Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

APEX ANESTHESIA FLASHCARDS > UNIT 2 ANS > Flashcards

UNIT 2 ANS Flashcards

1
Q

What are the 4 classifications of receptors?

A
  1. ion channel
  2. GPCR
  3. enzyme linked receptor
  4. intracellular receptor
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe the general architecture of the GPCR second messenger system.

A

1st messenger: extracellular signaling

Receptor: responds

G protein: turns off/on an effector

Effector: activates/inhibits a 2nd messenger

2nd messenger: primary intracellular signal

Enzymatic cascade

Cellular response

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

What second messenger system is associated w/ alpha-1 receptor? What other receptors share the same pathway?

A

Gq –> phospholipase C –> IP3/DAG/Ca++

others:
- histamine 1
- muscarinic 1, 3, 5
- vasopressin 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What second messenger is associated w/ alpha-2 receptor? What other receptors share a similar pathway?

A

Ex of 2nd messenger: adenylate cyclase –> ATP to cAMP

others:
- muscarinic 2
- dopamine 2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What second messenger system is associated w/ beta1 & beta2 receptors? What other receptors share a similar pathway?

A

Gs –> adenylate cyclase –> ATP to cAMP

others:
- histamine 2
- vasopressin 2
- dopamine 1

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

describe the autonomic innervation of the heart

A 
myocardium 
- B1 = increased contractility
- M2 = decreased contractility
conduction system 
- B1 = increased HR & conduction speed
- M2 = decreased HR & depressed CV

SNS: cardiac accelerator fibers from T1-T4
PNS: vagus

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

describe the autonomic innervation of the vasculature

A

vasculature:
arteries a1>a2 –> vasoconstriction
veins a2>a1 –> vasoconstriction

specific vascular beds:

  • myocardium B2 = vasodilation
  • skeletal m B2 = vasodilation
  • renal DA = vasodilation
  • mesenteric DA = vasodilation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Describe the autonomic innervation of the bronchial tree

A 
B2 = bronchodilation
M3 = bronchoconstriction

B2 aren’t innervated, just respond to catecholamines in the systemic circulation or the airway (inhaled)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Describe the autonomic innervation of the kidney

A

renal tubules: a2 = diuresis via ADH inhibition

renin release: B1 = increased renin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Describe the autonomic innervation of the eye

A

sphincter m (iris) = M = contraction (miosis)

radial muscle (iris) = a1 = contraction (mydiasis)

ciliary m =
B2 = relaxation (far vision)
M = contraction (near vision)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Describe the autonomic innervation of the GI tract

A

sphincters
a1 = contraction
M = relaxation

motility & tone
a1/a2/B1/B2 = decrease
M = increase

salivary glands
a2 = decrease
M = increase

gallbladder & ducts
B2 = relaxation
M = contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

describe the autonomic innervation of the pancreas

A

islet (beta cells)
a2 = decrease insulin release
B2 = increase insulin release

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

describe the autonomic innervation of the liver

A

a1/B2 = increase serum glucose

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

describe the autonomic innervation of the uterus

A 
a1 = contraction
B2 = relaxation
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

describe the autonomic innervation of the bladder

A

trigone & sphincter
a1 = contraction
M = relaxation

destrusor m
B2 = relaxation
M = contraction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

describe the autonomic innervation of the sweat glands

A 
a1 & M = increase secretion
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

list the steps of NE synthesis. What is the rate limiting step?

A

tyrosine

  • -> DOPA (via tyrosine hydroxylase)
  • -> dopamine (via DOPA decarboxylase)
  • -> NE (via dopamine B-hydroxylase)
  • -> Epi (via phenylethanolamine N-methyltransferase)

Tyrosine hydroxylase is the rate limiting step

All occurs in the adrenal medulla

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

What are the 3 ways in which NE can be removed from the synaptic cleft? Which is the most important?

A
  1. reuptake (80%)
  2. diffusion away
  3. reuptake by extraneural tissue
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

What enzymes metabolize NE & Epi? What is the final metabolic byproduct?

A

MAO & COMT

final byproduct = vanillylmandelic acid (VMA) aka 3-methoxy-4-hydroxymandelic acid

elevated VMA in urine aids in diagnosis of pheochromocytoma

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

list the three types of cholinergic receptors. Where are each of these found inside the body?

A

Nicotinic M type (muscle)
- NMJ

Nicotinic N type

  • preganglionic fibers at autonomic ganglia (SNS & PNS)
  • CNS

Muscarinic

  • postganglionic PNS fibers at effector organs
  • CNS
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Describe the synthesis, release, and metabolism of acetylcholine

A

choline diffuses into cholinergic neuron while the mitochondria produces AcetylCoA

Acetyl CoA + Choline = Ach (via the enzyme ChAT)

released into synaptic cleft onto mAChR or nAChR

converted to choline + acetate

  • choline reuptake
  • acetate into vasculature
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

list the 5 components of the autonomic reflex arc

A
  1. sensor
  2. afferent pathway
  3. control center
  4. efferent pathway
  5. effector
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

compare and contrast the architecture of the SNS & PNS efferent pathways

A

both have pre & post ganglionic nerve fibers

PNS

  • preganglionic: long, myelinated, B fiber, releases ACh
  • postganglionic: short, unmyelinated, C-fiber, releases ACh

SNS

  • preganglionic: short, myelinated, B-fiber, releases ACh
  • postganglionic: long, unmyelinated, C-fiber, releases NE normally
  • releases ACh at sweat glands, piloerector m, and some vessels
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

What is the origin of the efferent SNS pathways?

A

SNS efferent pathway: thoracolumber T1-L3

cell bodies from the intermediolateral region of the SC & axons exit via the ventral nerve roots

preganglionic fibers usually synapse w/ postganglionic fibers in the 22 paired sympathetic ganglia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

What is the origin of the efferent PNS pathways?

A

craniosacral CN 3, 7, 9, 10 & S2-S4

preganglionic synapse w/ postganglionic near or in each effector organ

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

describe the innervation of the adrenal medulla. How is it different that then typical SNS efferent architecture?

A

there are no postganglionic fibers

pregang release ACh onto the chromaffin cells & the chromaffin cells release Epi & NE into the systemic circulation at a 80/20 ratio

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

describe the hemodynamic management of the patient with pheochromocytoma

A

MUST ALPHA BLOCK BEFORE BETA BLOCK!!!!
if you dont:
- B2 block inhibits skeletal m vasodilation & increases SVR
- B1 block decreases inotropy & can precipitate CHF in the setting of increased SVR

a-antagonists:

  • nonselective: phenoxybenzamine & phentolamine
  • a1 selective: doxazosin & prazosin
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

What is the transcellular K+ shift & what causes it to occur?

A

describes a number of processes that alter serum K+ by shifting it in or out of cells

shift into cells = hypokalemia

  • alkalosis
  • B2 agonists
  • theophylline
  • insulin

shift out of cells = hyperkalemia

  • acidsois
  • cell lysis
  • hyperosmolarity
  • succinylcholine
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

describe the anatomy & physiology of the baroreceptor reflex

A

regulates short term blood pressure control

  • high BP, reflex = decreased HR, contractility, & SVR
  • low BP, reflex = increased HR, contractility, and SVR

sensors in the carotid bodies & the aortic arch –> medulla (efferent)

afferent is via SNS/PNS

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

describe the anatomy & physiology of the bainbridge reflex.

A

increases HR when venous return is too high This is beneficial in minimizing venous congestion & promoting forward flow

sensor = SA node, RV, pulmonary veins
afferent = vagus
control = vasomotor center of medulla
efferent = vagus 
effects = SA node
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

describe the anatomy & physiology of the Bezold-Jarisch reflex

A

decreases HR when venous return is too low. this gives an empty heart adequate time to fill

sensor = cardiac mechanoreceptors & chemoreceptors
afferent = vagus
control = medulla
efferent = vagus
effector = SA node & AV node

tx = restore preload & increase HR

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
32
Q

describe the anatomy & physiology of the oculocardiac reflex

A

KNOW THIS five (V) afferent & dime (X) efferent reflex

sensor = pressure to the eye or globe
afferent = long & short ciliary n. --> ciliary ganglion --> V1 of CN V --> Gasserian ganglion
control = medulla
efferent = vagus
effector = SA node & AV node (decreased HR & conduction velocity)

tx = remove stimulus, 100% FiO2, atropine/glyco

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
33
Q

What is the primary determinant of CO in the pt w/ a heart transplant? What is the consequence of this?

A

severed from autonomic influence, so HR is determined by intrinsic SA rate. Often have resting tachycardia 100-120

CO is dependent on preload in these patients, they are very sensitive to hypovolemia

34
Q

What drugs can be used to augment HR in the patient w/ a heart transplant?

A

no autonomic input from the cardiac accelerator fibers (T1-T4) or the vagus nerve. Thus, good to use: those that directly stimulate the SA node:

  • epi
  • isoproterenol
  • glucagon

those that indirectly stimulate SA cannot be used (atropine, glyco, ephedrine)

35
Q

A pt presents for removal of a glomus tumor. What are your primary concerns when planning your anesthetic?

A

(glomangiomas) originate from neural crest cells. Tend to grow in the neuroendocrine tissues that lay in close proximity to the carotid artery, aorta, CN IX, and middle ear. Usually not malignant

  • can release vasoactive substances that lead to HTN/hypotension (NE, 5-HT, histamine, bradykinin)
  • octreotide can be used to treat carcinoid-like s/sx
  • CN dysfunction (IX, X, XII) can cause swallowing impairment, aspiration of gastric contents, and a/w obstruction
  • surgical dissection of glomulus tumor that has invaded the IJ vein increases risk of VAE
36
Q

what are the anesthetic considerations for multiple system atrophy?

A

(previously known as Shy-Drager syndrome)

Autonomic dysfunction, and also causes degneration of the locus coeruleus, intermediolateral column of the SC (where cell bodies for SNS efferent fibers live), & peripheral autonomic nerves

  • autonomic dysfunction causes orthostatic hypotension
  • Premature death, cerebral hypoperfusion, urinary retention
  • treat with volume & direct acting sympathomimetics
  • exaggerated hypertensive response to ephedrine & possibly ketamine
37
Q

Compare & contrast low, intermediate, and high dose epi

A

low (0.01-0.03mcg/kg/min)
- nonselective B effects predominate –> increased CO w/ reduction in SVR & possibly a slight reduction in BP w/ widened pulse pressure)

intermediate (0.03-0.15mcg/kg/min)
- mixed B & a effects

high (>0.15mcg/kg/min)
- a effects prevail –> HTN, risk for SVT

38
Q

describe the cardiovascular effects of isoproterenol

A

synthetic catecholamine that stimulates B1 & B2 receptors

  • increases HR, contractility, & myocardial O2 consumption
  • decreases SVR, which reduces DBP, which may reduce CPP
  • causes severe dysrhythmias & tachycardia
  • vasodilates nonessential vascular beds (i.e. muscle & skin). This precludes its use in septic shock.
39
Q

list 4 clinical indications for isoproterenol

A
  1. chemical pacemaker for bradycardia unresponsive to atropine
  2. heart transplant
  3. bronchoconstriction
  4. cor pulmonale
40
Q

in what situations should ephedrine not be used to treat hypotension?

A
  • when neuronal catecholamine stores are depleted (sepsis) or absent (heart transplant)
  • risk of hypertensive crisis in pts on MAO inhibitors
  • conditions where increased HR or contractility is detrimental to hemodynamics
41
Q

How does vasopressin increase BP

A 
V1 = intense vasoconstriction 
V2 = increases intravascular volume by stimulating the synthesis & insertion of aquaporins into the walls of the collecting ducts (increases water reabsorption & lowers serum osmolarity)
42
Q

What is the best treatment for vasoplegic syndrome

A

aka refractory hypotension. Key = hypotension doesn’t respond to conventional therapies such as adrenergic agonists, hydration, and reducing depth of anesthesia

  • vasopressin is the best tx (0.5-1U IV bolus, 0.03U/min)
  • incidence is increased by ACEI or ARBs
  • methylene blue is the next best choice
43
Q

list 6 drugs that are selective for the B1 receptor

A 
atenolol
acebutolol
betaxolol
bisoprolol
esmolol
metoprolol
44
Q

list 6 nonselective B blockers

A 
coreg
labetalol
nadolol
pindolol
propranolol
timolol
45
Q

what is the primary site of metabolism of the commonly used beta blockers? what are two exceptions?

A

most depend on the liver as their primary site of metabolism

2 exceptions: esmolol (by RBC esterases) & atenolol (by kidneys)

46
Q

which beta blockers have LA properties? What is another name for this?

A

propanolol
acebutolol

another name = membrane stabilizers

effect = reduction in the rate of the rise of the cardiac AP

47
Q

what is intrinsic sympathomimetic activity? Which drugs exert this effect?

A

BB that exert a partial agonist effect, while simultaneous blocking other agonsts that have a higher affinity for the B receptor

labetalol
pindolol

48
Q

list 3 alpha antagonists. What is the MOA for each?

A

reduce BP by causing vasodilation (decreased SVR)

phenoxybenzamine: nonselective, noncompetitive binding, long acting- you can’t reverse it

phentolamine: nonselective, competitive binding, short acting

prazosin: selective alpha1 antagonist

49
Q

In which cranial nerves are parasympathetic nervous system preganglionic fibers found?

A

There’s a total of 4 pairs: 3,7,9,10

50
Q

What drugs cause apoptosis?

A

Anything that has GABA agonist or NMDA antagonist

Like ketamine, propofol, nitrous oxide

51
Q

Beta 1

A

Increases renin release

52
Q

CAMP in vessels cause _________

A

Dilation

While cAMP in the heart = constriction

53
Q

What turns off caMP?

A

PDE3

54
Q

Alpha 2

A

Decreases insulin, sedation in the locus coerulus, and decrease pain in dorsal horn

55
Q

Cushing’s triad

A

Hypertension, bradycardia, irregular respirations

56
Q

Signal transduction steps

A

RECAP: 1st messenger, G protein, Effector, 2nd messenger

1st messenger example is Epi and glutamate

57
Q

Exogenous NE metabolized

A

MAO and COMT and by liver and kidneys

58
Q

What is the primary area for relay of afferent chemoreceptor and baroreceptor information from the vagus and glossopharyngeal nerves?

A

Located within the medulla, the nucleus tractus solitarius is the main area responsible for relaying afferent chemoreceptor and baroreceptor information from the vagus and glossopharyngeal nerves.

59
Q

What is referred to as the thoracolumbar nervous system?

A

The efferent SNS is also known as the thoracolumbar nervous system.

It starts in the intermediolateral gray column of T1-12 and the first three lumbar segments (L1-3) of the spinal cord.

60
Q

The fusion of the inferior cervical and first thoracic sympathetic nervous system ganglia is called the

A

Fusion of the inferior cervical and first thoracic SNS ganglia is called the stellate ganglion. It provides sympathetic innervation to the head, neck, upper extremities, heart, and lungs.

61
Q

The parasympathetic innervation of the gastrointestinal tract is primarily via which nerve?

A

The vagus nerve provides the primary parasympathetic innervation to the gastrointestinal tract. It is comprised of both efferent and afferent fibers.

62
Q

What is the predominant pathway for inactivation of the endogenous catecholamines?

A

Reuptake is the main pathway for inactivation of the endogenous catecholamines, while metabolism by the liver and kidneys is the main pathway for catecholamines rendered eXogenously.

63
Q

Which of the following would be caused by beta-2 receptor stimulation? (select two)

A. vasodilation
B. bronchodilation
C. increased cardiac contractility
D. increased heart rate
A

A. vasodilation
B. bronchodilation

64
Q

Which BB has membrane stabilizing properties?

A

Propranolol

KNOW THIS MATCHING CHART

65
Q

Where is renin produced?

A

Kidney!!

Liver produces Angiotension

66
Q

KNOW THIS

A
67
Q

Which muscarinic receptors signal through Gq and PLC?

A

M1 and M3

68
Q

Inhibitory responses at postsynaptic membranes are produced

A

Potassium and chloride

69
Q

Primary excitatory neurotransmitter in the brain?

A

Glutamate

70
Q

Increased platelet aggregation is mediated by:

A

Alpha 2 agonist

71
Q

Adenylate cyclase is inhibited by stimulation of the:

A
  • alpha-2 receptor
  • muscarinic-2 receptor
72
Q

Type N nicotinic cholinergic receptors are located at the:

A

The three locations where N nicotinic cholinergic receptors are found are:

Parasympathetic ganglia
Neuromuscular junction
Sympathetic ganglia

73
Q

Nicotinic cholinergic receptors are found in the:

A

Adrenal medulla

74
Q

Parasympathetic fibers emerge with spinal nerves from which spinal segments?

A

S2-S4

75
Q

Nonshivering thermogenesis in the neonate is modulate by:

A

NE

76
Q

enzyme dopamine beta-hydroxylase is abundant in:

A

Adrenal medulla and sympathetic nerve endings

77
Q

Norepinephrine can inhibit its own release by agonizing the:

A

presynaptic alpha-2 receptor

78
Q

Which sign or symptom is MOST likely in multiple system atrophy (formerly Shy-Drager syndrome)?

A

Difficulty maintaining blood pressure when standing

79
Q

Which agents possess intrinsic sympathomimetic activity?

A

Carvedilol, labetolol, Pindolol

80
Q

Calcium channel blockers improve ischemic myocardium by:

A
  • decrease preload
    -decrease afterload
  • increase diastolic perfusion

APEX ANESTHESIA FLASHCARDS (14 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions