Autonomic Nervous Systetm

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sashatom
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34380
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Autonomic Nervous Systetm
Updated:
2010-09-15 11:51:43
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ANS PNS cholinergic adrenergic parasympathetic sympathetic
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Autonomic Nervous System Physiology
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  1. What neurotransmitter is secreted by the preganglionic neuron in the parasympathetic nervous system?
    ACh
  2. What neurotransmitter is secreted by the postganglionic neuron of the parasympathetic nervous system?
    ACh
  3. Which ANS increases heart rate?
    Sympathetic
  4. Which ANS decreases heart rate?
    Parasympathetic
  5. Which ANS dilates the broncioles?
    Sympathetic
  6. Which ANS dilates the pupils?
    Sympathetic
  7. Which ANS conserves energy?
    Parasympathetic
  8. Which ANS empties the bowels and the bladder?
    Parasympathetic
  9. Which ANS constricts the pupils?
    Parasympathetic
  10. Which ANS increases gastric secretion and motility?
    Parasympatheric
  11. What are the three patterns of innervation by the ANS?
    • Opposed
    • Complementary
    • Singular
  12. What type of receptor is on the postganglionic neuron of the ANS?
    Nicotinic N receptors
  13. What receptor is found on the effector organ of the parasympathetic nervous system?
    Muscarinic cholinergic
  14. What receptor is found on most of the effector organs of the sympathetic nervous system?
    Adrenergic
  15. What are the four adrenergic receptor types?
    • Alpha 1
    • Alpha 2
    • Beta 1
    • Beta 2
  16. Which effector is the exception in the sympathetic nervous system receptors?
    Sweat glands (muscarinic cholinergic)
  17. What organ acts as a postganglionic neuron in the sympathetic nervous system?
    Adrenal medulla
  18. What neurotransmitter is excreted by the adrenal medulla?
    Epinephrine
  19. From what portion of the spinal cord do sympathetic preganglionic neurons originate?
    • T1 - T 12
    • L1 - L2
  20. What cells of the adrenal medulla are innervated by the pregangltionic neuron of the sympathetic nervous system.?
    enterochromaffin cells
  21. What receptors are activated when the adrenal medulla secretes epinephrine into the synapse at an effector organ?
    Beta 2
  22. Which ANS is known as the thoracolumbar nervous system?
    Sympathetic
  23. What receptor is found at the neuromuscular junction?
    Nicotinic M
  24. Which ANS is known as the craniosacral nervous system?
    Parasympathetic
  25. From where do the preganglionic neurons of the parasympathetic nervous system originate?
    • Cranial Nerves 3, 7, 9 and 10
    • Sacral Spinal Nerves S2 - S4
  26. Which ANS has a general function that is catabolic?
    Sympathetic
  27. Which ANS has a general function that is anabolic?
    Parasympathetic
  28. What is the nature of the peripheral response in the sympathetic nervous system?
    Generalized
  29. What is the nature of the peripheral response in the parasympathetic nervous system?
    localized
  30. What is the response of alpha 1 receptors to neurotransmitter or agonist?
    Constriction of the bladder, arteries and veins
  31. What is the response of alpha 2 receptors to neurotransmitter or agonist?
    Inhibits sympathetic outflow in the CNS
  32. What is the response of beta 1 receptors to neurotransmitter or agonist?
    • Increase in heart rate, speed of conduction and contractility of the heart
    • Release of renin by the kindey
  33. What is the response of beta 2 receptors to neurotransmitter or agonist?
    • Dilation of the bronchioles
    • Dilation of the arterioles in skeletal muscle
    • Relaxation of the uterus
  34. What is a pressor?
    Raises BP
  35. What class of drugs will increase BP?
    Alpha 1 agonists
  36. What class of drugs are used for urinary retention or hypertension?
    • Alpha 1 antagonists
    • (block constriction of arteries/veins, block constriction of the bladder)
  37. What is benign prostatic hypertrophy?
    When the prostate becomes enlarged and puts pressure on the urethra, making it hard to urinate.
  38. What is pheochromacytoma?
    A catecholamine producing tumor in the adrenal medulla that produces large amounts of epinephrine and NE causing extremely high BP.
  39. What can be used to treat pheochromocytoma?
    • Alpha 1 antagonist
    • and Beta-1 blocker (to lower HR)
  40. (will block constriction of arteries and veins, which will lower BP)
  41. Adverse effects of alpha-1 blocker
    • Orthostatic hypotension (peripheral veins cannot constrict to increase venous return)
    • Reflex tachycardia (heart compensates for decreased BP)
    • Ejaculation inhibition (alpha-1 receptors cannot produce ejaculation)
    • Nasal congestion (vessels in nose are dilated)
  42. What are three examples of alpha-1 agonists?
    Phenylephrine (Neo-synephrine®)

    Oxymetazoline (Afrin®)

    Pseudoephedrine (Sudafed®)
  43. What are three examples of Alpha-1 Antagonists?
    Prazosin (Minipres®)

    Terazosin (Hytrin®)

    Doxazosin (Cardura®)
  44. What is the therapeutic effect of beta 1 agonists?
    Increasing heart rate or strength of contraction
  45. What are two examples of beta 1 agonists?
    • Isoproteranol
    • Dobutamine
  46. What are therapeutic effects of beta 2 agonists?
    • Bronchodilation
    • Stop preterm labor
  47. What are three examples of beta-2 agonists?
    • albuterol
    • terbutaline
    • ritrodine
  48. What are four categories of beta blockers?
    • Cardioselective (Beta 1 specific)
    • Nonspecific Beta blockers
    • Beta blockers with ISA
    • Alpha/Beta Blockers
  49. What is an example of a cardioselective beta blocker?
    metoprolol
  50. What is an example of a Nonselective Beta Blocker?
    Propranolol
  51. Examples of alpha/beta blockers?
    • labetolol
    • carvedilol
  52. Which class of antagonist drugs are really partial agonists having little effect on resting heart rate or cardiac output?
    Beta blockers with ISA
  53. What are six therapeutic uses for Beta blockers?
    •Angina: (Decrease the workload on the heart by lowering HR and contractility)

    •Hypertension: (Reduce peripheral vascular resistance)

    •Cardiac Dysrrhythmias: (Have been shown to prevent sudden death in post-MI patients)

    •Myocardial Infarction: (reduce infarct size and risk of 2nd heart attack/re-infarction).

    •Stage fright: (prevent tremulousness)

    •Glaucoma: (given topically for this indication)
  54. Adverse effects of beta 1 blockade
    • Bradycardia
    • Exacerbation of heart failure, reduced CO
    • A/V heart block
    • Rebound cardiac excitation if stopped abruptly (leads to MI)
  55. Adverse effects of beta 2 blocker
    • Brochoconstriction
    • Hypoglycemia (r/t inhibition of glycogen breakdown)
  56. What is the effect of ACh on the nicotinic N receptors?
    • 1. Transmission of postganglionic neuron in both sympathetic and parasympathetic nervous system?
    • 2. release of epinephrine and NE from the adrenal medulla
  57. What is the effect of ACh on Nicotinic M receptors?
    Contraction of the skeletal muscle
  58. What is the effect of ACh on muscarinic receptors?
    • Slowed heart rate and speed of conduction
    • Bronchoconstriction and increased secretions
    • Bladder contraction
    • Increased GI motility and secretions
  59. What muscarinic agonist is used for glaucoma?
    Pilocarpine
  60. Why are muscarinic agonists not used often?
    They have multiple unpleasant effects (SLUDGE)
  61. What muscarinic agonist is used for urinary retention?
    bethanecol (not very often though)
  62. What muscarinic agonist is used for dry mouth?
    Bethanecol (topically)
  63. What class of drugs are also referred to as anti-cholinergic?
    Muscarinic Antagonists
  64. What are some adverse effects of muscarinic antagonists/anticholinergic drugs?
    • Inhibits contraction of bladder (can't pee)
    • Dilation of pupils (can't see)
    • Decreases GI secretions (can't spit)
    • Decreases GI motility (can't sh__)
    • Confusion/delirium
  65. What are some uses for Muscarinic Antagonists?
    • Dry up secretions pre-operatively
    • Dilate pupils
    • Speed up heart or improve heart block
    • Anti-diarrheal (not anymore)
  66. What are some examples of muscarinic antagonists?
    Atropine

    Scopolamine

    Glycopyrolate
  67. What does SLUDGE stand for?
    • salivation
    • lacrimation
    • urination
    • defecation
    • GI distress
    • emesis
  68. What causes SLUDGE?
    Excess of ACh
  69. What are the symptoms of cholinergic crises?
    • SLUDGE
    • CNS depression
    • Muscle fasciculation, fatique, spasm
  70. What can be used to treat cholinergic crisis?
    Atropine
  71. What can atropine be used to treat?
    • Cholinergic crisis
    • Bradycardia (if parasympathetic stimulation is cause)
  72. What class of drugs can be used to treat urinary incontinence?
    Muscarinic antagonists
  73. What are two examples of muscarinic antagonists that are marketed to treat incontinence?
    Ditropan (oxybutynin)

    Detrol (tolterodine)
  74. How does a non-depolarizing neuromuscular blocker work?
    It blocks ACh from binding to the nicotinic M receptor at the NMJ, thereby inhibiting muscle contraction.
  75. What is an example of a nondepolarizing neuromuscular blocker?
    tubocarine
  76. What is tubocurarine used for?
    • Intubation
    • Conservation of energy for mechanically ventilated patients
  77. What is an example of a depolarizing neuromuscular blocker?
    Succinylcholine
  78. Which is easily reversible using acetylcholinesterase inhibitors?
    Tubocurarine
    Succynylcholine
    Tubocurarine
  79. Reversible acetylcholinesterase inhbitor
    Neostigmine
  80. What class of drugs are irreversible acetylcholinesterase inhibitors?
    Nerve Agents
  81. What is an example of long term use acetylcholinesterase inhibitors?
    Treatment of myasthenia gravis or Alzheimers
  82. What are some examples of acetylcholinesterase inhibitors?
    • Neostigmine,
    • edrophonium,
    • physostigmine,
    • pyridostigmine,
    • tacrine,
  83. What are some adverse effects of Neostigmine?
    SLUDGE
  84. What is short term use of Neostigmine or other AChesterase inhibitors
    reversal of nondepolarizing neuromuscular blockers
  85. What are the adverse effects of Nerve Agents?
    • Respiratory Arrest
    • SLUDGE
    • Twitching/convulsing
    • Multi-organ involvement
    • GI effects
    • Coma/stupor
  86. What is the antidote to Nerve AGents?
    • Atropine (stops SLUDGE)
    • 2-PAM Chloride (reactivates AChesterase at NMJ for respiration)
    • Lorazepam (anticonvulsant)
  87. What is the mechanism of action for CNS stimulants?
    • (1) Increase catecholamine release and (2) inhibit reuptake of catecholamines
    • thus increasing concentration of neurotransmitters in synapse.
  88. What are three common CNS stimulants?
    • Methylphenidate
    • Methylxanthines
    • Theobromine
  89. What is methylphenidate?
    Ritalin
  90. What is a common methylxanthine?
    caffeine
  91. What is theobromine?
    chocolate
  92. What are the effects of abrubtly discontinuing methylphenidate?
    • extreme fatigue
    • depression
  93. What is the mechanism of action of caffeine?
    It is unclear.

    *most likely, it is an adenosine receptor antagonist

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