Criselle

 Angeli  C.  Barcenas,  MD,  DPBA,  FPSA,  

MMHA  
 Subdivisions  of  the  ANS  
•  SympatheBc  Nervous  System  
•  ParasympatheBc  Nervous  System  
 Physiologic  Anatomy  of  the  
SympatheBc  Nervous  System    
•  SympatheBc  nerve  fibers  originate  in  
the  spinal  cord  with  spinal  nerves  
between  cord  segments  T1  -­‐  L2  
•  SympatheBc  chain  
–  (1)Paravertebral  sympatheBc  chains  of  
ganglia  
–  (2)  Prevertebral  ganglia  (celiac,  
superior  mesenteric,  aorBco-­‐renal,  
inferior  mesenteric,  and  hypogastric)  
–  (3)  nerves  extending  from  the  ganglia  
to  the  different  internal  organs  
•  SympatheBc  pathway:  preganglionic  
neuron  +  postganglionic  neuron  
.  
 Segmental  DistribuBon  of  the  
SympatheBc  Nerve  Fibers    
•  T1  -­‐  head  
•  T2-­‐  neck  
•  T3,  T4,  T5,  T6-­‐  thorax  
•  T7,  T8,  T9,  T10,  T11-­‐  
abdomen  
•  T12,  L1,  L2-­‐  legs  
 Special  Nature  of  the  
SympatheBc  Nerve  Endings  in  
the  Adrenal  Medullae    
•  Preganglionic  
sympatheBc  nerve  
fibers  pass,  without  
synapsing,  all  the  way  
from  the  
intermediolateral  horn  
to  the  adrenal  medulla  
 Physiologic  Anatomy  of  
the  ParasympatheBc  
Nervous  System    
•  CN  III     -­‐  eye  
-­‐  lacrimal,  nasal,  
•  CN  VII   submandibular  glands  
•  CN  IX   -­‐  ParoBd  gland  
-­‐  heart,  lungs,  esophagus,  
•  CN  X-­‐  75%  stomach,  enBre  small  intesBne,  
proximal  half  of  the  colon,  liver,  
gallbladder,  pancreas,  kidneys,  
and  upper  porBons  of  the  ureters.    
•   S2,  S3  (S1,  S4)  -­‐à  PELVIC  NERVES-­‐  
descending  colon,  
rectum,  urinary  
bladder,  and  lower  
porBons  of  the  ureters  ,  
external  genitalia    
Preganglionic  and  Postganglionic    
Neurons    
•  .  
SYMPATHETIC   PARASYMPATHETIC  
 
Thoracolumbar  OuClow   Craniosacral  OuClow  
 
Long  postganglionic  nerve  fibers   Short  postganglionic  nerve  fibers  
 
•  SynapBc  transmi_er  substances  in  the  ANS  
–  Acetylcholine  àsecreted  by  cholinergic  fibers  
–  Norepinephrineà  secreted  by  adrenergic  fibers  
 (adrenalin)  
 
•  All  preganglionic  neurons  are  cholinergic  
•  Almost  all  postganglionic  neurons  of  PNS  are  
cholinergic  
•  Most  of  postganglionic  neurons  of  SNS  are  
adrenergic  
*PNS-­‐  ParasympatheBc  Nervous  System  
*SNS-­‐  SympatheBc  Nervous  System  
 
Preganglionic  and  Postganglionic  
Neurotransmi_ers    
SYMPATHETIC   PARASYMPATHETIC  
 
Thoracolumbar  OuClow   Craniosacral  OuClow  
 
Long  postganglionic  nerve  fibers   Short  postganglionic  nerve  fibers  
 
Norepinephrine   Acetylcholine  
 
SecreBon  of  Ach  &  NE    
 Acetylcholine  

•  Acetylcholine  acetyl  cholinesterase>  acetate  +  choline  

Norepinephrine  
 Norepinephrine  
•  Removal  of  NE  
1.  Reuptake  (50-­‐80%)  
2.  Diffusion  into  body  fluidsà  blood  
3.  DestrucBon  (by  MAO,  COMT)  
 
Receptors  
 Acetylcholine  receptors  
•  Muscarinic  
–   use  G  proteins  as  their  signaling  mechanism  
–   postganglionic  cholinergic  neurons  of  SNS  &  PNS  
•  NicoBnic  
–   ligand-­‐gated  ion  channels  
–   preganglionic  and  postganglionic  neurons  of  SNS  
&  PNS  
 Preganglionic  and  Postganglionic  
Neurotransmi_er  Receptors  

NicoBnic  

NicoBnic  

Muscarinic   Muscarinic  
NicoBnic   NicoBnic  
 Adrenergic  Receptors  
•  Alpha-­‐  A1,  A2  
–  Use  G  proteins  for  signaling  
•  Beta-­‐  B1,  B2,  B3  
–  Use  G  proteins  for  signaling  

Norepi-­‐excites  mainly  alpha  receptors  

Epi-­‐  excites  both  equally  
•  .  
•  .  
•  .  
•  .  
 FuncBon  of  the  Adrenal  Medullae    
•  causes  large  quanBBes  of  epi  (80%)  and  norepi  
(20%)  to  be  released  into  the  circulaBng  blood  
•  effects  last  5  to  10  -mes  longer-­‐  bec  they  are  
removed  from  the  blood  slowly  over  a  period  of  2  
to  4  minutes  
 
•  Epinephrine-­‐  more  effect  on  B-­‐receptors,  more  
effect  on  cardiac  sBmulaBonà  inc  cardiac  output  
–  Greater  inc  in  metabolic  rate  than  Norepinephrine  
•  Norepinephrine-­‐  stronger  constricBon  of  
vesselsà  inc  TPR  and  BP  
 SympatheBc  and  ParasympatheBc  
"Tone"    
•  allows  a  single  nervous  system  both  to  increase  
and  decrease  the  ac-vity  of  a  s-mulated  organ  
–  Sympathe-c  tone  of  arterioles  
–  Parasympathe-c  tone  of  GIT  
•  Tone  Caused  by  Basal  SecreBon  of  Epinephrine  
and  Norepinephrine  by  the  Adrenal  Medullae  -­‐  
0.2  μg/kg/min  of  epinephrine  and  0.05  μg/kg/min  
of  norepinephrine  
 DenervaBon  SupersensiBvity  of  
SympatheBc  and  ParasympatheBc  
Organs  Aker  DenervaBon  
 Autonomic  Reflexes    
•  Cardiovascular  Autonomic  Reflexes  
–  Ex.  Baroreceptor  reflex  
•  GastrointesBnal  Autonomic  Reflexes  
•  Renal  –  micturiBon  reflex  
•  Sexual  reflexes  
 SBmulaBon  of  SympatheBc  &  
ParasympatheBc  
•  SympatheBc  System  SomeBmes  Responds  by  
Mass  Discharge    
•  ParasympatheBc  System  Usually  Causes  
Specific  Localized  Responses    
 "Alarm"  or  "Stress"  Response  of  the  
SympatheBc  Nervous  System    
•  Increased  arterial  pressure    
•  Increased  blood  flow  to  acBve  muscles  concurrent  with  
decreased  blood  flow  to  organs  such  as  the  gastrointesBnal  
tract  and  the  kidneys  that  are  not  needed  for  rapid  motor  
acBvity    
•  Increased  rates  of  cellular  metabolism  throughout  the  body    
•  Increased  blood  glucose  concentraBon    
•  Increased  glycolysis  in  the  liver  and  in  muscle    
•  Increased  muscle  strength    
•  Increased  mental  acBvity    
•  Increased  rate  of  blood  coagulaBon    
 Pharmacology  of  the  ANS  
1.  Drugs  That  Act  on  Adrenergic  Effector  Organs  
A1.  SympathomimeBc  Drugs    
•  Epinephrine,  norepinephrine,  methoxamine,  phenylephrine  (A),  
isoproterenol  (B),  albuterol  (B2)  
A2.  Drugs  That  Cause  Release  of  Norepinephrine  from  Nerve  
Endings  (Indirect  sympathomimeBcs)  
•  Ephedrine,  tyramine,  amphetamine  
B.      Drugs  That  Block  Adrenergic  AcBvity    
•  Reserpine,  guanethidine,    
•  A-­‐phenoxybenzamine,  phentolamine,  
•  A1-­‐  prazosin  and  terazosin,  
•  A2-­‐  yohimbine  
•  B1,  B2-­‐propanolol  
•   B1-­‐  atenolol,  nevibolol,  metoprolol    
 
 
 Pharmacology  of  the  ANS  
2.  Drugs  That  Act  on  Cholinergic  Effector  Organs    
 A1.  ParasympathomimeBc  Drugs  (Muscarinic  
Cholinergic  Drugs)    
   -­‐pilocarpine,  methacoline  
 A2.  Drugs  That  Have  a  ParasympatheBc  
PotenBaBng  Effect-­‐AnBcholinesterase  Drugs  
   -­‐neosBgmine,  pyridosBgmine,  ambenonium    
 B.  Drugs  That  Block  Cholinergic  AcBvity  at  
Effector  Organs-­‐AnBmuscarinic  Drugs    
   -­‐atropine,  homatropine,  scopolamine  
 Pharmacology  of  the  ANS  
3.  Drugs  That  SBmulate  or  Block  SympatheBc  
and  ParasympatheBc  Postganglionic  Neurons  
 A.  Drugs  That  SBmulate  Autonomic  
Postganglionic  Neurons    
   -­‐NicoBne  
 B.  Ganglionic  Blocking  Drugs    
   -­‐tetraethyl  ammonium  ion,  
hexamethonium  ion,  pentolinium  
 
•  .  
 Autonomic  Centers  
1.  Medulla  
–  Vasomotor  center  
–    Respiratory  center  
–  Swallowing,  coughing,  and  vomiBng  centers  
2.  Pons  
–    Pneumotaxic  center  
3.  Midbrain  
–  MicturiBon  center  
4.  Hypothalamus  
–  Temperature  regulaBon  center  
–   Thirst  and  food  intake  regulatory  centers  
Control  of  the  ANS