Autonomic Nervous System Clinical Correlate

Question 1

Post ganglionic sympathetic sweat messenger

Answer 1

Ach

Question 2

Where are nicotinic and muscarinic receptors found?

Answer 2

Nico - autonomic ganglia and adrnela medulla

Musc - smooth muscle, cardiac muscle, exocrine glands

Question 3

Acute angle closure glaucoma

Answer 3

Intraocular pressure rises rapidly due to imbalance between aqueous fluid production and draiange

Emergency

Question 4

Tx of closeure glaucoma

Answer 4

Reduce intraocular pressure

INcrease aqeous humor flow through anterior chamber by contricting the pupiol

Question 5

Tx of acute angle close glaucoma

Answer 5

Muscarinic agents - act on M3 receptor in the iris causing pupillary constriction and on ciliary muscle causing contraction (pilocarpine)

2) Topical beta blockers or carbonic anhydrase inhibitors to decrease production (timolo)
3) osmotic agents to reduce aqeuous volume within the eye (glycerol, IV mannitol)

Question 6

Mydriatic and cycloplegic agents

Answer 6

Used during eye exam to visualize retina

Question 7

Mydriatics

Answer 7

Sympathomimetics that dilate the pupil

Alpha-adrenergic agonist (phenylephrine HCl)

Question 8

Cycloplgeics

Answer 8

Parasympatholytics

Dilate pupil and paralyze accomodation

Muscarinic antagonists weaken contraction of ciliary muscle (atropine)

Question 9

Tx of anticholinergic toxicity

Answer 9

Stabilize airway, breathing, ciruclation
Discontinue offending agent

Physostigmine (AchE inhibitor that acts to increase concentration of ACh at muscarinic receptors)

Question 10

Organophosphate poisoning

Answer 10

Potent AChE inhibitors

DUMBELS 
Defecation
Urination
Miosis
Bronchorrhea 
Emesis
Lacrimation
Salivation

Question 11

Organophosphate CNS and NM effects

Answer 11

CNS - wide range

NM - twitching, weakness, paralysis

Question 12

Tx of organophosphate poisoning

Answer 12

IV atropine sulfate competes with ACh at muscarinic sites

Cholinesterase generator compounds like pralidoxime (2-PAM)

Question 13

Green tobacco sickness

Answer 13

Nicotine toxicity by dermal absorpiton from leaves in field workers

Worst if wet

More likely in non-smokers

Question 14

Immediate vs delayed nicotine toxicity

Answer 14

Immediate - think “Hyper”

Delayed - think “hypo”

Question 15

Tx of green tobacco

Answer 15

Remove work from field
Antiemitcs
Atropine for cholinergic symptoms
Benzodiazepines for seizure

Question 16

Nerves in micturition

Answer 16

Parasymp (cholinergic) - bladder contraction

Symp - bladder relaxation (beta)

Symp - bladder neck and urethral contraction (alpha)

Somatic (pudendal nerve) - contraction of pelvic floor musculature

Question 17

Urinary urge incontinence

Answer 17

Uninhibited detrusor muscle contractions during bladder filing

Could be neuro or bladder caused

Question 18

Tx of urinary urge incontinence

Answer 18

Lifestyle changes
Behavioral
Pelvic floor
meds (muscarinic antagonisis to relax detrusor muscle)

Question 19

Therapy for urinary urge incontinence

Answer 19

Oxybutynin and tolterodine

Question 20

BPH

Answer 20

Delay in micturition
Interruption of voiding
Weak stream
Terminal dribbling

Question 21

BPH evaluation

Answer 21

rule out other lower urinary tract symtpoms

If score over 8, then tx with meds

Question 22

Tx of BPH

Answer 22

Alpha adrneergic receptor blockers…block the sympathetic mediated contraction of the protactic smooht muscle cells and bladder neck…tamsulosin is selective

Can also use antimuscarinic agents (oxybutynin and tolterodine)

Question 23

Tx of COPD

Answer 23

Smoking cessation
Bronchodilators
Inhaled steroids

Question 24

COPD meds

Answer 24

B2 agonists stimulate smooht muscle relaxation and bronchodilation (short acting albuterol)

Anticholinergics decrease secretions and relax smooth muscle (short acting ipratropium)

Question 25

Side effects of B2 adrenergic and anticholinergics

Answer 25

Palpitations, tachycardia, tremor

Dry mouth, urinary retention, symptoms of narrow angle galucoma