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65 Cards in this Set

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T/F

All viscera is dually innervated by SANS and PANS.
False!

Blood vessels have only sympathetic innervation.
What neurotransmitter is released by the sympathetic, post-ganglionic neurons innervating the sweat glands?
Acetylcholine

*This is an exception, having sympathetic cholinergic fibers. SANS is normally epi or norepi, while PANS is Ach.
When do post-ganglionic sympathetic neurons innervate a muscarinic receptor INSTEAD of the usual adrenergic receptor?
In sweat glands, where the postganglionic neuron releases Ach at a muscarinic receptor.
Odd-numbered muscarinic receptors (M1, M3, M5) are (inhibitory/excitatory).
Excitatory
Even-numbered muscarinic receptors (M2, M4) are (inhibitory/excitatory).
Inhibitory
EvIN
What are excitatory muscarinic receptors coupled to and what pathway do they activate?
Coupled to Gq/11
Activation of PLC
What are inhibitory muscarinic receptors coupled to and what pathway do they inhibit?
Coupled to Gi
Inhibit adenylate cyclase
What type of Ach receptor is found in autonomic ganglia, the presynaptic nerve terminal, and CNS neurons?
M1

*It acts through increased IP3, DAG, and intracellular Ca2+. Its effect is modulation of neurotransmission.
What type of Ach receptor is found in cardiac tissue (SA and AV nodes) and in presynaptic and postsynaptic nerve terminals?
M2

*It acts through increased K+ efflux and decreased cAMP. Its effect is slowing of heart rate and conduction.
What type of Ach receptor is found in smooth muscles and glands, endothelium, and vascular smooth muscle?
M3

Smooth muscles and glands - Acts through increased IP3, DAG and intracellular Ca2+. Its effect is contraction of smooth muscle and stimulation of glandular secretions.

Endothelium - Acts through increased NO formation. Effect is NO-mediated vasodilation.

Vascular smooth muscle - Acts through increased cGMP (mediated by NO). Effect is vasodilation.
What is the mechanism of signal transduction for nicotinic receptors?
Increased Na+ influx

NM at skeletal NMJ. Muscle contraction.
NN at postganglionic cell body and dendrites. Excitation of postganglionic neurons.
What are the primary tissue locations of alpha1-adrenergic receptors?
Postjunctional smooth muscle (contraction)
What are the primary tissue locations of alpha2-adrenergic receptors?
Presynaptic neurons, postsynaptic tissues (ocular, adipose, intestinal, hepatic, renal, endocrine) and blood platelets.

(mostly inhibitory)
What are the primary tissue locations of beta1-adrenergic receptors?
Heart (stimulation)

(not vasculature)
What are the primary tissue locations of beta2-adrenergic receptors?
Bronchial, uterine, and vascular smooth muscle (relaxation)
What are the primary tissue locations of beta3-adrenergic receptors?
Lipolysis in adipose tissue

*No drugs specifically target beta3
What are some possible signs of a cholinergic response?
sweat, vomit, diarrhea, arrhythmias, salivation, mental confusion
Gq, which stimulates PLC, is associated with what adrenergic receptor?
Alpha 1
Gi, which inhibits Adenylcyclase (AC), is associated with what adrenergic receptor?
Alpha 2
Gs, which stimulates Adenylcyclase (AC), is associated with what adrenergic receptor?
Beta 1 AND Beta 2
Which receptor causes contraction of smooth muscles, vasoconstriction, and inhibits secretion of renin?
alpha 1
Which receptor inhibits norepi release from presynaptic terminals and causes vasoconstriction (post-synaptic) and a decrease in insulin secretion?
alpha 2
Which receptor causes an increase in heart rate, contractility, and conduction and activates secretion of renin?
beta 1
Which receptor causes relaxation of smooth muscle, uptake of potassium in smooth muscles, glycogenolysis, and an increase in insulin secretion?
beta 2
What muscle changes the shape of the lens?
Ciliary muscle
Miosis is mediated by what receptor?
M3 (PANS)
Mydriasis is mediated by what receptor?
alpha1 (SANS)

*Withdrawal of the parasympathetic tone or blockade of muscarinic receptors can also cause dilation of the pupil
Why is blurred vision a side effect of many muscarinic antagonists?
Accommodation is the mechanism whereby an image is focused upon retina by changing the shape of the lens.

Close object -> PANS activation at M3 receptors -> contract ciliary muscle -> slackens suspensory ligaments -> lens becomes rounded -> accomodation for near vision

Inability to accommodate for the distance of the object leads to blurry vision.
Aqueous humor secretion is predominantly under control of the (PANS/SANS).
SANS
What receptors are related to aqueous humor secretion?
alpha receptors -> constriction of vascular bed in ciliary epithelium -> reduces humor secretion

beta2 receptors -> dilation of vascular bed -> increases humor secretion
T/F

In glaucoma, when going from light to dark, the iris can stick to the lens.
True!
What types of drugs ENHANCE aqueous humor drainage?
Muscarinic agonists and Acetylcholine esterase inhibitors
b/c mydriasis causes angle block
What types of drugs REDUCE aqueous humor drainage?
Beta antagonists and Alpha agonists
Which receptor helps the ciliary muscle relax for far vision?
Beta 2
Lacrimal/tear glands are mediated by which receptor?
M3

Have only PANS innervation (facial nerve/CN VII).
What types of drugs lead to dry mouth and eyes?
Anticholinergic/antimuscarinic drugs
If bronchiolar smooth muscle only receives PANS innervation, how does bronchodilation occur?
The bronchiolar smooth muscle expresses beta2 receptors, a major site of action for circulating epinephrine (from adrenal medulla, SANS).
Which receptors in the bronchiolar smooth muscle are responsible for bronchoconstriction?
M3
How are mucosal secretions in the bronchioles regulated?
By sympathetic modulation of the vascular bed.

Alpha agonists -> reduce secretions
Beta2 agonists -> Increase secretions
The right vagus primarily innervates the ____ node, while the left vagus innervates the ____ node.
SA
AV
Which has more vagal innervation - atrial muscle or ventricular muscle?
Atrial muscle
T/F

Sympathetic efferent nerves are present throughout the atria (except for the SA node) and ventricles, including the conduction system of the heart.
FALSE!


Sympathetic efferent nerves are present throughout the atria (ESPECIALLY in the SA node) and ventricles, including the conduction system of the heart.
What 4 parameters determine the overall effects of autonomic drugs on the heart?
Direct effect on the heart
Vascular effects
Redistribution of the blood
Reflex phenomena
The beta1 receptors (moreso than beta2 receptors) in the heart are associated with what effects?

SA node -
Atria -
AV node -
His-Purkinje -
Ventricles -
SA node - increase HR
Atria - increase contractility and conduction velocity
AV node - Increase in automaticity and conduction velocity
His-Purkinje - (same as AV node) Increase in automaticity and conduction velocity
Ventricles - Increase in contractility, conduction velocity, automaticity, AND rate of ventricular pacemakers
The M2 receptors in the heart are associated with what effects?

SA node -
Atria -
AV node -
His-Purkinje -
Ventricles -
SA node - Decrease HR
Atria - Decrease in contractility and shortened AP duration
AV node - Decrease in conduction velocity; AV block
His-Purkinje - NONE
Ventricles - slight decrease in contractility
What type of effects are associated with the M3 receptors on the following arterioles/veins?

Arterioles:
1. Coronary -
2. Skin & Mucosa -
3. Skeletal Muscle -
4. Splanchnic -
5. Renal & Mesenteric -

Veins:
6. Systemic (all veins) -
Arterioles:
1. Coronary - Dilation
2. Skin & Mucosa - Dilation
3. Skeletal Muscle - Dilation
4. Splanchnic - Dilation
5. Renal & Mesenteric - None

Veins:
6. Systemic (all veins) - None

**Arterioles and veins are NOT innervated by parasympethic nerves. HOWEVER, the endothelium of most blood vessels have M3 receptors, activation of which by circulating muscarinic agonists causes release of endothelium derived releasing factor (EDRF) leading to vasodilation.
What type of effects are associated with alpha1 (moreso than alpha2) receptors on the following arterioles/veins?

Arterioles:
1. Coronary -
2. Skin & Mucosa -
3. Skeletal Muscle -
4. Splanchnic -
5. Renal & Mesenteric -

Veins:
6. Systemic (all veins) -
Arterioles:
1. Coronary - Constriction
2. Skin & Mucosa - Constriction
3. Skeletal Muscle - Constriction
4. Splanchnic - Constriction
5. Renal & Mesenteric - Constriction

Veins:
6. Systemic (all veins) - Constriction
What type of effects are associated with the beta2 receptors on the following arterioles/veins? Also, when relevant, what other receptor(s) has the same affect at that tissue?

Arterioles:
1. Coronary -
2. Skin & Mucosa -
3. Skeletal Muscle -
4. Splanchnic -
5. Renal & Mesenteric -

Veins:
6. Systemic (all veins) -
Arterioles:
1. Coronary - Dilation
2. Skin & Mucosa - NONE
3. Skeletal Muscle - Dilation (also M*)
4. Splanchnic - NONE
5. Renal & Mesenteric - Dilation (also Dopamine)

Veins:
6. Systemic (all veins) - Dilation

M* Arterioles in the skeletal muscle have some sympathetic cholinergic fibers.
What part of the baroreceptor response (sitting to standing) is affected by alpha1-antagonists?
The increase in peripheral resistance is disrupted
In the baroreceptor response, what causes increased HR?
Decreases PANS to the SA node
In the baroreceptor response, what causes increased stroke volume?
Increased venous return from increased SANS output to the veins
Increased contractility from increased SANS output to the ventricles
In the baroreceptor response, what causes increased peripheral resistance?
Increased sympathetic efferent output to the arterioles
Why do many drugs on the market lead to dry mouth, nausea, vomiting, and constipation?
anticholinergic effects, especially on the GI tract and salivary glands
What effect is associated with M3 receptors in the following digestive tissues?

GI Tract:
1. Smooth muscle walls -
2. Smooth muscle sphinchters -
3. Secretions (enzymes, acid, HCO3-, etc.) -

Salivary Gland:
4. Secretions -
GI Tract:
1. Smooth muscle walls - Contracts
2. Smooth muscle sphinchters - NONE... but M2 causes relaxation
3. Secretions (enzymes, acid, HCO3-, etc.) - Increases

Salivary Gland:
4. Secretions - copious, watery secretions and enzymes
How do the sympathetics affect the following digestive tissues?

GI Tract:
1. Smooth muscle walls -
2. Smooth muscle sphinchters -
3. Secretions (enzymes, acid, HCO3-, etc.) -

Salivary Gland:
4. Secretions -
GI Tract:
1. Smooth muscle walls - alpha2 and beta2 relax
2. Smooth muscle sphinchters - alpha1 contracts
3. Secretions (enzymes, acid, HCO3-, etc.) - alpha2 inhibits

Salivary Gland:
4. Secretions - alpha1 thick viscous secretions
What receptors in the liver help maintain plasma glucose by stimulating gluconeogenesis and glycogenolysis?
alpha and beta2 receptors

*There is no parasympathetic response in the liver.
Describe the sympathetic response on insulin secretion in the pancreas.
Alpha2 inhibits insulin secretion
Beta2 stimulates insulin secretion

During fight/flight or in exercise, alpha2 dominates over beta2 to promote muscle glycogenolysis (epi, beta2 mediated) and allowing the muscle to increase its work while maintaining glycemia so that the brain function isn't impaired.
What parasympathetic receptor increases insulin secretion from the pancreas?
M3
What are M3 antagonists used to treat in the bladder?
Overactive bladder
What are the sympathetic effects and receptors in the bladder?

1. Detrusor -
2. Sphinchter -
1. Detrusor - beta2 relaxes
2. Sphinchter - alpha1 contracts
What are the parasympathetic receptors and action on the bladder?

1. Detrusor -
2. Sphinchter -
1. Detrusor - M3 contracts
2. Sphinchter - M2? M3? relaxes
Where is renin secreted from?
JG cells in the kidney
What stimulates renin secretion?
Increase in renal sympathetic outflow to beta1 adrenergic receptors
What decreases renin secretion?
Activation of alpha1 receptors

(direct or indirect effect?)
Loss of Ach receptors in the NMJ occurs in what disease?
Myasthenia Gravis