited therapeutically?
– Receptor subtype specificity?
– Receptor tissue distribution?

What type of drug would be required?
– Agonist?
– Antagonist?

26
Q

Name some muscarinic ACh receptor agonists

A
  • Pilocarpine
    Constriction of pupils (miosis) Non-selective muscarinic agonist Glaucoma (to decrease IOP)
    Xerostomia (following head/neck radiotherapy)
  • Bethanechol
    Non-selective muscarinic agonist Bladder and gastrointestinal hypotonia
27
Q

Name some muscarinic ACh receptor antagonists

A

-Atropine
Non-selective antagonist Well absorbed orally CNS effects
Adjunct for anaesthesia Anticholinesterase poisoning Bradycardia / cardiac arrest

-Glycopyrronium
Similar to atropine
Does not cross blood brain barrier
Similar to atropine

-Hyoscine hydrobromide
Similar to atropine CNS effects
Hypersalivation Motion sickness

-Hyoscine butylbromide
Similar to atropine but poorly absorbed Does not cross blood brain barrier
Gastrointestinal spasms

-Ipratropium
Delivered via inhaler or nebuliser Does not cross blood brain barrier
Maintenance treatment of COPD

-Tropicamide
Similar to atropine but shorter acting
Ophthalmic use (mydriasis)
28
Q

What are the muscles innervated by the ANS in the eye?

A

Pupillary dilator muscle – Sympathetic innervation only
• Mydriasis

Pupillary constrictor muscle – Parasympathetic innervation
• Miosis

29
Q

Discuss muscarinic ACh receptor pharmacology

A

Very few diseases of ↓parasympathetic activity, moredueto↑ac vity
– Little therapeutic use for agonists

General problem of selectivity with antagonists
– Few differentiate between subtypes effectively
– Muscarinic ACh receptors widespread  side effects
– Control by route of administration and distribution

30
Q

How should one approach pharmacology questions?

A

During surgery, a patient becomes bradycardic as a result of a muscle relaxant.
What pharmacological agent could be used to counter this?

Semester 2 Year 1 (82 decks)

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