1. SSO Pendahuluan Maret 2008i
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7/26/2019 1. SSO Pendahuluan Maret 2008i
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PENDAHULUAN
SUSUNAN SYARAFOTONOM
Prof.Dr.dr.Jazanul Anwar SpFK
Departemen Farmakologi dan Terapetik
Universitas Sumatera Utara
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Nervous System
Central Nervous System Peripheral Nervous System
Autonomic Nervous System Somatic Nervous System
Sympathetic Nervous System Parasympathetic Nervous System
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NA
NA = noradrenaline
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TYROSINE DOPA NA
2
2
1
1
3
Adrenalin
MAO COMT
NA NA
Syaraf pasca anlion si!pa"i#
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Tyrosine
Tyrosine hydroxylase ↓
DOPA
DOPA carboxylase ↓Dopamine
Dopamine β hydroxylase ↓
!oradrenalineP!"T ↓
Adrenaline
Prod$c"ion of Noradrenalin
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Or$anisasi sis%em simpa%i&
Figure 16.3'
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Pola $!$! s"i!$lasi sis"e! si!pa"i#
( %& Menin#a"#an #eseiaan !en"al( '& Mena!(a) #ecepa"an !e"a(oils!e
( *& Men$rani f$nsi pencernaan dan penel$aran $rin
( +& Mena#"if#an cadanan enersi
( ,& Mena!(a) #ecepa"an pernafasan dan !endila"asisal$ran pernafasan
( -& Mena!(a)#an deny$" .an"$n dan "e#anan dara)
( /& Mena#"if#an #elen.ar #erina"
)*n$si +aal sis%em simpa%i&
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( A&%i-asi simpa%i& dalam keadaan krisis a&an meliba%
sel*r*h sis%em simpa%i&. /al ini di&endali&an oleh p*sa%p*sa% simpa%i&yan$ %erdapa% didalam hipotalamus.
( Per*bahanper*bahan yan$ dirasa&an adalah0
( 1. Peningkatan kewaspadaan melal*i a&%i-asi
sis%em re%i&*ler0
menyebab&an perasaan “on edge”
( 2. Perasaan bertenaga dan euphoria dan diser%ai
perasaan mengabaikan rasa takut dan
%emporer tidak sensitif terhadap nyeri
A&%i-asi simpa%i&
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*& 0er"a!(a) a#"i1i"as pada p$sa"2p$sa"
#ardio1as#$ler dan pernafasan dari pons dan
!ed$la o(lona"a yan !enye(a(#an
penin#a"an3
Te#anan dara)
4edala!an pernafasan
+& Penin#a"an "on$s o"o" secara $!$!
2 !e!($a" pena!pilan !aca! "ean
,& Mo(ilisasi "enaa2"enaa cadanan
!ena!(a) li#oenolisis dan pe!(e(asan lipid
A&%i-asi simpa%i&
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( %im*la%ion o+ sympa%he%ic di-ision has %o dis%inc%
res*l%s
elease o+ ace%ylcholine or a% speci+ic loca%ions
ecre%ion o+ and in%o $eneral circ*la%ion
( ympa%he%ic $an$lionic ne*rons end in %elodendria
s%*dded i%h 1aricosi"ies +illed i%h
ne*ro%ransmi%%er ranchin$ ne%or& %ha% resembles a s%rin$ o+ pearls
!e*ro%ransmi%%ers and
sympa%he%ic +*nc%ion
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( "os% pos%$an$lionic +ibers are adreneric
elease
( a*ses -asocons%ric%ion
( A +e are0 C)olineric
( elease ace%ylcholine
%im*la%es sea% $land secre%ion
a*ses -asodila%ion Ni"ro5ideric
( elease ni%ric oxide
( a*ses immedia%e -asodila%ion
!e*ro%ransmi%%ers and
sympa%he%ic +*nc%ion
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( 8++ec%s o+ sympa%he%ic s%im*la%ion res*l% primarily
+rom in%erac%ions i%h membrane recep%ors
sensi%i-e %o0
( To %ypes o+ recep%ors0
Alp)a recep"ors
0e"a recep"ors
( 9n $eneral s%im*la%es alpha recep%ors
( s%im*la%es bo%h alpha and be%a recep%ors
!e*ro%ransmi%%ers and
sympa%he%ic +*nc%ion
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( o locali:ed sympa%he%ic ac%i-i%y a% -aricosi%ies
in-ol-es %he release o+ and %h*s a++ec%s alpha
recep%ors
( ;enerali:ed sympa%he%ic ac%i-i%y in-ol-es %he
release o+ by %he adrenal med*lla and %here+ore
a++ec%s bo%h alpha and be%a recep%ors
!e*ro%ransmi%%ers and
sympa%he%ic +*nc%ion
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TYROSINE DOPA NA
2
2
1
1
3
Adrenalin
MAO COMT
NA NA
Syaraf pasca anlion si!pa"i#
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( To %ypes o+ alpha recep%ors Alp)a2%
( /as an exci%in$ e++ec% on %he %ar$e% cell
)or example s%im*la%ion o+ alpha1 recep%ors on %he s*r+aces o+
smoo%h m*scle cells is responsible +or0
< ons%ric%ion o+ peripheral blood -essels< los*re o+ sphinc%ers alon$ di$es%i-e %rac%
Alpha recep%ors
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Alp)a2'
( es*l%s in loerin$ o+ cyclic-AMP le-els in %he
cy%oplasm
cA"P is an impor%an% messen$er %ha% can ac%i-a%e
or inac%i-a%e &ey en:ymes
( ;enerally has an inhibi%ory e++ec% on %he cell
( The presence o+ alpha2 recep%ors helps coordina%e
ac%i-i%ies be%een sympa%he%ic and parasympa%he%ic
di-isions
( =hen sympa%he%ic di-ision is ac%i-e binds %o
parasympa%he%ic ne*rom*sc*lar and ne*ro$land*lar
>*nc%ions
( This inhibi%s %heir ac%i-i%y
Alpha recep%ors
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Alp)a2'
( es*l%s in loerin$ o+ cyclicA"P le-els in %he cy%oplasm
cA"P is an impor%an% messen$er %ha% can ac%i-a%e or inac%i-a%e &ey
en:ymes
( ;enerally has an inhibi%ory e++ec% on %he cell
( The presence o+ alpha2 recep%ors helps coordina%e ac%i-i%ies
be%een sympa%he%ic and parasympa%he%ic di-isions( =hen sympa%he%ic di-ision is ac%i-e binds %o parasympa%he%ic
ne*rom*sc*lar and ne*ro$land*lar >*nc%ions
( This inhibi%s %heir ac%i-i%y
Alpha recep%ors
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Alp)a2'
( es*l%s in loerin$ o+ cyclicA"P le-els in %he cy%oplasm
cA"P is an impor%an% messen$er %ha% can ac%i-a%e or inac%i-a%e &ey
en:ymes
( ;enerally has an inhibi%ory e++ec% on %he cell
( The presence o+ alpha2 recep%ors helps coordina%e ac%i-i%ies
be%een sympa%he%ic and parasympa%he%ic di-isions( =hen sympa%he%ic di-ision is ac%i-e binds %o parasympa%he%ic
ne*rom*sc*lar and ne*ro$land*lar >*nc%ions
( This inhibi%s %heir ac%i-i%y
Alpha recep%ors
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( There are %hree %ypes o+ be%a recep%ors b*% %o
primary %ypes
0e"a2%( es*l%s in an increase in me%abolic ac%i-i%y
( )or example s%im*la%ion o+ be%a1 recep%ors on s&ele%al m*scle
accelera%es %he me%abolic ac%i-i%ies o+ %he m*scle
( %im*la%ion o+ be%a1 recep%ors in %he hear% ca*ses an increase inhear% ra%e and in %he +orce o+ con%rac%ion
( 0e"a (loc#ers are classes o+ dr*$s %ha% bloc& %he s%im*la%ion o+
be%a1 recep%ors
Th*s ca*sin$ a decrease in hear% ra%e and +orce o+ con%rac%ion
e%a recep%ors
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0e"a2'( %im*la%ion o+ be%a2 recep%ors ca*ses inhibi%ion
( This %ri$$ers %he relaxa%ion o+ smoo%h m*scles alon$ %he
respira%ory %rac%
( As a res*l% %he diame%er o+ %he respira%ory passa$eays
increases
( This ma&es i% easier %o brea%h
( This response acco*n%s +or %he e++ec%i-eness o+
9nhalers *sed %o %rea% as%hma
8pipens *sed %o %rea% se-ere respira%ory a%%ac&s
e%a recep%ors
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0e"a2'( %im*la%ion o+ be%a2 recep%ors ca*ses inhibi%ion
( This %ri$$ers %he relaxa%ion o+ smoo%h m*scles alon$ %he
respira%ory %rac%
( As a res*l% %he diame%er o+ %he respira%ory passa$eays
increases
( This ma&es i% easier %o brea%h
( This response acco*n%s +or %he e++ec%i-eness o+
9nhalers *sed %o %rea% as%hma
8pipens *sed %o %rea% se-ere respira%ory a%%ac&s
e%a recep%ors
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0e"a2*( A %hird %ype
( *% no% considered a primary %ype
( )o*nd in adipose %iss*e
( %im*la%ion o+ be%a3 recep%ors leads %o lipolysis rea&don o+ %ri$lycerides s%oried i%hin adipocy%es
< )a%%y acids $enera%ed %hro*$h lipolysis are released in%o %he
circ*la%ion +or *se by o%her %iss*es
e%a recep%ors
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Production o+ Ach
choline acetate Acetylcholine
Acetylcholine choline acetate
Acetylcholinesterase
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Figure 16.7
)i$*re 16.7 The Or$ani:a%ion o+
%he Parasympa%he%ic Di-ision o+%he A!
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Acetate
!holine
A!h
A!h A!h
N
"1
"2
"3
"#
"$
A!hE
Acetate !holine
Syaraf pasca anlion parasi!pa"i#
2#
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( Pre$an$lionic +ibers lea-e %he brain as
cranial ner-es0 666 2 Oc$lo!o"or ner1e
( )ibers synapse in %he ciliary anlia
han$e %he diame%er o+ %he p*pil
han$e %he shape o+ %he lens %o +oc*s ima$es on %he re%ina
Or$ani:a%ion and ana%omy o+
%he parasympa%he%ic di-ision
2'
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( Pola $!$! dari f$nsi syaraf parasi!pa"i#
( %& Men$rani #ecepa"an !e"a(olis!e
( '& Men$rani deny$" .an"$n dan "e#anan dara)&
( *& Mena!(a) se#resi l$da) dan #elen.ar sal$ran cerna
( +& Mena!(a) era#an dan aliran dara) sal$ran
cerna
( ,& Meransan penel$aran $rin dan defe#asi
)*n$si +aal Parasympa%he%i&
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76 2 Facial ner1e
( )ibers synapse in %he p"eryopala"ine ands$(!andi($lar $an$lia
( 9nner-a%es0
?acrimal $lands
mall $lands o+ %he nasal ca-i%y and pharynx *bmandib*lar sali-ary $land
*blin$*al sali-ary $land
Or$ani:a%ion and ana%omy o+
%he parasympa%he%ic di-ision
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68 2 9lossop)aryneal ner1e
( )ibers synapse in %he o%ic $an$lia
9nner-a%es %he paro%id sali-ary $land 8 2 7a$s ner1e
( )ibers synapse in %he in%ram*ral $an$lia
Tar$e%s -isceral or$ans o+0
< !ec&
< Thoracic ca-i%y
< Abdominal ca-i%y
( acral ne*rons @2 4 +orm %he pel1ic ner1es
Or$ani:a%ion and ana%omy o+
%he parasympa%he%ic di-ision
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Figure 16.8
)i$*re 16.# The Dis%rib*%ion o+
Parasympa%he%ic 9nner-a%ion
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( 8++ec%s prod*ced by %he parasympa%he%ic
di-ision ons%ric%ion o+ p*pils
)oc*sin$ o+ %he lenses o+ %he eye on nearby
ob>ec%s ecre%ion by n*mero*s di$es%i-e $lands
ecre%ion o+ hormones %ha% promo%e absorp%ion
and *se o+ n*%rien%s
han$es in blood +lo and $land*lar ac%i-i%y
associa%ed i%h sex*al aro*sal
9ncrease in smoo%h m*scle ac%i-i%y alon$ %he
di$es%i-e %rac%
Parasympa%he%ic ac%i-a%ion
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%im*la%ion and coordina%ion o+ de+eca%ion
on%rac%ion o+ %he *rinary bladder d*rin$
*rina%ion
ons%ric%ion o+ %he respira%ory passa$eays
ed*c%ion in hear% ra%e and +orce o+ con%rac%ion
ex*al aro*sal and %he s%im*la%ion o+ sex*al
$lands in bo%h $enders
Parasympa%he%ic ac%i-a%ion
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( These +*nc%ions cen%er on0
elaxa%ion
)ood processin$
8ner$y absorp%ion
( Parasympa%he%ic sys%em has been called
%he ana(olic sys"e!
9%s s%im*la%ion leads %o a $eneral increase in %he
n*%rien% con%en% o+ %he blood
This s*ppor%s body processes and crea%es
ener$y reser-es
A4T67AS6 PARAS6MPAT64
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( Dr*$s may be $i-en %o co*n%erac% or red*ce
symp%oms ca*sed or a$$ra-a%ed by
a*%onomic ac%i-i%ies
( Dr*$s are called !i!e"ic i+ %he mimic %he
ac%i-i%y o+ one o+ %he normal a*%onomic
ne*ro%ransmi%%ers
( Dr*$s %ha% red*ce %he e++ec%s o+ s%im*la%ion
by &eepin$ %he ne*ro%ransmi%%er +roma++ec%in$ %he pos%synap%ic membranes are
&non as (loc#in aen"s
ys%em )*nc%ion
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( "ime%ic dr*$s o+%en ha-e ad-an%a$es o-er na%*ral
ne*ro%ransmi%%ers
)or ins%ance i%h and 0( "*s% be adminis%ered in%o %he bloods%ream
( 8++ec%s are shor%li-ed
=i%h sy!pa")o!i!e"ic dr*$s0
( They may s*r-i-e oral adminis%ra%ion 8n%eric coa%in$
( Prod*ce lon$erlas%in$ e++ec%s
*s%ained release
( "ore speci+ic ac%ion
"odi+yin$ A*%onomic !er-o*s
ys%em )*nc%ion
3#
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( 8xamples incl*de0
Dr*$s inhaled %o dila%e %he respira%ory passa$eays
Drops %o dila%e %he p*pils
( Sy!pa")e"ic (loc#in aen"s (symp tholyt cs: bind%o %he recep%or si%es and pre-en% a normal response %o %hepresence o+0
!e*ro%ransmi%%ers
ympa%homime%ic dr*$s
"odi+yin$ A*%onomic !er-o*s
ys%em )*nc%ion
3'
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( Alphabloc&ers elimina%e peripheral
-asocons%ric%ion Bs*ally accompanies sympa%he%ic s%im*la%ion
( e%abloc&ers are e++ec%i-e +or %rea%in$0
hronic hi$h blood press*re O%her +orms o+ cardio-asc*lar disease
"odi+yin$ A*%onomic !er-o*s
ys%em )*nc%ion
4,
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( Parasy!pa")o!i!e"ic dr$s may be *sed
%o mimic ac%i-i%y o+ %he parasympa%he%ic
ner-e +ibers
*ch as %o increase ac%i-i%y alon$ %he di$es%i-e
%rac% and %o enco*ra$e de+eca%ion
( Parasy!pa")e"ic (loc#in aen"s %ar$e%
%he m*scarinic recep%ors o+ ne*rom*sc*laror ne*ro$land*lar >*nc%ions
O+%en *sed %o con%rol diarrhea and crampin$
associa%ed i%h +ood poisonin$
"odi+yin$ A*%onomic !er-o*s
ys%em )*nc%ion
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( /i$her order +*nc%ions share %he +olloin$ %hreecharac%eris%ics0 Are per+ormed by %he cerebral cor%ex and in-ol-e
complex in%erac%ions 9n-ol-e conscio*s and *nconscio*s in+orma%ion
processin$ Are s*b>ec% %o modi+ica%ion and ad>*s%men% o-er %ime
/i$her order +*nc%ions