Chapter 15 Neuromuscular Physiology Flashcards
(166 cards)
1
Q
Which part of the CNS controls head, neck, and below the belt?
A
Parasympathetic
2
Q
Which part of the CNS controls between neck and belt (thoracolumbar)?
A
Sympathetic
3
Q
Main inhibitory neurotransmitter in brain?
A
GABA
4
Q
Main inhibitory neurotransmitter in spinal cord?
A
glycine
5
Q
What toxins block glycine?
A
tetanus and strychnine
6
Q
main excitatory neurotransmitter
A
glutamate
7
Q
mostly excitatory neurotransmitter and stimulates NMDA pathway
A
Aspartate
8
Q
an Alzheimer drug that inhibits the prolonged influx of Ca ions to prevent excitotoxicity in NMDA pathway
A
Memantine
9
Q
Monoamines
A
serotonin, doopamine, epinephrine, norepinephrine, histamine
10
Q
used to make epinephrine and norephinephrine
A
dopamine (need tyrosine!)
11
Q
5 areas dopamine is used in brain
A
- chemotactic trigger zone and area postrema (vomiting centers)
- mediates psychosis antipsychotics are dopamine blockers
3.mesolimbic system (urges): makes you feel “high” - hypothalamus to inhibit prolactin (high levels of prolactin block GnRH and TRH)
- Basal ganglia and refining movement
12
Q
What will increase with dopa inhibiting antipsychotic meds?
A
prolactin
13
Q
dopa blocker to inhibit vomiting in children
A
promethazine
14
Q
dopa blocker to inhibit vomiting in adults
A
prochlorperazine
15
Q
methyl donor everywhere except for in nucleotides
A
SAM (S-adenosyl methionine)
16
Q
methyl donor in nucleotides?
A
THF
17
Q
Is epinephrine a neurotransmitter or a hormone?
A
hormone
18
Q
at low levels epinephrine will stimulate which receptors?
A
B2
19
Q
at high levels epinephrine will stimulate which receptors
A
alpha 2 (constrict vessels, up BP)
20
Q
Which system does serotonin control?
A
RAS reticular activating system (helps you wake up and focus and located in raphe nucleus)
21
Q
toxic dose of SSRI or interact with TCAs, flushing, wheezing, diarrhea, clonus, and hyperreflexia
A
serotonin syndrome
22
Q
DOC serotonin syndrome
A
cyproheptadine
23
Q
serotonin blocker in peripheral nervous system
A
octreotide
24
Q
What serotonin blocker helps with GI vomiting?
A
ondansetron, granesetron
25
How does capsaicin stop pain?
blocks substance P (neuro polypeptide)
26
most abundant neuro polypeptide?
neuropeptide Y
27
main opioids
beta endorphins, dynorphins, enkelphalins
28
what electrolyte do opioids work on
cause K to leave cell making cell more negative, harder to depolarize
29
marijuana high symptoms
1. blood shot eyes 2) hunger 3) laughter 4)paranoia
30
what amino acid makes NO
L-arginine
31
MOA nitric oxide
stimulates cGMP to vasodilate
32
What neurotransmitter does the sympathetic nervous system use at the pre ganglionic fibers?
Ach
33
What neurotransmitter does the parasympathetic nervous system use at the post ganglionic fibers?
norepinephrine
34
What does the sympathetic system use as second messenger?
cAMP (unless it is smooth muscle contraction which is IP3/DAG or smooth muscle distention which is calmodulin)
35
What breaks down Dopamine pre-synaptically?
MAO
36
What breaks down dopamine post synaptically?
COMT
37
what is Dopamine broken down into?
HVA
38
What is norepinephrine and epinephrine broken down into?
VMA and metanephrines
39
Which amino acid makes serotonin?
tryptophan
40
What is the rate limiting step?
tryptophan hydroxylase
41
What is the breakdown product of serotonin?
5HIAA
42
pt on SSRi and you want to switch to MAOi, how many weeks must you wait?
4 weeks
43
If on MAOi and you want to give SSRI, wait how many weeks?
2 weeks
44
What neurotransmitter is used for most parasympathetic receptors except ganglia or neuromuscular junctions (skeletal muscles)?
muscarinic
45
Which neurotransmitter is for parasympathetic receptors in ganglia and neuromuscular junctions ?
nicotinic
46
What do the M1 receptors control?
CNS, secretions
47
What do the M2 receptors control?
heart(bradycardia); decreased contractility
48
What do the M3 receptors control?
smooth muscle contraction like bladder, lungs, GI; miosis, and ciliary muscles to increase accomodation (adjusting to near and far objects)
49
Myasthenia gravis treatment
pyridostigmine
50
used to diagnose asthma
methacholine
51
used for post op urinary retention
bethanechol, carbachol
52
for glaucoma
pilocarpine
53
acetylcholinesterase inhibitors
organophosphates
54
tx for organophosphate poisoning
1) strip off clothing
2) atropine
3)pralidoxime
55
What are COMT inhibitors used for?
Parkinson's to decrease degradation of dopa agonists
56
antimuscarinic for travel sickness?
scopolamine
57
antimuscarinic for COPD
ipratropium, tiotropium
58
anticholinergic used for dystonia
benztropine
59
best tx of dystonia
benadryl (easier to buy and cheaper)
60
used for surgery to dry up secretions
glycopyrrolate
61
tx for urge incontinence in adults
oxybutynin and toterodine
62
sympathetic receptors, nicotinic or muscarinic?
nicotinic, except for sweat which is muscarinic
63
alpha 1 agonists?
vasocontrict, tighten sphincters, mydriasis
64
alpha 1 antagonists
loosen sphincters and constrict pupils
65
DOC for septic shock
norepinephrine
66
DOC for anaphylactic shock
epinephrine
67
most common decongestant
ephedrine
68
best for allergies
pseudo-ephedrine (Sudafed) Sudafed can be used for incontinence until you figure out what is the cause.
69
DOC for neurogenic shock
phenylephrine
70
tx for pheochromocytoma
phenoxybenzamine
71
tx for BPH
terazosin, doxazosin
72
Where can alpha 2 receptors be found?
all presynaptic fibers to prevent norepinephrine release; in islet cells of pancreas to prevent insulin release
73
alpha 2 agonist
clonidine (behavior medicine); alpha methyldopa (HTN for second /third trimester pregnancy; doesn't cross the placenta but could cause hemolytic anemia; mirtazapine (antidepressant that causes weight gain)
74
Where are beta 1 receptors found?
CNS,SA node, JG apparatus; alpha cells of glucagon release
75
beta 1 drugs
isoproterenol; metaproterenol both beta 2 and beta 1 not used much
76
beta 2 agonists
brochodilation (albuterol)terbutaline (preterm labor); salmeterol (LABA)
77
starts with A-M, but not C &L Beta 1 or Beta 2 blocker?
beta 1 blocker
78
When to use beta 1 blocker?
heart failure, COPD, advanced heart block, diabetes, peripheral vascular disease
79
#1 beta blocker for stage fright?
propranolol
80
shortest acting beta blocker
esmolol
81
for open angle glaucoma
timilol
82
blocks potassium channel (Class III antiarrhythmic)
Soltalol
83
HTN crisis or pheochromocytoma
labetalol, cardivelol
84
reduce mortality after MI
carvedilol, bisoprolol, metoprolol
85
How does morphine inhibit pain after injury?
causes K to leak out and hypopolarize the cell, harder to depolarize, lower pain
86
Which muscle doesn't need outside calcium to make it start working?
skeletal muscle (smooth and cardiac use outside Ca to stimulate inside Ca use for contraction)
87
What do you need for anterograde movement (forward) in a nerve?
kinesin
88
what do you need for retrograde (backward) movement in a nerve?
dynein
89
ACH at neuromuscular junction depolarizes myocytes which depolarizes T tubules to release DHP protein which stimulates ryanodine arm in cytoplasm which opens sarcoplasmic reticulum to open letting Ca into cytoplasm and lead to contraction
true
90
drugs that block Ca
penicillamine
dimercaprol (BAL)
EDTA
91
what receptors do botulin toxn block
block SNARES from binding to presynaptic terminals; no AcH release, hypotonia, paralysis of diaphragm, death
92
Do you need ATP for muscle contraction?
No, only need for muscle release
93
How does a myocyte cause muscle contraction?
calcium binds troponin C; troponin C releases troponin I(inhibitory); Troponin I releases tropomyosin which will release the actin binding site to let myosin bind with actin.
94
How does release from contraction work?
myosin binds to ATP and hydrolyzes it, splitting of P to provide energy for release
95
What happens after release?
troponin I will cover tropomyosin, troponin C will bind troponin I, and Ca ATPase will pump Ca back into sarcoplasmic reticulum
96
Eaton Lambert Syndrome
hard time sequestering Ca; Ca builds up in cytoplasm and get severe muscle spasms
2nd cause of Eaton Lamber Ab to Ca vesicles
97
middle aged male with chest pain first three differentials
1. acute MI
2. dissection of aorta
3. angina
98
first sign of ischemia on EKG
peaked T wave (K leaked out); followed by ST depression
99
tx of unstable angina or MI
1. oxygen 2. aspirin 3.morphine 4. betablocker 5. heparin (if not contraindicated) 6. clopidogrel/ticagrelor 7. ACEi 8 atorvastatin
stop metformin (interacts with contrast); stop CCB; can also give nitrates and tPA if needed and not contraindicated
100
inflammation timeline
1. cell swells because Na/K pump stopped working
2. 4. 5 hours neutrophils, predominate in 24 hours, peak in 3 days
3. Tcells and macrophages show up day 4 peak day 7
4. fibroblast show up day 7, peak 30 days, completion 6 months
101
If you cannot get patient to PCI hospital in 2 hours, give tPA immediately and transfer
102
indication for bypass
70% or more stenosis of left main and LAD plus circumflex
70% or more occulusion in 3 or more vessels
70% or more occulsion in 2 vessels in a diabetic
103
after stent replacement: if bare metal stent replacement what anticoagulant shouldyou use
aspirin + clopidogrel 30 days then stop clopidogrel and continue aspirin for life
104
if you have drug eluting stent ?
aspirin and clopidogrel for one year; after one year just aspirin for life
105
If you see T wave inversion on MI EKG which drug should you start and why?
Lidocaine to prevent v fib
106
What is the functional unit of muscle called?
sarcomere
107
The band between the two sarcomeres that contains only actin molecules?
I band
108
The band that will shorten when muscles contract?
A band
109
The band that contains CPK?
M line
110
Who usually has higher CPK and why?
Men usually have higher CPK than women because they have more muscle mass.
111
If CPK is higher than expected, which conditions should you consider?
myositis, polymyositis, dermatomyositis
112
MCC of myositis
hypothyroidism 2. statins or any fat soluble drug
113
drugs that cause myositis (F-RIPS)
Fibrates, Rifampin, INH, Prednisone, Statins
114
What marker is involved in polymyositis and dermatomyositis that signals lung fibrosis?
Anti-Jo1 (antithyroid synthatase)
115
MCC of rhabdomyolysis?
crush injury (trauma)
116
what marker is increased in rhabdomyolysis?
myoglobin
117
How can you prevent injury to kidney in crush injury?
Use IV fluids and bicarbs before lifting off object causing crush injury.
118
What is calcium dependent calcium release?
when extracellular calcium is used to cause intracellular calcium release (ventricles of heart)
119
hyperactive bowel sounds
obstruction
120
rebound, significant guarding or rigidity
peritonitis
121
bowel sounds increased
gastroenteritis or GI obstruction
122
MCC of ileus (bowels don't move)
hypokalemia
123
diastolic heart failure
hypertrophy of ventricles, cannot fill fully
124
best NSAID for muscle spasm after strain?
baclofen
125
joint sprain RICE
rest, ice, compression and elevation
126
muscle strain or sprain, ice or heat?
heat
127
Tx CHF (left sided)
1. oxygen (for brain) 2. diuretics to lessen EDV and heart strain 3.inotropics digoxin, dobutamine 4)ACEi/ARB (decrease TPR)
128
clue: orthopnea, paroxysmal nocturnal dyspnea
left sided heart failure (crackles)
129
tx for right sided heart failure
fluids (Frank-Starling) increase volume, increase contractility (don't take PCWP any higher than 18)
130
MOA digitalis
blocks Na/K by competing with K; be careful to monitor Ca levels because if Ca gets trapped in cell, too much contractility
131
tx for digitalis toxicity
digibind, digifab
132
now first line drug MOA Sacubitril
inhibits neprilysin which normally breaks down ANP, increase ANP increase blood flow to kidneys eliminating excess fluid
133
ADH blockers
Conivaptan, Tolvaptan
134
MC cause of death in neuromuscular pathologies
respiratory failure (diaphragm)
135
What can you get from eating raw bear meat? and what can it do?
trichenella spiralis; cause myositis
136
What other parasite can cause myositis?
taenia solium
137
dermatomyositis: you must rule out?
colon cancer; must order CT of the abdomen
138
TX fibromyalgia
SSRI; gabapentin (serotonin modulates pain); amytriptyline
139
TX fibromyalgia
SSRI; gabapentin (serotonin modulates pain); amitriptyline
140
#1 for chronic pain
amitriptyline
141
chronic pain and HF
gabapentin
142
shooting stabbing pain
carbamazepine
143
next step in management for temporal arteritis
steroids (before biopsy or other investigations)
144
tx for polymyalgia rheumatica and temporal arteritis?
prednisone (rule of 60s: age more than 60; ESR more than 60 need 60 mg of prednisone daily)
145
early onset (Duchenne's muscular dystrophy) most likely to be caused by what kind of mutation?
frameshift or nonsense
146
later onset (Becker's) most likely what kind of mutation?
missense
147
muscular dystrophy of trinucleotide repeats
myotonic CGT cataracts, gonads, toupee (also birds beak appearance because of tightness of muscles)
148
autoimmune attack after C. jejuni?
Guillain Barre
149
TX Guillain Barre
IVIG, steroids
150
What is attacked in Argyll Robertson pupil and which microbe is responsible?
Edinger-Westphal nucleus of eyes; cause is tertiary syphilis
151
tx for cholinergic crisis in myasthenia gravis
atropine to reverse effects and lessen dose of neostigmine
152
autoimmune disease associated with neoplasia where presynaptic Ca channels are blocked
Eaton-Lambert
153
Reversible anticholinesterase used for myasthenia gravis?
neostigmine
154
irreversible anticholinesterase used as pesticides
end in --thion (Malathion, Parathion)
155
antidote for anticholinesterase toxicity
1. atropine 2. pralidoxime (2-PAM); don't forget if someone who works on farm comes in; cut off all their clothes
156
which neuropathy of children that have arysulfatase enzyme deficiency causes demyelination of neurons?
metachromatic leukodystrophy
157
Tx for neuropathyies (MS and Metachromatic leukodystrophy)
steroids, IV gamma globulins, plasmapheresis if respiratory compromise
158
descending paralysis; UMN and LMN; fasciculations; CST and ventral horn involvement; no sensory neuron involvement
Amyotrophic Lateral Sclerosis (ALS)
159
newborn floppy baby syndrome; no motor neurons
Werdnig Hoffman's Disease
160
enterovirus hides in the dorsal root ganglia
POLIO
161
GAA trinucleotide repeat
Friedreich's Ataxia
162
Carnitine acyltransferase 1 deficiency; X linked recessive; cortical white matter involvement; adrenal gland failure
adrenoleukodystrophy (fatty acids trapped in cytoplasm, can't get to mitochondria, no ketones)
163
permanent neurological damage before age 21
cerebral palsy
164
midline cortical problem, legs worse than arms
spastic diplegia (UMN)
165
cortical problem on one side of body; one side more affected than other ; could be caused by herpes (temporal lobe) or toxoplasmosis (parietal lobe)
spastic hemiplegia
166
no muscle tone; frontal cortex involved; involves corticospinal tract (puts body in tone)
atonic
