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SNS thoraco-lumbar pre-ganglonic: short axon into prevertebral chain post-ganlionic: long axon to organs widely spread system one neuron can go to MULTIPLE places
Exception to SNS ganglia adrenal glands long pre and short post neuron that goes here ONLY goes here
PSNS brain stem and sacral cord long pre and short post very restrictive; one neuron to one place
Acetylcholine (Ach) used by PRE-ganglionic axons agonist for NICOTINIC receptor
Norepinephrine (NE) major transmitter for SNS activates alpha 1/2 > beta 1 (mixed adrenergic agonist) used for hypotension
Exception to NE for SNS adrenal gland; chromaffin cell is post ganglia and releases Ach whcih which stimulates Epinephrine
Flow of transmitter signaling SNS Ach --> nicotinic --> NE --> Alpha/beta
PSNS and somatic cholinergic system
Flow of transmitter signaling for heart (PSNS) Ach --> nicotinic --> Ach --> muscarinic
Flow of transmitter signaling for somatic Ach --> nicotinic --> Ach --> nicotinic
In the SNS terminal, what is dopamine converted to? NE
What causes the "lipid bubble" containing NE to move to the surface and open into the synapse? Ca++
Uptake 1 NE transporter; pulls NE out of the synapse and back into terminal where MAO breaks it down
receptors that exist in tissues but DO NOT have direct innervation Extra junctional
this receptor is activated to slow the system down because of too much NE; type of feedback inhibition pre-synaptic alpha 2
Enzymes that degrade trasnmitters COMT
Predominant tone belongs to which system? PSNS; exception is blood vessels
Low concentrations of NE will have high affinity for what? Alpha
Epinephrine beta 1/2 >> alpha 1/2 (mixed adrenergic agonist) used for: asthma, anaphylactic shock, cardiogenic shock, and prolongs actions of local anesthetics
Low concentrations of Epi have high affinity for what? beta 1/2 BUT, if dose increases 10x then alpha (dilate) will out-power beta (constrict)
Dopamine alpha 1 and beta 1 (mixed adrenergic agonist) CNS functions was once used to treat CHF indirectly acting adrenergic agonist
pseudoephedrine alpha and beta (mixed adrenergic agonist) used for colds
Phenylephrine selective alpha 1 agonist used for hypotension, bradycardia, and as decongestant
Methoxamine selective alpha 1 agonists
Clondine selective alpha 2 agonist centrally acting anti hypertensive
A patient with high SNS activity will have? HYPERtension
Isoproternol beta 1/2 non selective beta agonist cardiac transplants
Dobutamine Selective beta 1 agonist low doses will increase force of contraction but NOT heart rate
metaproterenol selective beta 2 agonist treats asthma
albuterol selective beta 2 agonist asthma: 1/2 life 6-7 hrs
salmetrol selective beta 2 agonist asthma: 1/2 life 12 hrs
Phentolamine non-selective alpha 1/2 antagonist used for OD of alpha agonists; used in pts with pheochromocytoma Side effects: orthostatic hypotension, tachycardia, PSNS effects
Prazosin and silodosin selective alpha 1 anatagonists
terazosin selective alpha 1 antagonist anti hypertensive agent water soluble
Propanolol, Nadolol, Timolol and Pinolol Non-selective beta antagonists Tx: HTN, angina, MI, arrhythmia, stage fright, glaucoma, tremor, migraine, and anxiety contraindication: asthma attack in those with asthma
Labetalol and carvedilol non selective beta antagonists also work on alpha 1
Tyramine dietary substance indirectly acting adrenergic agonost
ephedrine indirectly acting adrenergic agonist can also bind to beta receptors increase SNS activity
amphetamine indirectly acting adrenergic agonist
Indirectly acting agonists DO NOT bind to receptors but produce effects that look like SNS agonists cause increase in NE release; more rapid
Uptake blockers cocaine tricyclic antidepressants amphetamine (high doses)
MAO inhibitors pargyline and tranylcypromine
What could cause increase in BP in those taking MAO inhibitors? Tyramine
Cholinergic receptors are? nicotinic and muscarinic
what has no clinical use? Ach as muscarinic agonist
Bethanechol choline esther; M agonist effects mostly on GI and urinary systems when administered orally or subQ prevents urinary retention side effects: over-stimulation of M receptors
carbachol choline esther; M and N agonist produce miosis(constrict) druing ocular surgery
Pilocarpine alkaloid; M agonist NO N effects used topically to treat glaucoma somewhat selective for salivary glands used for Sjorgen's syndrome Side effects: over-stimulation of M receptors
Atropine and Scopolamine Belladonna alkaloids; M anatagonists (selective) used when PSNS tone is desirable pre-op use for reduction of salivation/bronchial secretions treat poisoning by AchE inhibitor
Atropine toxic actions dry as a bone, hot as a pistol, red as a beet, blind as a bat, and mad as a hatter
Cholinesterase (AchE inhibiotrs) agents used to enhance transmission at cholinergic junctions
carbamates bind to the esteratic site of AchE (reversible)
Physostigmine carbamate readily penetrates CNS drug of choice to treat poisoning with atropinic agents
Neostigmine carbamate does NOT penetrate CNS used to treat myasthenia gravis used as antidote for overdose of "curare-like" drugs
edrophonium carbamate short acting diagnostic agent used to test for myasthenia gravis
Donepezil (aricept) carbamate short term fix for alzheimer's
Organophosphates irreversibly phosphorylate serine hydroxyl at active site of AchE ex: insecticides and nerve gases
what is the only way to restore function after exposure to organophosphates? make new enzymes; could take 2-3 weeks antidote for insecticide= 2-pralidoxine (2-PAM)
Botulinum toxin (Botox) prevents Ach release from cholinergic neurons AP occurs, but nothing happens and muscle is paralyzed
What is used in surgery to promote skeletal muscle relaxation? Neuromuscular (NMJ) blocking agents
Tubocurarine NMJ blocker long duration
Pancuronium NMJ blocker intermediate duration
Succinylcholine NMJ blocker used for setting bones
How are NMJ blockers reversed? With AchE
terbutaline beta 2 agonist used for premature labor to relax uterus
Created by: larsyy



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