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ANS Review
S1B2
| Name | Feature |
|---|---|
| Neurotransmitters of PNS | Acetylcholine (Ach) |
| Neurotransmitters of SNS | Acetylcholine for pre and Norepinephrine (NE) for post |
| Discharge pattern of PNS | DISCRETE 1 preganglionic to 1 postganglionic |
| Discharge pattern of SNS | DIFFUSE 1 preganglionic to many postganglionic |
| ANS Receptors | Cholinergic: Muscarinic, Nicotinic and Adrenergic: Alpha, Beta |
| Muscarinic Cholinergic Receptors M1 | CNS, ANS ganglia |
| Muscarinic Cholinergic Receptors M2 | Heart |
| Muscarinic Cholinergic Receptors M3 | Smooth muscle, gland |
| Muscarinic Cholinergic Receptors M4 and M5 | CNS |
| Nicotinic Cholinergic Receptors Nn | CNS, ANS ganglia |
| Nicotinic Cholinergic Receptors Nm | Skeletal muscle |
| Adrenergic Receptors in SNS | Alpha and Beta |
| Adenyl cyclase | Increase protein phosphorylation |
| Ca2+ dependent exocytosis | Action potential --> depolarization --> Ca enables fusion of storage granule proteins with nerve terminal membrane followed by neurotransmitter release into synapse |
| Autoreceptors | Respond neurotransmitter released from its nerve terminal; usu inhibits release of transmitter |
| Heteroreceptors | Respond to transmitters released from other nerve terminals from nearby tissue or blood |
| Decrease ACH release from PNS | M2, M4 presynaptic receptors from PNS and alpha2A and 2C receptors stimulated by NE from SNS |
| Increase ACH release from spinal nerve | Nn receptors stimulated by ACH released from spinal nerves to skeletal muscle --> prolongs NMJ function during prolonged high-frequency contraction of skeletal muscle |
| Increase flow of oxygenated blood | Beta 1 (dilation), Beta 2 --> positive chronotropic (rate) and inotropic (force of contraction) and alpha 1 (shunt blood to skeletal muscle) |
| Alpha 1 | Contract Spleen --> Increase RBC in blood |
| Increase skeletal muscle contractibility | Beta 2 increases rate and force of contraction |
| Increase/maintain blood glucose | alpha 2 decreases insulin secretion and Beta 2 increase glucagon secretion |
| increase platelet aggregation | Alpha 2 |
| Contract radial muscle of iris --> mydriasis | Alpha 1 |
| Relax ciliary muscle for far vision | Beta 2 |
| Increase sweat glands | Alpha 1 and M3 |
| Distant vision accomodation --> relax --> flat | SNS |
| Near vision accomodation --> contract --> thicker | PNS |
| Parasympathomimetic direct | muscarinic receptor agonists |
| Parasympathomimetic indirect | inhibit ACHE |
| Parasympatholytic direct | Receptor antagonists |
| Parasympatholytic indirect | Decrease ACH release |
| Ganglionic blockers | Hypertensive emergency |
| Cycloplegia | Loss of accomodation d/t antimuscarinic drugs (atropine) |
| Parasympathomimetic Amines | Treatment of Glaucoma: Open angle --> primary = abnormal trabecular network; MOA: contraction which opens trabecular network, pb = reduce accomodation; close angle: medical emergency, lens position blocks access to aqueous humor |
| Pilocarpine | pure muscarinic agonist, med of choice for open-angle glaucoma |
| Cevimeline | Xerostomia d/t radiation or Sjorgen's syndrome |
| Bethenechol | Relatively specific for M3 receptors of GI and GU, for GERD and post-op urinary retention, pb with circulatory collapse and cardiac arrest |
| Indirect ACting Parasympathomimetic Drugs (Neostigme and Prostigmin= reversible) | Broader clinical use than muscarinic agonists --> urinary retention (contract bladder wall and relax internal sphincter), paralytic ileus, open-angle glaucoma, myasthenia gravis |
| Myasthenia gravis | Skeletal muscle weakness d/t decreased number pf nicotinic receptors at neuromuscular jxn, ACHE inhibitors increase the amount of ACH to stimulate available nicotinc receptors |
| Organophosphates (irreversible ACHE inhibitors)--> Echothiophate, diazinon | phosphorylated ACHE enz extremely stable, good absorption across body membranes, |
| Diazinon, Malathion, Malaoxon, Parathion | insecticides |
| Echothiophate | Open Angle Glaucoma |
| Pralidoxime | Regenerates ACHR, breaks ACHE-organophosphate boned --> Tx of nicotinic effects; rapid injection: laryngospasm, muscle rigidity and weakness |
| Atropine | Tx of muscarinic effects: blocks muscarinic receptors, IV for 5-15 min to dry bronchial secretions, ? efficacy to treat CNS toxicity |
| Benzodiazepines | Tx of seizure |
| Atropine (Parasympatholythic muscarinic receptor antigonist) | Adjunct to general anesthesia (prevent vagal reflex and reduce bronchial secretion), Myocardial infarction (prevent reflex bradycardia and AV Block) and Mushroom poisoning |
| Parasympatholythic muscarinic receptor antigonist --> Tolerodyne, Oxybutynin, Detrol, Ditropan | Urinary Incontinence |
| Botulinum Toxin (botox) --> antinicotinic | decrease ACH release from spinal nerves into NMJ, temporary paralysis of skeletal muscle --> Comestic |
| NMJ blockers Non-Depolarization --> Curare and succinylcholine | Adjunct to general anesthesia --> flaccid paralysis and reversible competitive blockage for crurare and persistent opening of nicotinic receptor channel for succinyl |
| Ambenonium | Treat myasthenia gravis |
| Pyridostigmine | Reverse NM blockage |
| Tacrine | ACHE inhibitor, block neuronal K+ channels, prolong action potential --> increase ACH release; AE: rate limiting, liver tox., loose stools - Tx Alzheimer |
| Donepezil, Galantamine, Rivastigmine | Selective inhibitor of CNA ACHE 1/day; AE less GI effects d/t little inhibition of pseudocholinesterase |
| Nemantine | Dose-dependent blockade of glutamine receptors; reduces rate of clinical deterioration in Alzheimer |
| ACHE inhibitor longer duration of action | edrophonium then neostigmine |
| ACHE inhibitor with longest duration of action | Echothiophate |
| Miosis | Contraction of circular ciliar body |
Created by:
gladho
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