bruno (L4-8) Flashcards

1
Q

organisation of the peripheral nervous system (pns)

A
  • somatic ns (skeletal muscle)
  • autonomic ns // sympathetic ns and parasympathetic ns (targets all except skeletal muscles)
  • enteric ns (guts)
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2
Q

types of nerve fibres (2)

A

AFFERENT fibres carry sensory information to the CNS
and
EFFERENT fibres carry signals from the CNS to the periphery

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3
Q

3 types of horns

A

dorsal horn (sensory inputs, on the back of the spinal cord)

lateral horn (spinal preganglionic neurones of ANS)

ventral horn (somatic motor neurons)

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4
Q

the 5 steps to communication in the CNS/PNS to synaptiic transmission

A
  1. Synthesis of neurotransmitter
  2. Store neurotrans in vesicles - 2 reasons to store (protect neurotrans from enzymes that can metabolise them, package neurotrans at high conc in vesicles so that when released, the conc is much higher than in the synaptic cleft and achieve a burst)
  3. Release neurotrans - many steps are involved, you have to dock the vesicle with the ??? calcium catalyses the fusion of vesicles and the axon membrane, exocytosis, retrieve the membrane to recycle by endocytosis
  4. Activation of neurotrans receptors - 2 types (ligand gating receptors with ion channel through them, G protein coupled receptors). Neurotran activates either G protein one only, or both.
  5. Inactivation - remove neurotrans by 2 mechanisms (enzyme present that metabolises the neuro into inactive components, or remove complete neurotrans or breakdown product of the neurotrans). This is to achieve a phasic fashion for the neurotrans to have a high conc gradient and ensure a high impact.
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5
Q

efferent pathway of somatic nervous system

A

it consists of a single neurone
cell body of neuron lies in the ventral horn of the spinal cord or nuclei within higher brain centres

motor neuron (efferent) runs directly to the skeletal muscle fibres
synapses at a specialised structure (NMJ neuromuscular junction, or endplate)
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6
Q

efferent pathway of somatic nervous system

A

consists on 2 neurons

  • preganglionic neurone
  • ganglion
  • postganglionic neuron
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7
Q

classification of somatic and autonomic synapses

A
  • somatic motoneurones
    1 neuron from cns to skeletal muscle
    nAChR
  • parasympathetic motor neurones
    2 neurons from cns to ganglia to eg salivary glands
    nAChR pregang / mAChR postgang
  • sympathetic motor neurons
    2 neurons from cns to ganglia to blood vessels
    nAChR pre / NA post
    OR: 2 neurons from cns to adrenal medulla to all cells
    nAChR pre / adrenaline post
    OR: 2 neurons from cns to ganglia to sweat glands
    nAChR pre / mAChR post
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8
Q

classification of parasympathetic nervous system

A

LONG PREGANGLIONIC NEURON / SHORT POSTGANGLIONIC NEURON

from brain stem (medulla) to different tissues
-2 neurons (medulla to peripheral ganglion to pupils or salivatory glands)
-2 neurons with vagus (X) nerve as a preganglionic nerve
(medulla to peripheral ganglion to bronchi, heart, gallbladder, gut motility, bladder, genitals)

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9
Q

classification of

sympathetic nervous system

A

SHORT PREGANGLIONIC NEURON / LONG POSTGANGLIONIC NEURON

from spinal cord to ganglion in sympathetic chain to different tissues

  • 2 neurons through sympathetic chain (blood vessels, hari erection, sweat glands)
  • 2 neurons through sympathetic chain (pupils, bronchi, heart rate and contractility)
  • 2 neurons, ganglia after the sympathetic chain (gut motility, liver, renal)
  • 1 neuron to adrenal glands
  • 2 neurons through hypogastric ganglion (vas deferens in ejaculation)
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10
Q

Probability of the neurotransmitter releasing

A

Probability of the neurotransmitter releasing across the synapses is rarely 1, which means that if you send an action potential down a nerve the chances that one of the viral posities will release neurotransmitter is not one so it will not happen every single time

the probability is actually quite low at these varicosities, which is why we have so many vesicles. the probability of releasing something that can be modified can be increased buy the circuits of the brain to ensure that the response will be put into action.

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11
Q

acetylcholine in the parasympathetic NS

A

ACETYLCHOLINE is the neurotransmitter released from all parasympathetic postganglionic neurones at the neuroeffector junction

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12
Q

how do you classify synapses

A

Synapses can be classified according to the transmitter released from the presynaptic neurone.

At synapses where the presynaptic neurone synthesises and releases acetylcholine (ACh) transmission is classed as cholinergic. Receptors upon which ACh acts are called cholinoceptors.

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13
Q

Two classes of cholinoceptor in the NS

A
  • nAChR
    Nicotinic cholinoceptors
    are activated by ACh or the tobacco alkaloid nicotine but not by muscarine.
    ALL ARE LIGAND GATED ION CHANNELS
  • mAChR
    Muscarinic cholinoceptors
    are activated by ACh or the fungal alkaloid muscarine but not by nicotine.
    ALL ARE G PROTEIN COUPLED RECEPTORS
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14
Q

define noradrenergics and name 2 types of their receptors

A

At synapses where the transmitter is noradrenaline, transmission is described as noradrenergic and the receptors activated are called adrenoceptors.

Two classes of adrenoceptor are found
in the nervous system:
α-adrenoceptors and β-adrenoceptors

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15
Q

molecular structure of nicotinic cholinoceptors (subunits, domains etc)

A

consists of 5 subunits (αβγαδ) to form a pentameric ligand gated ion channel

Extracellular domain will respond to ach
Transmembrane domains - M2 domain creates the ion channel, M2 determines ion conduction or ion cell activity of the channel.

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16
Q

how do ions flow through the nicotinic cholinoceptors?

A

the Ach has to bind to the 2 a subunits for the ion channel to open by shape change, ions move down their electrochemical gradient

OR IONS (EG SODIUM)

Sodium ions are repelled from the positive ion dense region at the bottom. Fenestrations are found on the sides of the structure of the channel. They could be roots for ions to flow through.
so the ions flow through the channel from the top and out its sides

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17
Q

g couple protein coupled receptor cycle

A

by agonist binding, the receptor then becomes occupied and causes a conformational change which allows it to interact with the alpha subunit of the G protein
alpha subunit then loses its affinity to the GDP and its affinity to GTP increases.
Activated the G protein, it goes to interact with its target proteins (activate or inhibit)
To stop the cycle - alpha subunit metabolises the GTP to GDP. GTPase activity switches off the signal. Returns to resting state.

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18
Q

difference in rates of activation between nicotinic receptors and ligand gated channel

A

Process occurs over a few milliseconds while the activation of a ligand ion gated channel occurs in many seconds so the time scale is very different
this is because nicotinic receptors are found at the skeletal muscles where we need very quick control of activity, whereas in the gut we don’t need quick control so we can use ligand gated channels
Signalling of these 2 processes is very different

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19
Q

process of Botulinum toxin affecting the neuromuscular junction

A

The fusion of the vesicles to the presynaptic membrane gets interactions of many proteins (snare, syntaxin etc)
They tether the synaptic vesicle to the presynaptic membrane
Ca enters cell, tethers are taken up, take it to close proximity to the membrane, fusion, release of neurotransmitter

B toxin can interfere with one of the proteins (synaptotagmin) to get a complex form
Internalised through endocytosis - bond between HC and LC is broken.
LC cleaves the SNARE proteins
→ PARALYSIS

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20
Q

define mEPP and the result of its summation

A

Release of a vesicle gives a “quanta” of transmitter
At NMJ each quanta gives rise to a miniature end plate potential (mEPP) via activation of nAChRs

mEPPs summate to give an end plate potential (EPP), which, if large enough, can initiate an action potential (AP) and hence muscular contraction

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21
Q

2 phases of NMJ block

A

PHASE 1 BLOCK -
persistent activation of endplate nicotinic receptors by suxamethonium
Causing strong depolarization of the muscle which results in inactivation of voltage gated sodium channels (these channels need to rest but as you depolarise the membrane then it tends to deactivate the voltage gated sodium channels). so they become desensitised

PHASE 2 BLOCK - Because nicotinic receptor has been heavily stimulated, so leads to desensitisation of receptors, maintains the blockade of NMJ

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22
Q

ganglionic blockers

A

ganglion blockers
reduce the actions of both the sympathetic and parasympathetic nervous systems

Both sympathetic and parasympathetic NS have ganglion so blocking ganglia will block the whole autonomic nervous system

23
Q

difference between the autonomic ganglia and NMJ ganglia

A

These nicotinic receptors are diff from the ones at the NMJ
Before, they knew this because the drugs used at NMJ don’t work at ganglion. (this is weird because they both respond to nicotine but only one of them response to suxamethonium)

Subunit composition for nicotinic receptors at the ganglia is different
Pharmacology of receptors is diff they have their own antagonists and agonists

24
Q

muscarinic receptor subtypes

A

M1 neutral (Autonomic ganglia) - Modulation of ganglionic transmission
M2 cardiac (Cardiac atria and conducting tissue) - Cardiac slowing
↓ force of contraction
M3 glandular (Salivary glands and smooth muscle of gut) - Secretion of saliva and ↑ gut motility
M4 (CNS) - Modulation of synaptic transmission
M5 (CNS, substantia nigra) - Modulation of synaptic transmission

25
Q

muscarinic receptor / G protein subtype / typical second messengers / physiological response

A

M1,3,5 / Gαq / Protein Kinase C (PKC) Ca2+ / Excitation, secretion, contraction

M2,4 / Gαi / Reduced cAMP & PKA activity
Gβγ opens K+ channels / Inhibition, reduced force/rate contraction

26
Q

differences between Gαq and Gαi

A

Gαq - stimulates phospholipase C β (PLCβ) which breaks down phosphatidylinositol 4,5-bisphosphate (PIP2) to diacylglycerol (DAG) and inositol 1,4,5-trisphosphate (IP3). DAG activates PKC and IP3 causes the release of Ca2+ from internal Ca2+ stores

Gαi - inhibits adenylate cyclase (AC) which results in a reduction in cAMP, reduced activation of PKA and reduced Ca2+ channel activity. Gβγ activates certain K+ channels that leads to K+ efflux from the cell, membrane hyperpolarisation and reduced excitability

27
Q

cholinesterases

A

termination of the effects of acetylcholine by degrading it into acetyl group and choline group

Enzyme works in the active cleft of receptor of the enzyme, there are binding sites for the molecule
Anionic site binds the choline moiety of ACh
Allosteric site binds acetyl end of the molecule
Electrostatic attraction keeps the molecule in the catalytic pocket
Cleaves the bond to release the 2 groups

VERY RAPID, HIGH TURNOVER NMBR

28
Q

2 types cholinesterases

A
True acetylcholinesterase (AChE/AChase) // present at cholinergic synapses
bound to the postsynaptic membrane in the synaptic cleft

Pseudo-cholinesterase // widely distributed and found in plasma
important in inactivating the depolarising neuromuscular blocker, suxamethonium
–> both true and pseudo cholinesterases are inhibited equally by most clinically-relevant anticholinesterases

29
Q

cholinergic hypothesis of alzheimer’s disease

A

Shows reduction of vesicular acetylcholine transporters (that pump acetylcholine into synaptic vesicles)
Reduction correlates with the severity of dementia
You can use acetylcholinesterase inhibitors to reduce the activity of acetylcholinesterase in the brain
Get improvements in cognitive functions

30
Q

myasthenia gravis

A
  • Auto-immune disease (where the body produces antibodies to the nicotinic receptors
    antibodies attach to the receptors and induce a compliment response from the immune systems
    called the membrane attack complex)
  • Loss of NMJ nAChR
  • Loss of NMJ structure (Invaginations are lost so membranes of postsynaptic membranes on muscle are not invaginated and are flat and smooth
    Reduces surface area for the nicotinic receptors)
  • Muscular weakness, paralysis
31
Q

define the alpha2 receptor’s role and the feedback loop of a noradrenergic synapses

A
alpha2 receptor (alpha2 being the subunit for the alpha receptor type) is found on presynaptic terminals of varicosities - it inhibits the release of noradrenaline
Release of noradrenaline is detected by post and presynaptic receptors and switches off calcium channels 
So these are called inhibitory autoreceptors - senses the release of its own neurotransmitter
So that levels of noradrenaline neurotrans dont get too elevated in synaptic cleft → VERY SENSITIVE FEEDBACK LOOP 
allows synaptic transmission that is finely tuned
32
Q

2 types of pumps that allow the uptake mechanisms of noradrenaline

A

Uptake mechanisms of pumps removing noradrenaline from synaptic cleft into pre or postsynaptic cell
2 types of pumps - norepinephrine (high affinity, and target of many drugs) or extraneuronal monoamine transporters (found on a variety of postsynaptic tissues)

33
Q

enzymes that metabolise noradrenaline and adrenaline

A

NA and Adr are metabolised by enzymes - MAO (associated with mitochondria) and MAO COMT (degrades NA and Ard)

34
Q

adrenoceptor diversity and their rank order of potency

A

α-adrenoceptors (α1 and α2)
β-adrenoceptors (β1, β2 and β3)

the α2 is on presynaptic terminal which inhibits noradrenaline release

ALPHA - very sensitive to noradrenaline, less to adrenaline, not at all to isoprenaline
BETA - very sensitive to isoprenaline, less to adrenaline, not at all to noradrenaline

35
Q

adrenoceptor subtypes / representative tissue / physiological response

A

α1 - vascular smooth muscle
vas deferens smooth muscle (inhibits NA release so contracts muscle)

α2 - adrenergic nerve terminals (inhibits NA release)

β1 - cardiac muscle (increases the heart rate and force of contraction)

β2 - cardiac blood vessels
skeletal muscle blood vessels
bronchial smooth muscle (used for treatment of asthma)

β3 - adipose tissue, not found in brain (breakdown of fat)

36
Q

alpha adrenoceptor subtypes / G protein subtype / typical second messenger / physiological response

A

α1 / Gαq / Protein Kinase C (PKC) Ca2+ / Contraction of vascular
smooth muscle

α2 / Gαi / Reduced cAMP & PKA activity
Gβγ ↓voltage-gated Ca2+ channels / inhibits noradrenaline and insulin release

37
Q

beta adrenoceptor subtypes / G protein subtype / typical second messenger / physiological response

A
all are coupled to Gαs
increased cAMP and PKA activity
increased cardiac output
increased dilation and relaxation 
lipolysis
38
Q

drugs acting at the presynaptic terminal and inhibiting noradrenergic transmission
(synthesis of noradrenaline)

A

L-TYROSINE
tyrosine hydroxylase (inhibited by a-methylparatyrosine)
DOPA
dopa decarboxylase (inhibited by carbidopa, benserazide)
DOPAMINE
dopamine B-hydroxylase (inihibited by disulfiram antabuse)
NORADRENALINE

39
Q

where do carbidopa and benserazide act in the brain

A

Carbidopa and benserazide will not enter the brain. Otherwise we will get seizures. It is an antagonist of GABA A receptors

40
Q

drugs acting at the presynaptic terminal and inhibiting noradrenergic transmission
(storage of noradrenaline)

A

RESERPINE

Inhibits NA uptake
Depletes NA (and DA, 5HT)
General decrease in sympathetic function
Damages vesicles
Decreases HR, BP
but……
Postural hypotension
Hypothermia
Sedation, depression (suicidal at high doses)
α-METHYL DOPA
Converted to α-methyl NA
Replaces/displaces NA
Released instead of NA
Less potent than NA at α1
Activates α2 - less NA release
Decreases HR, BP
41
Q

drugs acting at the presynaptic terminal and inhibiting noradrenergic transmission
(release of noradrenaline)

A

BRETYLIUM
GUANETHIDINE
(noradrenergic neurone blocking drugs, long lasting depletion of NA)
used for ventricular arrhythmia and hypertension

CLONIDINE (alpha 2 agonist so inhibits NA release)
used for hypertension and tourette’s

42
Q

α Adrenoceptor Antagonists (2)

A
PRAZOSIN
receptor is a1
decreases BP 
used for hypertension
fewer side effects
doesn't affect HR
LABETALOL
receptor is a/B
decreases BP
used for hypertension
blocks reflex
increases HR via B1 block
43
Q

β Adrenoceptor Antagonists

A

PROPRANOLOL
receptor is B (non selective)
↓HR, ↓BP, ↓cardiac output, causes hypoglycaemia and cardiac failure
treats angina and dysrhythmias

ATENOLOL
receptor is B (cardioselective)
↓HR, ↓BP, ↓cardiac output (via B1)
treats hypertension

PINDOLOL
it's a partial agonist
doesn't give max response
inhibits action of full agonists
treats hypertension
44
Q

directly acting sympathomimetics

A

NORADRENALINE
receptor is a and B1
↑ BP due to α1 vasoconstriction
treats shock and cardiac arrest

ADRENALINE
receptor is a and B
↑HR (chronotropic)
↑force (ionotropic) bronchodilation
treats cardiac arrest, anaphylatic shock and used as local anaesthetics

SALBUTAMOL
receptor is B2
relaxes smooth muscle like bronchodilation
treats asthma and inhibits premature labour

45
Q

monoamine neurotransmitter 2 types

A

catecholamines (noradrenaline and dopamine)

tryptamines (serotonin)

46
Q

define NET

A

norepinephrine transporter. it takes up noradrenaline from the synaptic cleft

47
Q

cognitive enhancers - name the psychological effects it was thought to have

A
  • Reduce mental fatigue
  • Maintain attention and concentration
  • Increase motivation (especially for dull & repetitive tasks – (eg exam revision)
  • Alter memory processing (i.e. enhance memory)
  • Normalise behavior (eg schizophrenia, autism disorders, addiction)
  • Caffeine, modafinil, methyphenidate, ampakines…..
48
Q

ampakines as cognitive enhancers

A

Enhance activation of glutamate AMPA receptors

Promote release of brain-derived neurotrophic factor (BDNF)

Show evidence of enhancing cognition in a range of tests

49
Q

monoamine theory for depression

A

First proposed by Joe Schildkraut in 1965 based on evidence that drugs that enhance monoamine levels improve mood and symptoms of depression and vice versa (eg reserpine) for drugs lowering monoamine levels.

Other factors may be involved (stress hormone levels, neurogenesis)

50
Q

name the antidepressant drugs that elevate the monoamine levels

A

PHENELZINE
monoamine oxidase inhibitors

IMIPRAMINE
monoamine uptake inhibitors (tricyclics)

CITALOPRAM FLUOXETINE, PROZAC
monoamine uptake inhibitors (selective)

REBOXETINE
monoamine uptake inhibitors (selective)

DULOXETINE
monoamine uptake inhibitors (dual action)

51
Q

positive symptoms of schizophrenia

A

(over-activity in the mesolimbic dopaminergic pathway activating dopamine D2 receptors)

Delusions/paranoia
Hallucinations (voices)
Thought disorder
Abnormal behaviour (eg stereotyped movements)
Catatonia/immobility
52
Q

negative symptoms of schizophrenia

A

(symptoms: decreased activity in the mesocortical dopaminergic pathway (D1 receptors))

Social withdrawal
Flattening of emotion
Anhedonia (inability to experience enjoyment)
Apathy (eg for hygiene, routines)

53
Q

cognitive symptoms of schizophrenia

A

(attention and memory – mesocortical pathway)

54
Q

Side Effects of Antipsychotic Drugs

A
  • Motor effects
  • Extrapyramidal effects
  • D2 receptor antagonism in nigrostriatal pathway
  • Involuntary movements / tremor / spasms / rigidity – symptoms of Parkinson’s disease
  • Acute dystonias (shortly after treatment onset - reversible)
  • Tardive dyskinesia (long after treatment starts - irreversible and progressively worsens)
  • Less of a problem with second generation antipsychotics
  • Increased prolactin secretion leading to gynecomastia (in men) and galactorrhea
  • Weight gain
  • Sedation/drowsiness