Õîëèíèäýâõèò ñèñòåìä íºëººò ýì

Ï.Áàòõóÿã, ÀÓ-íû äîêòîð, äýä ïðîôåññîð

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Ìýäðýëèéí ñèñòåìèéí á¿òýö

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Ìýäðýëèéí ñèñòåìèéí åðºíõèé á¿òýöORGANIZATION OF THE NERVOUS SYSTEM

BRAINSPINAL CORD

CENTRALNERVOUS

SYSTEM (CNS)

PERIPHERALNERVOUS SYSTEM

AFFERENT

NERVES

EFFERENT

NERVES

EXTERO-RECEPTORS

INTERO-RECEPTORS SOMATIC AUTONOMIC

EFFECTORORGANS

SKELETALMUSCLES

SMOOTH AND CARDIAC MUSCLES

AND GLANDS

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8Âåãåòàòèâ ìýäðýëèéí ñèñòåì (Óðãàë

ìýäðýë)Autonomic Nervous System

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Ïàðàñèìïàòèê áîëîí ñèìïàòèêèéí ýðõòýíä ¿ç¿¿ëýõ íºëºº

Ïàðàñèìïàòèê Ýðõòýí ÑèìïàòèêÌèîç: Í¿äíèé äàðàëò áàãàñíà

Í¿ä Ìèäðèàç: Í¿äíèé äàðàëò

• Ç¿ðõíèé àãøèëò õ¿ч ñóëàðíà

• Ç¿ðõíèé öîõèëò öººðíº

• Ñýðýë äàìæóóëàëò óäààøðàíà

Ç¿ðõ • Ç¿ðõíèé àãøèëò õ¿чæèíý

• Ç¿ðõíèé öîõèëò îëøèðíî

• Ñýðýë äàìæóóëàëò õóðäàñíà

Ààðöãèéí ñóäàñ ºðãºñíº

Ñóäàñ Ñóäàñ íàðèéñч ööóñíû äàðàëò èõñýíý

• Ãèëãýð áóëчèí àãøèæ õºíäèé íàðèéñíà

• Ø¿¿ðýë èõñýíý

Áðîíõ • Ãèëãýð áóë÷èí ñóëàðч õºíäèé òýëíý

• Ø¿¿ðýë áàãàñíà• Ã¿ðâýëçýõ

õºäºë㺺í ýðчèìæèíý

• Ø¿¿ðýë èõýñíý

ÕîîëÁÇ, ØýýñßÇ • ÿðâýëçýõ õºäºë㺺í ñóëàðч

• Ø¿¿ðýë áàãàñíà

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8Âåãåòàòèâ ìýäðýëèéí ñèñòåì

Autonomic Nervous System

Ïàðàñèìïàòèê Çàíãèëàà (Ganglia)

• Ýðõòýíä îéð áàéðëàíà

• Ìèåëèíæñýí àêñîíòîé

Ñèìïàòèê çàíãèëàà Ganglia

• Íóãàñàíä îéð áàéðëàíà

• Çàíãèëààíû ºìíºõ àêñîí íü ìèåëèíæñýí

• Çàíãèëààíû äàðààõ àêñîí íü ìèåëòíæýýã¿é

Æèч:Ñîìàòèê (èõ áèåèéí) ìýäðýë íü çàíãèëààã¿é áàéäàã

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Âåãåòàòèâ ìýäðýëèéí ñèñòåì Autonomic Nervous System

Ìåäèàòîðóóä (Transmitters):

• Acetylcholine: – Ñèìïàòèê áà ïàðàñèìïàòèê 2 çàíãèëààíä

(ALL preganglionic neurons)– Ïàðàñèìïàòèêèéí òºãñãºëä (ALL

parasympathetic postganglionic neurons)

• Norepinephrine (= Noradrenalin):– Ñèìïàòèêèéí òºãñãºëä (MOST

sympathetic postganglionic neurons)– Áàéäàãã¿é íü :

• Sweat glands (Acetylcholine); • Renal arteries (Dopamine)

• Epinephrine (= Adrenalin):– Áººðíèé äýýðõ áóë÷èðõàéí ãîðìîí

(Adrenal medulla)

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Âåãåòàòèâ ìýäðýëèéí ñèñòåì Autonomic Nervous System

Receptors:

• Cholinergic Receptors: – Ì-õîëèíîðåöåïòîð :(Muscarinic)

Ïàðàñèìïàòèêèéí òºãñãºëä(poison of Amanita muscaria)

– Í-õîëèíîðåöåïòîð (Nicotinic):

5 ãàçàðò: • Âåãåòàòèâ çàíãàëàà, • Àðàã ÿñíû áóë÷èí,• Áººðíèé äýýä áóë÷èðõàéí òàðõèëàã äàâõàð, • ÿðýýíèé ò¿¿äãýíöýð, • ÒÌÑ

• Adrenergic Receptors: Ñèìïàòèê ìýäðýëèéí òºãñãºëä áàéíà.– a, b - receptors

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Õîëèíèäýâõèò ñèñòåì Cholinergic System

Cholinergic receptors:• Muscarinic receptors:

,, ãóðâàëò G protein-coupled– CNS, gastric mucosa: M1 – Cardiac: M2– Glandular/Smooth muscle: M3

• Nicotinic receptors:Ion channel-coupled– Muscle type (motor endplate)– Ganglion type– CNS type

Acetylcholine íü ñèíàïñèéí çàâñàðò Acetylcholinesterase ôåðìåíòèéí íºëººãººð õóðäàí çàäàðäàã

Cholinoceptor drugs

AgonistsCholinomimetics

Antagonists

DirectMuscarinic receptors

IndirectAnticholinesterase

Muscarinic (& nicotinic)

Choline esters

Alkaloids

NictonicMuscarinic

Reversible Irreversible

Bethanechol

Pilocarpine Physostigmine

Neostigmine

Ecothiopate

Hexamethonium

Trimethaphan

Bungarotoxin

Atropine

Hyoscine

Tropicamide

Ipratropium

Oxybutyinin

http://www.srcf.ucam.org/~ja297/CHOLINERGIC%20TRANSMISSION.pdf

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Õîëèíèäýâõèò ñèñòåìèéã èäýâõèæ¿¿ëýã÷èäCholinergic System - Agonists

= Cholinomimetics = Parasympathomimetics ñîìàòèê ìýäðýëèéí òºãñãºëä

2 á¿ëýãò àíãèëàãäàíà:

• Øóóä íºëººò (ðåöåïòîðò øóóä íºëººëäºã) (Direct Parasympathomimetics):

– M áîëîí N –õîëèíîðåöåïòîðò : Àöåòèëõîëèí– Çºâõºí M type receptors: Ïèëîêàðïèí)

• Øóóä áóñ íºëººò (ðåöåïòîðò øóóä íºëººëäºãã¿é ìåäèàòîðò íºëººëäºã) Indirect Parasympathomimetics :

– Acetylcholinesterase ôåðìåíòèéã õîðèãëîíî => Àöåòèëõîëèí çàäðàõã¿é òóë ðåöåïòîðò íºëººëºëºë íü èäýâõèæíý.

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Õîëèíèäýâõèò ñèñòåìèéã èäýâõèæ¿¿ëýã÷èä

Cholinergic System - AgonistsÌ-õîëèíîìèìåòèê¿¿ä (Muscarinic

Parasympathomimetics)Pilocarpine:• Àlkaloid in Pilocarpus jaborandi• Í¿äíèé äàðàëò èõñýõ ºâ÷íèé

ýì÷èëãýýíä õýðýãëýíý (glaucoma)Õ¿¿õýí õàðààíû öàãèðàã áóë÷èíã àãøààæ õ¿¿õýí õàðààã íàðèéñãàíà =>Ôîíòàíû çàé ºðãºñ, Øë¸ìûí ñóâàã íýýãäýí í¿äíèé øèíãýíèéí ýðãýõ óðñãàë ñàéæèð÷ í¿äíèé äîòîîä äàðàëò áóóðíà .

• Muscarine:–Àlkaloid in Amanita muscaria–Ýì÷èëãýýíä õýðýãëýäýãã¿é.

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Õîëèíèäýâõèò ñèñòåìèéã èäýâõèæ¿¿ëýã÷èä

Cholinergic System - AgonistsAcetylcholinesterase Inhibitors:=> Àöåòîëõîëèíû çàäðàëò óäààøðàíà => Ò¿¿íèé M áîëîí N

õîëèíîðåöåïòîðò íºëººëºõ èäýâõè íýìýãäýíý.

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8Õîëèíèäýâõèò ñèñòåìèéã èäýâõèæ¿¿ëýã÷èä

Cholinergic System - Agonists

Acetylcholinesterase Inhibitors

Neostigmine:• Í¿äíèé äàðàëò èõñýõ

ºâ÷èí (Glaucoma)• Èõ áèåèéí áóë÷èíãèéí

ñàà, ñààæèëò (Myasthenia Gravis, ïàðåç, ïàðàëè÷

• Ãýäýñíèé ìåõàíèê áóñ ò¿ãæðýëò

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Õîëèíèäýâõèò ñèñòåìèéã èäýâõèæ¿¿ëýã÷èä

Cholinergic System - Agonists

Acetylcholinesterase Inhibitors

• “Horny goat weed” – Epimedium sagittatum– Õîëèíñòåðàçà-ã ñààòóóëæ áóéòàé àäèë íºëººëíº – Ñóäàñíû M3 ðåöåïòîðûã øóóä áóñààð èäýâõèæ¿¿ëæ NO-í

¿¿ñýëòèéã èõýñãýíý => ñóäàñ òýëýãäýíý (Sildenafil (Viagra®).

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Õîëèíèäýâõèò ñèñòåìèéã ñààòóóëàã÷èäCholinergic System - Antagonists

Õîëèíîëèòèê¿¿ä = Cholinolytics

• Muscarinic receptor blockers (Àòðîïèí ã.ì.): • Õîäîîä áîëîí ãóóðñàí õîîëîéí ø¿¿ðëèéã áàãàñãàíà• Ãèëãýð áóë÷èíãóóäûã òýëíý (ãóóðñàí õîîëîé,

í¿äíèé öàãèðàã áóë÷èí, ñôèíêòåð¿¿ä ã.ì.)• Ç¿ðõíèé äîòîîä ñýðýë äàìæóóëàëòûã ñàéæðóóëíà

• Nicotinic receptor blockers:– Âåãåòàòèâ çàíãèëààã õîðèãëîã÷èä (Ganglion-specific

blockers): Àðôîíàä, ïåíòàìèí ã.ì.– Neuromuscular blockers: Èõ áèåèéí áóëчèí

ñóëðóóëàãчèä áóþó Ìèîðåëàêñàíòóóä (Muscle relaxants): Òóáîêóðàðèí, ñóêñàìåòîí, âåêóíîðèé ã.ì.

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Õîëèíèäýâõèò ñèñòåìèéã ñààòóóëàã÷èä Cholinergic System - Antagonists

Ì-õîëèíîëèòèê¿¿ä (Muscarinic Parasympatholytics)Atropine

Chief alkaloid in Atropa belladonna: CNS-stimulant (leaves were used as “asthma cigarettes”)

Hyoscine (=Scopolamine)Chief alkaloid in Datura stramonium: CNS-depressant => antiemetic

(motion sickness)

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Õîëèíèäýâõèò ñèñòåìèéã ñààòóóëàã÷èä Cholinergic System - Antagonists

Ì-õîëèíîëèòèê¿¿ä (Muscarinic Parasympatholytics)Õýðýãëýõ çààëòóóä:• Atropine:

– before anesthesia: prevent hypersecretion of bronchial mucus– Bradycardy– Acetylcholinesterase-inhibitor and mushroom poisoning– Ophtalmology (eye exams)

• Scopolamine:– Motion sickness (as patches)

• Ipratropium:– Inhalation for asthma and bronchitis

• Pirenzepine:– Peptic ulcers: selectively inhibits M1 receptors (gastric mucosa) =>

reduced gastric acid production

• N-Butyl-scopolamine:– Spasmolytic (intestinal or menstrual cramps)

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Õîëèíèäýâõèò ñèñòåìèéã ñààòóóëàã÷èä Cholinergic System - Antagonists

Í-õîëèíîëèòèê¿¿ä (Nicotinic Parasympatholytics):

2 á¿ëýã áîëãîí àíãèëíà (2-óóë ìýäðýã áóë÷èíä õîðèã ¿¿ñãýíý => Èõ áèåèéí áóë÷èíã ñóëðóóëíà (muscle relaxants):

• Çàðèìäàã àíòàãîíèñòóóä (Competitive antagonists = Nondepolarizing blockers)

• Àíòàãîíèñòóóä (Agonists = Depolarizing blockers)

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Õîëèíèäýâõèò ñèñòåìèéã ñààòóóëàã÷èä Cholinergic System - Antagonists

Í-õîëèíîëèòèê¿¿ä (Nicotinic Parasympatholytics)Òóéëøðàë ¿ë ¿¿ñãýí áóë÷èí ñóëðóóëàã÷èä (Nondepolarizing

blockers)• Curare:

– Plant derived arrow poison in S-America– Active ingredient is d-Tubocurarine

– Death occurs through respiratory paralysis– Tubocurarine is not absorbed orally => no risk eating the prey– Tubocurarine was used clinically as muscle relaxant during surgery

but: Tubocurarine triggers histamine release => blood pressure drops

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Õîëèíèäýâõèò ñèñòåìèéã ñààòóóëàã÷èä Cholinergic System - Antagonists

Í-õîëèíîëèòèê¿¿ä (Nicotinic Parasympatholytics)

Òóéëøðàë ¿ë ¿¿ñãýí áóë÷èí ñóëðóóëàã÷èä (Nondepolarizing blockers)

Synthetic quarternary ammonium compounds:

– Replaced tubocurarine as muscle relaxants– No or little histamine release

• Pancuronium long-lasting action (1-2h)Used in lethal injection (together with

barbiturate + KCl)• Vecuronium intermediate-lasting action

(<30min)

• Atracurium intermediate-lasting action

• Mivacurium short action (<15min)

• etc.

Pancuronium

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Õîëèíèäýâõèò ñèñòåìèéã ñààòóóëàã÷èä Cholinergic System - Antagonists

Í-õîëèíîëèòèê¿¿ä (Nicotinic Parasympatholytics)

Òóéëøðàë ¿¿ñãýí áóë÷èí ñóëðóóëàã÷èä (Nondepolarizing blockers)

• Succinylcholine = Suxamethonium– Acts agonistic like AcCh– NOT hydrolyzed by AcCh-esterase

(only by plasma-esterases)– Initial depolarization triggers muscle

twitching– Followed by persistant depolarization

(~10min)– Used for brief procedures (e.g.

intubation; shock therapy)

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Õîëèíèäýâõèò ñèñòåì

Cholinergic System

Ïàðàñèìïàòèê ìýäðýëä íºëººò ýìèéí òîâ÷îîí

(Parasympathetic Drugs – Summary)

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Bolohguu bol micare.mn ees mongol fond uud tataad awaarai