Autonomic Nervous System I Flashcards

1
Q

Autonomic nervous system

A
  • has 2 primary divisions
  • the sympathetic nervous system (thoracolumbar division) and the parasympathetic nervous system (craniosacral division)
  • a 3rd division, the enteric nervous system is sometimes included
  • the SNS and PNS innervate smooth and cardiac muscle, secretory epithelial, and glands
  • as such they contribute to regulation of arterial pressure, gastrointestinal motility and secretions, urinary bladder emptying, sweating, body temperature, and other processes
  • SNS- fight or flight, PNS mediates vegetative responses involved in resting and digesting
  • survival is possible without ANS, but physiological function is severely compromised
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2
Q

Sympathetic nervous activation

A
  • stimulation of heart rate at the SA node (positive chronotropic effect)
  • stimulation of AV nodal conduction (positive dromotropic effect)
  • stimulation of myocardial contractility (positive inotropic effects)
  • via activation of B1-adrenergic receptors
  • B1-adrenergic receptor antagonists such as propranolol are used to treat hypertension and tachycardias
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3
Q

Parasympathetic nervous system activation

A
  • inhibition of heart rate at the SA node (negative chronotropic effect)
  • inhibition of AV nodal conduction (negative dromochronotropic effect)
  • inhibition of artrial contractlity- mild
  • the PNS does not significantly innervate other regions of the heart and thus does not exert major effects on the heart muscle itself
  • strong vagal stimulation decreases contractility of the atria (negative inotropic effect)
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4
Q

Pharmacological agonists and antagonists

A
  • used as receptor specific activators or inhibitors
  • agonist - activator; antagonist = inhibitor
  • muscarine = exogenous agonist of muscarinic chlinergic receptors
  • atropine is an exogenous antagonist of these receptors
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5
Q

2 synapse pathway

A
  • cell bodies of preganglionic neurons lie in CNS in columns in brain stem and spinal cord, their axons exit CNS and synapse with postganglionic neurons in peripherial ganglia
  • sympathetic pre- short, post- long
  • parasympathetic pre- long, post- short (lie within or close to target tissue)
  • pre- axons- small diameter, slow, myelinated B fibers; post- axons- small diameter, slower, unmyelinated C- fibers
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6
Q

Divergence

A
  • average preganglionic axon in the SNS contacts and estimated 100 postganglionic neurons by collateral branching, thus contributing to a diffuse output pattern
  • property of divergence enables the SNS to generate widespread responses of numerous effectors when physiologically necessary
  • PNS: more discrete, one pre- synapses with 15-20 posts
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7
Q

En passant synapses

A
  • varicosites

- characteristic of the ANS and permit a single axon to have broad actions in target tissues

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8
Q

Target transmitters of the ANS

A
  • somatic neurons- the pathway between the CNS and effector cell is monosynapic
  • neuron releases ACh binds to N1 nicotinic cholinergic receptos on the post synaptic membrane of the skeletal muscle cell (N1 receptor antagonist = d-tubocurarine; nicotinic receptor agonist= nicotine)
  • for both Sym and Para pre release ACh- binds N2 nicotonic cholinergic receptors on postsynaptic membrane
  • para post is ACh- muscarinic cholinergic receptor; sym post is norepinephrine adrenergic receptor either alpha or beta
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9
Q

Chromaffin cells

A
  • the SNS directly innervates the chromaffin cells of adrenal medulla which releases primarily epinephrine (~80%) and some norepinephrine
  • hormones are carried by blood and broadly effect multiple tissues of the body
  • the effects are similar to direct sympathetic stimulation, but last 5-10 times longer because the hormones are inactivated more slowly
  • they reach tissues that do not receive sympathetic innervation (epi increases metabolic rate in almost all cell types
  • the adrenal medulla secretes enough epi (+ norepi) to maintain a near normal blood pressure if sympathetic innervation to the heart is interrupted
  • there can also be co-transmitters in their presynaptic terminals (ATP, neuropeptide Y)
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10
Q

SNS target tissues

A
  • express distinct adrenergic receptor subtypes with different affinities for epi and norepi
  • sometimes use muscarinic cholinergic receptors (eccrine sweat glands), even though usually cholinergic receptors
  • broadly activated by epi-norepi from the adrenal medulla
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11
Q

PNS target tissues

A

-express various combinations of 5 muscarinic cholinergic receptors (M1-M5)

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12
Q

Mechanism of action of alpha-1 adrenoreceptors

A
  • in the inactive state, the alpha q subunit of the Gq protein is bound to GDP
  • in the active state with norepinephine bound to the alpha 1 receptor, the alpha q subunit is bound to GTP
  • phospholipase C work with the G protein mechanism
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13
Q

Mechanism of action if Beta adrenoreceptors

A
  • in the inactive sate, the alpha subunit of the Gs protein is bound to GDP
  • in the active state, with norepinephrine bound to the B receptor, the alpha subunit is bound to GTP
  • B1 and 2 have the same mechanisms
  • the alpha part does in the adenylyl cyclase and ATP to cAMP to physiologic actions
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14
Q

Mechnism of action of nicotinic cholinergic receptors

A
  • exert their action through GPCRs
  • PLC leading to generation of IP3 and DAG (M1, M3, M5; like alpha1-adrenergic receptors)
  • inhibition of adenylate cyclase leading to decreased intracellular cAMP (M2, M4)
  • nicotinic cholinoreceptors for acetylcholine
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15
Q

Cholinergic and adrenergic receptors and properties

A
  • N1 nicotinic ACh, ACh agonist, d-Tubocurarine antagonist
  • N2 nicotinic ACh, ACh agnoist, Hexa-methonium antagonist
  • M1, M3, M 5 muscarinic ACh, ACh agonist, Atropine antagonist, Galpha, PLC pinked enzyme, IP3 and DAG second messenger
  • M2, M4 muscarinic ACh, Ach agnoist, Atropine antagonist, Galphai and Galpha0, adenylyl cyclase enzyme, decrease cAMP second messenger
  • Beta 1 adrenergic, Epi (more than NE), propranolol/metoprolol antagonists, Galphas, adenylyl, increase cAMP
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16
Q

effects of the ANS on organ system function

A
  • in many cases the SNS and PNS exert opposing actions (HR is increased by SNS and decreased by the PNS, and GI motility is increased by PNS and decreased by SNS)
  • in some cases they act in a complimentary manner- PNS activation causes penile erection and SNS activation causes ejaculation both aiding in male reproductive frunction
17
Q

Massive SNS discharge

A
  • increase mydriasis and eyelid retraction (alpha 1)
  • increase heart rate and force of contraction (beta 1)
  • increase bronchial dilation (beta 2)
  • increase vasoconstriction (alpha 1)
  • increase sweating (muscarinic)
  • increase cellular metabolism: epi from adrenal medulla (alpha and beta)
  • increase blood flow to active muscles (vasodilation via B-adrenergic receptors of skeletal and coronary muscles contributes but local factors such as adenosine cause most of the vasodilation and decreased flow to GI system, kidney and skin
  • activated primarily by centers in the hypothalamus, brain stem,and spinal cord and can respond rapidly-eg heat rate can double, and the urinary bladder can empty involuntarily in a matter of seconds
18
Q

Epinephrine has greater affinity for B adrenergic receptor

A
  • epinephrine has a greater affinity than norepinephrine for B-adrenergic receptors, whereas norepi has somewhat greater affinity for alpha adrenergic receptors
  • the adrenal meduallary contribution of the SNS reflects this difference in different target organs
  • epi effects are more prominant in targets where B adrenergic receptors predominate, such as the heart, lungs, and liver, whereas norepi effects predominate in the vasculature where alpha adrenergic receptors are expressed
19
Q

Adrenal meduula

A
  • releases epinephrine and norepinephrine into the bloodstream during activation of the sympathetic nervous system
  • the effects of epinephrine and norepinephrine, including relative magnitude are illustrated for lots of places
20
Q

Pheochromocytoma

A
  • tumor of the adrenal medulla
  • secrete excessive amounts of norepinephrine (most common) epinephrine or both resulting in sustained hypertension and other effects (cold hands and feet, sweating and feeling hot)
  • increased dopamine secretion rare
  • less than 0.1% hypertension
  • observed at all ages, male and female, especially in 40s and 50s
  • tumors are well-circumscribed with weights ranging from 1 gram to several kilograms
  • treatment- excise the tumor. To treat the symptoms, a combination of alpha1 and B1-adrenergic antagonists can be used
21
Q

Horner syndrome

A
  • anhidrosis, (dryness of face)
  • ptosis (dropping eye)
  • miosis (constriction of eye)

1st order lesion- brainstem lesions interrupting descending tracts (stoke)
2nd order lesion- preganglionic sympathetic cell bodies or fibers supplying eye synapse in superior cervical ganglion
-3rd order lesion- postganglionic sympathetic cell bodies or fibers

22
Q

Anatomy of sympathetic division

A

Cell bodies of the sympathetic motor neurons lie in the intermediolateral cell column (lateral horn) between thoracic level T1 and lumbar level L3

  • their axons enter the nearest paravertebral ganglion via a white ramus and synapse within that segment or travel to another para- or to a prevertebral ganglion
  • the sympathetic chains extend from the upper part of the neck to the coccyx, and they are bilateral
23
Q

Anatomy of the sympathetic prevertebral plexus

A
  • major prevertebral plexus are the celiac, superior mesenteric and inferior mesenteric
  • the prevertebral plexus is bilateral and lies in front of the aorta and along its major arterial branches
  • the ganglia and each associated plexus are named after the artery with which they are associated
  • celiac- stomach, liver, pancreases, gallbladder, small intestine, spleen, kidneys
  • superior mesenteric- innervating the small and large intestines
  • inferior mesenteric- innervating the lower colon and rectum, urinary bladder, reproduction organ