The autonomic nervous system

sensory neurons

bring information from the body to the brain

motor neurons

bring information from the brain to the body

nerves

neurons connected by connective tissue

ganglia

midpoint between the neurons coming from the CNS and the neurons that continue on to the target organ

phases of a synapse

a neural signal reaches the neuron, Ca channels open and the Ca enters the neuron, neurotransmitter secretion into the synaptic space

signs of PSNS stimulation

bradycardia, vasodilation, bronchoconstriction, miosis, increased activity of the digestive and urinary systems

miosis

constriction of pupils

signs of SNS stimulation

tachycardia, vasoconstriction, bronchodilation, increased respiratory rate, mydriasis, decreased activity of the digestive and urinary systems, sweat secretion

mydriasis

dilation of the pupils

eye

example of an area of the body that has both SNS and PSNS innervation

adrenal glands, sweat glands, skin hair muscles, blood vessels

areas of the body where there is only SNS innervation

nerve stimulation

vasoconstriction is caused by directly by a _____

NO release

vasodilation isn't caused by PSNS stimulation rather it is caused by _____

ganglia, neuromuscular junctions, and areas stimulated by the PSNS

in what areas will acetylcholine be the neurotransmitter secreted in the synapse

noradrenaline

which neurotransmitter is secreted in the synapse of an area that has SNS innervation

glands

these areas that are stimulated by the SNS will secrete acetylcholine instead of noradrenaline as their neurotransmitter

because it will cause a never ending loop of noradrenaline secretion

why is noradrenaline not the neurotransmitter secreted in the synapse of glands innervated by the SNS

botulinum

the strongest toxin that is created by bacteria

botulism

poisoning of the botulinum toxin. It causes respiratory and muscular arrest

causes of botulism

food poisoning, for babies: eating honey, diminished Acetylcholine release

inhibits acetylcholine release

how does botulinum decrease the amount of Acetylcholine in the body

botox

brand name for the botulinum toxin. It is given as an injection with a small dose to a specific area in order to cause muscle paralysis in that area

things botox can treat

wrinkles, increased sweating, headaches, spasms, dystonia, irritable bladders, squinting eye

dystonia

imbalance between the constriction and relaxation of a muscle so that parts of the muscle are always constricted

acetylcholinesterase

enzyme that breaks acetylcholine in the synapse

psuedocholinesterase

enzyme that breaks down any acetylcholine that makes it to the blood stream

cholinergic receptors

receptors in the body that bind to acetylcholine

muscarinic and nicotinic receptors

the 2 types of cholinergic receptors

muscarinic receptors

a type of G coupled protein receptors that bind to acetylcholine and have a relatively slow reaction

nicotinic receptors

a type of ligand gated ion channel receptors that bind to acetylcholine and have a relatively quick reaction

muscarine

a poison found in mushrooms

cardiovascular, respiratory, digestive, and reproductive systems

in which body systems are there muscarinic receptors

presynaptic receptors

these muscarinic receptors are in charge of regulating acetylcholine release into the synapse

Nicotinic 2/ N-N receptors

these nicotinic receptors are located in the ganglia where there is a connection between 2 nerves

nicotinic 1/N-M receptors

these nicotinic receptors are located in the neuromuscular junction

M1

this type of muscarinic receptor acts on the CNS and also stomach acid secretion

M2

type of muscarinic receptor located in smooth muscle of the heart

M3

type of muscarinic receptor located in the bladder, secretion glands, and smooth muscle

sputum

acetylcholine and the PSNS causes the release of this in the lungs. It is released during PSNS because the body is relaxed and requires less oxygen

calcium

mineral that causes muscle constriction

magnesium

mineral that causes muscle relaxtion

effects of acetylcholine

bradycardia; secretion of saliva, digestive juices, sputum, tears, sweat; bronchoconstriction, bradypnea, increased activity of the digestive and urinary systems, muscle constriction, miosis, sleep and memory regulation

reasons why acetylcholine can't be used as a drug

acetylcholine can't pass through membranes, it would activated many body systems when administered, an enzyme would break it up quickly before it could have an effect

parasympathomimetics/cholinomimetics

name of cholinergic agonists

act similiar to acetylcholine, block AChE from working

what roles can cholinergic agonists have

carbachol

a cholinergic agonist with a positive charge so it isn't absorbed in the digestive system. It is a muscarinic and nicotinic agonist and undergoes very slow metabolism

things carbachol can treat

closed angle glaucoma, it can lower intraocular pressure, an antidote to a AChE inhibitor overdose

closed angle glaucoma

a bulge around the cornea that stops fluids from being drained from the eye. carbachol treats it by causing miosis leading the bulge to pop and drain

methacholine

a muscarinic agonist that is a quaternary nitrogen (amine) so it isn't absorbed by the digestive system or passes the BBB. it causes bradycardia and lowers blood pressure

asthma

methacholine is mainly used to diagnose ____

methacholine challenge test

methacholine is given in a small dose to the patient if it causes a higher than normal level of bronchoconstriction this indicated that the patient has asthma or COPD

in a COPD patient the patient's bronchi won't dilate when given bronchodilaters

how do you differentiate between a COPD and an asthmatic patient during a methacholine challenge test?

Bethanechol

a muscarinic agonist that undergoes extremely slow metabolism and has a long lasting effect

Urecholine

brand name of bethanechol

PO

in what route is bethanechol administered

uses of bethanechol

treatment of constipation and digestive muscle weakness, cancels the effect of atropine after a surgery

side effects of bethanechol

sweating, saliva secretion, hypotension, stomach pain, diarrhea, bronchospasms

muscarine

a muscarinic agonist that is a poison that comes from a mushroom. it is a quaternary nitrogen (amine) and in high doses can pass through the BBB

signs of muscarine poisoning

headaches, nausea, constrictions of the larynx
and then it will progress to: increased saliva secretion, tears, miosis, blurry vision, diarrhea, increased urine excretion, bronchoconstrictions, dyspnea

8-9 hours

if muscarine poisoning isn't treated within ________ the patient will die

atropine

antidote to muscarine poisoning

pilocarpine

alkaloid, muscarinic antagonist, that works mainly on the secretion glands

uses of pilocarpine

to treat dry mouth and glaucoma, to diagnose CF by using it to increase sweat and then measuring the salt levels in the sweat

side effects of pilocarpine

signs of acetylcholine overdose, headaches if it passes through the BBB, fogginess

nicotine

nicotinic agonist, tertiary amine, that causes constriction of the intestines, bladder, and bronchioles

effects of nicotine on the SNS

noradrenaline release, vasoconstriction, hypertension, tachycardia

effects of nicotine on the CNS

alertness, pleasure, hyperventilation, shaking, seizures, coma, death

AChE blockers

this group of drugs connects to the serine of acetylcholinesterase so that acetylcholine can't, therefore blocking the enzyme from working

effect of AChE blockers on skeletal muscle

small dose: increase strength of constriction
medium dose: fibrillations, fasciculations
large dose: the muscle will be stuck in a state of depolarization

effects of AChE blockers

increased digestive activity, increased secretions, bradycardia

salagen

brand name of pilocarpine

neostigmine

a reversible anti AChE. It is a quaternary amine so it doesnt pierce the BBB or get absorbed in the digestive system. it blocks AChE and affects the neuromuscular junction

prostigmine

brand name of neostigmine

PO or IV

routes of administration for neostigmine

uses of neostigmine

treatment of myasthenia gravis and an antidote of for tubocurarine

myasthenia gravis

an autoimmune disease that destroys nicotinic receptors of skeletal muscle causing muscle weakness and fatigue

tubocurarine

a nicotinic inhibitor that is used to paralyze muscles before surgery

physostigmine

reversible anti AChE, tertiary amine, that is absorbed by the BBB and activates movement of the bladder and digestive system

eserine

brand name of physostigmine

uses of physostigmine

antidote of atropine, treats closed angle glaucoma

pyridostigmine

reversible anti AChE, that has a 3-6 hour active time making it a good treatment for chronic myasthenia gravis

mestinon

brand name of pyridostigmine

edrophonium

a reversible anti AChE with a 10-20 minute active time and effects similiar to neostigmine. It is used to diagnose myasthenia gravis

Alzheimer's

an irreversible condition that slowly gets worse charachterized by: decline in memory, decreased ability to perform routine actions and to orient themselves, decreased language and communication skills, changes in behavior, poor judgement, decreased acetylcholine levels in the brain

Tetrahydroaminoacridine

medication effective in the early stages of alzheimer's. It slows development of the disease by increasing acetylcholine levels in the brain. It is given 4 times/day

side effects of THA

nausea and vomiting, diarrhea, anorexia, fogginess, liver damage

tacrine and cognex

brand names of THA

donepezil

specifically effects cholinergic receptors in the brain and it doesn't have many side effects. administered once a day

aricept, memorit

brands names of donepezil

side effects of donepezil

nausea, vomiting, and diarrhea

rivastigmine

blocks both acetylcholinesterase and pseudocholinesterase. Has similar effects as donepezil but with more side effects. taken twice a day

sticker or pill

routes of administration of rivastigmine

exelon

brand name of rivastigmine

galantamine

AChE blocker that also activates pre and post-synaptic nicotinic receptors. administered once a day

side effects of galantamine

nausea, vomiting, and sleep disturbances

reminyl

brand name of galanatamine

irreversible AChE blockers

organophosphates that connect covalently to the serine of AChE, this is irreversible and renders the enzyme inactive

echothiophate

a hydrophilic irreversible AChE blocker. It has a much faster effect than reversible blockers

drops or eye injection

route of administration of echothiophate

organophosphates

lipophilic materials that can pierce body systems through the skin, respiratory, and digestive systems. examples include pesticides and nerve agents (gasses)