Video 1 Parasympathetic Activation

Question 1

Where in the body is the parasympathetic nervous system?

Answer 1

Cranial nerves: III, VII, and X (75% of the fibers).

2nd and 3rd sacral spinal nerves.

Question 2

Which are the characteristics of the Nicotinic receptors?

Answer 2

Ligand-gated Na+/K+ channels: Autonomic ganglia and Neuromuscular junction.

Question 3

What are the characteristics of the Muscarinic receptors?

Answer 3

G-protein-coupled receptors and 5 subtypes: M1-M5.

Question 4

38-year-old man presents to the emergency department with shortness of breath, diaphoresis, and agitation. He has excessive urination and diarrhea. He recently moved to the area and works at a local farm. Physical exam shows he has constricted pupils, a heart rate of 55 bpm, mild inspiratory wheezes, excessive salivation and muscle twitching throughout his body. What is the mechanism of action of the medication most likely used to treat this patient’s symptoms?

Answer 4

Organophosphate poisoning exulting in inactivation of acetylcholinesterase resulting in excess cholinergic activation and caused DUMBBELSS
The treatment: Goal: 1) Decrease stimulation of excess acetylcholine on muscarinic receptors. 2)Atropine block muscarinic receptors. 3)Pralidoxime regenerates ACh.

Question 5

Which are the symptoms of the cholinergic excess?

Answer 5

DUMBBELSS (Diarrhea, Urination, Miosis, Bronchospasm, Bradycardia, excitation of muscles, Lacrimation, Salivation and Sweating).

Question 6

What is the Atropine function?

Answer 6

Blocks muscarinic receptors.

Question 7

What is the function of Pralidoxime?

Answer 7

Pralidoxime regenerates acetylcholinesterase

Question 8

Which are the types of cholinergic agonists?

Answer 8

1) Direct agonists.

2) Indirect Agonists.

Question 9

What are the cholinergic Direct agonists?

Answer 9

Bethanechol, Carbachol, Pilocarpine, Methacholine.

Question 10

What are the indirect cholinergic agonists?

Answer 10

Neostigmine, pyridostigmine, edrophonium, physostigmine, echothiophate and Donapezil.

Question 11

Which are the drugs used in Alzheimer disease?

Answer 11

Donapezil, Galantamine, Rivastigmine.

Question 12

What is Myasthenia Gravis?

Answer 12

It is an antibodies to the acetylcholine receptors.

Question 13

In myasthenia Gravis what is the most common board question presentation?

Answer 13

Ptosis and Diplopia that worsen throughout the day.

Question 14

How do you do the diagnosis?

Answer 14

TensilonTest.

Question 15

What is the percentage of myasthenia Gravis associated with Thymus pathology?

Answer 15

1) 50% associated with thymic hyperplasia.
2) 20% associated with thymic atrophy.
3) 15% associated with thymic tumor (thymoma)

Question 16

What is the characteristic of the mysthenic crisis?

Answer 16

Rapidly progressing weakness esp. In respiratory muscles.

Question 17

Which are the different types of treatment for myasthenia Gravis?

Answer 17

1) Indirect cholinergic agonists.
2) Immunotherapy.
3) Thymectomy.
4) Plasmapheresis.

Question 18

Hod does the parasympathetic nervous system affect the heart?

Answer 18

Decrease heart rate and small decrease in contractility.

Question 19

Hod does the parasympathetic nervous system affect the eye?

Answer 19

Miosis, contraction of ciliary muscle.

Question 20

Hod does the parasympathetic nervous system affect the salivary glands?

Answer 20

Increase saliva production and secretion.

Question 21

Hod does the parasympathetic nervous system affect the bronchioles smooth muscle?

Answer 21

Contraction.

Question 22

Hod does the parasympathetic nervous system affect the bladder?

Answer 22

Contract bladder wall, relax sphincter

Question 23

Hod does the parasympathetic nervous system affect the male GU?

Answer 23

Erection.

Question 24

Hod does the parasympathetic nervous system affect the GI tract?

Answer 24

Contraction of intestinal wall, relaxation of the sphincter

Question 25

What drug regenerates acetylcholinesterase after organophosphate poisoning?

Answer 25

Pralidoxime.

Question 26

What is the antidote for organophosphate poisoning?

Answer 26

Atropine.

Question 27

Which anticholinesterases are used in the treatment of Alzheimer disease?

Answer 27

Donepezil.

Question 28

RFF: Amyloid deposits in gray matter of the brain.

Answer 28

Senile plaques (Alzheimer disease)

Question 29

RFF: Drooling farmer

Answer 29

Organophosphate poisoning

Question 30

Which cholinesterase inhibitor is used to make the diagnosis of myasthenia Gravis?

Answer 30

Edrophonium

Question 31

Which cholinesterase inhibitor is used to treat myasthenia Gravis?

Answer 31

Pyridostigmine.

Question 32

What surgical procedure is sometimes helpful in myasthenia Gravis?

Answer 32

Thymectomy

Question 33

Which are the two opposing parts of the Autonomic Nervous system?

Answer 33

1) Sympathetic “Fight or Flight”.

2) Parasympathetic “Rest and digest”.