ZENUWSTELSEL
Perifeer zenuwstelsel
- Afferent: sensorische prikkels naar CZS.
- Efferente
o AZS
PZS
Pre en postganglionaire vezels met synap in autonome ganglia
o Pre = mesencephalon, medulla oblongata en sacraal
ruggenmerg.
o Post = glad spierweefsel, hart en exocriene klieren.
Uitsluitend P: m. constrictor pupillae, m. ciliaris, GI-klieren,
traanklieren, bronchiale gladde spieren.
OZS
Pre en postganglionaire vezels met synap in autonome ganglia
o Pre = thoracaal ruggenmerg, bezenuwd glas spierweefsel,
hart, exocriene klieren, bijniermerg, eilandjes van
Langerhans, lever, nier, vetweefsel en skeletspier
o Contact post vezels en bezenuwd weefsel =
neuroeffectorjunctie
Uitsluitend O: zweetklieren, pilomotorspieren, BV, niet, skeletspier
en m. dilatator pupillae.
EZS
Parasympatische ganglia
Intrinsieke neuronen in intramurale plexus van darmwand
Postganglionaire vezels van OZS + preganglionaire vezels van PZS.
o MZS
Alfa en gamma motroneuronen: projectie ventrale ruggenmerg naar
skeletspier, met neuromusculaire junctie.
- Denervatiesupersensitiviteit
o Opheffen blokkade = rebound effect
Proliferatie R
Verlies mechanisme om NT te verwijderen
Verhoogde synaptische gevoeligheid
, CHOLINERGE TRANSMISSIE
AZS (PZS, OSZ en EZS) en NMJ van MZS.
Acetylatie choline: acetyl van AcCoA naar choline oiv CAT ACh in granulen exocytose
postsynaptische R stimulatie of hydrolyse tot choline oiv cholinesterase en heropname.
Activatie
- Muscarine-R-agonisten
Oog Miosis (M3)
Speekselklier, traanklier, neussslijmvlies Secretie (M3)
Longen Secretie + bronchocontrictie (M3)
Hart Sinusknoop: (-)chromotroop (M2)
Atriale spier: contractiekracht daalt
AV-knoop: (-)dromotroop evt AV-blok
GI Secretie, motiliteit (M3) en relaxatie sfincter
Blaas Contractie fundus + relaxatie sfincter (M3)
Genitaal Erectie
BV VD (NO vrij via endotheelcellen)
CZS Afhankelijk doorgang BHB
o ACh: lokaal mioticum.
o Pilocarpine = 3° amine (BHB = centrale effecten): lokaal mioticum, po monddroogte.
o Carbachol = 4° amine (M- en N-agonist): lokaal peroperatief mioticum.
o Betanechol = 4° amine: postoperatieve urineretentie of blaasatonie.
- Nicotine-R-agonisten
o Ganglia AZS
CZS: overheerst OS-effecten
Hoge dosis: depolarisatieblok BD-val, shock en spierverlamming
o NMJ
Normaal: geen effect enkel bij MG
Hogere dosis: spierfascicultaties of spiertrekkingen
Hoge dosis: depolarisatie blok met slappe spierverlamming = cholinerge crisis
o Substitutie: kauwgom, inhaler.
o Varenicline = N-agonist of bupropion = AD (niet bij epileps en MAO-inhibitor.
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