© 2013 Pearson Education, Inc. Muscle Tissue Highly vascularized Responsible for most types of movement Three types Skeletal muscle tissue Found in skeletal muscle Voluntary Cardiac muscle tissue Found in walls of heart Involuntary Smooth muscle tissue Mainly in walls of hollow organs other than heart Involuntary © 2013 Pearson Education, Inc. Skeletal muscle Description: Long, cylindrical, multinucleate cells; obvious striations. Function: Voluntary movement; locomotion; manipulation of the environment; facial expression; voluntary control. Location: In skeletal muscles attached to bones or occasionally to skin. Photomicrograph: Skeletal muscle (approx. 440x). Notice the obvious banding pattern and the fact that these large cells are multinucleate. Striations Nuclei Part of muscle fiber (cell) Figure 4.9a Muscle tissues. Muscle Tissue Skeletal Muscle Location: Skeleton Function: Features © 2013 Pearson Education, Inc. Cardiac muscle Description: Branching, striated, generally uninucleate cells that interdigitate at specialized junctions (intercalated discs). Function: As it contracts, it propels blood into the circulation; involuntary control. Location: The walls of the heart. Photomicrograph: Cardiac muscle (900x); notice the striations, branching of cells, and the intercalated discs. Striations Nucleus Intercalated discs Figure 4.9b Muscle tissues. Muscle Tissue Cardiac Muscle Location: Heart Function: Features © 2013 Pearson Education, Inc. Smooth muscle Description: Spindle-shaped cells with central nuclei; no striations; cells arranged closely to form sheets. Function: Propels substances or objects (foodstuffs, urine, a baby) along internal passageways; involuntary control. Location: Mostly in the walls of hollow organs. Photomicrograph: Sheet of smooth muscle (720x). Smooth muscle cell Nuclei Figure 4.9c Muscle tissues. Muscle Tissue Smooth Muscle Location: Organs and blood vessels Function: Features Neuromuscular Junction NEUROMUSCULAR JUNCTION STRUCTURES AXON TERMINAL End of axon that contacts the muscle cell SYNAPTIC END BULBS Feet on the end of the axon terminal SYNAPTIC VESICLES Inside end bulbs Filled with Acetylcholine (Ach) Muscle- Terms Skeletal muscles Shorten & pull on the bones they are attached to Muscle Attachment Sites: Origin Insertion Origin & Insertion Origin Fixed point where muscles attach to a bone (normally proximal) Insertion Moveable point where muscles attach to bone (normally distal) In some muscles, both attachment points can function as either the origin or insertion Depends on which end is stabilized by other muscles Types of Movement Prime mover (agonist): Main muscle responsible for a particular movement What muscle is the prime mover when you flex your arm? Antagonist: Works in opposition to prime mover Relaxes when prime mover contracts What muscle is an antagonist to the biceps? Synergist: Assists prime mover in producing a moveme.

1. © 2013 Pearson Education, Inc.
Muscle Tissue
Highly vascularized
Responsible for most types of movement
Three types
Skeletal muscle tissue
Found in skeletal muscle
Voluntary
Cardiac muscle tissue
Found in walls of heart
Involuntary
Smooth muscle tissue
Mainly in walls of hollow organs other than heart
Involuntary
© 2013 Pearson Education, Inc.
Skeletal muscle
Description: Long, cylindrical,
multinucleate cells; obvious
striations.
Function: Voluntary movement;
locomotion; manipulation of the
environment; facial expression;
voluntary control.
Location: In skeletal muscles
attached to bones or occasionally
to skin.
Photomicrograph: Skeletal muscle
(approx. 440x). Notice the obvious banding
pattern and the fact that these large cells are

2. multinucleate.
Striations
Nuclei
Part of
muscle
fiber (cell)
Figure 4.9a Muscle tissues.
Muscle Tissue
Skeletal Muscle
Location: Skeleton
Function:
Features
© 2013 Pearson Education, Inc.
Cardiac muscle
Description: Branching, striated,
generally uninucleate cells that
interdigitate at specialized
junctions (intercalated discs).
Function: As it contracts, it
propels blood into the circulation;

3. involuntary control.
Location: The walls of the heart.
Photomicrograph: Cardiac muscle (900x);
notice the striations, branching of cells, and
the intercalated discs.
Striations
Nucleus
Intercalated
discs
Figure 4.9b Muscle tissues.
Muscle Tissue
Cardiac Muscle
Location: Heart
Function:
Features
© 2013 Pearson Education, Inc.
Smooth muscle
Description: Spindle-shaped
cells with central nuclei; no
striations; cells arranged closely

4. to form sheets.
Function: Propels substances or
objects (foodstuffs, urine, a baby)
along internal passageways;
involuntary control.
Location: Mostly in the walls of
hollow organs.
Photomicrograph: Sheet of smooth
muscle (720x).
Smooth
muscle
cell
Nuclei
Figure 4.9c Muscle tissues.
Muscle Tissue
Smooth Muscle
Location: Organs and blood vessels
Function:
Features
Neuromuscular Junction
NEUROMUSCULAR JUNCTION STRUCTURES

5. AXON TERMINAL
End of axon that
contacts the muscle cell
SYNAPTIC
END BULBS
Feet on the end
of the axon terminal
SYNAPTIC VESICLES
Inside end bulbs
Filled with
Acetylcholine (Ach)
Muscle- Terms
Skeletal muscles
Shorten & pull on the bones they are attached to
Muscle Attachment Sites:
Origin
Insertion
Origin & Insertion
Origin
Fixed point where muscles attach to a bone (normally proximal)
Insertion
Moveable point where muscles attach to bone (normally distal)
In some muscles, both attachment points can function as either
the origin or insertion
Depends on which end is stabilized by other muscles
Types of Movement
Prime mover (agonist):

6. Main muscle responsible for a particular movement
What muscle is the prime mover when you flex your arm?
Antagonist:
Works in opposition to prime mover
Relaxes when prime mover contracts
What muscle is an antagonist to the biceps?
Synergist:
Assists prime mover in producing a movement
Types of Movement
Flexion
Makes angle between bones smaller
Extension
Makes angle between two bones larger
Hyperextension
Extension of joint past straight position
Types of Movement
Protraction
Forward movement of jaw or mandible
Retraction
Posterior movement of jaw or mandible
Elevation
Movement upward
Depression
Movement downward

7. Types of Movement
Abduction
Movement away from midline
Adduction
Movement towards the midline
Rotation
Movement around an axis
Circumduction
Circular movement of a structure where the proximal end
remains fixed
Types of Movement
Supination
Palm up or anterior
Pronation
Palm down or posterior
Dorsiflexion
Top of the foot is elevated, toes point upward
Plantar flexion
Bottom of the foot is downward, toes point downward
Muscles that Move the Mandible
Temporalis
O: Temporal bone
I: Coronoid process
What does this muscle do?
Masseter
O: Zygomatic bone& maxilla

8. I: Mandible ramus
What does this muscle do?
Are these muscles synergists or antagonists?
Muscles of Facial Expression
Orbicularis oris
Closes and puckers lips (kissing)
Orbicularis oculi
Closes eyelid
Epicranius
Muscles of Facial Expression
Zygomaticus minor
Raises upper lip
Zygomaticus major

9. Draws angle of mouth up (smiling)
Zygomaticus minor
Zygomaticus major
Activity
Locate the mandible and facial muscles on your models.
Remember to use the WOODEN POINTERS when touching the
models, NOT PENS.
Muscles of the Neck
Platysma
O: Deltoid fascia, pectoralis major
I: Mandible, muscles of mouth
Depresses mandible, pulls lower lip down
Muscles of the Neck
Sternocleidomastoid
O: Sternum & clavicle
I: Mastoid process
Flexes and rotates head

10. Muscles of the Neck
Splenius capitis
O: Thoracic and cervical vertebra
I: Occipital bone
Extends, laterally flexes and rotates head
Six muscles that insert on the exterior surface of the eyeball
Four rectus muscles
Superior rectus
Inferior rectus
Lateral rectus
Medial rectus
Two oblique muscles
Superior oblique
Inferior oblique
Extrinsic Muscles
Rectus muscles
Superior rectus

11. Eyeball movements
Superior
Inferior rectus
Eyeball movements
Inferior
Extrinsic Muscles
Superior rectus
Superior rectus
Inferior rectus
Extrinsic Muscles
Rectus muscles
Lateral rectus
Eyeball movements
Lateral
Medial rectus
Eyeball movements
Medial
Lateral rectus
Medial rectus
Medial rectus
Two oblique muscles
Superior

12. Eyeball movements
Inferior, lateral, and medial
Inferior
Eyeball movements
Superior, lateral, and medial
Extrinsic Muscles
Superior oblique
Inferior oblique
Superior oblique
Activity
Locate the muscles of the neck on your models.
Remember to use the WOODEN POINTERS when touching the
models, NOT PENS.
Muscles that move the Neck and Scapula
Trapezius
O or I: Occipital bone and cervical & thoracic vertebrae
I or O: Scapula & clavicle
Elevates and adducts scapula
Extends neck

13. Muscles that Move Upper Arm
Latissimus dorsi
O: Thoracic & lumbar vertebrae
I: Humerus
Adducts and extends arm
Muscles that Move Upper Arm
Deltoid
O: Clavicle & scapula
I: Humerus
Abducts the arm
Pectoralis major
O: Clavicle, sternum & ribs
I: Humerus
Adducts, flexes, the arm
Anterior Deep Thoracic Muscles
Pectoralis minor
O :3.4,5 ribs
I or O: Coracoid process of scapula
Elevates ribs

14. Abducts and rotates Scapula
Serratus anterior
O or I: Scapula
I or O: Ribs
Stabilizes & abducts scapula
Activity
Locate the muscles of the thorax and arms on your models.
Remember to use the WOODEN POINTERS when touching the
models, NOT PENS.
Muscles that Move Arm
Biceps brachii
O: Coracoid process of Scapula & Edge of glenoid cavity, I:
Radius
Flexes the forearm
Brachialis
O: Humerus, I: Ulna
Flexes forearm
How are these muscles related to each other?

15. Muscles that Move Arm
Brachioradialis
O: Distal humerus, I: Styloid process of the radius
Flexes the forearm
Triceps Brachii
O: Scapula, Humerus, I: Ulna
Long head
Lateral head
Medial head
Extends the forearm
Muscles that Move the Arm
Flexor Group
O (FCR): Medial epicondyle of Humerus
I(FCR): 2nd & 3rd Metacarpals
Flexor carpi ulnaris

16. Flexes and adducts hand
Flexor carpi Radialis(FCR)
Flexes and abducts hand
Carpal Tunnel Syndrome
Repetitive motions cause inflammation and pressure on median
nerve
Extensor Group
O: Humerus
I: Metacarpals and phalanges
Extensor Carpi radialis longus.
Extends hand and fingers & abduct the hands
Extensor carpi ulnaris
Extends and adducts hand
Activity
Locate the muscles of the arm on your models.
Remember to use the WOODEN POINTERS when touching the
models, NOT PENS.

17. Muscles of the Abdominal Wall
Rectus abdominus
O: Pubic crest, Pubic symphysis
I: 5th -7th ribs, xipyhoid process
Compresses abdomen, flexes vertebral column
Rectus Sheath and Linea alba
External oblique
O: Inferior 8 ribs
I: Iliac crest, Linea alba
Compresses abdomen, flexes and rotates vertebral column
Muscles of the Abdominal Wall
Internal oblique
O: Iliac crest, I: last 3 or 4 ribs
Same as external oblique
Transversus abdominis
O: Iliac crest, I: 12th rib, Lumbar vertebrae
Compresses abdomen
Activity
Locate the Muscles of the Abdomen on your models.
Remember to use the WOODEN POINTERS when touching the
models, NOT PENS.

18. Muscles that Move the Thigh
Adductor longus
O: Pubis, I: Femur
Adducts and flexes, rotates thigh
Adductor magnus
O: Pubis, ischial tuberosity, I: Femur
Adducts and flexes, extends rotates thigh
Muscles that Move the Thigh
Gluteus maximus
O: Ilium, sacrum, I: Femur
Extends the thigh
Gluteus medius
O: Ilium(lateral surface) I: Greater trochanter of femur
Abducts the thigh

19. Muscles that Move the Thigh
Iliopsoas (2 parts)
Iliacus + Psoas major
O: Lumbar vertebrae, Ilium
I: Lesser trochanter of Femur
Flex the thigh
Tensor faciae latae
O: Ilium
I: Tibia
Flexes and abducts thigh
Muscles that Move the Leg
Sartorius
O: Ilium, I: Tibia
Flexes knee laterally rotates thigh
Muscles that Move the Leg
Quadraceps femoris:
Rectus femoris
O: Iliac spine
I: Patella
Extends knee.
Vastus lateralis, medialis, intermedius

20. O: Femur
I: Tibia, patella
Extends knee
Muscles that Move the Leg
Hamstring muscles:
Semimembranosus (medial)
Semitendinosus (medial)
Biceps femoris (lateral)
O(BF): Ischial tuberosity.linea aspera of femur.
I: Fibula & Tibia
Flex knee .
Activity
Locate the Muscles of the leg on your models.
Remember to use the WOODEN POINTERS when touching the
models, NOT PENS.

21. Muscles that Move the Foot
Tibialis anterior
O- Tibia, I-Cuneforms & Metatarsals
Dorsiflexes foot
Muscles of the Calf
Gastrocnemius
O: Medial and lateral condyl of femur
I: Calcaneus
Planter flexes foot.
Soleus
O: Fibula & Tibia
I: Calcaneus
Planter flexes foot
Calcaneal (Achilles) tendon
Point of attachment for to calcaneus for soleus and
gastrocnemius
54
Tendons & Fascia
Calcaneal (Achilles) tendon
Rectus Sheath
Linea alba

22. Inferior and Lateral View
Gastrocnemius
Activity
Locate the Muscles of the Foot on your models.
Remember to use the WOODEN POINTERS when touching the
models, NOT PENS.
Attention Deficit Hyperactivity
Disorder
A Young Girl With ADHD
At each decision point stop to complete the following:
Decision #1,#2,#3
Which decision did you select?
Why did you select this decision? Support your response with
evidence and references to the Learning Resources.
What were you hoping to achieve by making this decision?
Support your response with evidence and references to the
Learning Resources.
Explain any difference between what you expected to achieve
with Decision #1 and the results of the decision. Why were they
different?

23. BACKGROUND
Katie is an 8 year old Caucasian female who is brought to your
office today by her mother & father. They report that they were
referred to you by their primary care provider after seeking her
advice because Katie’s teacher suggested that she may have
ADHD. Katie’s parents reported that their PCP felt that she
should be evaluated by psychiatry to determine whether or not
she has this condition.
The parents give the PMHNP a copy of a form titled “Conner’s
Teacher Rating Scale-Revised”. This scale was filled out by
Katie’s teacher and sent home to the parents so that they could
share it with their family primary care provider. According to
the scoring provided by her teacher, Katie is inattentive, easily
distracted, forgets things she already learned, is poor in
spelling, reading, and arithmetic. Her attention span is short,
and she is noted to only pay attention to things she is interested
in. The teacher opined that she lacks interest in school work and
is easily distracted. Katie is also noted to start things but never
finish them, and seldom follows through on instructions and
fails to finish her school work.
Katie’s parents actively deny that Katie has ADHD. “She would
be running around like a wild person if she had ADHD” reports
her mother. “She is never defiant or has temper outburst” adds
her father.
SUBJECTIVE
Katie reports that she doesn’t know what the “big deal” is. She
states that school is “OK”- her favorite subjects are “art” and
“recess.” She states that she finds her other subjects boring, and
sometimes hard because she feels “lost”. She admits that her
mind does wander during class to things that she thinks of as
more fun. “Sometimes” Katie reports “I will just be thinking
about nothing and the teacher will call my name and I don’t
know what they were talking about.”
Katie reports that her home life is just fine. She reports that she
loves her parents and that they are very good and kind to her.

24. Denies any abuse, denies bullying at school. Offers no other
concerns at this time.
MENTAL STATUS EXAM
The client is an 8 year old Caucasian female who appears
appropriately developed for her age. Her speech is clear,
coherent, and logical. She is appropriately oriented to person,
place, time, and event. She is dressed appropriately for the
weather and time of year. She demonstrates no noteworthy
mannerisms, gestures, or tics. Self-reported mood is euthymic.
Affect is bright. Katie denies visual or auditory hallucinations,
no delusional or paranoid thought processes readily appreciated.
Attention and concentration are grossly intact based on Katie’s
attending to the clinical interview and her ability to count
backwards from 100 by serial 2’s and 5’s. Insight and judgment
appear age appropriate. Katie denies any suicidal or homicidal
ideation.
Diagnosis: Attention deficit hyperactivity disorder,
predominantly inattentive presentation
Decision Point One
Begin Wellbutrin (bupropion) XL 150 mg orally daily
Begin Intuniv extended release 1 mg orally at BEDTIME
Begin Ritalin (methylphenidate) chewable tablets 10 mg orally
in the MORNING
Decision Point Two
Continue same dose of Ritalin and re-evaluate in 4 weeks
Change to Ritalin LA 20 mg orally daily in the MORNING
Discontinue Ritalin and begin Adderall XR 15 mg orally daily
Decision Point Three
Change to Ritalin LA 20 mg orally daily in the morning
Obtain a STAT EKG
Discontinue Ritalin and begin Adderall (amphetamine d, l) 10
mg orally daily

25. RESOURCES
§ Conners, C. K., Sitarenios, G., Parker, J. D. A., & Epstein, J.
N. (1998). Revision and restandardization of the Conners'
Teacher Rating Scale (CTRS-R): Factors, structure, reliability,
and criterion validity. Journal of Abnormal Child Psychology,
26, 279-291.
Stahl, S. M. (2013). Stahl’s essential psychopharmacology:
Neuroscientific basis and practical applications (4th ed.). New
York, NY: Cambridge University Press.
To access the following chapters, click on the Essential
Psychopharmacology, 4th ed tab on the Stahl Online website
and select the appropriate chapter. Be sure to read all sections
on the left navigation bar for each chapter.
· Chapter 12, “Attention Deficit Hyperactivity Disorder and Its
Treatment”
Stahl, S. M., & Mignon, L. (2012). Stahl’s illustrated attention
deficit hyperactivity disorder. New York, NY: Cambridge
University Press.
To access the following chapter, click on the Illustrated Guides
tab and then the ADHD tab.
· Chapter 4, “ADHD Treatments”
Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New
York, NY: Cambridge University Press.
Study guide for A & P 1 –Exam 4.
The names of the fiber tract that arise from the primary motor
cortex (precentral gyrus).
The layers of meninges in the brain compared to that in the
spinal cord. Also the names and composition of the spaces
between the meninges.

26. The production of cerebrospinal fluid(CSF) in the ventricles, its
rate of production per day, its pathway of flow within the brain,
its circulation within and around the brain, and how it is able to
get back into the blood circulation through the superior sagittal
sinus.Composition of CSF.
Structures in the brain associated with memory.Also the
categories of memory.
Anatomy of autonomic nervous system (ANS), including the
names and location of the ganglia. Know also the characteristic
of ANS (Sympathetic and parasympathetic).Know the
distribution of the ANS to the effectors. Know the differences
between paravertebral and prevertebral ganglia of sympathetic
division of ANS .Know what form the splanchnic nerve in the
sympathetic division.Also know which brach of ANS is ‘resting
and digestion’.Major route of parasympathetic outflow to the
body.
Know the comparison between autonomic and somatic nervous
system.
Know the center in the brain that controls/regulates
wakefulness.
Effects of binding of acetylcholine(ACH) to nicotinic receptor.
Also the locations of nicotinic, muscarinic receptors.
The meaning of dual innervation and the exception to dual
innervation.Also the unique characteristic of adrenal medulla
(How it is different from other ANS effectors).
The components of blood-brain barrier and how it is different
from what operate in other body tissues.Also know some
chemical that the blood brain barrier is not effective against.
The parts of the cerebral cortex that is involved in speech
production, understanding speech, sight (seeing), hearing and
recognizing an object. Also the functional area of the cortex
that control cognition.Know the general function/role of
cerebral cortex.
Damage to what part of the brain result in Parkinsonism.
The functions of hypothalamus.The effects of damage to the
hypothalamus.

27. The meaning of cerebral activities being contralateral.
Effects of a cut/severe to the vagus nerve, especially on the
heart.
Locations of dural septa (falx cerebri, falx cerebelli, tentorium
cerebelli) in the brain
Effects of binding of norepinephrine to beta receptors in the
heart and lung.
What linking of new facts with old ones already stored is called
Pathway of fiber communication within and between the
cerebral hemispheres.
Pathway of sending sympathetic signals from the brain to the
rectum. Also pathway of sending parasympathetic signals from
the brain to the urinary bladder.
Effects of sympathetic division of ANS on blood vessels of the
skeletal muscles. Also the effects of the sympathetic division of
ANS on organs like the stomach, lungs, salivary glands, pupils,
and gastric glands.
Effects of disorder of premotor cortex.
The differences between sulci and gyri,and also fissures.
Somatic vs. AutonomicVoluntarySkeletal muscleSingle efferent
neuronAxon terminals release acetylcholine Always
excitatoryControlled by the cerebrumInvoluntary Smooth,
cardiac muscle; glandsMultiple efferent neuronsAxon terminals
release acetylcholine or norepinephrineCan be excitatory or
inhibitoryControlled by the homeostatic centers in the brain –
pons, hypothalamus, medulla oblongata
ANS Versus Somatic Nervous System (SNS)The ANS differs
from the SNS in the following three areasEffectorsEfferent

28. pathwaysTarget organ responses
Somatic vs. Autonomic Nervous SystemBoth have motor
fibersDiffer in:EffectorsEfferent pathwaysANSPreganglionic
neuronGanglion Postganglionic neuronTarget organ responses
to neurotransmitters
*
Efferent PathwaysHeavily myelinated axons of the somatic
motor neurons extend from the CNS to the effectorAxons of the
ANS are a two-neuron chainThe preganglionic (first) neuron has
a lightly myelinated axonThe ganglionic (second) neuron
extends to an effector organ
Neurotransmitter EffectsAll somatic motor neurons release
Acetylcholine (ACh), which has an excitatory effectIn the
ANS:Preganglionic fibers release AChPostganglionic fibers
release norepinephrine or ACh and the effect is either
stimulatory or inhibitoryANS effect on the target organ is
dependent upon the neurotransmitter released and the receptor
type of the effector
Comparison of Somatic and Autonomic Systems
Figure 14.2

29. ANS ArchitectureBoth ANS divisions share the same general
structure. Autonomic pathways always consist of 2 neurons in
series.They synapse in an autonomic ganglion – would this be
inside or outside the CNS?The 1st neuron in the autonomic
pathway is the preganglionic neuron, Cell body in CNS,
myelinated, and projects to the autonomic ganglion.While the
2nd neuron is the postganglionic neuron.Cell body in autonomic
ganglion, unmyelinated, and projects to the effector.
ANS Divisions & Dual Innervation
*
Exceptions To Dual InnervationAdrenal medullaSweat
glandsArrector piliKidneysMost blood vessels
*
AUTONOMIC NERVOUS SYSTEM
Regulates (examples)GlandsBlood glucoseBody
temperatureOsmotic balanceCardiac muscleHeart rateBlood
pressureSmooth muscleDigestionWaste disposalBreathing

30. Lecture 4
Organization of the Autonomic Nervous System (ANS)
Central components:
hypothalamus
brain stem
spinal cord
Peripheral components
sympathetic nerves
parasympathetic nerves
Autonomic Nervous System (ANS)The ANS consists of motor
neurons that: Innervate smooth and cardiac muscle and
glandsMake adjustments to ensure optimal support for body
activitiesOperate via subconscious controlHave viscera as most
of their effectors
ANS Anatomy
Distinctions between divisionsUnique origin siteRelative
lengths of fibersGanglia location
*
Parasympathetic Division
Craniosacral divisionCranial outflowSacral outflow

31. *
Role of the Parasympathetic DivisionConcerned with keeping
body energy use lowInvolves the D activities – digestion,
defecation, and diuresisIts activity is illustrated in a person who
relaxes after a mealBlood pressure, heart rate, and respiratory
rates are lowGastrointestinal tract activity is highThe skin is
warm and the pupils are constricted
Sympathetic Nervous SystemThoracolumbarMore complex
*
*
Role of the Sympathetic DivisionThe sympathetic division is the
“fight-or-flight” systemInvolves E activities – exercise,
excitement, emergency, and embarrassmentPromotes
adjustments during exercise – blood flow to organs is reduced,
flow to muscles is increasedIts activity is illustrated by a person
who is threatenedHeart rate increases, and breathing is rapid
and deepThe skin is cold and sweaty, and the pupils dilate

32. Lecture 4
*
A dynamic balance between sympathetic and parasympathetic
activity maintains homeostasis in the body.
The sympathetic division helps us during fight or flight
situations, while the parasympathetic division helps us during
times of rest and calm
Antagonistic ControlMost internal organs are innervated by
both branches of the ANS which exhibit antagonistic control.A
great example is heart rate. An increase in sympathetic
stimulation causes HR to increase whereas an increase in
parasympathetic stimulation causes HR to decrease.
Sympathetic OutflowArises from spinal cord segments T1
through L2Sympathetic neurons produce the lateral horns of the
spinal cordPreganglionic fibers pass through the white rami
communicantes and synapse in the chain (paravertebral)
gangliaFibers from T5-L2 form splanchnic nerves and synapse
with collateral ganglia Postganglionic fibers innervate the
numerous organs of the body
2.bin

33. Sympathetic Trunks and PathwaysThe paravertebral ganglia
form part of the sympathetic trunk or chainTypically there are
23 ganglia – 3 cervical, 11 thoracic, 4 lumbar, 4 sacral, and 1
coccygeal
Sympathetic Chain GangliaEach paravertebral ganglion is
connected to spinal nerves by 2 branchesWhite communicating
ramusGrey communicating ramusFlow in 3 different ways
*
Sympathetic Trunks and PathwaysA preganglionic fiber follows
one of three pathways upon entering the paravertebral
gangliaSynapse with the ganglionic neuron within the same
ganglionAscend or descend the sympathetic chain to synapse in
another chain ganglionPass through the chain ganglion and
emerge without synapsing
Neurotransmitters and ReceptorsAcetylcholine (ACh) and
norepinephrine (NE) are the two major neurotransmitters of the
ANSACh is released by all preganglionic axons and all
parasympathetic postganglionic axonsCholinergic fibers – ACh-
releasing fibers Adrenergic fibers – sympathetic postganglionic
axons that release NE Neurotransmitter effects can be excitatory
or inhibitory depending upon the receptor type

34. Cholinergic ReceptorsThe two types of receptors that bind ACh
are nicotinic and muscarinicThese are named after drugs that
bind to them and mimic ACh effects
Nicotinic ReceptorsNicotinic receptors are found on:Motor end
plates (somatic targets)All ganglionic neurons of both
sympathetic and parasympathetic divisionsThe hormone-
producing cells of the adrenal medullaThe effect of ACh
binding to nicotinic receptors is always stimulatory
Muscarinic ReceptorsMuscarinic receptors occur on all effector
cells stimulated by postganglionic cholinergic fibersThe effect
of ACh binding: Can be either inhibitory or excitatoryDepends
on the receptor type of the target organ
Adrenergic ReceptorsThe two types of adrenergic receptors are
alpha and betaEach type has two or three subclasses
notable exception –
stimulatory whereas binding to B2 receptor on the bronchioles
is inhibitory
Sympathetic vs. Parasympathetic

35. Receptor/NT Differences:
Symp . Parasymp.NT at Target
SynapseNorepinephrine
(adrenergic neurons)Acetylcholine
(cholinergic neurons)Type of NT Receptors at Target
SynapseAlpha and Beta
GanglionAcetylcholineAcetylcholineReceptor at
GanglionNicotinicNicotinic
Local vs. Diffuse EffectsThe parasympathetic division has more
localized effects for two reasons:ACH is quickly destroyed by
acetylcholinesteraseParasympathetic preganglionic axons
synapse with few ganglionic neuronsThe sympathetic effects are
more diffuse:NE is taken back up by the preganglionic
neuronSympathetic preganglionic neurons synapse with many
ganglionic neurons

36. *
Duration/Location of Parasympathetic EffectsParasympathetic
preganglionic neurons synapse on only a few postganglionic
neurons.
Would you expect parasympathetic activity to be
widespread or local?
All parasympathetic fibers release ACh.ACh is quickly broken
down by what enzyme?
What can you say about the duration of parasympathetic
effects?
Why Is Sympathetic Activity Diffuse?Preganglionic fibers have
their somata in the lateral horns of the thoracic and lumbar
spinal cord.Preganglionic fibers leave the cord via the ventral
root and enter a white ramus communicans to enter a chain
ganglion – which is part of the sympathetic trunk.Prolonged by
stimulation of ADRENAL MEDULLA
How Does the Brain Control the ANS?The hypothalamus is the
Boss:Its anterior and medial regions direct parasympathetic
function while its posterior and lateral regions direct
sympathetic functionThese centers exert control directly and via
nuclei in the reticular formation (e.g., the cardiovascular
centers in the MO, respiratory centers in MO and pons, etc.)The
connection of the limbic system to the hypothalamus mediates

37. our “flight or flight” response to emotional situations.The
relationship btwn the hypothalamus and the amygdala and
periaquaductal gray matter allow us to respond to fear
(emotion).
REGULATION OF AUTONOMIC NERVOUS SYSTEM
HYPOTHALAMUSMajor control and integration
centerReceives input on Smell, tasteTemperatureChemical
composition
of bloodVisceral changesEmotionsSends commands
throughMedulla and spinal cord
Lecture 4
*
The hypothalamus is a critical site of much of autonomic
control*Nuclei in centers here control the activities of the
autonomic nervous system, and also the pituitary gland
Identify the muscle used to bring the thigh in this position.

38. Identify three muscles used to bring the leg in this position
Identify the muscle used to bring the eye in this position.
What muscle is responsible for bringing the mouth in this
position?
1
2
3
4
Identify the muscle
What is the action?
What is the insertion of #6?
What is the origin of #6?
5
6
Identify the muscle 7a. What is the action 7b. Identify one
antagonist
Identify the muscle 8a. What is the action 8b. Identify one

39. synergist
7
8
9
Identify the muscle
What is the action?
Identify the muscle
What is the action?
Identify the muscle
What is the action?
13. Identify the muscle
What is the action if one origin contracts?
What is the action of both origins contract?
Identify one synergist
Identify one antagonist
10
11
12
13
Identify the muscle
Identify one antagonist
Identify the muscle

40. What is the action?
Identify the muscle
What is the action?
Identify the muscle
What is the action?
Identify the muscle
What is the action?
Identify one antagonist
15
16
17
18
14
Identify the muscle
What is the action?
Identify three synergists.
Identify one antagonist
Identify the muscle
What is the action?
Identify the muscle
What is the action?
Identify one antagonist.
20
21

41. 22. Identify the structure
Why is it ruffled?
Identify the structure
Identify the structure
What is the function?
Identify the structure
What is the function?
Identify the muscle used to bring the hand in this position.
Identify the muscle used to bring the hand in this position
26
27
Identify the muscle
Identify the muscle
Identify the muscle
Name 3 antagonists
28
29
30

42. Identify two muscles used to bring the foot in this position
Identify one antagonist