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What are two main divisions of our nervous system? CNS / PNS
The Peripheral Nervous System is divided into what two parts? Somatic Nervous System / Autonomic Nervous System
What are three divisions of the Autonomic Nervous System? Sympathetic / Parasympathetic / Enteric*
T/F: The Enteric system may or may not be part of the Autonomic Nervous System depending on certain literature? True - However, the enteric system can be effected by the ANS.
What two organs make up the Central Nervous System? Brain / Spinal Cord
Which part of the brain is more responsible for ANS functions? Hypothalamus
Which part of the brain is more responsible for CNS functions? Cerebral Cortex
What is another name for the functions of the Cerebral Cortex? Higher Brain Functions
What are the three sections of the brain? Hindbrain / Midbrain / Forebrain
What is another name for the Hindbrain? Reptilian Brain
What structures make up the Hindbrain? Medulla / Pons / Cerebellum
What does the medulla control? Ventilation / HR / BP
What does the Pons control? Sensory Information / Facial Expressions
What does the cerebellum control? Movement / Coordination / Balance / Muscle tone / Learning motor skills
What does the Reticular Formation regulate? Hindbrain activity / Sleep / Wakefulness
What structure relays sensory information from the spinal cord to the forebrain? Midbrain
What two sections make up the Midbrain? Superior Colliculus / Inferior Colliculus
Which part of the brain is responsible for circadian rhythm? Pineal Gland
What is significant about the pineal gland? Postulated to be important in sex organ maturation.
What sections of the brain make up the Limbic System? Hypothalamus / Thalamus / Amygdala / Hippocampus / Entorhinal Cortex
What does the Thalamus do? Relays information to the appropriate parts of the brain?
What is the exception to the Thalamus? Does not relay information to the olfactory portion of the brain.
What are the functions of the Hypothalamus/Pituitary Gland Basic Biological drives / Hormonal Levels/ Sexual behavior / Autonomic Function
Name some basic autonomic functions? Hunger / thirst / body temp
What part of the brain is important for the visual field? Explain. Optic Chiasm - the left and right cross over point
T/F: The septum stimulates sexual pleasure? True
What is the Hippocampus responsible for? Learning and new memory
What part of the brain do Benzodiazepam drugs effect? Hippocampus
What functions does the amygdala regulate? Anxiety / emotion / fear
What is another name for the Mamillary body? What functions are regulated? Fornix - emotional behavior / Learning / motivation
What parts of the brain are responsible for movement, emotions and integration of sensory data? Basal Ganglia/ Caudate Nucleus/ Putamen/ Globus Pallidus
What creates a cushion for brain protection? CSF
What parts of the brain contain CSF? Ventricles / Central Canal
What is the Cingulate gyrus responsible for? Internal Stimuli / Sense of self
What is another name for internal stimuli? Pain
What are the nerves bundles that link the cerebral hemispheres? Corpus collosum
What part of the brain controls movement, thinking and feeling? Frontal Lobe
What is another name for the frontal lobe? Conscious brain
The movement that the frontal brain controls is (voluntary/involuntary)? Voluntary
What part of the brain causes children to make inappropriate decisions? Prefrontal cortex - it is still developing.
What are the functions of the Pre-frontal Cortex? Inhibits Inappropriate Actions/ Conceptual thinking / planning/ focus attention / adds meaning to perceptions
What part of the brain manages skin sensation? Parietal Lobe
What part of the brain manages vision? Occipital Lobe
What part of the brain manages hearing and speech? What is another name for this area? Temporal Lobe - Auditory Cortex
Where is the spinal cord located? Mid Dorsal line of the body.
What are two functions of the spinal cord? Center for reflex arc. Conduit for communication between brain and spinal nerves.
T/F: The reflex arc involves higher conscious thought. False - it is an action that DOES NOT require higher conscious thought.
What does dorsal mean? Relays sensory information TO the brain.
What does ventral mean? Relays messages FROM (MOTOR) the brain.
What does AVM stand for? Anterior Ventral Motor
What does SDP stand for? Sensory Dorsal Posterior
What part of the spinal cord is effected by pain medication? Dorsal Root
T/F: White matter contains myelinated nerves. True
What is the main function of white matter? COMMUNICATION between areas of gray matter.
T/F: Gray matter contains only unmyelinated nerves. False - has both myelinated and unmyelinated nerves.
What is the function of gray matter? Responsible for processing information.
What should we think about with a myelinated nerve? Fast transmission of signals.
What three 3 types of nerves are involved in the CNS/PNS? Sensory neuron/ Somatic motor neuron/ Automatic motor neuron
Sensory neurons receive signals from what? Sensory organs
Somatic motor neurons deliver signals to what? Skeletal muscles
Autonomic motor neurons deliver signals to what? Smooth muscle/ Cardiac muscle/ Glands (via pre and post ganglionic fibers)
ANS deals with (voluntary/involuntary) regulation? Involuntary
What are some functions of the Autonomic nervous system? Arterial BP/ GI motility & Secretions/ Urinary bladder emptying/Sweating/ Body temp
How fast can the ANS regulate BP and HR? Who stated this research? HR 3-5 seconds BP 10-15 seconds (Guyton)
What parts of the body can trigger the ANS? Spinal cord/ brain/ hypothalamus/ limbic cortex of the cerebral cortex
What is the response initiated by the ANS called? Visceral reflex
BONUS: What does viscera mean? Internal organ
What is the Principal site of ANS organization? Hypothalamus nuclei
What are the physiological responses of the hypothalamus? Stress / BP/ temp regulation
When we give anesthetics, why is temperature control so important? Anesthetics (Volatile) are CNS depressants and inhibit the regulation of temperature. KEEP PATIENTS WARM!
What are the key functions of the medulla and pons? Hemodynamic control/ Automatic ventilatory control
What assessment would be made on a patient with a medullary/pons injury (tumor)? Irregular respirations or wide fluctuations in HR/BP.
What is our job in Anesthesia? To avoid deleterious effects on the ANS.
Impaired ANS may cause what? Alterations in expected outcomes to surgery/anesthesia.
What can improve patient outcomes? Attenuating the stress response to surgery.
What do efferent autonomic signals refer to? Signals being carried away from the CNS.
What two parts of the PNS do efferent signals travel too? SNS/ParaSN
What is another name for the sympathetic nervous system? Fight or flight
What is another name for the ParaSN Rest and digest
Where do the fibers of the SNS arise from? Preganglionic fibers arise from the thoracolumbar region of the spinal cord
Where do the fibers of the ParaNS arise from? Preganglionic fibers arise from the craniosacral region of the spinal cord
How are nerves classified? By the chemical transmitters they contain.
Nerves containing Ach are called? Cholinergic
Nerves containing epinephrine/norepi are called? Adrenergic
Drugs that mimic Ach are called what and what response do they have? Cholinomimetic / Cause a predictable cellular response
Drugs that block AcH are called? Cholinergic antagonist / anticholinergics
What are cell membrane proteins that react with AcH? Where do they act? Cholinergic receptors Muscles/glands
What does it mean to have muscarinic effects? AcH mediated action in the parasympathetic NS
Drugs that mimic muscarinic effects (agonist) can also be called? Where do they act? Muscarinic drugs or Parasympothomimetics (heart/ smooth muscles/glands)
Drugs that block muscarinic effects can also be called? Antimuscarinic / parasympatholytic
What receptors refer to the skeletal muscles? Nicotinic
Where are the cholinergic nerves located? Postganglionic parasympathetic Preganglionic Parasympathetic Some postganglionic sympathetic such as sweat glands/blood vessels and preganglionic sympathetic that arise from the greater splanic nerve and innervate the adrenal medulla.
Adrenergic nerves deal with what neurotransmitter and what are those drugs called? Norepinephrine / Sympatholmimetic
What do you call drugs that inhibit NE? Sympatholytic
What is special about the adrenal medulla? Releases Epi/Norepi into the blood stream. No effector organ
What are the main adrenergic receptors? Alpha 1 Alpha 2 Beta 1 Beta 2
Where is alpha 1 located and what does it cause? Postsynaptic: mydriasis, bronchoconstriction, vasocontriction, uterine constriction, constriction of gastrointestinal/genitourinary tracts. Inhibits insulin. +Gluconeogenesis/Glycogenolysis
Where is alpha 2 located and what does it cause? Presynaptic: Inhibits further Norepi release. Alpha 2 postsynaptic may cause vasoconstriction but cause sedation in the CNS.
Where are beta 1 receptors and what does it cause? Postsynaptic: mainly in the heart (+chrono/domo/ino)
Where are beta 2 receptors and does it cause? Postsynaptic: Smooth muscles and glands. Smooth muscle relaxation
Where do first order neurons originate from? CNS
What is another name for first order neurons? Preganglionic fibers
Where do preganglionic fibers relay impulses to? Postganglionic fibers (Second order neurons)
What are the cell bodies called located on the second order fibers? Autonomic Ganglia
T/F: Preganglionic fibers are myelinated? True
T/F: Postganglionic fibers are myelinated? False
Myelination creates a (fast/slow) conduction? Fast
What part of the spine is the thoracolumbar system? T1-L3
Where are the preganglionoc sympathetic neuron cell bodies located? What is another name for them? Horns of the spinal gray matter (intermediolateral columns)
Cell bodies from the spinal gray matter can extend to three types of ganglia, what are they? Paired sympathetic chain Unpaired distal plexus Terminal/collateral ganglia (near target organ)
How many paired ganglia are located in the sympathetic chain? Where is this chain located? 22 / Paravertebral
Where do preganglionic nerves exit? Anterior nerve root
Where do the preganglionic nerve roots enter? Via what structure? Ganglion of the spinal nerve trunk/ White ramus
What set of nerves carry signals from sympathetic trunk ganglia to spinal nerves? Via what structure? Postganglionic nerves/ Gray Ramus
Sympathetic division from the head and neck come from what part of the spinal cord? 3 ganglia of the cervical sympathetic chain.
What function does the cervical sympathetic chain have? The 3 ganglia of the cervical sympathetic chain are responsible for: vasomotor/pupillodilator/ secretory and pilomotor functions.
Where do the preganglionic fibers originate from to supply the 3 ganglia of the cervical chain? Upper thoracic segments
What is the stellate ganglion? Is formed from the fusion of the inferior cervical ganglion and the first thoracic ganglion.
What percent of people have a stellate ganglion? 80%
Where is the stellate ganglion located? Anterior to transverse process of the C7, posterior to the neck of the first rib, just below subclavian artery.
What symptoms may be resolved with transection or block of the stellate ganglion? Raynaud's phenomenon Hyperhydrosis Complex regional pain syndrome
What is hyperhydrosis? Excessive sweating
What is a complication of a stellate ganglion block? Horner's Syndrome
What are the three hallmark signs of hornet's syndrome? Ptosis, miosis, anhydrosis
Where do the prevertebral ganglia reside? Abdomen and pelvis (anterior to vertebral column)
What are the ganglia of the prevertebral ganglia? Celiac, Superior/Inferior mesenteric, Aorticorenal ganglia
What is the celiac ganglia innervated by? Innervates what organs? T5-T12, Liver, spleen, kidneys, pancrease, small bowels, and prox colon.
The superior mesenteric/inferior mesenteric ganglia innervate what organs? SM - distal colon IM - rectum, bladder, genitalia
What is the abdomen and pelvis innervated by? Thoracic sympathetic fibers
What does the adrenal medulla secrete? Norepinephrine, Epinephrine
T/F: Autonomic reflexes remain after spinal cord transection. True
How are autonomic reflexes inhibited? Supraspinal feedback
If a transection is made to the autonomic reflexes and the supra spinal feedback is inhibited, what could occur? Exaggerated sympathetic response
How many nerve pairs are located in the spinal cord? Cervical - 8 Thoracic - 12 Lumbar - 5 Sacrum - 5 Coccygeal - 1
What nerves are responsible for the parasympathetic NS? III (Oculomotor) VIII (Vestibulocochlear) IX (Glossopharyngeal) V (Vagus) Sacral segments
Where are the ganglia located in the parasympathetic NS? Proximal or within the innervated organ
How does the ganglia from the parasympathetic NS differ from the SNS? Leads to a more targeted response
What does the glossopharnygeal nerve innervate? mucosal, salivary, and lacrimal glands
How much of the vagus never supplies the impulses of the ParaNS? 3/4th
What organs are innervated by the vagus nerve? Heart, tracheobronchial tree, liver, spleen, kidneys and all GI tract.
Where does the vagus nerve not innervate in the GI Tract? Distal colon
Where does cranial nerve III innervate? Iris/ciliary muscle
What are the nerves of the sacral segment? What do they innervate? pelvis splanchnic nerves (rectum and GU)
The paraNS has preganglionic fibers that arise from what parts of the spinal cord? What nerves are related to these fibers? Midbrain - III & IV Medulla Oblongata - IX & X Sacral portion - S1 & S2
What is cranial nerve IV? Trochlear
What is the third division of the nervous system? Eneteric System
T/F: A lot of information exist on the Enteric system of our nervous system. False
How is the Enteric system formed? Derived from the neuroblast of the neural crest that migrate to GI tract and vagus nerve
What does Miller say about the Enteric system? It has local autonomy
T/F: Miller states that if there was a transection of the spinal cord, the enteric system would not work. False
What are some factors that can alter the enteric system? Mood disturbances, Stress (anxiety/depression)
What are some examples of disorders that can occur with mood disturbances effecting the enteric system? Crohn's Disease Ulcerative colitis
Where do the sympathetic preganglionic fibers arise from that innervate the gut? T5-L1
Sympathetic pregangilonic fibers are (excitatory/inhibitory) to the gut. Inhibitory
What neurotransmitter is present with sympathetic postganglionic fibers of the gut? NE
What are the three types of enteric neurons? Sensory, associative, motor
Sensory enteric neurons are responsible for what? Monitor intestinal wall tension and chemical content
Associative enteric neurons are responsible for what? Communicate with afferent and efferent nerves
What is another name for Associative enteric neurons? Interneurons
Motor enteric neurons are responsible for what? Muscular contraction vessel dilation, transport of water/lytes
T/F: Motor enteric neurons can be inhibitor & excitatory. True
The sympathetic NS is mainly responsible for what type of response? Stress
The parasympathetic NS is mainly responsible for what response? Energy conservation
What parts of our body are exclusive to sympathetic tone? Certain blood vessels, spleen, piloerector muscles
The innervation of most organs by both the SNS/PNS contributes to what? Resting tone
Where are neurotransmitters released from? Vesicles in the presynaptic neurons.
How many classes of neurotransmitters are there? What are they? 4:Monoamines, Amino acids, Neuropeptides, and AcH
What are examples of monoamines? Epi/Norepi/ Dopamine/Serotonin/ Histamine
What are examples of amino acids? Glycine/GABA/ Aspartate/glutamate
What are examples of neuropeptides? Substance P/opioids/ hormones
What is substance P important for? Pain
What are the amino acid neurotransmitters dependent upon? presynaptic reuptake and Enzymatic breakdown.
What enzymes breakdown amino acid neurotransmitters? Monoamine oxidase Catecholamine methyltransferase
What is the main amino acid neurotransmitter in the CNS? Where is it mostly located? Is it excitatory or inhibitory? Dopamine / Basal ganglia (Inhibitory)
Norepinephrine is (excitatory/inhibitory) and located where? Inhibitory / RAS & hypothalamus
Serotonin is (excitatory/inhibitory) and responsible for what? Inhibitory / affects mood
Histamine is (excitatory/inhibitory) and located where? Inhibitory / RAS & Hypothalamus
What is the primary excitatory transmitter? Located where? Glutamate (cerebral cortex, hippocampus, and substantia gelatinosa of the spinal cord)
What does glutamate play a role in? Learning, memory, pain
What is a major inhibitory neurotransmitter in the CNS? Where is it located? GABA (basal ganglia, cerebral cortex, cerebellum, spinal cord)
What is the primary inhibitory transmitter in the spinal cord? Glycine
What is significant about glycine and surgery? Glycine absorbed during prostate surgery can lead to visual changes
Which type of neurotransmitters are important for pain? What are some examples and how do they work? Neuropeptides: opioids, endorphine, enkephalins, and dynorphins all act on opioid receptors in brain and spinal cord
What is cAMP? Cyclic adenosine monophosphate: a second messenger necessary for intercellular signal conductance. ESP epi/glucagon
COMT? Catechol-O-methyltransferase: enzymatic degradation of Catecholamines ESP epi/norepi/dop
MAO? Monoamine oxidase: deoxidative deamamination (O2 used to remove an amine group) ESP serotonin/epi/norepi
What do MAOIs do? Indirectly increase levels of cop/epi/norepi
T/F: Research shows that patients do not need to d/c MAOI medication prior to surgery. True
What do SSRIs do? Surgery issue? Decrease neuronal reuptake of serotonin. (MAY CONTINUE)
Tricyclic Antidepressants do what? Alpha adrenergic blocking drugs.
What can taking Tricyclic antidepressants lead too? Block neuronal reuptake of norepi which can lead to dysrhythmias and vasodilation. (USE NOREPI to TX HYPOTENSION)
Why do certain drugs need to be tapered? Up/Down regulation
What is the function of the midbrain? Sensory information from spinal cord to forebrain
Created by: gmg005