Autonomic Nervous System (with Sympathetic NS) Flashcards
Subdivision of efferent peripheral nervous system (neurons outside the CNS)
Autonomic Nervous System
Mechanism of impulse transport across a synapse
Synaptic Neurotransmission
Parts of Synapse (3)
▪️ Sending
▪️ Synthesis storage RELEASE of neurotransmitters
▪️ Autoreceptors or presynaptic receptors; for modulation or regulation of NT release
Pre-synapse
Parts of Synapse (3)
▪️ Responsible for inactivating NTs
▪️ Metabolizing enzyme containing
Synaptic cleft
Parts of Synapse (3)
▪️ Receptors primary location
▪️ Majority of receptors:Excitatory
Post-Synapse
▪️Origin of Neurons: Thoracolumbar (T1-T12, L1-L5)
▪️Length of PRE-GANGLIONIC fiber: shorter
▪️Length of POST-GANGLIONIC fiber: longer
▪️Location of Ganglion: Near the Spinal Cord
Sympathetic Nervous System
▪️Origin of Neurons: Craniosacral (CN 3,7,9,10, S1-S4)
▪️Length of PRE-GANGLIONIC fiber: loger [ParaLongPre]
▪️Length of POST-GANGLIONIC fiber: shorter
▪️Location of Ganglion: Near the Target Organ / Effector
Parasympathetic Nervous System
NEUROTRANSMITTERS
Pre-Ganglionic: ACh
Post-Ganglionic: NE, Epi, Dopa
RECEPTORS [Adrenergic]
Ganglion: Nicotinic neural (Nn)
Target Organ/Effector: a,B,D
Sympathetic Nervous System
NEUROTRANSMITTERS
Pre-Ganglionic: ACh
Post-Ganglionic: ACh
RECEPTORS [Cholinergic]
Ganglion: Nicotinic neural (Nn)
Target Organ/Effector: M,N
Parasympathetic Nervous System
Funtional [General]
NE: Adrenergic NS
□ Stress
□ Fight/Flight/Fright
Sympathetic Nervous System
Funtional [General]
ACh: Cholinergic NS
□ Basal
□ Rest and Digest
Parasympathetic Nervous System
Funtional [Specific]
▪️HEART: Tachycardia
▪️SMOOTH MUSCLES: Relaxation ( ↓pressure)
▪️PUPILS: MyDriasis (dilation)
▪️BRONCHI: BronchoDilation
▪️GIT: Ileus (loss of peristalsis)
▪️URINARY BLADDER (Walls): Urinary Retention
▪️SWEAT GLANDS: Apocrine (palms/soles)
Sympathetic Nervous System
Funtional [Specific]
▪️HEART: Bradycardia
▪️SMOOTH MUSCLES: Contraction ( ↑ pressure)
▪️PUPILS: Miosis (constriction)
▪️BRONCHI: BronchoConstriction
▪️GIT: Bowel Mvmt. (diarrhea)
▪️URINARY BLADDER (Walls): Urination
▪️SWEAT GLANDS: Eccrine (thermoregulation)
Parasympathetic Nervous System
Sympathetic Drugs (4-EAAA)
- Endogenous Catecholamines
- Adrenoceptors
- Agonist: (-mimetic)
- Antagonist (-lytic)
Biosysthesis of Cathecholamines:
Precursor: Tyrosine
STEPS: [True Love Does Not Exist]
Tyrosie→L-DOPA→Dopamine→NE→Epinephrine
Enzymes on the ff.
1. Formation of L-Dopa
2. Formation of Dopamine
3. Formation of Norepinephrine
4. Formation of Epinephrine
Enzymes on the ff.
1. Tyrosine hydroxylase
2. L-DOPA decarboxylase
3. Dopamine-B-hydroxylase
4. Phenyl Ethanolamine-N-Methyl Transferase (PENMT)
What is the First Catecholamine
Dopamine
Storage of Dopamine
Vesicle
Exocytotic release of NT
Stimulators: [TEAAM]
Inhibitors: [GGB]
Stimulators: Tyramine, Ephedrine, Amphetamine, Angiotensin II,
Inhibitors: Guanethidine, Guanadrel, Bretylium
What adrenoceptors?
▪️Vascular Smooth Muscles = Qontraction; Vasoconstriction (↑BP)
▪️Urinary Bladder, Trigone & Sphincter: Closure (urinary retention)
▪️Prostatic Smooth Muscles: Contraction (urinary retention)
▪️Radial Muscles (iris): Mydriasis
▪️Pilometer SM: Piloerection (goosebumps)
Alpha 1 (Q1)
What adrenoceptors?
▪️Autoregulation - inhibits further release of NE
▪️Consequences:
● Central: Sedation & Depression
● Peripheral: Vasodilation (↓ BP)
Pre-Synaptic Inhibitory Gi (Alpha 2)
Alpha 2
▪️Pre-synaptic : Inhibitory (?)
▪️Post-synaptic : Excitatory (?)
▪️Pre-synaptic : Inhibitory Gi
▪️Post-synaptic : Excitatory Gq
What adrenoceptors?
▪️Location: Blood Vessels
▪️Vasoconstriction
Post-Synaptic Excitatory Gq (Alpha 2)
What adrenoceptors?
▪️Heart:
○ (+) Inotropy- force of contraction
○ (+) Chronotropy-HR
○ (+) Dromotropy-Conduction Velocity
▪️Kidneys:Juxtaglomerular Apparatus
○ ↑ Renin release=↑BP
Beta 1
What adrenoceptors?
▪️Smooth Muscle:
○ Bronchi: Bronchodilation
○ Uterus: Relaxation (Tocolysis)
○ BV: Vasodilation
▪️Skeletal Muscle
○ ↑ K intake=Hypokalemia occurs
○ Contriction=tremors
Beta 2
What adrenoceptors?
▪️Adipocytes
○ Lipocytes=weight loss
Beta 3
What adrenoceptors?
▪️Receptors: GIT
○ ↓GIT Motility (Ileus) Constipation
Dopamine 2 (D2)
▪️First line cardiac stimulant
▪️First line for anaphylaxis and anaphylactic shock (due to allergy)
▪️Local vasoconstrictor
Epinephrine or Adrenaline
▪️ First line inotropic agent for septic shock
▪️ Aka Levarterenol
Norepinephrine or Noradrenaline
▪️ First line for cardiogenic shock
▪️ Alternative: Management of septic shock
▪️ Management of acute heart failure complicated by oliguria (< 500mL/day) or anuria (<50mL/day)
Dopamine (B1-Selective Agonist)
Eye Drops
Treatment of Red Eye
Tetrahydrozoline Eye Drops (Eye Mo Red)
Intranasal
Treatment of Nasal Congestion
Oxymetazoline Nasal Spray (Drixine)
Non-selective beta agonist
Uses:
▪️Alternative during shock states
▪️Mgt. of AHF (pwedeng B1 Agonist)
▪️Synthetic Catecholamime
Isoproterenol or Isoprenaline
▪️ Binds to pre-synaptic alpha 2 receptors in general
▪️ Anti glaucoma and Antihypertensive drugs
Selective alpha 2 Agonist
Alpha 2
▪️Antiglaucoma Agents (2-AB)
- Apraclonidine
- Brimonidine
Alpha 2
▪️Antihypertensive Agents (4-MCGG)
- Methyldopa
- Clonidine
- Guanfacine
- Guanabenz
First line reliever for Bronchial Asthma
SABA
Controllers in BA with inhaled corticosteroids
LABA
What type of drug class are?
▪️Ritodrine
▪️Isoxsuprine-most common
▪️Tx: Mgt. of Pre-term labor
Tocolytics
Indirect Acting
▪️Releasers (4-TEAM)
Tyramine
Ephedrine
Amphetamine
Metamphetamine
From Ma Huang
Ephedrine
- 1st line Mgt. ADHD
- Alternative for ADHD
- Methylphenidate
- Amphetamine &Atomoxetine
Aka Shabu
Metamphetamine
1st Line: Narcolepsy
Modafinil
Indirect-Acting (under Releasers)
▪️For Anorexiant
Phenmetrazine
Management of Obesity
Sibutramine
Tx. Nasal Congestion & Hypotension
T/E: ↑ risk of hemorrhagic stroke
Phenylpropanolamine (PPA)
What class of drugs are the following:
▪️ Prazosin
▪️ Doxazocin
▪️ Terazosin
▪️ Tamsulosin
Alpha 1 Selective (-zosin) [Sympathetic Antagonist]
▪️Vasodilators →AntiHTNsive
What drug use in Benign Prostatic Hyperplasia (BPH) | Prostate Enlargement?
Selective Alpha 1
▪️Finasteride
▪️Dutasteride
What class of drugs are the following:
▪️Yohimbine
▪️Rauwolscine
Alpha 2 Selective [Sympathetic Antagonist]
▪️Non-Selective
▪️Irreversible; Non-competitive
▪️DOC for management of Carcinoid Syndrome
Phenoxybenzamine [Sympathetic Antagonist]
▪️Non-Selective
▪️Reversible; Competitive
▪️Mgt. of Pheochromocytoma
▪️Tx. of Erectile Dysfunction (local injection)
Phentolamine [Sympathetic Antagonist]
Tumor/ hyperplasia in adrenal medulla; causes hypersecretion of catecholamines
Pheochromocytoma
Neuroendocrine condition associated with malignancy affecting enterochromaffin cells
Carcinoid Syndrome
Digital vasospasm in response to stress/cold environment; vasoconstriction causes necrosis
Tx: alpha blockers (DOC), CCBs (alternative)
Raynaud’s Syndrome
Cardioselective B-blockers less likely to cause bronchospasm
Selective B1-Blockers
What are the Cardioselective (B1) [Sympathetic Antagonist]
Mnemonics: CBEAM
Celiprolol
Bisoprolol, Betaxolol
Esmolol (shortest t1/2; given IV)
Atenolol, Acebutolol
Metoprolol
What are the Non-Selective (B2) Bronchoconstriction [Sympathetic Antagonist]
Mnemonics: NSTP
Nadolol
Sotalol - Class III B-blocker Anti-arrhytmic
Timolol - Antiglaucoma
Propranolol - Prototype (Inderal)
Beta-blockers with special properties:
- Intrinsic Sympathomimetic Activity (ISA) [CLAP]
- Membrane stabilizer [PALM]
- Vasodilation (Mixed Action) [CLN]
- Carteolol, Celiprolol, Lebatalol, Acebutalol, Pindolol, Penbutolol
- Propranolol, Acebutolol, Labetalol, Metoprolol
3.Carvedilol, Labetalol, Nebivolol
▪️Most Cardioselective
▪️HTN: 1st line-px w/hx of post-myocardial infarction
▪️Mgt. of Angina Pectoris & Stable HF
Nebivolol
Drug use for Management of Stable Heart Failure (only useful) BCMN
Bisoprolol
Carvedilol
Metoprolol succinate
Nebivolol
Drug use for Management of Arrhythmia
Class II Arrhythmics
Drug use for Management of Glaucoma [↓ IOP] (TB-lol)
Timolol
Betaxolol
Drug use for treatment of sympathetic symptoms of hyperthyroidism
Propranolol (inh. the peripheral conversion of T4 to T3)
Carvedilol - less sedating
Drug use for:
▪️Prophylaxis: Migraine Headache
▪️For Stage Fright
Propranolol
What adrenoceptors;
▪️Mgt. Of BA & COPD
▪️Mgt. of Pre-term labor
▪️Adjuncts in the mgt. of hyperkalemia (B2 has hypOkalemic effects)
Selective B2 Agonist
