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135 Cards in this Set
- Front
- Back
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The central nervous system is composed of the
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brain & spinal cord & receives sensory input from PNS
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The peripheral nervous system (PNS) is divided into
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- Autonomic Nervous System (ANS)(involuntary - digestion, circulation)
- Somatic Nervous System (voluntary) |
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The _______ is composed of motor nerve cells that transmit impulses to smooth muscels (eg. intestinal, urinary bladder, uterus, eyes, lungs, and small arteries and veins), cardiac muscle and glands
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Autonomic Nervous System (ANS)
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The Autonomic Nervous System (ANS) is further divided into
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- Sympathetic
- Parasympathetic |
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The _______ innervates the skeletal muscles causing contractions
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Somatic nervous system
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The ________ is a two neuron chain, which means there are two neurons between the CNS and the effector organ, and the _________ only has a single neuron between the CNS and skeletal muscle
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- Autonomic Nervous System (ANS)
- Somatic Nervous System |
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Neurons communicate with other neurons and with target (effector) organs at the _________, and the actual space is called the __________
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- syanapse
- snaptic cleft |
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If the connection between the two neurons is outside the CNS, it is called __________
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ganglion
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the neurons of the sympathetic division originate in the ___________ portion of the spinal cord as ____________
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- thoracolumbar portion
- preganglionic (or presynaptic) nerve fibers (neurons) |
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in the sympathetic division, the long ________ extend to the organs they innervate (eg. heart, eye, lung, blood vessels, stomach, and intestines, kidngey, secretory glands, & urinary bladder)
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postganglionic (or postsynaptic) neurons
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in the parasympathetic division, the cell bodies of the __________ originate from four cranial Nerves ___________ in the brain and from the __________ region of the spinal cord
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- preganglionic neurons
- CN III, VII, IX, X - sacral (S2-5) |
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The nerves of the parasympathetic division do not travel through the spinal nerves but rather the short ____________ synapse at or near the target organ
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postganglionic neurons
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Preganglionic neurons are the neurons located _________ the synaptic cleft and Postganglionic neruons are the neurons located ________ the synaptic cleft
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- before
- after |
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__________ is how one neuron communicates with the next neuron and with the organ they innervate.
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Neurotransmitters (NT)
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The Neuron located in the brain is tranformed into a chemical signal through the release of a substance called a _____________, which carry nerve impulses (action potentials) across the synapse
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Neurotransmitter (NT)
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the NT is released from the vesicles into the symaptic space and _____________ ______________________, which results in the creation of a new action potential with the release of more __________, which crosses the synapse and binds to the receptors on the target organ.
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- binds to receptors on the postsynaptic or postganglionic neuron
- Neurotransmitters (NT) |
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The result of the neurotransmitters are an action on the organ that are either _________ or ________
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- inhibitory
- excitatory |
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________ is a process whereby a specific NT is taken back up into the axon terminal where it is inactivated by enzymes
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reuptake
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The Primary Neurotransmitters found in the ANS are
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- Acetylcholine (ACh)
- Norepinephrine (NE)(released from adrenal glands) |
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The other Neurotransmitters found in ANS are
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- epinephrine (EPI)
- Dopamine - serotonin (5HT) - GABA (gamma aminobuteric acid) |
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_________ are structures (usually proteins) receiving NT's released from the axonal terminals of the neuron
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Receptors
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Receptors are located on the dendrites of ___________ neurons and on/in smooth muscle, cardiac muscle, and glands
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postganglionic neurons
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True/False
Most organs of the body are innervated by neurons of both the sympathetic and parasympathetic divisions of ANS |
True
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The only organs not innervated by both divisions of the ANS are
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- sweat glands
- smooth muscles of the hair follicle - adrenal medulla - blood vessels of the skin |
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As a general rule, the stimulation of the sympathetic and parasympathetic nerves cause
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opposite responses - if one division increases the activity of an organ, the other decreases it
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_________ is known as the "fight or flight response" and prepares the individual for emergency/stressful situations and the actions inlcude increase in heart rate, decrease in blood flow to skeletal muscles, and dilation of bronchii (to breathe easier)
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Sympathetic Nervous System
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_________ is known as the "rest and digest response" and maintains the body organs at activity levels that are most efficient in maintaining homeostasis of the body, it slows heart rate, lowers blood pressure and stimulates GI tract
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Parasympathetic Nervous System
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The neurotransmitter released from every preganlionic nerve terminal in the sympathetic division is __________, which causes excitment of the adrenergic postganglionic nerve and initiates the synthesis and release of _________ from most postganglionic nerve terminals into the neuroeffector junction
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- Acetylcholine (ACh)
- Norepinephrine (NE) |
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Once the release of _________ has been initiated it then diffuses on the effectors tissue (smooth muscle [intestines, uterus, and small arteries and veins], gland or cardiac muscle)
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Norephinephrine
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_________ are also known as adrenergic neurotransmitters , and are derived from the amino acid tyrosine
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Catecholamines
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The principle catholamines are
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EPI, NE and dopamine
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Nerve fibers that synthesize and release ACh are called __________ and cause ____________
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- Cholinergic fibers
- Cholinergic effects |
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Neurons that secrete NE are called _________ and cause __________
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- adrenergic neurons
- Adrenergic effects |
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Sweat glands are innervated only by _________, which releases _______ to cause sweating, thus these postganglionic fibers are _________ not __________
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- sympathetic cholinergic pathway
- ACh - Cholinergic - Adrenergic |
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The center portion of the adrenal glands located superior to kidneys consists of the adrenal medulla and is innervated by ______________ that releases ______, which then causes the release of two hormones: _______ and _______. there are no ___________ fibers innervating the adrenal medulla
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- sympathetic preganglionic nerve
- ACh - EPI (85%) - NE (15%) - postganglionic fibers |
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the blood vessels, skeletal muscles, skin, brain and nose are innervated only by the ____________ which originate in either the ___________ segements of the spinal cord. The majority of these __________ release _______ to produce vasoconstriction of the blood vessels which carry blood to skeletal muscle, skin, brain and the nose
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- sympathetic preganglionic nerves
- thoracic or lumbar segments - sympathetic postganglionic fibers - NE |
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The Sympathetic nervous systems different effector tissues (smooth muscle, cardiac muscle, and glands) contain different typs of receptors with which the sympathetic neurotransmitters, NE, and EPI may interact:
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- Alpha (a) receptors
- Beta (b) receptors |
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There are two type of Alpha subreceptors, ______, that are located on postganglionic smooth muscle (BLOOD VESSELS, genitourinary system, sweat glands, eye, intestine) and their activation causes _________, and ________, which are located on postganglionic neurons and are called _________ because activation causes ______________
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- Alpha 1 receptors
- contraction of smooth muscle - Alpha 2 receptors - autoreceptors - inhibition of NE release, decreases secretion of insulin, decreases blood pressure and decreases eye secretion |
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there are three typse of Beta subreceptors:
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- Beta 1
- Beta 2 - Beta 3 |
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________ receptors are located on cardiac tissue (heart tissue) and when stimulated produce heart stimulation leading to a positive chronotropic effect (increased heart rate) and a positive inotropic effect (increased contractility or contraction force)
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Beta 1 receptors
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________ receptors are found in/on bronchial, uterine, and vascular (arteries, veins) smooth muscle and activation of this receptor causes relaxation of GI smooth muscles & vascular smooth muscle, whereas ______ and ______ are equally potent and effective at _____ receptors on cardiac tissue, ______ is more potent than _______ on _________
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- Beta 2
- EPI - NE - Beta 1 receptors - EPI - Beta 2 receptors |
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_______ are found on/in fat cells (adipocytes) and produce breakdown of lipids
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Beta 3 receptors
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Alpha ___ receptors and Beta ___ receptors deal with vessel constriction and dilation and Beta ___ deals with cardiac output, and Alpha ____ deals with decrease of secretion of insulin, blood pressure & eye secretion
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- Alpha 1
- Beta 2 - Beta 1 - Alpha 2 |
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Other sympathetic Nervous System Receptors include:
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- Cholinergic (nicotinic) receptors
- Adrenergic (muscarinic) receptors |
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________ receptors bind ACh and are located in skeletal muscle
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Cholinergic (nicotine) receptors
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________ receptors bind NE & E and are located in smooth muscle, cardiac muscle, glands
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Adrenergic (muscarinic) receptors
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_________ are chemicals that mimic naturally occuring neurotransmitters
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Agonists
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________ inhibit agonists
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Antagonists
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Receptors receive ___________ and are located on the ___________
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- neurotransmitters
- postganglionic neurons (tissue/oragan [heart, lungs, intestine]) |
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Alpha1 and Alpha2 neurotransmitters have a greater affinity for ____ receptors than ______ receptors
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- NE
- EPI |
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Beta2 neurotransmitters have a greater affinity for _____ receptors while Beta1 has an ______ affinity for _________
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- EPI
- equal affinity - both NE & EPI receptors |
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_________ innervations predominates over ___________ innervations of salivary glands, lacrimal glands, and erectile (penile) tissue
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- Parasympathetic Nervous System
- Sympathetic Nervous System |
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Stimulation of the parasympathetic division causes
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secretion of saliva and tearin, bronchiole contraction, and gut relaxation
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__________ is the NT released from the parasympathetic preganglionic and postganglionic nerves
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Acetycholine (ACh)
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In the parasympathetic nervous system, in each instance the released ACh binds to and acts on ____________ contained in the postganglionic nerve and effector tissue
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cholinergic receptors
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Two types of Parasympathetic nervous system cholinergic receptors are
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- Muscarinic cholinergic receptors
- nicotinic cholinergic receptors |
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_____________ receptors are located in tissue innervated by parasympathetic postganglionic nerves (and by sympathetic cholinergic nerves) which innervate sweat glands, skeletal muscles, eyes, gut, penis, lung and activation of by ______ causes increased secretions, bronchoconstriction, miosis (pupil constriction), and erection
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- Muscarinic Cholinergic Receptors
- ACh |
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__________ are located in autonomic ganglia (sympathetic and parasympathetic) and motor end plate of skeletal muscle. When activated causes __________ of skeletal muscle.
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- Nicotinic Cholinergic Receptors
- contraction |
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___________ is a type of neurotransmitter AKA _________ that is produced primarily by platelets, cells in the gastrointestinal tract, and neurons.
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- Serotonin
- 5-hyroxytryptamine (5-HT) |
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____________ has physiologic effects of platelet aggregation, stimulation of gastrointestinal motility, vasoconstriction, and controlling sleep, pain, behavior, and emotions such as depression
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Serotonin (5-HT)
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________ work by acting as agonists or antagonists at cholinergic and adrenergic receptors
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Autonomic Drugs
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_______ bind to receptor on the tissue and produce maximal response, excitatory, or inhibitory, obtainable in the tissue
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Agonists
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_______ bind to recceptors and only produce a submaximal response in the tissue by blocking and reversing the effects of the NT (inhibit)
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Antagonists
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___________ are drugs that act as mediators of sympathetic transmission and cuase a sympathetic response
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Sympathomimetics or adrenergic agonists
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Drugs that decrease sympathetic activity are called
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sympatholytics or adrenergic antagonists
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the excitatory action of sympathomimetics (contraction of smooth muscle) is due to the _____ receptors. This action is antagonized by an __________
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- a-receptors
- a-adrenergic blocking agent |
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The cardiac excitatory action of sympathomimetics is due to the stimulation of the ________ and this action is antagonized by ___________
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- B1-adrenergic receptors
- B-Blocking agents |
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the most striking and characteristic actions of sympathomimetic drugs are exerted on the
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cardiovascular system
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With the lower doses of ________ (as used in dentistry), there is no biphasic effect; there is simply and increase in systolic pressure that is due to _____ stimulation (vasoconstriction) and a _______ stimulation (direct stimulation of heart muscle)
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- epinephrine
- a- - B1 |
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_________ are divided into drugs that act directly binding to and activating ___ or ____ receptors on the tissue, imitating the action of the NT and drugs that act indirectly
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- Adrenergic agonists
- a receptors - b receptors |
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_________ are drugs that directly bind to and activate the a and b receptors on the tissue, and ________ are drugs that act indirectly (do not themselves bind or act on the receptor, but cause the release of norepinephrine from the nerve terminals)
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- direct acting
- indirect acting |
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Adrenergic agonists are also classified according to ___________ _______________, so it is best to select a drug that has selectivity for the receptor intended so as to minimize adverse effects
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- receptor site (location) specificty (a1,a2,b1,b2)
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Alpha 1 receptors are located on _________ and Alpha 2 receptors are located on ___________
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- smooth muscle of blood vessels supplying organs (heart, skin, salivary glands, smooth muscle of eye, glands, GI tract & urinary bladder)
- Ends of presynaptic neurons (Autoreceptors - stimulation leads to negative feedback) |
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_________ are used in the treatment of hypotension and shock by increasing blood pressure via constriction of blood vessels (vasoconstriction)
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Direct-Acting Adrenergic Agonists
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__________________ agonists bind to and activate a1-receptors.
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Direct-acting a1-adrenergic Agonists
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The sympathomimetic effect on nasal mucous membranes (a1-adrenergic receptors) is constriction of the blood vessels of the nasal mucosa, which reduces vascular congestion and mucus secretions are treated with ______________ drugs such as ___________ & _________
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- direct-acting a1-adrenergic Agonists
- phenylephrine (Neo-Synephrine) - oxymetazoline (Afrin) |
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__________ stimulate a2-receptors in the brain and turn off the activity of sympathetic nerves due to inhibition of NE release
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Direct-Acting a2-adrenergic Agonists
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Even thought direct-acting a2-adrenergic agonists drugs are agonists, they work like blockers to treat _________ by decreasing blood pressure, and heart rate. The protype drug is ___________
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- hypertension
- clonidine (Catapress) |
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____________ are used in the treatment of asthma. the _________ acts on both B1 & B2 receptors and therefore may have side effects on the heart due to beta1.
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- Direct-Acting Beta adrenergic agonists
- nonselective beta adrenergic agonists |
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the nonselective beta adrenergic agonists prototype drug used to treat asthma is ___________. However there is a ________________ drug that only affects the b2-receptors and causes no side effects on the heart. The drug used is ________
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- Isoproterenol
- Selective beta2-adrenergic agonists - albuterol |
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__________ release store of NE from the sympathetic neurons and the released NE activates ____________ and cause powerful sympathomimetic effect.
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- Ampehtamines
- Adrenergic receptors |
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Amphetamines are ___________ and aid in ___________ and __________
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- Indirect-Acting adrenergic Agonists
- Narcolepsy - ADHD |
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Mixed Acting Adrenergic Receptor Agonists such as ________ and _________ activate both ________ and _______ adrenergic receptors by direct and indirect methods
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- Ephedrine
- pseudoephedrine (Sudafed) - a1 - b1 |
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Mixed-acting Adrenergic Receptor Agonists are used as ____________ due to stimulation of _________ resulting in vasoconstriction
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- nasal decongestants
- a1-receptors |
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_________ cause smooth muscle contraction, which leads to vasoconstriction, dilation of the pupils and contraction of the bladder muscle. These drugs are used in the treatment of shock and hypotension and as a nasal/ocular decongestant
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A1-receptor agonists
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__________ are used in the treatment of hypertension to lower blood pressure. These drugs will inhibit the release of NE resulting in lower levels of NE
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A2-receptor agaonists
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__________ used to increase rate and force of cariac contractions in patients with hypotension and shock and is given intravenously
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B1-receptor agonists
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__________ used to cause relaxation / dilation of smooth muscle in lungs (bronchodilation) in patients with asthma. These drugs are usually long acting drugs and are given orally or inhaled
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B2-receptor agonists
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Adverse effects of sympathomimetic drugs inlcude
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- Xerostomia (dry mouth)
- nausea - vomiting - headache - dizziness - palpitations |
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Nonselective B-agonists may cause the adverse side effect of
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hyperglycemia
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____________ interacts with sympthomimetic drugs by blocking the reuptake of catecholamines and thus may increase they hypertensive effects of _________. Thus the amount of ______ should be limited to ________
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- Tricyclic antidepressants
- EPI - EPI - 0.04 mg (2 cartridges 1:100,000) |
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__________ are drugs that directly block a- and b- adrenergic receptors on tissues, resulting in decrease sympathetic activity and are used in the treatment of hypertension, urinary retention, headache (migrane), and glaucoma (increased intraocular pressure)
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Sympatholytics
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the ___________ are used in the treatment of hypertension by blocking vasoconstrictive actions of NE and EPI on vascular (blood vessels) smooth muscle
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a1-Adrenergic Receptor Antagonists (Blockers)
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____________ bind both a1 and a2 receptors on smooth muscle of blood vessels
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Nonselective a-adrenergic Antagonists (blockers)
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The ___________ block only a1 receptors and include the drugs __________, and ___________, and is used in the treatment of hypertension and prostate enlargement
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- Selective a1-adrenergic antagonists (blockers)
- prazosin (Minipress) - Terazosin (Hytrin) |
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___________ block only A2-receptors and include the drug __________, and is used in the treatment of impotency in men
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- Selective A2-adrenergic antagonists (blockers)
- Yahimbine (Yocon) |
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___________ are either selective or nonselective in blocking B-receptors
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B-Adrenergic Receptor Antagonists (b-blockers)
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B-blockers therapeutic uses include:
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- Hypertension
- Angina - Heart Arrhythmias - Panic attacks - Migraine headaches - Glaucoma |
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__________ block both beta1 and beta2 receptors and have many side effects. ________ is the protoype drug that is used to treat hypertension
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- Nonselective B-adrenergic Receptor Antagonists (B-blockers)
- Propanolol (Inderal) |
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__________ are referred to as cardioselective b-blockers because ____ receptors are primarily located on cardiac tissue. __________ is the prototype drug.
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- Selective B1-adrenergic Antagonists (B1-blockers)
- B1-receptors - atenolol (Tenormin) |
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The adverse effects of a-adrenergic blockers include
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- postural hypotension and bradycardia with initial dose
- dizziness (taking with food may decrease dizziness - food may delay absorption but does not affect extent of absorption) |
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The adverse effects of b-adrenergic blockers include
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- can cause heart failure
- caution should be used in diabetics as these drugs increase insulin action resulting in hypoglycemia - nonselective b2-blockers may cause bronchoconstriction so it is contraindicated in patients with asthma |
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Additive hypotensive effects occur with a1-blockers when used concurrently with
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other antihypertensive drugs and diuretics
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Concurrent administration of __________ with the b-blockers has an additive hypotensive effect
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phenothiazines
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Drugs that act as mediators of cholinergic (ACh) transmission are called
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parasympathetic or cholinergic agents
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_________ are agents which block the effects acetylcholine on parasympathetic nervous activity
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parasympatholyics (or anticholinergics)
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There are two types of cholinergic agonists: _________, which have an affinity and activity at cholinergic receptors at either nicotinic or muscarinic receptors; and _________, which have a cholinergic action by inhibiting cholinesterase, the enzyme that breaks down acetylcholine, allowing for accumulation of ACh at the receptor site
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- Direct-acting agents
- Indirect-acting cholinergic receptor agonists (cholinesterase inhibitors) |
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Ideally, direct-acting cholinergic agonists should have a greater affinity for the ________ receptors because these receptors are found at the organ site.
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muscarinic
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Direct-acting Cholinergic Agonists are indicated for ____________ _____________________ and the prototype drugs are __________ and __________, although there is almost no clinical use for __________ because it is rapidly destroyed and causes many adverse side effects
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-Slowing of heart and increasing smooth muscle tone of the GI and urinary tract, which may result in nausea and evacuation of the bladder
- Acetylcholine - Bethanechol (Urecholine) - Acetycholine |
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Natural Plant Alkaloids that are cholinergic agents include ________, __________ and __________
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- muscarine
- nicotine - pilocarpine |
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____________are natural plant alkaloids obtained from plant shrubs and are used in the treatmen of Xerostomia
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Pilocarpine
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________ is a natural plant alkaloid that is obtained from plants, cigarettes and other tobacco products and is used for smoking cessation
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Nicotine
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Cholinesterase inhibitors show a mixture of _______ and ______ effects and are divided into two classes depending on their duration of action: ________ & __________ inhibitors
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- muscarinic
- nicotinic - reversible - irreversible |
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Cholinesterase reversible inhibitors ____________ to receptors and Cholinesterase irreversible inhibitors ___________ to receptors
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- do not bind tightly to
- bind irreversibly to |
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Examples of reversible inhibitors include _________ and ________ which are used to treat symptoms of myathenia gravis, and _________ is used to treat glaucoma. Also ________ and ________ are newer, centrally acting reversible cholinesterase inhibitors tht concentrate in brain and are used in treatment of Alzheimers's disease
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- Neotigmine
- Pyridostigmine - Physostigmine - Donepezil (Aricept) - tacrine (Cognex) |
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Irreversible inhibitors are all _______ and are primarily used as pesticides, however some agents such as ________, ________ and _______ were developed as nerve gases. These agents are highly lipid soluble and they are absorbed through the skin and eye
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- Organophosphates
- Tabun - Sarin - Soman |
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_________ block both the muscarine and nicotinic receptors.
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Cholinergic antagonists (Anticholinergic Agents)
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The muscarinic receptors of the cholinergic antagonists compete with the ______ for muscarinic receptors at the organ site, thereby inhibiting the effects of the parasympathetic nerve stimulation
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ACh
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There are two types of muscarinic receptor antagonists:
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- Belladonna alkaloids
- semisynthetic and synthetic muscarinic receptor antagonists |
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Belladonna alkaloids inlcude ______ and _______; ______ is used for motion sickness
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- atropine
- scopolamine - scopolamine |
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Certain foods such as tomatoes, peppers, white potatoes, and eggplant are part of the __________ family and should be avoided in people with ________
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- Belladonna (nightshade)
- arthritis |
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Indications for Atropine include:
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- Ocular: to produce dilation (mydrasis) and facilitate an eye exam (drug used is Topicomine [Mydriacyl])
- Cardiac - to treat bradycardia after myocardial infection - GI & urinary tract - to treat GI & bladder spasms - CNS - prevent motion sickness & treat excessive muscle movement especially of face & nec (acute dystonia) caused by antipsychotic medications - to counteract organophosphate poisoning |
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the semisynthetic and synthetic muscarinic receptor antagonists drugs are _________ and ________, which are synthetic agents with strong affinity to muscarinic receptors in GI tract making them useful in decreasing GI motility in IBS. Another drug is __________ and it is used for the treatment of urinary incontinence
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- Dicylomine (Bentyl)
- Propantheline (Pro-Banthine) - Tolterodine (Detrol) |
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the adverse effects of anticholinergic drugs include
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- Xerostomia
- urinary retention - blurred vision - constipation - tachycardia |
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additive anticholinergic side effects are seen when these drugs are given concurrently with drugs that have anticholinergic effects, such as _________ and ____________ suchas ____________
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- tricyclic antidepressants
- antihistamines - diphenhydramine (Benadryl) |
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True/False
Parasympathetic (cholinergic drugs) have few therapeutic uses because of their numerous side effects |
True
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True/False
Cholinergic Agonists are used to to increase heart rate (atrophine) and to treat urinary incontinence (oxybutynin), motion sickeness (scopolamine), and IBS (dicylomine, propantheline, scopolamine) |
FALSE
-ANTICHOLINERGIC DRUGS are used to to increase heart rate (atrophine) and to treat urinary incontinence (oxybutynin), motion sickeness (scopolamine), and IBS (dicylomine, propantheline, scopolamine) |
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True/False
Cholinergic drugs are primarily used in the treatment of xerostomia (cevimeline, pilocarpine) and Alzheimer's disease (donepezil, tacrine, rivastigmine) |
True
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True/False
the primary use of b-blockers is hypertension |
True
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True/False/True/False
a1-receptor agonist drugs are used for nasal decongestant and hypotension. a2-receptor agonists drugs are used for hypertension |
True/True
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A local dental anesthetic such as _________, containing a sympathomimetic vasoconstrictor like _________, should be used with precautions if the patient is a cocaine abuster or taking amphetamines
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- lidocaine
- Epinephrine |
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True / False
A severe hypertensive crisis and cardiac damage and even death can occur due to toxic levels of EPI, which is a sympathetic agonists |
True
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True/False/True/False
Epinephrine is a more potent vasoconstrictor than cocaine. Epinephrine should not be used for at least 24 hours after the last dose of cocaine. |
FALSE / True
- Epinephrine is a vasoconstrictor and cocaine is the most potent vasoconstrictor. |
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True/False/True/False
The amount of epinephrine injected in dental anesthesia will produce only a b1 systemic effect resulting in an increase in heart rate, cardia output, stroke volume, and cardiac oxygen consumption that may not be noticeable, but do occur. Use no more than 2 cartridges (0.04 mg) of 1:100,000 EPE in a cardia patient taking nonselective beta blockers and patients taking anidepressants |
True/True
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True/False/True/False
Drug actions of autonomic nervous system on various organs incuding the heart, eye, arteriole, glands (salivary and lacrimal or tear), skin, lung, GI tract, and urinary bladder result in either stimulation or relaxation of these organs. Most dental patients will not be taking any drugs that act on the autonomic nervous system |
True/FALSE
- Many patients in the dental office WILL be takine one or more drugs that act on the autonomic nervous system |
