Autonomic Nervous System Clinical Correlate Flashcards
Post ganglionic sympathetic sweat messenger
Ach
Where are nicotinic and muscarinic receptors found?
Nico - autonomic ganglia and adrnela medulla
Musc - smooth muscle, cardiac muscle, exocrine glands
Acute angle closure glaucoma
Intraocular pressure rises rapidly due to imbalance between aqueous fluid production and draiange
Emergency
Tx of closeure glaucoma
Reduce intraocular pressure
INcrease aqeous humor flow through anterior chamber by contricting the pupiol
Tx of acute angle close glaucoma
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)
Mydriatic and cycloplegic agents
Used during eye exam to visualize retina
Mydriatics
Sympathomimetics that dilate the pupil
Alpha-adrenergic agonist (phenylephrine HCl)
Cycloplgeics
Parasympatholytics
Dilate pupil and paralyze accomodation
Muscarinic antagonists weaken contraction of ciliary muscle (atropine)
Tx of anticholinergic toxicity
Stabilize airway, breathing, ciruclation
Discontinue offending agent
Physostigmine (AchE inhibitor that acts to increase concentration of ACh at muscarinic receptors)
Organophosphate poisoning
Potent AChE inhibitors
DUMBELS Defecation Urination Miosis Bronchorrhea Emesis Lacrimation Salivation
Organophosphate CNS and NM effects
CNS - wide range
NM - twitching, weakness, paralysis
Tx of organophosphate poisoning
IV atropine sulfate competes with ACh at muscarinic sites
Cholinesterase generator compounds like pralidoxime (2-PAM)
Green tobacco sickness
Nicotine toxicity by dermal absorpiton from leaves in field workers
Worst if wet
More likely in non-smokers
Immediate vs delayed nicotine toxicity
Immediate - think “Hyper”
Delayed - think “hypo”
Tx of green tobacco
Remove work from field
Antiemitcs
Atropine for cholinergic symptoms
Benzodiazepines for seizure
Nerves in micturition
Parasymp (cholinergic) - bladder contraction
Symp - bladder relaxation (beta)
Symp - bladder neck and urethral contraction (alpha)
Somatic (pudendal nerve) - contraction of pelvic floor musculature
Urinary urge incontinence
Uninhibited detrusor muscle contractions during bladder filing
Could be neuro or bladder caused
Tx of urinary urge incontinence
Lifestyle changes
Behavioral
Pelvic floor
meds (muscarinic antagonisis to relax detrusor muscle)
Therapy for urinary urge incontinence
Oxybutynin and tolterodine
BPH
Delay in micturition
Interruption of voiding
Weak stream
Terminal dribbling
BPH evaluation
rule out other lower urinary tract symtpoms
If score over 8, then tx with meds
Tx of BPH
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)
Tx of COPD
Smoking cessation
Bronchodilators
Inhaled steroids
COPD meds
B2 agonists stimulate smooht muscle relaxation and bronchodilation (short acting albuterol)
Anticholinergics decrease secretions and relax smooth muscle (short acting ipratropium)
Side effects of B2 adrenergic and anticholinergics
Palpitations, tachycardia, tremor
Dry mouth, urinary retention, symptoms of narrow angle galucoma
