Lecture

• 31 pairs spinal nerves and 12 pairs of cranial nerves
• visceral refers to the autonomic nervous system
• Most vasculature only has SNS innervation except for the Coronary and Penile arteries
• the SNS is the thoracolumbar division and it orginates from T1 to L3
• The PSNS is the craniosacral division and it originates from cranial nerves 3,7,9 and 10 and then s2 to s4
• The PSNS has selective function in such as relaxing urinary sphincter while the SNS is all or nothing
• SNS post-ganglionic nerve is longer than pre while PSNS pre is longer than post
• Both PSNS and SNS pre-ganglionic nerve releases ACH while post for SNS releases NE and for PSNS releases ACH
• Post-ganglionic receptors sites have Nn receptors
• Nn (nicotinic neuronal) receptors can receive ACH
• Mydriasis is pupil dilation while miosis is pupil contraction
• PTs can faint while shitting due to stimulation of the vagus nerve, which drops cardiac output
• Mammalian dive reflex: submerging your face in cold water can depress cardiac output and your vitals
• Pathway for NE is: tyrosine -> DOPA -> Dopamine -> NE
• NE either gets re-used or destroyed by monoamine oxidase (MAO)
• NE does not affect beta 2 receptors so it doesn't relax smooth muscle
• Alpha 2 affects the adrenergic nerve ending
• Beta 1 receptor stimulation starts the RAAS system
• Beta 2 receptor stimulation helps with uterine relaxation
• Alpha adrenergic drugs are: pseudophedrine(Sudafed), phenylphrine, tetrahydrolozine (Visine and Tyzine), xylometazoline(Otrivin), NE(Levophed) and midotrine(ProAmatrine)
• Alpha Adrenergic drugs that increase blood pressure: NE(Levophed) and midodrine(ProAmatine)
• Alpha adrenergic drugs that are nasal decongestant: Pseudoephedrine(Sudafed), phenylephrine, tetrahydrolozine(Tyzine) and xylometazoline(Otrivin)
• For alpha adrenergic drugs, NE is the prototype while for beta, its EPI
• Beta adrenergic drugs: EPI, ephedrine, isoproterenol(Isuprel), salbutamol(ventolin), terbutaline(Brethine) and salmeterol(serevent)
• Only beta 2 drugs: salbutamol(ventolin), terbutaline(brethine) and salmeterol(serevent); terbutaline also aids with preterm labour
• isoproterenol(isuprel) is a beta 1 and 2 agonist; it's a bronchodilator and cardiac stimulant
• Salbutamol is a short acting bronchodilator while salmeterol is long acting
• Dopamine is a drug used for circulatory shock, doesn't cross the BBB and substitutes NE because it requires a pump(short lasting effects)
• A low dose of dopamine is 0.5 to 2 mcg, a moderate is 2 to 10 mcg and high is > 10 mcg
• Low dose of dopamine stimulates receptors in renal and mesenteric blood vessels for vasodilation and increased renal flow
• Moderate dose of dopamine stimulates beta 1 receptors and increases inotropy
• High doses of dopamine stimulates alpha receptors for widespread vasoconstriction, increasing BP
• Adrenergic neuronal blockers act at adrenergic nerve endings to reduce formation and release of NE
• Raynaud's phenomenon: decreased blood flow to the fingers, ears and toes
• Diabetics can get hypoglycemia if they take beta blockers
• don't give beta blockers to someone with asthma
• Lipid-soluble beta blockers can cause CNS depression
• alpha blockers aka the "sin"s are: doxazosin (Cardura), prazosin(Minipress), sildosin(rapaflo), tamsulosin(flomax) and terazosin(hytrin)
• Alpha blockers that treat Benign prostatic hyperplasia are: doxazosin(cardura), silodosin(rapaflo), tamsulosin(flomax) and terazosin(hytrin)
• Alpha blockers that treat hypotension are: doxazosin(cardura), prazosin(minipress) and terazosin(hytrin); out of these minipress treats only hypotension