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Neuro > Autonomic NS > Flashcards

Autonomic NS Flashcards

1
Q

Nucleus Tractus Solaritus

A
  • in dorsalmedial caudal medulla; gets all visceral afferents
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2
Q

Role of Reticular Formation

A

Reticular formation neurons then integrate info from hypothalamus, NTS, etc and regulated sympathetic and parasympathetic outflow

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3
Q

Sympathetic Basics

A
  • Thoracolumbar - cell bodies in intermediate horn of thoracic and upper lumbar SC
  • Short pre-ganglionic cell w/ body in interomediolateral cell column —> spinal nerve —> through white ramus —> sympathetic chain ganglia (post-synaptic cell body)
    • 1- synapse on chain ganglia it enters
    • 2- move up or down chain and synapse on another ganglia in sympathetic chain
    • 3- pass through chain w/o synapsing and synapse on pre-vertebral ganglia
      • Celiac, superior mesenteric, inferior mesenteric

**Adrenal medulla - pre-ganglionic fibers pass w/o synapsing through sympathetic chain and synapse right on adrenal gland —> epinephrine/NE into blood stream

  • Pre-ganglionic releases Ach onto nicotinic receptor
  • Post-ganglionic release NE onto alpha or beta receptors
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4
Q

Parasympathetic Basics

A
  • Craniosacral - cell bodies in CN ganglia (3, 7, 9, 10) or sacral SC
    • Long pre-ganglionic axon then synapses on post-ganglionic cell embedded in target organ
  • Pre-ganglionic releases Ach onto nicotinic receptors
  • Post-ganglionic releases Ach onto muscarinic receptors (mult subtypes)
  • **HUGE effect on GI contraction
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5
Q

How does Viagra work? Side Effects?

A
  • NO causes vasodilation (produced by endothelial cells then diffuses into smooth muscle —> relaxation)
  • NO —> activates guanylyl cyclase —> inc cGMP —> ATPase pumps Ca++ out —> relaxation
  • Viagra (Sildenafil) inhibits phosphodiesterase (PDE5) which normally degrades cGMP in corpus cavernosum; so only works if sexual stimulated to begin with
  • Mild side effects b/c effect on other phosphodiesterase (ex - PDE6 in retina —> color vision abnormalities)
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6
Q

Which 4 CN have parasympathetic outflow?

A 
Oculumotor Nerve (III) - Ciliary musc (accommodation)
Sphincter of Pupil (constrict pupil- dilates)
Facial Nerve (VII) -Lacrimal gland (tears)
Nasal glands (mucus)
Palatine glands (mucus)
Submandibular gland, sublingual gland, lingual glands (saliva)

Glossopharyngeal Nerve (IX)- Parotid gland (salivation)

Vagus (X) - All thoracic and abdominal viscera (heart, lungs, esophagus, stomach, SI, proximal colon, pancreas, upper ureters)

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7
Q

Alpha 1 (affinity & effects)

A

NE&raquo_space; epi

  • Constrict arterioles (skin, mucosa, skeletal muscles, veins)
  • Contract radial muscle of pupil (widens it)
  • Dec bronchial gland secretions (NE)
  • Inc secretion of sweat glands of palms and feet

**-Parasympathetic contracts sphincter of pupil to close it
BUT no parasympathetic control on arteriole or vein pressure

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8
Q

Alpha 2 (affinity & effects)

A

NE&raquo_space; epi

-Constrict arterioles (skin, mucosa, skeletal muscles, veins)

**-NO parasympathetic control of arteriole or vein pressure

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9
Q

Beta 1 (affinity & effects)

A

NE = epi

-Inc HR and inc contractility

**-Parasympathetic can combat by dec HR BUT no parasympathetic control of contractility

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10
Q

Beta 2 (affinity & effects)

A

Epi&raquo_space; NE

  • Dilation of coronary arteries, arterioles to skeletal muscles, arterioles to abdominal viscera
  • Relax ciliary muscle to flatten lens for far vision
  • Relax bronchiole muscles and inc bronchial gland secretions (epi)
  • Inc contractility of skeletal muscle
  • *-Parasympathetic does not control vessels and NO parasympathetic effect on skeletal muscle contractility
  • Parasympathetic does combat by contracting ciliary muscle making lens more convex AND contraction of bronchiole muscles and inc secretions (protective if something in lungs)
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11
Q

Pupil Constriction Path v Pupil Dilation Path

A
  • Parasympathetic v Sympathetic
  • Parasymp - pupil constriction; EWN —> ciliary ganglion —> short ciliary fiber to iris
  • Symp - pupil dilation; hypothalamus —> interomediolateral of C8-T2 —> superior cervical ganglion —> follow carotid artery to eye for dilator & superior tarsal muscle
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12
Q

Anisocoria

A

asymmetry in pupil size; 20% of normal ppl

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13
Q

How does pupillary light reflex work?

A

Light signal —> optic tract —> pre-tectal nucleus —>synapses on BOTH EWN —> both direct & consensus reflex

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14
Q

2 Poss Causes of Pinpoint Pupils

A

pontine lesions (block symp but not parasymp) OR narcotic use

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15
Q

Argyll Robertson Pupil

A

seen in late syphilis; small pupils that react to light but not accommodation

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16
Q

Adie’s Pupil (+ pharm test)

A
  • degeneration of ciliary ganglia —> “tonic pupil” (taks long time to move)
  • Pharm Test- give pilocaprine (parasymp mimetic) and if constriction it confirms dx
17
Q

4 Poss Causes of Horner’s + Pharm Test

A
  • Causes can be at any point of sympathetic tract …
    • Brainstem (part of lateral medially system)
    • Lateral horns of C8-T2 or superior cervical ganglion
    • Pancoast tumor at top of lung can compress as it travels w/ carotid
    • Carotid artery lesions - if b/f bifurcation then includes sweat glands (anhydrosis) but id ABOVE bifurcation then sweating fine
  • Pharm Test - use apraclonidine (alpha agonist) which should reverse miosis; de-nervated muscles are more sensitive to drugs
18
Q

Bladder Afferents & Efferents

A
  • Afferents
    • Stretching of depressor —> A delta —> sacral SC (b/c parasymp control)
    • Bladder neck & internal sphincter —> thoracic SC (b/c symp control)
  • Efferents
    • Interomediolateral sacral SC —> detrussor (para-symp)
    • Sacral gray matter (Onuf’s nucleus) —> external sphincter (VOL CONTROL)
    • Interomediolateral thoracic SC —> bladder neck and internal sphincter (symp)
19
Q

Descending Bladder Control + Reflex

A
  • Descending Control - integration in aquaductal grey —> pontine micturition center —> efferents
  • “Reflex” - stretch (A delta) —> sacral SC —> contract detrussor
20
Q

Sequence of Micturition

A
  • Voluntarily relax perineum
  • Inc tension of abdominal wall
  • Slow contraction of detrussor
  • Associated opening of internal sphincter
  • Voluntary relaxation of external sphincter
21
Q

4 Bladder Problems

A
  • Hyperactive detrussor- disrupt descending inhibitory fibers (inc urgency, nocturia, urge incontinence, inc frequency)
  • Dyssynergia - incomplete emptying and prone to UTIs b/c disconnect b/n detrussor and sphincter relaxation
  • Urinary retention - PAINFUL; SC lesions, BPA, transverse myelitis, etc; pre-disposed to UTIs
  • Sensory Bladder - neuropathy of bladder afferents or SC lesion; not painful b/c no A delta afferents but also predisposed to UTIs
22
Q

Bethanechol

A

can produce bladder contractions in a flaccid bladder. This is generally disappointing clinically

23
Q

How to treat spastic bladder

A

oxybuytinin

24
Q

Terazosin and Doxazosin

A

can relax urinary sphincters and may be useful in dyssynergia, and in prostatic hypertrophy

Neuro (31 decks)

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