U N I T XI

Textbook of Medical Physiology, 11th edition

GUYTON & HALL
Chapter 60: lecture3
The Autonomic Nervous System (ANS);
The Adrenal Medulla

By
Dr. Mudassar Ali Roomi (MBBS, M.Phil)
Assistant Professor Physiology
Function of the Adrenal Medulla
Adrenal medulla is a large sympathetic ganglion
when stimulated releases epinephrine (80%) and norepinephrine (20%)
into the blood stream
causes prolonged activity of the substances (2-4 minutes)
helps the body deal with stress
Difference b/w action of epinephrine and nor-epinephrine:
Epinephrine has greater effect on cardiac stimulation
epinephrine raises the arterial pressure to a lesser extent but increases the
cardiac output more
Epinephrine has 5 to 10 times as great a metabolic effect as
norepinephrine
Importance of adrenal medulla:
1. the dual mechanism of sympathetic stimulation provides a safety
factor, one mechanism substituting for the other if it is missing.
2. to stimulate structures of the body that are not innervated by direct
sympathetic fibers

Sympathetic and
Parasympathetic Tone
the basal rate of activity of each system
Importance: this background activity allows for
an increase or decrease in activity of an organ by a
single system
sympathetic tone normally causes about a 50 %
vasoconstriction (so, SANS has more effect on vessels)
increasing or decreasing tone can change vessel
diameter
parasympathetic tone provides background G.I. activity
(so, PANS has more effect on GIT)
Mechanism of Denervation Supersensitivity: up-
regulation of the receptors

Autonomic Reflexes
Cardiovascular Autonomic Reflexes
Gastrointestinal Autonomic Reflexes
Other Autonomic Reflexes
Sympathetic System Often Responds by
Mass Discharge
Parasympathetic System Usually Causes
Specific Localized Responses.
Stress Response (fight or flight response)
mass sympathetic discharge
increase in arterial pressure, heart rate and contractility, blood flow to
muscles, blood glucose, metabolic rate, muscle strength, mental
activity, blood coagulation
prepares the body for vigorous activity need to deal with a life-threatening
situation
1. Increased arterial pressure
2. Increased blood flow to active muscles concurrent with decreased blood
flow to organs such as the gastrointestinal tract and the kidneys that are not
needed for rapid motor activity
3. Increased rates of cellular metabolism throughout the body
4. Increased blood glucose concentration
5. Increased glycolysis in the liver and in muscle
6. Increased muscle strength
7. Increased mental activity
8. Increased rate of blood coagulation

Pharmacology of the Sympathetic
Nervous System
adrenergic or sympathomimetic drugs act like
norepi and epi
these drugs have an effect which is much more
prolonged than that of either norepi or epi
phenylephrine stimulates alpha receptors
isoproterenol stimulates both beta
1
and beta
2
receptors
albuterol stimulates only beta
2
receptors
some drugs act indirectly by increasing the release
of norepi from its storage terminals
ephedrine, tyramine, and amphetamine
Pharmacology of the Sympathetic
Nervous System
drugs that block the effect of norepi and epi
synthesis and storage
reserpine
release from the nerve terminal
guanethidine
alpha blockers
phentolamine and phenoxybenzamine
beta blockers
beta
1
and
2
- propranolol, beta
1
- metoprolol
ganglionic blockers
hexamethonium
Pharmacology of the
Parasympathetic Nervous System
parasympathomimetic drugs
nicotine
activates nicotinic receptors (nicotinic agonist)
pilocarpine and methacholine (muscarinic agonist)
activates muscarinic receptors, cause profuse sweating
cholinesterase enzyme inhibitors
neostigmine, pyridostigmine,and ambenonium
potentiates the effect of acetylcholine
antimuscarinic drugs
atropine and scopolamine (muscarinic antagonist)
blocks the effect of acetylcholine on effector cells
Some Disorders of the Autonomic Nervous
System
Horner syndrome :
Chronic unilateral pupillary constriction (miosis), sagging of the eyelid
(ptosis), withdrawal of the eye into the orbit, flushing of the skin, and
lack of facial perspiration,
resulting from lesions in the cervical ganglia, upper thoracic spinal
cord, or brainstem that interrupt sympathetic innervation of the head.
Raynaud disease :
Intermittent attacks of paleness, cyanosis, and pain in the fingers and
toes, caused when cold or emotional stress triggers excessive
vasoconstriction in the digits;
most common in young women.
In extreme cases, causes gangrene and may require amputation.
Sometimes treated by cutting sympathetic nerves to the affected
regions.