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Autonomic Nervous System Flashcards

1
Q

Adrenergic stimulation of the eye effects what two structures, via what receptor

A

Pupil (dilated) via A1

Cliary muscle (relaxation-far vision) via B2

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2
Q

Cholinergic stimulation of the eye effects what two structures, via what receptor

A

Pupil Miosis (constriction) via M3,M2

Ciliary body (contraction-near vision) via M3,M2

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3
Q

Adrenergic stimulation of the heart effects what structures of the heart, what effect via what receptor

A

SA node (increased HR) via B1

AV node and conduction system (increased conduction velocity) via B1

Ventricles (increased force of contraction) via B1

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4
Q

Cholinergic stimulation of the heart effects what structures of the heart, what effect via what receptor

A

SA node (decreased HR) via M2

AV node and conduction syst. (decreased conduction velocity-AV block) via M2

Ventricles (decreased force of contraction) via M2

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5
Q

Adrenergic stimulation of blood vessels effect what specific structures, what effect via what receptor

A

Most arteries & veins (constriction) via *A1/a2

Arteries of skeletal muscle (constriction) via A1

Arteries of skeletal muscle (relaxation) via B2

*A1 vasoconstriction counters SM arteries vasodilation in fight or flight situation

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6
Q
  • Cholinergic stimulation of blood vessels effect what specific structures, what effect via what receptor
A

Sympathetic cholinergic fibers cause arteries and veins (dilation) NO receptor

Arteries of skeletal muscle (dilation) via M3 SYMPATHETIC CHOLINERGIC fibers

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7
Q

Adrenergic stimulation of lungs effect what specific structures, what effect via what receptor

A 
Muscles of the Trachea and Bronchials, (relaxation) via B2
Bronchial glands (secretion) B2
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8
Q

Cholinergic stimulation of lungs effect what specific structures, what effect via what receptor

A 
Muscles of the Trachea and Bronchials (constriction) M2=M3
Bronchial glands (stimulation) M3
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9
Q

Adrenergic stimulation of stomach/intestines effect what specific function, what effect via what receptor

A

Motility and tone (decreased) via A1/A2

Smooth muscle sphinters (contraction) via A1

Secretion (inhibited) A2

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10
Q

Cholinergic stimulation of stomach/intestines effect what specific function, what effect via what receptor

A

Motility and tone (increased) via M2=M3

Smooth muscle sphinters (relaxation) via M3

Secretion (stimulated) via M3

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11
Q

Adrenergic stimulation of kidney effect what specific function, what effect via what receptor

A

Renin secretion (increased) via B1

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12
Q

Cholinergic stimulation of kidney effect what specific function, what effect via what receptor

A

trick quesiton, there is no cholinergic stimulation of kidney

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13
Q

Adrenergic stimulation of adrenal gland effect what specific function, what effect via what receptor

A

trick question, there is no adrenergic stimulation of adrenal gland

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14
Q
  • Cholinergic stimulation of adrenal gland effect what specific function, what effect via what receptor
A

release of Epi/NE via SYPATHETIC CHOLINERGIC fibers

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15
Q

Adrenergic stimulation of bladder effect what specific structures, what effect via what receptor

A 
Detrusor muscle (bladder relaxation) via B2
Trigone & sphincter (contraction) via A1
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16
Q

Cholinergic stimulation of bladder effect what specific structures, what effect via what receptor

A 
Detrusor muscle (bladder contraction) via M3
Trigone & sphincter (relaxation) via M3
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17
Q

Adrenergic stimulation of gravid uterus effect what specific function, what effect via what receptor

A

relaxation via B2

contraction via A1

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18
Q

Cholinergic stimulation of gravid uterus effect what specific function, what effect via what receptor

A

trick question, there is no cholinergic effect on uterus

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19
Q

Adrenergic stimulation of Penis & seminal vesicles effect what specific function, what effect via what receptor

A

Ejaculation via A1

  • Remember adrenergic “shoot”
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20
Q

Cholinergic stimulation of Penis & seminal vesicles effect what specific function, what effect via what receptor

A

Erection via M3

  • Remember cholinergic “point”
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21
Q

Adrenergic stimulation of sweat glands effect what specific function, what effect via what receptor

A

Palm of hand (minimal secretion) via A1

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22
Q

Cholinergic stimulation of sweat glands effect what specific function, what effect via what receptor

A

Generalized secretion via SYMPATHETIC CHOLINERGIC fibers M1

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23
Q

Adrenergic stimulation of liver effect what specific function, what effect via what receptor

A

Glycogenolysis & Gluconeogenesis via A1/B2

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24
Q

Cholinergic stimulation of liver effect what specific function, what effect via what receptor

A

trick quesiton, there is no cholinergic stimulation of liver

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25
Q

Adrenergic stimulation of beta cells of pancreas effect what specific function, what effect via what receptor

A

Insulin increase via B2

Insulin inhibition via A2

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26
Q

Cholinergic stimulation of beta cells of pancreas effect what specific function, what effect via what receptor

A

trick question, there is no cholinergic stimulation of beta pancreas cells

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27
Q

Adrenergic stimulation of fat cells effect what specific function, what effect via what receptor

A

lipolysis via B1,B3

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28
Q

Cholinergic stimulation of fat cells effect what specific function, what effect via what receptor

A

No innervation

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29
Q

The PSNS has neuronal fibers in what where

A

cranium and sacrum

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30
Q

What are the 4 cranial nerves assoc. with PSNS

A

cranial nerves III, VII, IX, and X

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31
Q

What are the sacral levels assoc. with PSNS

A

S2 thru S4

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32
Q

The sympathetic’s (thoracolumbar) nervous system is spans what levels of the vertebral column

A

T1-L2

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33
Q

What are the major differences between the somatic and autonomic systems

A

somatic system needs external neural stimulation to effect a response

ANS, organs and glands are regulated within ANS and can function without external control

somatic system, all reflexes are mediated in CNS

ANS, visceral reflexes can occur in periphery (autonomic dysreflexia)

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34
Q

Is the somatic nervous system a one or two neuron systems?

A

One

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35
Q

Is PSNS and SNS a one or two neuron system

A

parasymp-always two

Sympath- mostly two, but one with adrenal medulla (relases ACh directly on gland, gland then releases Epi to target organs)

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36
Q

the postganglionic SNS release what neurotransmitter mainly, and what exceptions

A

postganglionic SNS contains mostly adrenergic nerve fibers that release NORepi; however, it also contains cholinergic nerve fibers that secrete ACh (sweet glands, smooth muscle of skeletal muscle arteries, and adrenal gland)

  • the SNS uses only a single neuron to communicate with adrenal cortex
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37
Q

What are the characteristics of the autonomic innervation of effector organs

A

No recognizable end-plate (like in skeletal muscle)

nerve fibers run along membrane of effector cells

branches are beaded by varicosities (enlargements)

  • not covered with Schwann cells
  • contain synaptic vesicles
  • approx. 20,000 per neuron
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38
Q

What are the three types of autonomic sensory receptors found throughout the body

A

Mechanoreptors

Chemoreceptors

Visceral Nociceptors

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39
Q

Mechanoreceptors respond to what three types of physical stimuli

A

Tension- baroreceptors
Stretch- volume receptors
Pressure- pressoreceptors/ baroreceptors

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40
Q

Carotid Sinus and Aortic Arch contain

A

Mechanoreceptors-Baroreceptors

41
Q

Chemoreceptors respond to what

A

changes in the chemical environment such as, osmolality, pH, O2, and CO2 changes
AKA Osmoreceptors

  • located throughout body atria, pulmonary vascu, kidney, GI tract
42
Q

Carotid Body and Aortic Body contains

A

Chemoreceptors-osmoreceptors

*located throughout the body GI tract, brain, etc

43
Q

Visceral Nociceptors respond to what

A

Pain in visceral organs which may initiate both autonomic and somatic reflexes

44
Q

Referred pain is

A

pain felt at another location as a result of noxious stimuli to visceral organs

45
Q

What are the two types of cholinergic receptors

A

Nicotinic

Muscarinic

46
Q

What are the two types of Nicotinic receptors, where are they located, and when activated, what response is triggered

A

Nm (N2) receptors-Neuromuscular junction. Causes end-plate depolorization which leads to skeletal muscle contraction

Nn(N1) receptors-Autonomic Ganglia when stimulated, leads to depolorizing & firing of postganglionic neurons

47
Q

What are the five types of muscuranic receptors

A

M1, M2, M3, M4, M5

48
Q

what three Muscuranic receptors are well known

A

M1, M2, M3

49
Q

Describe the biosynthesis pathway of epinephrine

A

Tyrosine transported into noradrenergic varicosity by carrier-linked sodium uptake
Then, tyrosine is hydroxylated into DOPA via tyrosine hydroxlase
Then, DOPA is decarboxylated into Dopamine via DOPA decarboxylase
Then, Dopamine is transported into a vesicle by a carrier (blocked by reserpine)
Then, Dopamine converted to Norepi by dopamine beta-hydroxylase
Then, Norepi is converted to Epi by Phenylethanolamine N-methyltransferase

50
Q

List the epi precursors and their respective enzymes

A

Tyrosine>LDOPA>Dopamine>Norepi>Epi

Tyrosine hydroxylase>L-aa decarboxylase>Dopamine-hydroxylase> Phenylethanolamine N-methyl-transferase

51
Q

What are the four fates of Norepi

A
  1. interacts with pre/post-synaptic adrenoreceptors
  2. diffuses out of cleft into circulation
  3. uptaken back into varicosity via H ions, and degraded by Monoamine Oxidase (MAO)
  4. Degraded post-synaptically by hepatic “CATECHOL-O-METHYL TRANSFERASE. Extrajunctionally
    * Epi and Norepi share same degradation pathway. MAO>COMT
    * Dopamine degradation will start with MAO or COMT
52
Q

What is the degradation product of Epi/NorEpi

A

Methoxy-hydroxy-Mandelic Acid (VMA)

*measured in urine for patients suspected of pheochromocytomas. Will be high

53
Q

What is the degradation product of Dopamine

A

Homovanillic Acid

54
Q

What are the different types of adrenergic receptors

A

a1, a2, b1, b2, b3,

Dopamine:
da1-vasodilation of smooth muscle of renal & mesentery
da2- presynpathic adrenergic receptors- inhibits release of NE

55
Q

Binding to beta receptors activates what adrenergic G-protein family

56
Q

Binding to alpha2 receptors activate what adrenergic G-protein family

57
Q

Binding to alpha1 receptors activate what adrenergic G-protein family

58
Q

Cholinergic agonist are classified as

A

Direct acting or Indirect acting (anticholinesterases)

Cholinesterase resistant or NOT

59
Q

Direct cholinergic agonists include

A

Bethanochol, Carbachol, Muscurine, and Pilocarpine

*cholinesterase resistant

60
Q

Indirect cholinergic agonists include

A

Reversible- Neostigmine, pyridostigmine, edrophonium, physostigmine (crosses BBB)

Irreversible-Echothiphate (antagonizes succs), insectisides (Malathione, Parathion), nerve gases (Sarine, Tabun, Soman, DFP)

61
Q

Bethanochol is used for

A

GI/GU tract
Stimulates gastric motility
Increased detrusor muscle initiating micturition

*Postop/Postpartum nonobstructive urinary retention, and neurogenic bladder with retention.

62
Q

Dont use Bethanochol concurrently with

A

beta blockers

63
Q

Carbachol is used for

A

decrease intraocular pressure

Nicotinic and Muscarinic activity

64
Q

Pilocarpine is used for

A

to decrease IOP via stimulating ciliary muscles and produces miosis via contracton of muscles surrounding iris

65
Q

Pilocarpine can worsen

A

retinal detachment

66
Q

Echothiophate, irreversible anticholinesterase, is indicated for

A

open-angle glaucoma, closed-angle, cross eyed

67
Q

echothiophate prolongs the effects of

A

succinylcholine and may cause CV collapse

68
Q

What two agents are given as an antidote for insecticide, or chemical poisioning

A

Atropine 1st, quickly followed by 2-PAM (cholinesterase reactivator)

69
Q

Alzheimer and Dementia anticholinesterases exert its effect by

A

increasing ACh concentration in CNS

*ACh is an excitatory NT

70
Q

Cholinergic Antagonists are subdivided into antimuscarinics and antinicotinics, name each

A

antimuscarinics: Atropine, Scopalomine, Glycopyrrolate, Ipratropium, cogentin, artane

Antinicotinics: NMBA, depolorizing succinylcholine and decamethonium

71
Q

What racemic mixture of atropine is active

A

Levo-rotary

72
Q

Atropine is used

A 
antisialogogue
to restore cardiac rate/arterial pressure
Lessen severity of AV block
Asystole
ingestion of muscarinic mushrooms
73
Q

Atropine is contraindicated in

A

glucoma
pyloric stenosis
prostate hypertrophy

74
Q

what is the antidote for atropine overdose

A

physostigmine

75
Q

what is the antidote of physostigmine overdose

76
Q

Scopalomine is used to treat

A

motion sickness

  • greater effect on iris, ciliary body and secretory glands
  • Don’t give in patients with Glaucoma
77
Q

Glycopyrrolate is used to treat

A

non-emergent decrease in HR

secretions (better than atropine)

*Does not cross BBB

78
Q

Ipratropium bromide (antimuscarinic) used to

A

treat bronchospasms
Not a first line therapy for bronchospasms

  • 1st give albuterol (B2 agonist), then ipratropium (M3 antagonist), then theophyline (phosphodiesterase inhibitor), then cromyln (mast cell stabilizer), ect…..
79
Q

Contraindications for Ipratropium/Propantheline Bromide

A 
Glaucoma
GI obstruction
Obstructive uropathy
Intestinal atony
ulcerative colitis
myasthenia gravis
80
Q

NMBA and Depolorizing muscle blockers are antinicotinics and include

A

Panc, Vecu, Pipe, Roc, Atra, Doxa, Miva, Cisatr.

Succinylcholine, Decamethonium

81
Q

Adrenergic AGONISTS include

A 
Nonselective B1 and B2 Isoproterenol
B1-Dobutamine
B2- Terbutaline, Albuterol, Salmeterol, Ritodrine
Mixed alpha and beta- Norepi, Epi,
D1-Fenoldopam
D2-Bromocritine
A1- Phenylephrine
A2-Clonidine, Dexmedetomidine
Mixed a1 and a2- Cocaine, Ephedrine, Amphetamines, MAO Inhibitors

*Clonidine is a centrally acting vasoconstrictor but peripherally acting vasodilator

82
Q

Adrenergic Antagonists include

A

Non-selective B-blockers-propranolol, sotalol, nadolol, timolol
B1 antagonists- Metoprolol, Esmolol,atenolol, bebivolol, betaxolol

Beta/Alpha 1 antagonists- *Labetalol, Carvedilol

Nonselective alpha antagonists- Phenooxybenzamine, phentolamine
A1 antagonists- prazosin, terazosin, doxazosin, tamsulosin
A2 antagonists- Yohimbine

83
Q

Direct-acting sympathomimetics include

A

Nor, Epi, Dopamine, Isoproterenol, Dobutamine

Non-catecholamines-Phenylephrine

84
Q

Indirect-acting Sympathomimetics that cause release of Norepi include

A

Ephedrine & Tyramine

Amphetamine

85
Q

Indirect-acting Sympathomimetics that inhibit reuptake on Norepi include

86
Q

Indirect-acting sympathomimetics that inhibit the metabolism of Norepi include

A

MAO inhibitors, Parnate, Marplan, etc.

  • stop two weeks before anesthetic
  • Tyramine-containing foods (beer, cheese)»HTN crisis
87
Q

Phenylephrine primarly agonizes

A

alpha 1 receptors

*sign. MAP and PVR increase with decrease in HR, CO, and renal blood flow

88
Q

Epineprine primarily agonizes

A

B1, but equally agonizes a1,a2, b2 receptors

  • Increased HR, CO, and MAP
  • Decreased Renal blood flow
  • Bronchodilation
89
Q

Ephedrine and Norepinephrine are similar and primarily agonizes

A

a1, a2, b1, b2

  • increased HR, MAP, CO, PVR
  • Norepi»>PVR
  • bronchodilaton (not Norepi)
  • decreased renal blood flow
90
Q

Dopamine primarily agonize

A

a1,a2, b1 equally

  • increased HR, MAP, CO, PVR, and Renal blood flow
  • No effect of bronchioles
91
Q

Isoproterenol primarily agonizes

A

B1, B2 receptors

  • significant increases in HR, CO, Bronchodilation
  • decreases in MAP and PVR
92
Q

Dobutamine primarily agonizes

A

B1 and B2

  • significat increase in CO
  • increase in HR and MAP, renal blood flow
  • decreases PVR
93
Q

Phenoxybenzamine is a Alpha antagonists used to manage

A 
pheochromocytoma
a1>a2
Decreased BP with reflex tachycardia
No direct effect on heart
miosis
94
Q

Prazosin, Doxazosin, Tamsulosin are both alpha1 agonists that

A

decrease BP without reflex tachycardia

*tamsulosin used to tx BPH

95
Q

Labetalol is a mixed alpha/beta(nonselective) antagonist used to

A

decrease BP, HR, & SVR

  • No effect on CO
  • Labetalol IV 1:7 blocade, 1 alpha, 7 beta
  • Labetalol PO 1: 4 blocade, 1 alpha, 4 beta, so alpha effects greater due to less b-effect
96
Q

Beta antagonists are classified

A

as selective vs. non-selective

97
Q

Name the b1 selective antagonists

A 
Atenolol
Acebutolol
Betaxolol
Bisoprolol
Celiprolol
Esmolol 
Nebivolol
  • All other b-blockers are nonselective
98
Q

What are the effects of beta blockers

A

decrease hr and contractility with smaller doses, but increased contractility with higher doses

hypotension, bronchoconstriction, inhibition of epi-induced glycogenolyisi & lipolysis

  • avoid rapid withdrawl
  • NPO status uneffected by patient’s on alpha/beta blockers

Pharmacology (27 decks)

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