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ANAP 510 > TEST 3 - ANS/ADRENAL MEDULLA > Flashcards

TEST 3 - ANS/ADRENAL MEDULLA Flashcards

1
Q

Innervates tissues/organs NOT usually under voluntary control

A

Autonomic nervous system

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2
Q

What tissues/organs are innervated by the ANS?

A 
Cardiac muscle
Electrical fibers of heart
Smooth muscle of blood vessels, ducts, urinary bladder, uterus, etc.
Glands
Visceral (GI) muscle
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3
Q

Where do the nerve cell bodies for somatic motor pathways start?

A

Anterior horn of the gray matter

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4
Q

From the spinal cord to the muscle, how many neurons in sequence in a somatic motor pathway?

A

ONE

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5
Q

How many neurons in sequence for an autonomic pathway? What are they called?

A

2 neurons

Preganglionic neuron
Postganglionic neuron

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6
Q

Where are the nerve cell bodies located for autonomic pathways?

A

Lateral horns of the gray matter (T1-L2; S2-S4)

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7
Q

Preganglionic neuron originates in the ______ horn of the gray matter and exits through the ______ horn of the gray matter.

A

LATERAL HORN

EXITS ANTERIOR HORN

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8
Q

Preganglionic neuron synapses with postganglionic neuron here

A

Autonomic ganglia/ganglion

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9
Q

PRE/POST ganglionic neuron synapses with target tissue

A

Postganglionic

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10
Q

2 divisions of the ANS

A

Sympathetic NS

Parasympathetic NS

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11
Q

Another name for sympathetic NS

A

Thoracolumbar division

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12
Q

Preganglionic neurons for this division of the ANS originate in the lateral horns of the gray matter at spinal segments T1-L2

A

Sympathetic NS

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13
Q

Another name for parasympathetic NS

A

Craniosacral Division

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14
Q

Where do preganglionic neurons originate for the PNS ?

A

In the brain stem (CN III, VII, IX, and X)

Lateral horns of the gray matter at spinal segments S2-S4

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15
Q

ALL preganglionic fibers in the ANS are MYELINATED. TRUE/FALSE?

A

TRUE

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16
Q

All preganglionic myelinated fibers are type ___ fibers

A

Type B

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17
Q

ALL postganglionic fibers of the ANS are MYELINATED TYPE B FIBERS.
TRUE/FALSE?

A

FALSE

Postganglionic fibers are UNMYELINATED TYPE C fibers

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18
Q

These lay on either side of the SC and anteriorly to the SC; associated with SNS.

A

Sympathetic chain ganglia on either side of the SC

Collateral ganglia, lays anterior to SC

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19
Q

In the upper thoracic region preganglionic neurons of the SNS synapse with postganglionic neurons where?

A

Sympathetic chain ganglia

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20
Q

After ~ T ____, preganglionic neurons of the SNS pass through the sympathetic chain ganglia and synapse with postganglionic neurons in the collateral ganglia

A

~T5

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21
Q

Preganglionic fibers of the SNS tend to be SHORT/LONG fibers, postganglionic fibers tend to be SHORT/LONG.

A 
Pre = SHORT
Post = LONG
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22
Q

Ganglia specific for PNS

A

TERMINAL ganglia

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23
Q

Why are PNS terminal ganglia called ‘terminal’?

A

Lies right next to tissue being innervated, sometimes even in the wall of the tissue

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24
Q

In the PNS, preganglionic fibers tend to be LONG, and postganglionic fibers tend to be SHORT.
TRUE/FALSE

A

TRUE

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25
Q

MOST organs are innervated by PNS, but only select few are innervated by SNS. TRUE/FALSE

A

FALSE

ALL organs are innervated by BOTH the PNS/SNS

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26
Q

Usually either the PNS or SNS is predominating, but this does not mean the other is absent. TRUE/FALSE

A

TRUE

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27
Q

In a TYPICAL SYMPATHETIC pathway, preganglionic myelinated fiber exits SC (T1-L2), synapses with postganglionic fiber at sympathetic autonomic ganglia and (NT) _____________ is released and binds to ____________ receptors on the postganglionic _________.

A

Ach is released

Binds with Nicotinic type II receptors

On the postganglionic Dendrite

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28
Q

In a TYPICAL sympathetic pathway, after postganglionic neuron synapses with target tissue, what NT is released and what type of receptors does is bind to to elicit physiologic response?

A

NE released

Binds with adrenergic receptors (alpha/beta)

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29
Q

The TYPICAL sympathetic pathway is described as a sympathetic ____________ response, the ATYPICAL sympathetic pathway is described as a __________ pathway

A

Typical = adrenergic response

Atypical = CHOLINERGIC response

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30
Q

What are the 2 sympathetic cholinergic responses that follow an atypical sympathetic pathway?

A

Thermoregulatory sweat glands

Pyeloerector muscles (goosebumps)

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31
Q

In an ATYPICAL sympathetic cholinergic pathway, sequence is the same, except, the postganglionic neuron synapses with target tissue and releases (Nt) ___________ and the target cell receptors are _________.

A

Releases ACH

Target cell receptors are MUSCARINIC

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32
Q

ALL parasympathetic pathways follow the same sequence, NO deviations. TRUE/FALSE

A

TRUE

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33
Q

At ALL preganglionic/postganglionic synapses, the NT is ________ and the receptors are )_________.

A

Nt ACH

Receptors: Nicotinic type II

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34
Q

What is a good example of an autonomic reflex; sensory input, autonomic output.

A

Baroreceptor Reflex

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35
Q

Where are the baroreceptors located?

A

Internal carotids and aortic arch

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36
Q

CN _____ is associated with internal carotid baroreceptors.

A

CN IX

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37
Q

CN X is associated with baroreceptors located where?

A

Aortic arch

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38
Q

What excites baroreceptors?

A

Increased BP

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39
Q

Increased BP increases tx of impulses through CN IX and X, these two pathways join to form _________, and terminate in ____________ in the medulla.

A

Tractus solitarius

Nucleus solitarius

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40
Q

When nucleus solitarius is excited, its excites ___________ receptors.

A

Central alpha II receptors

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41
Q

The end result of the baroreceptor reflex allows the PNS/SNS to predominate.

A

PNS

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42
Q

What is an example of an alpha II drug we might give that would slow the HR?

A

Precedex

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43
Q

Decreased HR, decreased strength of contraction, decreased stroke volume, blood vessel dilation, decreased preload all lead to decreased _______ in the PNS dominance from the baroreceptor reflex.

A

Decreased BP

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44
Q

When BP is low, there is less excitation of baroreceptors, less impulses through CN IX/X, nucleus solitarius and central alpha II are NOT excited, and this allows for PNS to predominate. TRUE/FALSE.

A

FALSE

Allows for SNS to predominate!!

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45
Q

PNS/SNS primarily innervated the SA node.

A

PNS

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46
Q

Decreased strength of contraction in the baroreceptor reflex is primarily due to what?

A

Lack of sympathetic innervation.

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47
Q

SA node, AV node, and ventricular contractile fibers are all innervated SYMPATHETICALLY.
TRUE/FALSE

A

TRUE.

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48
Q

We are unable to control/impact autonomic outflow. TRUE/FALSE.

A

FALSE

We can impact autonomic outflow with higher brain centers, cerebrum, and limbic system.

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49
Q

What are some examples of higher brain centers/ limbic system affecting autonomic outflow?

A

Nervous for test = increased HR/RR

Meditation = decrease HR

Pass out from IV stick

50
Q

Sympathetic innervation of the pupil = __________

A

Pupil dilation

51
Q

Sympathetic innervation of bronchiolar smooth muscle = ____________ for increased gas exchange

A

Dilation

52
Q

CN ______ causesed _________ innervation of the pupil = pupillary constriction.

A

CN III; Parasympathetic

53
Q

CN VII innervates what 3 things?

A 
Lacrimal glands (tears)
Nasal mucosa
Salivary glands
54
Q

CN ____ innervates the parotid gland

A

IX

55
Q

Major parasympathetic nerve; “to wander”.

A

Vagus; CN X

56
Q

Parasympathetic innervation of bronchiolar smooth muscle = __________ constriction

A

Mild

57
Q

__________ smooth muscle has a lot of sympathetic innervation and very little, if any, parasympathetic innervation.

A

Vascular

58
Q

Vasodilation is due to parasympathetic innervation directly. TRUE/FALSE.

A

FALSE

Vasodilation is due to LACK of sympathetic innervation

59
Q

Blood vessels, except for maybe __________ vessels, do not have parasympathetic innervation

A

Coronary

60
Q

A specific sympathetic pathway, PREganglionic neuron passes through the chain ganglia, collateral (celiac) ganglia and preganglionic neuron synapses directly on the __________

A

Adrenal medulla

61
Q

At the preganglionic synapse on the adrenal medulla, NT released is _________ and the target receptor is ________.

A

ACh

Nicotinic type II

62
Q

The adrenal medulla acts like a postganglionic neuron and released what 3 things?

A

NE
Epi
Dopamine

63
Q

This is a most potent Nt released from the adrenal medulla and released in the greatest quantity, ____%.

A

Epi

80-85%

64
Q

The adrenal medulla is one of only two places that the enzyme exists to convert NE to Epi. TRUE/FALSE

A

FALSE

Adrenal medulla is the ONLY place where enzyme is present to make Epi from NE

65
Q

The adrenal medulla enhances over all __________ response

A

Sympathetic

66
Q

If adrenalectomy performed, you will have NO Epi in your body. TRUE/FALSE

A

TRUE

67
Q

How are the neurohormones produced by the adrenal medulla transported to other synapses of sympathetic postganglionic neurons?

A

In the blood

68
Q

Catecholamine secreting tumor arising primarily from adrenal medulla tissue.

A

Pheochromocytoma

69
Q

Most common manifestations of pheochromocytoma (5)

A 
Htn (refractory to Tx)
Headache
Palpitations
Sweating
Nervousness
70
Q

What is the treatment for pheochromocytoma?

A

Surgical resection

71
Q

Surgical resection of pheochromocytoma is associated with what during anesthesia and surgical intervention?

A

Unpredictable and fluctuating hemodynamics

72
Q

Pheochromocytoma can go undiagnosed and present for Sx for another disease process or emergency. TRUE/FALSE.

A

TRUE

73
Q

Preoperative management for surgical resection of pheochromocytoma must begin _________ in advance

A

Weeks

74
Q

May need what to determine cardiac involvement of pheochromocytoma

A

EKG

Echo

75
Q

Medications given to optimize pt for surgical resection of pheochromocytoma

A

Alpha-adrenergic blockers

Beta-blockers

76
Q

Common alpha-adrenergic blocker given to optimize pt for surgical resection of pheochromocytoma

A

Prazosin

77
Q

Typical dosing period of alpha-adrenergic blocker (prazosin) is _________ weeks prior to Sx.

A

2-8 weeks

78
Q

Never start the patient on _____________ prior to _____________ because can lead to hypertensive crisis and pulmonary edema.

A

Never start BB before Alpha blockers

79
Q

Monitors for surgical resection of pheochromocytoma

A

Arterial line
Large bore IV’s

Not usually central line, PA cath, or TEE

80
Q

Induction and intubation should be as smooth and non-stimulating as possible, what are some ways to do this?

A

Consider giving lidocaine, LTA kit.

Make sure very deep before intubation

81
Q

How can we be ready for extreme fluctuations in blood pressure?

A

Have variety of vasoactive drugs available!! Uppers and downers.

Have IV fluids and blood readily available

82
Q

Any manipulation of tumor can cause significant hemodynamic instability, so communication with ________ is key for success!!

A

Surgeon

83
Q

What is the most significant portion of the case (surgical resection of pheochromocytoma)?

A

Manipulation of the tumor!!

84
Q

After Sx resection of tumor, Postoperatively, pts can still have hemodynamic instability and are typically transferred to _______

A

ICU

85
Q

After removal of pheochromocytoma, pts should have follow up for one year. TRUE/FALSE

A

FALSE

Should have LIFE LONG FOLLOW UP due to recurrence

86
Q

Difference between NT and neurohormone

A

NT = NE released at postgang symp neuron into a synapse

NH = NE, Epi, dopamine released from Ad. Medulla bc acts like NT bc bind to same receptors but act like hormones as well bc released, travel throughout body in blood and then released at receptor

87
Q

What type of receptors does dopamine bind to

A

D-1 and D-2 receptors

88
Q

NE receptors and in order

A

Alpha-1 > Beta-1 > beta-2

89
Q

Epi receptors in order

A

Beta-2 > Beta-1 = Alpha-1

90
Q

Parasympathetic cholinergic NT and receptors

A

Ach:

Nicotinic-2, muscarinic receptors

91
Q

Where are Nicotinic type I receptors found

A

Skeletal muscle

92
Q

Alpha-1 and Beta receptors are ___________ coupled receptors

A

G-protein

93
Q

In the inactivated state, the alpha subunit of the G-protein is connected to _______

A

GDP

94
Q

When A-1 receptor becomes activated, alpha subunit breaks off and GDP is replaced by ______

A

GTP

95
Q

During activation of alph-1 receptor, The alpha GTP complex binds with __________

A

Phospholipase C

96
Q

Phospholipase C converts PIP2 into _________ and ______

A

Diacylglycerol

IP3

97
Q

IP3 causes release of _______ from endoplasmic reticulum.

A

Calcium

98
Q

The Ca released by IP3 and diacylglycerol increase ____________ which brings about the physiologic response.

A

Protein kinase C

99
Q

Beta-1 and beta-2 receptors have the same mechanism. TRUE/FALSE.

A

TRUE

100
Q

After beta receptor excited, alpha-GDP breaks off, GDP converted to GTP, and alpha-GTP complex binds with enzyme ___________

A

Adenylyl cyclase

101
Q

Adenylyl cyclase converts ATP to cAMP, which increases _____________ to bring about physiologic response.

A

Protein Kinase A

102
Q

Physiologic response depends on the target tissue. TRUE/FALSE

A

TRUE

103
Q

Receptors that Usually lead to contraction of smooth muscle (particularly vascular)

A

Alpha-1

104
Q

Receptors that Cause inhibition of target cell responses

A

Alpha-2 receptors

105
Q

Receptors that cause inhibition of sympathetic outflow and allow parasympathetic domination

A

Central medullary alpha-2

106
Q

Many on presynaptic membrane of sympathetic neurons; when activated, usually decrease NE release into synapse (from postganglionic fibers)

A

Peripheral alpha-2 receptors

107
Q

Reason pts become tolerant of NE gtt

A

Over time will bind to peripheral alpha-2 receptors and decrease endogenous release of NE

108
Q

Receptors that Play a role in metabolic fxns, heart, and JG cells of the kidneys (renin)

A

Beta-1

109
Q

When JG cells in the kidneys are excited by NT, they release a substance called _______

A

Renin

110
Q

Receptors that lead to relaxation of vascular and bronchiolar smooth muscle

A

Beta-2

111
Q

Vascular smooth muscle does NOT have a lot of B-2 receptors. TRUE/FALSE

A

TRUE

112
Q

Nicotinic type II (and type I) receptors are Ach gated _________ channels

A

Sodium

113
Q

Most muscarinic receptors use same mechanism as ________ receptors

A

Alpha-1

114
Q

The exception to muscarinic receptors acting like alpha-1 receptors, is where in the body?

A

Sinoatrial node of the heart

115
Q

In the SA node of the heart, the alpha-GTP complex directly opens ________ channels in the SA node, which _____________ the SA node and decreased HR.

A

Directly opens POTASSIUM channels

HYPERPOLARIZES/INHIBITS the SA node

116
Q

When K moves out of the cell, what causes the decreased HR?

A

RMP moves farther from TP, takes larger stimulus to get to TP, longer upstroke, more time between AP

117
Q

Sympathetic stimulation of the SA node makes SA node more permeable to __________ which leads to hypopolarization of the cell and increased HR

A

Sodium

118
Q

Most, but not all, target tissues/organs have both sympathetic and parasympathetic innervation. TRUE/FALSE

A

TRUE

119
Q

BOTH sympathetic and parasympathetic excites some tissues/organs and inhibits others. TRUE/FALSE

A

TRUE

120
Q

Most sympathetic target tissue/organs have alpha receptors and some beta, but alpha predominates. TRUE/FALSE

A

FALSE

BOTH alpha and beta receptors present on most tissues, but one or the other predominates

121
Q

Responses in target tissues/organs depend on number and types of ________ in the organs.

A

Receptors

ANAP 510 (5 decks)

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