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ANS - Receptors

Katie Scanlon Anesthesia NCE Englisch 63 Karten

ANS Receptors & Actions

Karten in diesem Stapel (63)

  1. 1Categories of membrane bound receptors1) Ion Channel: voltage gated Na+ channel in neuron
    2) G coupled protein receptors: Muscarinic receptor in SA node
    3) Enzyme Linked Receptor: tyrosine kinase insulin receptor in skeletal muscle
  2. 22nd Messengers (5)1) cAMP: cyclic adenosine monophosphate
    2) cGMP: cyclic guanosine monophosphate
    3) IP3: Inositol triphosphate
    4) DAG: Diacylglycerol
    5) Ca2+
  3. 3Increased Phospholipase C: GqAlpha 1
    Muscarinic 1, 3, 5
    Vasopressin 1 (vasculature)
    Histamine 1
    2nd Messenger is therefore IP3, DAG, Ca+
  4. 4Increased Adenylate cyclase: GsBeta 1 & 2
    Dopmine 1 (postsynaptic)
    Vasopressin 2 (renal tubules)
    Histamine 2
  5. 5Decreased Adenylate cyclase: GiAlpha 2
    Muscarinic 2, 4
    Dopamine 2 (presynaptic)
  6. 6ANS Receptors & ActionsANS Receptors & Actions
  7. 7ANS Receptor & ActionANS Receptor & Action
  8. 8Alpha 1Arteries - vasoconstriction 1 >2, > veins
    Radial muscle (iris) - Mydriasis
    GI sphincter - contraction
    GI motility & tone - decreased
    Liver - Increase GLU
    Uterus, bladder sphincter - Contraction
    Sweat glands - ^ secretion
  9. 9Alpha 2Veins - vasoconstriction 2 >1
    Arteries - vasoconstriction 1 >2
    Renal tubules - Diuresis
    GI motility & tone - decreased
    Pancreas: Beta cell - Decrease Insulin
  10. 10Beta 1Myocardium - ^ Contractility
    Conduction sys - ^HR, conduction speed
    Kidney: Renin release - ^ renin
    GI motility & tone - decreased
  11. 11Beta 2Myocardium & skeletal musc. - Vasodilation
    Bronchiole - Bronchodilation
    Eye ciliary - relaxation
    Gallbladder - relaxation
    Pancreas: beta cell - ^ insulin
    Liver - Increase GLU
    Uterus, bladder detrusor - Relaxation
  12. 12Dopamine DARenal & Mesenteric - vasodilation
  13. 13Alpha 2 for AnesthesiaPresynaptic: NE in CNS & PNS
    Postsynaptic: smooth muscle/organs
    Nonsynaptic: platelets ^ aggregation
    Medulla - Decreased SNS
    Vagus - ^ PNS
    Locus coeruleus - sedation/hypnosis
    SC: dorsal horn - analgesia (antishivering?)
  14. 14Phosphodiesterase III InhibitionMilrinone ~ inodilator/ ^cAMP
    ^ intracellular Ca+ & force of contraction
    Accelerate Ca+ return to SR, rate of relax
    Vasodilation
    Decreased SVR
  15. 15NE SynthesisIn the cytoplasm:
    Tyrosine
    tyrosine hydroxylase -> DOPA
    DOPA decarboxylase -> dopamine
    Transport to synaptic vesicle by
    dopamine beta-hydroxylase
  16. 16Adrenal Medulla epi/NEMost NE is converted to epi by phenylethanolamine-N-methyltransferase
    Adrenal Medulla Secretes:
    80% epi
    20% NE
  17. 17NE ReleaseAP depolarizes nerve terminal
    Voltage gate Ca+ channels open release Ca+
    ^Ca+ causes NE to be released synaptic cleft
    NE inhibit own release by stim preS Alpa-2
    NE augment release stim preS Beta-2
  18. 18NE termination of actionUp to 80% reuptake in presynaptic nerve
    Reuptake extraneural - metab. MAO/COMT
    Diffusion - metab liver MAO/COMT
  19. 19NE pic of the whole thingNE pic of the whole thing
  20. 20Metabolites of NEMetanephrine & normetanephrine
    Final product = Vanillylmandelic acid
  21. 21Ach Synthesis1) Choline from blood to cytoplasm
    2) Acetyl Coenzyme A in mitochondria also released
    3) choline acetylttansferase, choline &
    acetyl CoA to form Ach
    4) Ach packaged into vesicles
  22. 22Ach ReleaseAction potential depolarizes nerve terminal
    Voltage gate Ca+ open & influx Ca+
    Ca+ release Ach from vesicles
    *Mg+ antagonizes Ca+ & explains muscle weakness
  23. 23Ach MetabolismAch is rapidly metabolized
    Acetylcholinesterase near cholinergic receptors hydrolzes Ach -> choline + acetate
    Choline goes back to nerve terminal
    Acetate diffuses away from cleft
  24. 24Efferent ANS nerve fibersPreganglionic = myelinated B-fiber
    releases Ach nicotinic type-N in ganglion
    Postganglionic = unmyelinated C-fiber
    PNS: cholinergic releases Ach to organ
    SNS: adrenergic releases NE to organ
  25. 25SNS Activation PNS ActivationSNS Activation PNS Activation
  26. 26Anatomy ANS & PNSAnatomy ANS & PNS
  27. 27SNS & PNS differencesSNS & PNS differences
  28. 28SNS vs PNS cont...SNS vs PNS cont...
  29. 29—SNS, preganglionic sympathetic fibers exit spinal cord via ventral nerve roots
    These fibers enter sympathetic chain by the white rami (white for myelination)    SNS, preganglionic sympathetic fibers exit spinal cord via ventral nerve roots These fibers enter sympathetic chain by the white rami (wh...
  30. 30Stellate GanglionSympathetic innervation ipislateral
    UE and some head & neck
    Horner's Syndrome: Very Homely PAM
    Vasodilation
    Horner
    Ptosis Anhidrosis Miosis
  31. 31Adrenal Medulla Medulla & CortexMedulla: catecholamines 80%Epi/ 20%NE
    Cortex: glucocorticoids,
    mineral corticoids,
    androgens
  32. 32Anatomy of Adrenal MedullaAnatomy of Adrenal Medulla
  33. 33Pheochromocytoma definedcatecholamine (NE) secreting tumor, usually originates from chromaffin (neural) in adrenal gland.
    Excessive SNS stim = HA, diaphoresis, ^HR
    *Elevated VMA in urine acids
  34. 34Pheochromocytoma ManagementAlpha antagonized BEFORE Beta
    beta 1st leaves unopposed alpha (^SVR)
    Non-selective Alpha: phenoxybenzamine &
    phentolamine
    Alpha-1 selective: doxazosin & prazosin
  35. 35Causes of transcellular K+ movementBeta-2 agonism (albuterol, theophylline, epi)
    Nicotinic type-m agonism (Succs)
    Destruction of cell membrane (rhabdo)
    Activation H+/K+ exchanger (acidosis)
    Activation Na+/K+ exchanger (epi/insulin)
  36. 36K+ shift IN K+ shift OUTK+ shift IN K+ shift OUT
  37. 37Stretch receptors (2)carotid sinus: nerve of Hering converges with IX nerve to send afferent impluse to nucleus tractus solitarius in medulla
    transverse aortic arch - afferent via vagus
  38. 38Vasomotor Center in the Medulla & PonsVasoconstriction
    Vasodilation
    Cardiac Stimulation
    Cardiac Inhibition
  39. 39Yet another diagramYet another diagram
  40. 40Barorecpetor ReflexCEA: carotid sinus -> bradycardia
    Mediastinoscopy: transverse arch -> brady
    Phenylephrine: agonism alpha-1 ^SVR & BP
    Baroreceptor reflex ^vagal tone decrease HR
  41. 41Drugs that impair baroreceptor reflexPropofol
    Labetalol
    VAA's
  42. 42Bezold-Jarisch Empty HeartBradycardia
    Hypotension
    Coronary vasodilation
    Tx: ^preload=IVF, Trend, elevate legs
    ^HR,
  43. 43Bainbridge Full HeartTachycardia
    to min venous congestion & promote flow
    Sensors: SA node, RV, Pulm veins
    Cardiac congestion ADH decreased from post pituitary which ^ANP = diuresis
  44. 44Oculocardiac Reflex: Hypotension/Brady JR/AVB/AsystoleFive & Dime Reflex:
    Afferent = V trigeminal
    Efferent = X vagus
    Brought on by: traction to extraocular muscles, pressure on orbital tissues, strabismus sx, ^CO2, hypoxemia, Lt anes.
  45. 45Cushing reflexIntracranial HTN: Brainstem compression
    HTN
    Bradycardia
    Irregular respirations
  46. 46Celiac ReflexTraction to mesentery/abd organs
    Vagus nerve
    Bradycardia & hypotension
  47. 47Chemoreceptor ReflexStimulated by hypoxia & hypercarbia
    Increases MV & SNS tone
  48. 48Heart Transplant Drugs for HR 2 p waves EKGDirect stimulate SA node:
    Epi, isoproterenol, glucagon
    Indirect stimulation SA node: won't work...
    atropine, glyco, ephedrine
  49. 49Glomus Tumor: vasoactive substancesNE - HTN
    Serotonin & kallikrein- bronchconstriction, HA, HTN, flush, diarrhea (tx. octeotride)
    Histamine/bradykinin - bronchoconstriction & Hypotension
  50. 50Multiple System Atrophy: Shy-Drager syn.Degeneration of the locus coeruleus, intermediolateral column of the spinal cord
    Autonomic dysfxn: orthostatic, impotence, bowel dysfxn, urinary retention
    Tx: Fluids & Direct sympathomimetics
  51. 51NE Alpha 1 & 2 Beta 1Dose= 0.02 -0.4 mcg/kg/min
    Low dose = Beta-1 ^HR & inotropy
    High dose = Alpha1&2, Beta 1 ^SVR brady
  52. 52Epi Beta & AlphaLow dose= 0.01-0.03 mcg/kg/min Beta 1 & 2
    Increased HR, CO, inotropy, Decreased SVR
    interm. dose= 0.03-0.15 mcg/kg/min A=B
    High dose= >0.15 mcg/kg/min Alpha predom.
    *Bronchodil, Mast cell stable, ^glu, hypoK+
  53. 53DopamineLow dose= 1-2 mcg/kg/min
    Renal vasodilates ^RBF
    Interm. dose= 2-10 mcg/kg/min
    Cardiac stim ^HR, inotropy, CO
    High dose= 10-20 mcg/kg/min A>DA & B
    Vasopressor effects
  54. 54Isoproterenol Beta 1 & 2Dose= 0.02-0.5 mcg/kg/min
    Cardiac stim ^ HR, inotropy, CO
    Vasodilation decreases SVR
    Be careful... CPP= AoDB-LVEDP
    *hrt trxpnt, bronchoconstrict, cor pulmonale
  55. 55Dobutamine Beta 1 > 2dose = 0.5-15 mcg/kg/min
    Cardiac stim ^ HR, inotropy, CO
  56. 56Phenylephrine Alpha 1 0 Betagtt= 10-200mcg/min
    ^SVR, coronaryPP, reflex brady
    Good for ^afterload is necessary - Tof F, hypertrophic cardiomyopathy
  57. 57Ephedrine Direct/Indirect Alpha 1 & 2 Beta 1 & 2IM dose= 25-50 mg
    Cardiac stim ^ HR, inotropy, CO, SVR
    endogenous cate stores
    tachyphylaxis
    null- hrt txplnt, sepsis
    HTN Crisis- MAOI's
  58. 58VasopressinProduced by the hypothalamus & released by post. pituitary gland
    V1 stim: intense vasoconstriction
    V2 stim: synthesis & insertion of aquaporins into collecting ducts. Increases water reabsorption & lowers osmolarity
  59. 59Phenoxybenzamine Alpha 1 & 2 antagonistnon-selctive, noncompetitive
    vasodilation by decreasing SVR
    Impairs NE regulation, preS A2 -reflex Tachy
    SE: orthostatics & nasal congestion
  60. 60Phentolamine Alpha 1 & 2 antagonistshort acting, non-selective, noncompetitive
    vasodilation by decreasing SVR
    Impairs NE regulation, preS A2 -reflex Tachy
    Tx of Pheo or autonomic hypereflexia
  61. 61Prazosin Alpha 1 antagonistSelective Alpha 1
    Vasodilation by decreasing SVR
    no reflex tachycardia
    Tx: HTN, BPH
  62. 62Yohimbine Alpha 2 Antagonist^Symp tone by ^NE from preS terminal
    Tx: orthostatic hypotension
  63. 63Carcinoid crisisSuccs
    atracurium
    epi
    NE
    isoproterenol
    Tx: octeotride & zofran

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NCE Anesthesia (ANS & Cardiac) Karteikarten am ANS - Receptors, erstellt von Katie Scanlon am 20/12/2016.
Erstellt von
Katie Scanlon
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