AUTONOMIC NERVOUS SYSTEM Part I Flashcards
1
Q
Anesthesiology define as ________
Goal of anesthesia: ______
A
The practice of ANS medicine
Keep ANS stable
2
Q
Division of ANS 3 anatomic divisions are:
A
Sympathetic
Parasympathetic
Enteric GI
3
Q
The ANS Is (vol/invo) and conducts impulse from ______ or _______to _____, ______, and _______Tissues
A
involuntary division of the PNS (conducts impulses from the brain stem or spinal cord to cardiac, smooth and glandular tissues)
4
Q
ANS also called (Not in control); 3 other names
A
Visceral, vegetative and involuntary NS
5
Q
ANS periphery involces
A
nerves, ganglia, plexuses
6
Q
ANS is accompanied by sensory (afferent) nerve fibers - visceral afferent system
A
send input from viscera
7
Q
**ANS is a ______ innervation. most organs have input for ______ and ______pathways
A
Dual innervation system: PNS and SNS
8
Q
ANS function
A
regulates structures that are NOT VOLUNTARY CONTROL and that function below the consciousness.
9
Q
Enteric Nervous system
A
Mixing, propulsion and absorption of nutrients in the GI tract.
Neurons located in wall of GI tract, link to pancreas and gallbladder function.
10
Q
It is the ENS through the _______ and __________that regulates _______activity
A
Myenteric, SUBMUCOUS PLEXI regulates the DIGESTIVE ACTIVITY
11
Q
***IMPORTANT: Main neurotransmitter in GI Nervous system
A
SEROTONIN
12
Q
HYPOTHALAMUS (CNS) act as a ____ ____ and _________ for the ANS FUNCTION
A
SIGNAL RELAY and integration center for ANS functions
13
Q
What are the 2 VITAL CENTERS FOR hemodynamics and ventilatory control
A
MEDULLA
PONS
14
Q
Adrenergic Axon is a
Cholinergic Axon is a
A
nerve fiber that secretes norepinephrine
nerve fiber that secretes acetylcholine
15
Q
Adrenergic Receptor
Cholinergic Receptor
A
receptor Binds to catecholamines: Norepinephrine and epinephrine, dopamine
Receptor that binds to Acetylcholine
16
Q
ANS is a 2 neuron pathway
A
Pre-ganglionic
and post ganglionic
17
Q
the cell body of the Pre-ganglionic neuron is located in 2 places: the ______(____nerves) and the ________ _____ (___Nerves)
A
Cell body is in brain (cranial nerves) or spinal cord (spinal nerves)
18
Q
Pre-ganglionic neuron does what?
A
Carries message to the autonomic ganglia
19
Q
the neurotransmitter released from the PREGANGLIONIC NEURON at the autonomic ganglion is ALWAYS
A
ACETYLCHOLINE
20
Q
The receptor that ACh binds on the POST GANGLIONIC NEURON Cell body is ALWAYS
A
a NICOTINIC CHOLINERGIC RECEPTOR (nAChR)
21
Q
Where does the cell body lies in the POST GANGLIONIC neuron? and where does it carry the message to? ______ _____
A
lies outside the CNS - CARRIES MESSAGE TO THE VISCERAL EFFECTOR ORGAN
22
Q
AXON in the POST ganglionic is (myelinated /unmyelinated)
A
UN-myelinated fiber.
23
Q
Axon is a myelinated fiber in a ____ ______neuron
A
PRE-GANGLIONIC Neuron
24
Q
Where is the cell body in post ganglionic? Where does it terminates _______
A
OUTSIDE of the CNS; In the visceral effector organ.
25
SNS pre-ganglionic comes from ________horn of the _________ from ___ -____segments
Intermediolateral horn of the spinal cord arising form T1-L2 or L3 segments
26
The preganglionic fibers are short, _______ and synapses Sympathetic autonomic ganglia
MYELINATED
27
PREGANGLIONIC fibers always release
ACh
28
SYMPATHETIC Post ganglionic fibers release primarily ________
The neurotransmitter release depends on the_______ ______
ANS the receptor can be either : _______Or ________/______
Norepinephrine ; effector organs
| adrenergic; muscarinic/ Cholinergic
29
Sweat glands SYMPATHETIC post-ganglionic EXCEPTION post ganglionic releases _____and binds to _____
release Ach which binds to muscarinic cholinergic receptors
30
Skeletal muscles and blood vessels are an EXCEPTION post ganglionic releases ____and binds to ______
release Ach bind to muscarinic cholinergic receptors
31
NE released from sympathetic postganglionic bind to adrenergic receptors
located on the effector organ
32
Pre-ganglionic fibers issuing from the spinal cord may synapse with the neurons of more than one
sympathetic ganglion
33
where are the cell bodies of the preganglionic neurons located? ____________ horn of the spinal cord and fibers from these pre-ganglionic cell bodies leave the spinal cord through what? the (anterior/posterior) nerve roots and pass via _________ to 3 different fates.
Intermediolateral horn of the spinal cord; anterior T1 to L2 - L3; WHITE RAMI
34
3 fates once passed through WHITE RAMI
1: preganglionic fibers will synapse with the paravertebral ganglia with a sympathetic post-ganglionic neuron and these post-ganglionic fibers pass through the grey rami to reach the spinal nerves.
2. Some PreGF will ascend or descend in the paravertebral ganglia to synapse with post ganglionic neurons in OTHER paravertebral ganglia
3. some PreGF will pass through the paravertebral ganglia WITHOUT synapsing and synapse in EITHER the prevertebral ganglia or terminal ganglia.
35
Function of sympathetic nervous system (fight or flight): effect:HR, BP, CO , bronchial tree, effect on Blood sugar? where does it shunt blood away from ____to better supply.
```
when activated:
Increased HR , CO
Increase BP
DILATE BRONCHIAL TREE
Shunt blood away from the intestine to better supply skeletal muscle
Increase BLOOD GLUCOSE concentration
```
36
Cell bodies of pre-ganglionic are located in the PARASYMPATHETIC system
brainstem
| and sacral nerves
37
Nerves arise from ___ ___ ___ __ ___ and _______-____ of sacral portion of the spinal cord.
CN III, VII, IX and X and S2-S4 sacral portion of the spinal cord.
38
What is the only neurotransmitter in the PNS system
ACh
39
The ration of pre to post for Parasympathetic
1:1
40
Exception: The ratio of preganglionic VAGAL fibers to Ganglion CELLS in the _________ _________is
MYENTERIC PLEXUS 1:8000
41
The receptor located on the postganglionic cell body is always
nACh R
42
Preganglionic fibers or the Parasympathetic NS is Long, myelinated and pass
UNINTERRUPTED
43
CN III innervates
Eye/orbit
44
**** CN X most important of PARASYMPATHETIC . why :
Vagus NERVE: becomes it transmits 75% of parasympathetic outflow.
45
CN VII innervates
lacrimal, nasal and SL, submaxillary glands
46
A massive parasympathetic response only prostrate and organism leaving it :
helplessly, salivating, wheezing, weeping, vomiting, urinating, defecating and seizing.
47
PNS Is_______
essential for the Maintenance of life.
48
Essential for the Maintenance of life which nervous system
PNS
49
Sympathetic ____pupils, para sympathetic ___pupils
dilate pupils
| Constrict pupils
50
Sympathetic ____bronchi, para sympathetic ___bronchi
Dilate bronchi
| Constrict
51
Length of the preganglionic nerve in Parasympathetic is
LONG
52
Length of the preganglionic nerve in sympathetic is
short
53
Effects of Sympathetic on heart
- CO
- HR Automaticity and conduction velocity
- SA and AV
- His purkinje
- Ventricle
- Increase HR (Beta 1)
- AV and SA node Increased (beta 1)
- Increased automaciticy and conduction velocity (Beta 1)
- his: increased automaticity and conduction velocity (Beta1)
- increased forces on contraction (Beta 1)
54
Effects of ParaSympathetic on heart
Decrease HR
- AV and SA node decreased
- decreased automaticity and conduction velocity
- his: minimal effect
- Slight decreases in forces on contraction.
55
In Parasympathetic, at the heart, AcH binds to
MUSCARINIC 2 receptors.
56
Effects of Sympathetic on ARTERIES:
Vasoconstriction (alpha 1)
| Vasodilation (Beta 2)
57
Effects of ParaSympathetic on ARTERIES
No direct innervation of the vasculature.
58
Effects of ParaSympathetic on VEINS
No direct innervation of the vasculature.
59
Effects of Sympathetic on VEINS
Vasoconstriction (alpha 1)
| Vasodilation (Beta 2)
60
Blood vessels do have _______ receptors : are they innervated from PNS?
muscarinic receptors; NO
61
Acetylcholine is a __________>
neurotransmitter
62
Synthesis of ACH
- occurs where?
- what is the EXCEPTION of post ganglionic
occurs in cytoplasm
Pre-ganglionic of SNS and PNS
Post-ganglionic PNS
Post-nganglinonic of SNS for innervation of sweat glands and skeletal muscles.
63
How is ACH synthesized
4 steps : What is the rate limiting step?
wher is Acetyl CoA synthesized?
-choline taken up by active transport from the ECF into the Axoplasm
- Choline acetyltransferase catalyzes the final step in the synthesis of ACH -->the acetylation of choline with AcetylCoA enzymes
-
ACH is packaged RAPIDLY into synaptic vesicles.
64
For ACH : Action potential arrives to the cholinergic nerve ending causing
4 steps
a) depolarization
b) Ca2++ influx through voltage gated calcium channels
c) Concentration of CA elevates inside cells, causing ACH vesicles fuse with the cell membrane
d) Exocitosis of Ach
65
Magnesium competes with Ca2++ so HYPERMAGNESEMIA affects
Ca2++ production; decreases Ach production
66
Once Ach release it can
bind to receptors on both pre and post synaptic sides.
67
Transmission of Ach is (slow or rapid)
rapid
68
The action of Ach is ______(fast/slow) and why ? Hydrolysis to ______ and _____by what enzyme ? ________
what happens to choline?
immediately hydrolysis to choline and acetate by acetyl-cholinesterase, which is associated with synaptic membranes.
Choline is transported back into the nerve ending where is used for synthesis of new ACh
69
If given drug which inhibits acetylcholinesterase
Ach production will continue and not be broken down.
70
____________ is the main enzyme breaking down Ach
Acetylcholinesterase
71
Another enzyme breaking down ACh but to a lesser degree
Butyrylcholinesterase
72
Butyrylcholinesterase breaks down 2 meds
Succynylcholine
| Myvacurium
73
****Very important in the metabolism of SUCCYNYLCHOLINE and MIVACURIUM
Butyrylcholinesterase
74
Ach binds to 2 major receptor types
```
Nicotinic receptors (ligand gated ion channels) Na, Ca, K resulting in depolarization)
Muscarinic receptors ( G protein coupled receptors)
```
75
ACh binding to nicotinic receptors response are
Rapid
76
ACh binding to muscarininc receptors response are
Slower, but still fast either excitatory or inhibitory
77
Muscarininc receptors response are either
Excitatory
| Inhibitory
78
*****Nicotinic Ach Receptors are al
ligand gated ion channels
79
*****Nicotinic Ach Receptors have 5 subunits
| 2Abed)
2 alphas
Beta
Epsilon
Delta
80
______molecules of AcH has to bind to Nicotinic ACh receptors for it to be activated
2;
81
Neuronal type N1
Autonomic ganglia, adrenal medulla, CNS
82
Muscle type N2
Neuromuscular junction of skeletal muscles.
83
MUSCURANIC ACh ReCEPTOR are the (larg/small), they are ______ _______ and they always link to ____ ____ ____receptors.
2nd messengers. ALWAYS Link with G-proteins
84
Most cells have _______ mAChR
multiple
85
In the heart what type Muscarinic Ach receptor dominates _____
M2
86
****Muscarinic receptors are present in tissue site that LACK parasympathetic innervation such as
BLOOD VESSELS.
87
Muscarinic receptors primarily located :
Peripheral organ and tissues
PERIPHERAL SWEAT GLANDS and SKELETAL MUSCLES BLOOD VESSES
****Vascular endothelial cells
88
M1 , M3, M5 linked to what G protein
G (q)
89
M2 and M4 are associated with what kind of G protein
G (i) and G (o)
90
M1 located in
CNS, autonomic ganglia
91
Atropine is a
non selective M1 and M2 antagonist
92
What does IP3 do?
Causing an increase in the release of Intracellular calcium causing CONTRACTION of smooth muscle and secretion
93
M2 and M4 are linked to the same ___ and ____GPCRs and signal through similar pathways that does what?
What do Inwardly rectifying K(+) (Kir) channels do ?
inhibit adenyl cyclase leading to a decrease in cAMP or activation of inwardly rectifying K channels at the target site.
Inwardly rectifying K(+) (Kir) channels allow K(+) to move more easily into rather than out of the cell.
94
Physiologic Effects At muscarinic receptors include:
HEART: HR, Conduction velocity, Force of contraction
RESP: Bronchoconstriction /dilate; inc/dec Bronchial secretions
URINE: Detrusor muscle cont/dila
GI: Inc/dec gastric sec
PERISTALSIS--> (inc/dec)
EYES:
Why should you use CAREFULLY in ASTHMATIC/COPD?
```
CV: Bradycardia
decrease in conduction velocity
decrease in force contraction
RESP Bronchoconstriction , increased bronchial secretions
GU: Detrusor muscle contraction
GI: Enhanced gastric secretions
EYES: Miosis, Lacrimation/salivation
```
Can cause severe BRONCHOCONSTRICTION
95
Which neuroglia are responsible for forming the myelin sheath in PERIPHERAL NS
Schwann cells
96
Resting membrane of neuron is closed to
-65
97
Protein responsible to maintain the shape of the AXON
NEUROFIBRILS
98
________Propagates the action potentials to the next neuron
AXONS
99
For the somatic NS, cells bodies are located in ______ _____ of the ____ ____; they don't have a middle _________; it is a ______neuron that releases ______ and binds to ________Cholinergic receptor on the ______muscle
various levels; spinal cord; ganglia; Motor neuron; ACh; nicotinic cholinergic receptor ; skeletal
100
For the Parasympathetic NS, cells bodies are located in ______and _____ parts of the ____ ____; Other name for the Parasympathetic system is ________-______; they have a middle _________; it is a ______neuron that releases ______ and binds to ________Cholinergic receptor on the post ganglionic fiber, which releases _______ and binds to _______cholinergic receptor on _____ muscle ,______muscle and ______ glands
Cranial and Sacral; spinal cord; autonomic ganglion; pre-ganglionic fiber; ACh; nicotinic ; ACh; muscarinic cholinergic receptor on Smooth, cardiac and secretory glands.
101
For the SYMPATHETIC NS first way, cells bodies are located in ______ _____ parts of the ____ ____; Other names for that system is _______ ________; they have a middle _________; it is a ______neuron that releases ______ and binds to _______Cholinergic receptor on the post ganglionic ___________fiber, which releases _______ and binds to _______and ________adrenergic receptors on _____ muscle ,______muscle and ______ glands
Thoracic and Lumbar; Spinal cord ; ganglia; preganglionic fiber; ACh; nicotinic; ADRENERGIC; NOREPINEPHRINE; Alpha and beta; smooth, cardiac and secretory glands.
102
For the SYMPATHETIC NS second way, cells bodies are located in ______ _____ parts of the ____ ____; they have a middle _________; it is a ______neuron that releases ______ and binds to _______Cholinergic receptor on the post ganglionic ___________fiber, which releases _______ and binds to _______ - ________ receptors on _______ and _____ _______
Thoracic and Lumbar; Spinal cord ; ganglia; preganglionic fiber; ACh; nicotinic; CHOLINERGIC FIBER; ACh ; Muscarinic - cholinergic ; Sweat glands and CERTAIN blood vessels.
103
For the SYMPATHETIC NS THIRD way, cells bodies are located in ______ _____ parts of the ____ ____; they (DO/DONT) have a middle _________; it is a ______neuron fiber that releases ______ and binds to _______Cholinergic receptor on ______ _____ and releases ____% of neurotransmitter _____ and ____% of neurotransmitter _______
Thoracic and Lumbar; Spinal cord ; DONT; GANGLIA; pre-ganglionic fiber; ACh;
nicotinic; ADRENAL MEDULLA; and releases 80% EPINEPHRINE and 20% NOREPINEPHRINE
104
The receptor located on the postganglionic cell body is ALWAYS a _________ ______
nAChR!
105
IN the SNS, Post ganglionic cell bodies arise from where? Name the 3 sympathetic AUTONOMIC ganglia?
SYMPATHETIC AUTONOMIC GANGLIA
Paravertebral Sympathetic
Pre-vertebral Sympathetic
Terminal Sympathetic
106
Which of the sympathetic Autonomic ganglia is the sympathetic trunk? and how many pairs of ganglia lies on either side of the trunk?
Paravertebral Sympathetic Ganglia (Sympathetic Trunk)
| 22 pairs of ganglia that lie on either side of the vertebral column
107
In the Sympathetic system : The ratio of pre- to post-ganglionic fibers is _______ also known as ( _________)
1:20 (Synaptic
| connectivity)
108
CN IX innervates the
Innervate the PAROTID GLAND
109
What is the action of Botulism Toxins with regard to ACh synthesis?
It blocks vesicular fusion and exocytosis release of ACh
110
Increasing extracellular Mg++
| ___________ACh release
decreases ACh
111
ACh can alos bind to ______mAChR or nAChR to modify its own release
Pre-synaptic
112
2 locations where the enzyme responsible for the rapid hydrolysis of ACh into choline & Acetate at nerve synapses. What is the name of the enzyme?
1. synapses of cholinergic neurons and
2. postsynaptic end plate of the neuromuscular junction
- Acetylcholinesterase
113
Why is AChE (Acetyltransferase) is one of the body’s most efficient enzymes?
Because 1 molecule can rapidly hydrolyze an estimated 300,000 molecules of ACh every minute into acetate and choline
114
Butyrylcholinesterase, that enzyme is very important in the metabolism which two medications?
SUCCINYLCHOLINE and MIVACURIUM
115
Muscarinic Acetylcholine Receptor
| mAChR) located primarily _______and________(such as_______
Sweat Glands and CERTAIN BLOOD VESSELS (skeletal)
116
mAChR also located in the _______ _____where they function as (_______) to decrease or increase the release of ______from presynaptic fibers
Autonomic ganglia
"Autoreceptors"
ACh
117
*****mAChR also found is
VASCULAR ENDOTHELIAL CELLS.
118
M1, M__, M__ receptors couple to the same G(____) protein and signal through similar transduction pathways involving ____________ activity, with the generation of the second messengers _________ or _____________ or ____________;
______ causes an increase in the release of intracellular calcium causing contraction of smooth muscle and secretion; On the other hand the other molecule _____activates _______which results in various physiological responses
3;5; (q) ; Phospholipase C ; diacylglycerol (DAG) ; inositol triphosphate (IP3) ; cAMP; IP3; DAG; protein kinases
119
M2 and M_ couple to the same G___and G__ proteins and signal through similar pathways that inhibit _________ _____leading to a________(inc/dec) in cAMP or activation of inwardly rectifying K+ channels at the target site. These effects cause ___________and _________responses in effector organs.
4; (i) (o); adenylyl cyclase ; Decrease in ; hyperpolarization; inhibitory
120
Activation of M2 and M4 autoreceptors on preganglionic fibers of the ANS is thought to represent a _________
physiologic negative-feedback
| control mechanism for ACh release at the autonomic ganglia
121
ANTIMUSCARINIC DRUGS Is a drug that antagonizes the transmission of neural impulses at
sites where there are muscarinic cholinergic receptors
A drug that antagonizes the transmission of neural impulses at sites where there are MUSCARINIC cholinergic receptors
122
Anti-muscarinic drugs examples (GAS): (sames as anticholinergic)
Glycopyrolate
Atropine
Scopalamine
123
Catecholamines are derivatives of __________which is the amino acid precursor _________
Body must make ________catecholamines
phenylalanine; tyrosine
| Endogenous;
124
What must be present in plasma to form tyrosine
Phenylalanine
125
MUST KNOW*****Tyrosine is transported into the _______nerve terminal and is converted into _______By the enzyme . And this step is ________; then _________ is then transported into synaptic vesicles by the
_______________-2. This _______-2 is also responsible for the uptake of other cytoplasmic monoamines into vesicles, including______, _______, ______
Most important is enzyme for rate limiting_________
presynaptic; L-DOPA; tyrosine HYDROXYLASE: The rate limiting step of catecholamines biosynthesis; Dopamine; vesicular monoamine transporter-2 (VMAT-2); VMAT-2; NE, Epi, Serotonin
TYROSINE HYDROXYLASE
126
The final step of converting NE into Epinephrine occurs only in the ______ _______ and in a few epinephrine-containing neuronal pathways in the brainstem since they have the enzyme ___________ ________
adrenal medulla; Phenylethanolamine-N- Methyltransferase
127
Name the 5 steps on how NE actions;
| DeViVO
1. Depolarization of the pre-synaptic cells
2. Voltage gated Ca2+ channels to open and rapid entry of Ca2+ into the cytoplasm
3. Increase Ca2+ in the nerve terminal triggers fusion of synaptic vesicles will cell membrane through Vesicle Associated Membrane proteins (VAMPs) and synaptosome-associated proteins (SNAPs)
4. Vesicle fusion results in exocytosis of NE and release into synaptic cleft.
5. Once in synapse, NE interact with adrenergic receptors on post synaptic cell.
128
NE can also interact with adrenergic receptors on the presynaptic membrane where binding can either diminish _____________or enhance ______the release of NE into the synaptic cleft
Alpha-2 receptors
| Beta receptors
129
Neuronal Reuptake
*****Pre-synaptic alpha-2 receptors and beta receptors to dictate what _________
Blocked by Cocaine
TCAs and others
Norepinephrine can either be up-regulared or down-regulated from nerve terminal .
130
The action of endogenously released NE is terminated at the ________By three 3 mechanisms .
Diffusion _%
Re-uptake ___%
and metabolism by enzymes _____ and _______
Synaptic Cleft.
1)Diffusion out of the synaptic cleft away from receptors responsible for ~8% removal of the released NE from the synaptic cleft
2) Re-uptake of NE back into the presynaptic nerve terminal responsible for ~87% removal of the released NE from the synaptic cleft
3) Metabolism of catecholamines occurs by the enzymes monoamine oxidase (MAO) or catecholamine-Omethyltransferase
(COMT)
131
Metabolism of NE is of relatively _________significance in terminating
the actions of endogenously released NE at the synaptic cleft
minor
132
~______% of the released NE is returned to the presynaptic adrenergic nerve terminal by a _______ ______ ____
87%; neuronal uptake transporter (NET) reuptake
133
What is the major/principal mechanism for terminating the
action of endogenous NE?
how?
Reuptake
| There is a transport PROTEIN called Norepinephrine reuptake channel done by NET.
134
Once transported back into the
| cytosol, NE can be re-stored in ______ or is metabolized by ________
the vesicle; MAO
135
_________,________, ________ and
NUMEROUS other drugs all inhibit/block (NET) this re-uptake mechanism of NE
How does the antidepressnat work and what does cocaine do?
Cocaine, TCA’s, Venlafaxine, ANTIDEPRESSANTS
Cocaine KEEPS Norepinephrine in the synapse.
Antidepressant keeps NE in a little longer.
136
_______ ________ by monoamine oxidase (MAO) enzymes. occurs in the _________ of the presynaptic nerve terminal after NE has been actively transported back into the presynaptic nerve terminal
MAO also metabolize other
Oxidative deamination ; Cytoplasm;
| Neurotransmitter.
137
******________ by catecholamine-O-methyltransferase (COMT) enzyme
Occurs in _________ ______ postsynaptic neurone uptake by ENT
Methylation ; extraneuronal uptake
138
Metabolism of catecholamines forms various end products that are conjugated with ____________ in the ______(organ) and excreted in the _____
glucuronic acid; Liver; urine
139
The primary urinary metabolite of catecholamine metabolism is _______ _________. This metabolite can be measured from a ______ ____________
for diagnostic purposes such as _____________
Vanillyl mandelic acid (VMA); 24-hour urine collection; pheochromocytoma
140
*******_________ _____ _____ is the final end product of catecholamine metabolism
VMA = vanillyl mandelic acid
141
*******All adrenergic receptors are ______ _____ _______ receptors
G protein-coupled type receptors!
142
Alpha-1 Adrenergic Receptors (α1) – coupled to _______, PRIMARILY LOCATED _______and generally produce an ______response. Further division into alpha 1 ___,___,____
AGONIZING THEM ALPHA inhibit _______synthesis
Gq-protein; Postsynaptically ; EXCITATORY; 1a, 1b, 1d
AGONIZING ALPHA-1 receptors of the NERVE THAT INNERVATES THE HEART WILL DECREASE HR.
INHIBITION of NE synthesis.
143
Alpha-2 Receptors (α2) coupled to ______, Primarily located ________Stiumlation resuls in _______ of NE synthesis and release (_________Feedback system) . Further division into alpha 2___,____, ____
Gi-protein; pre-synaptically on autonomic nerve terminal.
| Also is in the post-synaptic membrane.
144
*****ALL OF THE beta-adrenergic receptors couple to the ____-protein and activate _____ _______which_________ cAMP levels in cells. Further divided in ____, _____, ______
Gs-protein; adenylyl cyclase ; increases
| beta 1, 2, 3.
145
Beta-1 (β1) Predominant receptor found in the ______that produces _________ inotropic, chronotropic and dromotropic effects. Also found in _________Stimulation of these receptors is “________”
(1) heart; positive; kidneys; "excitatory”
146
Beta-2 (β2)Predominant receptor found in _________ ____that produces certain blood vessels to relax, ________ and _______ ;Also located in the ______
Stimulation of these receptors is “inhibitory”
2 lungs smooth muscles; eyes; inhibitory
blood vessels to relax, uterine relaxation, and bronchial smooth muscle dilation, bronchodilation
“inhibitory"
DeCREASES cAMP
147
Beta-3 (β3) Predominant receptor found in ______ ______ and predominant receptor producing metabolic effects Also found in the___________
adipose tissue; urinary system
148
Down-regulation : Receptor number goes (up/down) ______; *****Receptors are ________ and the number of receptors diminishes due to ____________
CHF patient’s have constant, ________ ______ ______which results in down-regulation of ________ _______receptors
Down; destroyed ; repeated/chronic exposure to an agonist
| high sympathetic outflow; Beta-1 adrenergic receptors
149
Up-regulation: The number of receptors increases due to _______ _______ ________( such as Beta-blocker, CVA, paralysis, denervation diseases)
increases; repeated/chronic
| exposure to an antagonist (Beta-blocker, CVA, paralysis, denervation diseases)
150
Beta-blocker therapy generally (Should/should not) be discontinued prior to surgery. Beta-blocker therapy SHOULD NEVER be ______ _____because of up-regulation, it takes time
SHOULD NOT; discontinued abruptly
151
****Postganglionic fibers of the SNS have generalized distribution and
are responsible for more ________ ______
generalized mass responses
152
SNS post-ganglionic neurotransmitter is _________ &_________ such as
__________blood vessels, which the neurotransmitter released at these exception sites is ACh
sweat glands ; camp; certain blood vessels such as skeletal muscle blood vessels; Acetylcholine.
153
2 Major subtypes of cholinergic receptors
Nicotinic
| Muscarinic
154
```
Muscarinic Receptors (mAChR's) are found p-_______ ___ ______ innervated by parasympathetic postganglionic neurons
(effector organs) and sympathetic postganglionic neurons of
SWEAT GLANDS and certain blood vessels (effector organs), and are also present in autonomic ganglia and on some cells (i.e.: vascular endothelial cells)
```
peripherally in tissues
155
```
Nicotinic Receptors (nAChR's) are found ___________ ____ ____ ________of skeletal muscles, sympathetic and
parasympathetic autonomic ganglia (the main ACh receptor at this site) and at the adrenal medulla
```
peripherally in the motor end-plate
156
The adrenal medulla is innervated by preganglionic sympathetic neurons which release_______, which binds to
_________ on the adrenal medulla __________ and cause the
release of ________ (__0%) and _______ (__0%) into the blood stream
ACh; nAChR’s; chromaffin cells; Epinephrine (80%) and Norepinephrine (20%)
157
ACh is the neurotransmitter released from:
a) Somatic Motor Neurons
b) Preganglionic and Postganglionic Parasympathetic Neurons
c) Preganglionic Sympathetic Neurons
d) Postganglionic Sympathetic Neurons to ________ _____and ____ ____ ____
SWEAT GLANDS and certain blood vessels
158
________is NEVER released as a neurotransmitter, because the Nerve terminal of that neurotransmitter don't have which enzume
Epinephrine; Phenyloanalnine- N- acetyltransferase
