Flashcards
ANS - Receptors
Cards in this deck (63)
- 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 - 22nd Messengers (5)1) cAMP: cyclic adenosine monophosphate
2) cGMP: cyclic guanosine monophosphate
3) IP3: Inositol triphosphate
4) DAG: Diacylglycerol
5) Ca2+ - 3Increased Phospholipase C: GqAlpha 1
Muscarinic 1, 3, 5
Vasopressin 1 (vasculature)
Histamine 1
2nd Messenger is therefore IP3, DAG, Ca+ - 4Increased Adenylate cyclase: GsBeta 1 & 2
Dopmine 1 (postsynaptic)
Vasopressin 2 (renal tubules)
Histamine 2 - 5Decreased Adenylate cyclase: GiAlpha 2
Muscarinic 2, 4
Dopamine 2 (presynaptic) - 6ANS Receptors & Actions
- 7ANS Receptor & Action
- 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 - 9Alpha 2Veins - vasoconstriction 2 >1
Arteries - vasoconstriction 1 >2
Renal tubules - Diuresis
GI motility & tone - decreased
Pancreas: Beta cell - Decrease Insulin - 10Beta 1Myocardium - ^ Contractility
Conduction sys - ^HR, conduction speed
Kidney: Renin release - ^ renin
GI motility & tone - decreased - 11Beta 2Myocardium & skeletal musc. - Vasodilation
Bronchiole - Bronchodilation
Eye ciliary - relaxation
Gallbladder - relaxation
Pancreas: beta cell - ^ insulin
Liver - Increase GLU
Uterus, bladder detrusor - Relaxation - 12Dopamine DARenal & Mesenteric - vasodilation
- 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?) - 14Phosphodiesterase III InhibitionMilrinone ~ inodilator/ ^cAMP
^ intracellular Ca+ & force of contraction
Accelerate Ca+ return to SR, rate of relax
Vasodilation
Decreased SVR - 15NE SynthesisIn the cytoplasm:
Tyrosine
tyrosine hydroxylase -> DOPA
DOPA decarboxylase -> dopamine
Transport to synaptic vesicle by
dopamine beta-hydroxylase - 16Adrenal Medulla epi/NEMost NE is converted to epi by phenylethanolamine-N-methyltransferase
Adrenal Medulla Secretes:
80% epi
20% NE - 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 - 18NE termination of actionUp to 80% reuptake in presynaptic nerve
Reuptake extraneural - metab. MAO/COMT
Diffusion - metab liver MAO/COMT - 19NE pic of the whole thing
- 20Metabolites of NEMetanephrine & normetanephrine
Final product = Vanillylmandelic acid - 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 - 22Ach ReleaseAction potential depolarizes nerve terminal
Voltage gate Ca+ open & influx Ca+
Ca+ release Ach from vesicles
*Mg+ antagonizes Ca+ & explains muscle weakness - 23Ach MetabolismAch is rapidly metabolized
Acetylcholinesterase near cholinergic receptors hydrolzes Ach -> choline + acetate
Choline goes back to nerve terminal
Acetate diffuses away from cleft - 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 - 25SNS Activation PNS Activation
- 26Anatomy ANS & PNS
- 27SNS & PNS differences
- 28SNS vs PNS cont...
- 29—SNS, preganglionic sympathetic fibers exit spinal cord via ventral nerve roots
These fibers enter sympathetic chain by the white rami (white for myelination)
- 30Stellate GanglionSympathetic innervation ipislateral
UE and some head & neck
Horner's Syndrome: Very Homely PAM
Vasodilation
Horner
Ptosis Anhidrosis Miosis - 31Adrenal Medulla Medulla & CortexMedulla: catecholamines 80%Epi/ 20%NE
Cortex: glucocorticoids,
mineral corticoids,
androgens - 32Anatomy of Adrenal Medulla
- 33Pheochromocytoma definedcatecholamine (NE) secreting tumor, usually originates from chromaffin (neural) in adrenal gland.
Excessive SNS stim = HA, diaphoresis, ^HR
*Elevated VMA in urine acids - 34Pheochromocytoma ManagementAlpha antagonized BEFORE Beta
beta 1st leaves unopposed alpha (^SVR)
Non-selective Alpha: phenoxybenzamine &
phentolamine
Alpha-1 selective: doxazosin & prazosin - 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) - 36K+ shift IN K+ shift OUT
- 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 - 38Vasomotor Center in the Medulla & PonsVasoconstriction
Vasodilation
Cardiac Stimulation
Cardiac Inhibition - 39Yet another diagram
- 40Barorecpetor ReflexCEA: carotid sinus -> bradycardia
Mediastinoscopy: transverse arch -> brady
Phenylephrine: agonism alpha-1 ^SVR & BP
Baroreceptor reflex ^vagal tone decrease HR - 41Drugs that impair baroreceptor reflexPropofol
Labetalol
VAA's - 42Bezold-Jarisch Empty HeartBradycardia
Hypotension
Coronary vasodilation
Tx: ^preload=IVF, Trend, elevate legs
^HR, - 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 - 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. - 45Cushing reflexIntracranial HTN: Brainstem compression
HTN
Bradycardia
Irregular respirations - 46Celiac ReflexTraction to mesentery/abd organs
Vagus nerve
Bradycardia & hypotension - 47Chemoreceptor ReflexStimulated by hypoxia & hypercarbia
Increases MV & SNS tone - 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 - 49Glomus Tumor: vasoactive substancesNE - HTN
Serotonin & kallikrein- bronchconstriction, HA, HTN, flush, diarrhea (tx. octeotride)
Histamine/bradykinin - bronchoconstriction & Hypotension - 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 - 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 - 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+ - 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 - 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 - 55Dobutamine Beta 1 > 2dose = 0.5-15 mcg/kg/min
Cardiac stim ^ HR, inotropy, CO - 56Phenylephrine Alpha 1 0 Betagtt= 10-200mcg/min
^SVR, coronaryPP, reflex brady
Good for ^afterload is necessary - Tof F, hypertrophic cardiomyopathy - 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 - 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 - 59Phenoxybenzamine Alpha 1 & 2 antagonistnon-selctive, noncompetitive
vasodilation by decreasing SVR
Impairs NE regulation, preS A2 -reflex Tachy
SE: orthostatics & nasal congestion - 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 - 61Prazosin Alpha 1 antagonistSelective Alpha 1
Vasodilation by decreasing SVR
no reflex tachycardia
Tx: HTN, BPH - 62Yohimbine Alpha 2 Antagonist^Symp tone by ^NE from preS terminal
Tx: orthostatic hypotension - 63Carcinoid crisisSuccs
atracurium
epi
NE
isoproterenol
Tx: octeotride & zofran
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- NCE Anesthesia (ANS & Cardiac) Flashcards on ANS - Receptors, created by Katie Scanlon on 20/12/2016.
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- Katie Scanlon
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