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V3-PNS-SNS
| Question | Answer |
|---|---|
| The peripheral nervous system is split into ____ and ______ | SOMATIC and AUTONOMIC |
| Draw the tree for the peripheral nervous system | paper… somatic-motor/sensory…. Autonomic-symp/para |
| Describe the MOTOR portion of the SOMATIC division of the peripheral nervous system (where, fibers, NTM) | Ventral Horn, efferent, Aa fibers, uninterrupted, releases ACH at skeletal muscle! |
| Describe the SENSORY portion of the SOMATIC division of the peripheral nervous system (where, fibers) | Dorsal, afferent, c fibers |
| Name the divisions of the AUTONOMIC nervous system | sympathetic and parasympathetic. |
| Describe the neurons in the SYMPATHETIC portion of the AUTONOMIC nervous system (what neurons look like) | SHORT PRE and LONG POST. |
| Transmitters released in the SYMPATHETIC portion of the ANS??? | SHORT PRE release ACH… the LONG POST release NE!!! |
| With the LONG post synaptic fibers of the sympathetic nervous system, NE is released at target except for where!!! | at the SWEAT GLANDS, ACH is released by the LONG POST synaptic sympathetic fibers!!! |
| Describe the neurons in the PARASYMPATHETIC portion of the AUTONOMIC nervous system | LONG PRE and SHORT POST! |
| Transmitters released by the PARASYMPATHETIC portion of the ANS??? | ACH ONLY |
| Describe the innervation of the ADRENAL MEDULLA | Innervated by SYMPATHETIC PREGANGLIONIC that DO NOT synapse!!!! Then releases EPI and NOR EPI directly into blood. |
| NTM released at the adrenal medulla? | Preganglionic Sympathetic neuron releases ACH at adrenal medulla! |
| What happens when the Adrenal Medulla is innervated and stimulated by a sympathetic preganglionic neuron? | EPI and NE are released in to the blood directly at a ratio of 80:20 |
| Ratio of EPI to NE from adrenal medulla? | 80:20 |
| What is special about the innervation of the sweat glands? | its a POST GANGLIONIC SYMPATHETIC neuron that releases ACH….. NOT NE!!!!!! |
| MUSCURINIC RECEPTORS are found in tissues innervated by _______? | the PARASYMPATHETIC nervous system |
| Where are nicotinic receptors found? | autonomic ganglia, cells of adrenal medulla, motor end plate of skeletal muscle |
| “ANDRENERGIC” receptors are found in tissues innervated by ____? | sympathetic nervous system! EXCEPT FOR SWEAT GLANDS |
| Describe the innervation and NTMs at sweat glands! | POST GANGLIONIC sympathetic neurons usually release NE to their target… at the sweat glands they release ACH! |
| Muscarinic receptors are WHAT TYPE of receptor? | metabotropic or “G-protein.” |
| Target receptors for parasympathetic innervation? | muscurinic receptors by ACH |
| Target receptors for sympathetic innervation? | andrenergic receptors by NE except at sweat glands. |
| What is it called when the nicotinic receptors at the motor end plate become desensitized to massive amounts of ACH to the point where the membrane is NON EXCITABLE… or succs? | phase 2 block…. Occurs at MOTOR end plate of SKELETAL muscle! |
| What nerve fibers adjust skeletal muscle FORCE and LENGTH? | Aa |
| What fibers are responsible for proprioception? | Aa and Ab |
| _____ nerve fibers carry THROBBING PAIN and TEMPERATURE sensations??? | dC |
| _____ fibers carry sensations of sharp, pin prick, and temp? | Ad |
| SYMPATHETIC and PARASYMPATHETIC PREganglionic neurons are what type of fibers??? | B fibers…. Pregang sym and parasymp are B fibers |
| POSTGANGLIONIC SYMPATHETIC neurons are what type of fibers? | C |
| Myelinated vs non-myelinated in terms of Action potentials | myelinated have greater velocities |
| Diameter and action potentials? | bigger diameter is faster velocity |
| Sympathetic system is AKA | THORACOLUMBAR |
| Sympathetic outflow arises at what vertebral levels? | T1-L2 |
| WHERE do most SYMPATHETIC PREganglionic neurons synapse with POSTsynaptic neurons? | paravertebral ganglia |
| Where are the cardiac accellerators? | T1-T4 |
| WHERE is the STELLATE GANGLIA!!! | Inferior cervical and 1st thoracic vertebrae |
| S&S of HORNERS SYNDROME! | Ptosis, Miosis, Anhydrosis, flush, increased temp, enopthalmos, stuffy nose… IPSILATERAL!!! |
| What happens to the HR of an infant with a high spinal? | No bradycardia due to immature ANS! |
| When does the ANS mature? | 6 months |
| s/s of high spinal in neonate? | desaturation.. not bradycardia |
| parasympathetic nervous system outflow is from….. | CRANIOSACRAL!!!! |
| Sympathetic preganglionic neuron arise from where!! | INTERMEDIOlateral horn of SC |
| What % of SYMPATHETIC PREGANGLIONIC fibers pass through the WHITE RAMI | ALL OF THEM |
| Talk about the GRAY and WHITE RAMI!!! | ALL SYMPATHETIC PREganglionic neurons pass through WHITE RAMI.. NOT all sympathetic POSTGANGLIONIC fibers pass through gray matter |
| If a sympathetic preganglionic neuron synapses in the paravertebral gangliojn… where does it go next? | GRAY RAMI! Then to spinal nerve! |
| Explain the pathway of a SYMPATHETIC PREGANGLIONIC NEURON! | originates in the intermediolateral horn of the SC… out to the white rami…. Either synapses there and goes through GRAY RAMI… if not it goes up or down the paravertebral ganglia and synapse out…. Or travel out to peripheral ganglia and synapse. |
| PRIMARY function of the GRAY RAMI? | allow coordinated MASS DISCHARGE of the sympathetic nervous system |
| Synthesis of NOREPI | Tyrosine, dopa, dopamine, nor-epi, epi |
| Where is NOR-epi stored? | vesicles in the adrenal medulla |
| Ratio of epi to norepi in the adrenal medulla? | 80/20 |
| What is needed to release a NTM from the nerver terminal? | Ca+ |
| Describe how NORepi is released… | AP travels down sympathetic POSTGANG neuron to terminal end… Ca channel opens and Ca rushes in… NOREPI released into cleft. … OR AP travels down symp. PREGANG to Adrenal medulla.. releases ACH onto medulla… medulla releases 80/20 |
| The cells response to the activation of ADENYLATE CYCLASE is ______ specific | tissue specific |
| What does NOREPI activate in the cell | adenylate cyclase (2nd messenger) to produce cAMP intracellularly |
| TERMINATION of action of NOREPI???? | diffusion away from the receptor! |
| Describe what happens to norepi after it DIFFUSES away from the receptor | 80% is transported BACK into the presynaptic terminal… 80%!!!! |
| Where is MAO found and how does it get into the cleft to metabolize NE? | found on the surface of the mitochondria… leaks out into cleft! |
| What happens to the remaining 20% of NE that has NOT been reuptaken? | it is either metabolized in the synaptic cleft by MAO… or eaten up by COMT after it diffuses into the plasma. |
| How ephedrine works… duh | indirectly by displacing NE from nerve terminal… and directly on andrenergic receptors. |
| AGENTS that should be AVOIDED in patients on MAOIs!!! | DEMEROL and EPHEDRINE!... trigger the release of NE….. may cause HTN crisis because of the blockage of MAO. |
| Decreases in DBP and possibly MAP… with low dose epi can be attributed to | BETA 2 mediated vasodilation… decrease in SVR |
| DBP changes in the same direction as | SVR |
| Side effects of B2 agonism? | tachy, hyperglycemia, hypoK, lactic acidosis, TREMORS from B2 in skeletal muscles |
| B2 agonist used as tocolytics? | ritrodine and terbutaline |
| What are the PREDOMINANT centrally acting ALPHA AGONISTS? | precedex, catapress, and alpha-methyldopa |
| How do the centrally acting A-agonists work? | decrease sympathetic outflow by stimulating POSTSYNAPTIC A2 receptors the the BRAINSTEM |
| Stimulation of postsynaptic A2 receptors in the vasomotor center of the medulla does what | inhibitory action on the SNS! |
| how does clonidine work peripherally? | stimulate A2 receptors of sympathetic POSTGANG neurons… thus inhibit release of NE |
| what happens if clonidine is abruptly withdrawn | rebound HTN |
| rebound HTN is mediated by | catecholemines.. renin… Angiotension 2 |
| receptors that PHENOXYBENZAMINE act on | blocks A1-A2 |
| receptors that PRAZOSIN act on | blocks A1 |
| receptors that TIMOLOL act on | B1-B2 |
| receptors that ESMOLOL act on | B1 mostly… B2 |
| receptors that LABETALOL act on | All but A2!!!! |
| receptors that CARVEDILOL act on | A1 mostly… but betas as well. |
| What is the NONSELECTIVE alpha andrenergic antagonist used to treat pheochromocytoma? | phenoxybenzamine |
| What is phentolamine? | NONselective alpha antagonist! |
| What is YOHIMBE!! | selective A2 antagonist for impotence! AND orthostatic hypoTN |
| PRAZOSIN is ____ | SELECTIVE A1 blocker! |
| How does prazosin work and why is it important?! | it is selective A1 to lower BP.. important because it DOES NOT block or cause the release of NE. |
| How is esmolol metabolized? | RED CELL ESTERASES |
| Problem with NONSELECTIVE antagonists | can cause airway irritability |
| Labetalol… BETA to ALPHA block ratio?? | 7:1 |
| How… specifically… do beta antagonists slow HR? | decrease the rate of PHASE 4 depolarization. |
| Long time beta blocker use… immediately stopped… what happens? | the UPREGULATION of receptors causes and bad tachy! WITHDRAW HYPERSENSITIVITY |
| Glucose effects of beta blockers | decreased gluconeogenesis… unrecognized hypoglycemia! No tachy! |
| Beta antagonists and POTASSIUM? | HYPER-K because they depress the Na-K pump… reduces rate of K into cell… more extracellularly. |
| Beta agonists and potassium? | HYPOK… drives K into cells |
| Treat beta blocker toxicity | ATROPINE… DOBUTAMINE… CaCl…. Glucagon… transvenous pacer |
| What can happen if heart is beta blocked with an increased afterload? | with higher SVR, heart may fail due to reducaed ability to contract |
| Betablocking patients with PHEOchromocytoma… and why | if beta blocking, the patient need alpha blockade…. May produce failure…. Same with cocaine use and betablockers. HTN crisis. |
| KETAMINE and beta blockers? | AVOID… sympathetic stimulation and depressing the heart |
| What produces more myocardial depression in the patient on BETA BLOCKERS?.. (enflurane or halothane?) | ENFLURANE |
| CHF… up or down regulation of receptors and WHY? | DOWN REGULATION… high sympathetic outflow to help compensate the failing heart… thus receptors diminish to high rate of outflow… chronic exposure to help failing heart |
| Chronic beta blockers cause (up/down) regulation? | UP reulation… decrease receptor activity/response to agonists |
| OB PARTURIENT need a pressor… ephedrine or Neo… why | either is ok but ephedrine is better… less decrease to placenta! |
Created by:
tjc5002