Week 1 Flashcards
(214 cards)
1
Q
What is hemiparesis?
A
weakness of the entire left or right side of the body.
2
Q
What is hemiplegia?
A
Paralysis of one side of the body.`
3
Q
Where does the brainstem begin
A
at FORAMEN MAGNUM
Mostly INFRATENTORIAL
4
Q
What are the Crainial Nerves associated with,Midbrain,PonsMedulla?
A
Md-3&4, Pons 5-8, and Medulla 9-12
5
Q
Cranial nerve func. ->sensory (Afferent)?
A
Pseudounipolar = GENERAL Sensory
Bipolar = SPECIAL Sensory
6
Q
What are the nerve funct. of motor (efferent) fibers?
A
Multipolar:
- Skeletal Muscle
- >Somites
- >Branchial Arches - Smooth Muscle
- >PREganglionic
- >Parasympathetics
7
Q
What are the functions of the nuclei of Cranial Nerves?
A
Sensory =2nd Order
Motor= Alpha Motor or Pregang. Parasymp.
8
Q
What are the ganglia in the the neurons of Cranial Nerves?
A
SENSORY-Pseudounipol. Bipolar
OR,Multipolar Parasymp. Gang
9
Q
What is the order of the alar & basal plate org. @ medulla level?
A
Somatic Sensory,-> Visceral Sensory,->Visceral motor-pregang Para,-> Somatic motor- Alpha Motor
10
Q
What sypmathetic muscle opens the eye?
A
Mueller’s Muscle
11
Q
What Somatic muscle opens the eye?
A
Levator palpebrae
12
Q
What is the trajectory of the upper motor neurons of the corticospinal tract?
A
It begins in the cerebral peduncle pierces the pons and goes inside the pons to go through the pyramid of the medulla
13
Q
What are the somatic motor CNs in the head?Branchial?
A
Somatic: EYE = 3, 4, 6 TONGUE = 12 Branchial Arch Muscle: Mastication = 5 Facial Expression = 7 Pharynx & Larynx = IX, X, XI (Nucleus Ambiguus)
14
Q
What are the cranial nerves of the Medulla?
A
Hypoglossal (XII)
Accessory (XI, ambiguus)
Vagus (X)
Glossopharyngeal (IX)
15
Q
Function of the Hypoglossal Nucleus?
A
TO Intrinsic and Extrinsic Muscles of the Tongue Somatic Motor (GSE)
16
Q
What nerves innervate the Spinal Accessory Nucleus and what muscles does that affect?
A
Spinal Accessory Nucleus (Cervical 1-5,6)
TO Sternocleidomastoid & Trapezius muscles
17
Q
What is the function of the dorsal motor nucleus of the vagus?
A
CN X; innervates the visceral motor to thorax and abdomen
18
Q
What are the symptoms of a Lower Motor Neuron Lesion? Where can it be?
A
LOWER MOTOR NEURON = Atrophy, Fasciculations
Lesion could be in Medulla or Nerve
19
Q
What are the symptoms of a Upper Motor Neuron Lesion? Where can it be?
A
UPPER MOTOR NEURON = Spasticity
Lesion in Cerebral Cortex or Corticobulbar Tract
20
Q
What are the clinical signs and lesion location in the body of a alternating hemiplegia?
A
IPSILATERAL TONGUE LMN SIGNS; CONTRALATERAL BODY UMN SIGNS
CN XII lost
21
Q
What are the ways YOU can GET AN UMN
LESION INVOLVING
TONGUE???
A
- Corticobulbar Tract=Contralateral to hypoglossal nuc. (weak but no fasciculations)
- If at the nucleus, ipsilateral
22
Q
What it the path for the hypoglossal nerve from the cortex?
A
From cortex->into corticobulbar tract-> decusates to hypoglosal nucleus
23
Q
What nerve would cause atrophy of trapezius?
A
Acessory Nerve (comes from medulla and cervical canal)
24
Q
Vocal paralysis comes from what nerve? What nucleus caused it?
A
10, Nuc. Ambig.
25
What senses can be found at the Spinal Trigeminal Nuc.?
Somatic Sensory for skin of Outer Ear
26
What are the nuclei for the vestibulocochlear N. (VIII)
Somatic Sensory (SSA):
1) (Hearing) Organ of Corti Spiral Ganglion Cochlear Nuclei
2) (Balance) Cristae Amp. & Macula Vestibular Ganglion Vestibular Nuclei
27
What Are the nuclei of the Pons?
Vestibulocochlear (VIII)
Facial (VII)
Abducens (VI)
Trigeminal (V)
28
What are the nuclei and sensory responsibilities for the AFF for Facial N?
AFF:
1) Somatic Sensory:
GSA: FROM Skin of Outer Ear (gen. gang.) Spinal trigeminal Nuc.
2) Visceral Sensory:
SVA: FROM Taste Buds on Ant. 2/3 Tongue (chorda tympani - gen. gang. - nervus intermedius) Nuc. of Solitary Tract
29
What are the nuclei and sensory responsibilities for the EFF for Facial N?
EFF:
1) Visceral Motor:
GVE: Superior Salv. Nuc. = Parasympathetic TO
A) Pterygopalatine ganglion (via nervus intermedius then gr. Superficial petrosal n.) to Lacrimal Gland
B) Submandibular ganglion (via nervus intermedius then chorda tympani) to Submand. & Subling. Glands
2) Branchial Motor:
SVE: Facial Motor Nuc. = Branchial Motor TO Musc. Facial Expression, platysma, stapedius, stylohyoid, & post. belly digastric
30
Why would the a patient not be able to move his forhead?
Corticobulbar Tract synpses on 2 facial nerves so damage spares the forehead; LMN lesion to VII would cause paralysis to entire 1/2 of face (Bell's Palsy)
31
What Nerve/Nucleus is responsible for Medial Strabismus?
Abducens!
LESIONS:
VI NERVE->NO Lateral Gaze Eye Same Side
VI NUCLEUS->NO Lateral Gaze Eye Same Side
NO Conjugate Contralateral Medial Gaze
32
Explain Internuclear Ophthalmoplegia
destruction of the medial longitudinal fasiculus inhibits Abducens->Oculomotor comm. Contralateral eye movement inhib.
33
What nerves does the Medial Longitudinal Fasciculus connect?
Connects the vestibular nucl. to 3,4,6
34
What are the functions of CN V AFF?
Somatic Sensory:
GSA:
FROM Skin of Face & ant. scalp, mouth & nasal Mucous Membrane, Dura (trigem. ganglion, V1,V2, V3)
Main Sensory Nuc. & Spinal Trigeminal Nuc.
FROM Stretch Receptors of Muscles of Mastication (JAW JERK)-> Mesencephalic Nucleus Motor Nucleus of V
35
What are the functions of CN V EFF?
Branchial Motor:
SVE: Motor Nucleus of V (Mandibular Nerve) TO Muscles of Mastication, tensor tympani, tensor veli palatini, mylohyoid, ant. belly digastric
36
What produces Aqueous humor and where does filter into?
Aqueous humor, continuously produced by the ciliary body, passes from the posterior chamber to the anterior chamber, then enters the Canal of Schlemm
37
Blockage of the aqueous flow can what disease?
Blockage of the aqueous flow can damage the optic nerve and cause glaucoma.
38
What is accommodation?
Changing the curvature of lens can help to bring an image to focus on the retina
39
Explain Presbyopia.
the lens looses its elasticity when it gets old and has trouble bringing a near image to focus
40
What are Cataracts?
problem of the lens, which occurs when the lens loses it opacity.
41
What is hyperopia? What lense fixes it?
The eyeball is too short, and light rays come to a focus behind the retina. Biconvex Lens
42
What is Myopia?
The eyeball is too long and light rays focus in front of the retina. Biconcave lens
43
What is Astigmatism?
curvature problems of the cornea or the lens
44
What are 4 major cell types in the internal nuclear layer?
Muller Supporting cell - is the major glia in the retina this extends the whole thickness of the retina.
Horizontal Cell - modulate signals sent out by photoreceptors
Bi-polar neuron - relay signals between cell layers.
Amacrine cell - modulate functions of ganglion cells.
45
What are the 3 layers in the retina?
External Nuclear, Internal Nuclear, and Ganglion Cells
46
What axon cells are collected into a bundle and to become the optic nerve?
Ganglion cells
47
What is the name of the area where sensory axons exit the eyeball? What is another name for it and where is it in the eye?
Papilla (optic disc) Blind Spot; medial to the macula densa
48
Why is the macula an area with high visual acuity? How is it related to the fovea?
Avascular so it has high visual acuity because light is not blocked by blood vessels and it has a high density of photoreceptors. The fovea has many cone photoreceptors!
49
What is the leading cause of blindness in the elderly population?
Macular Degeneration; looses central vision-external nuc. layer
50
What are the layers of meninges that wrap around the eyeball?
Choroid->Sclera->Retina
51
Possible cause(s) of high intracranial pressure
adsf
52
Why it can cause problems if you do lumbar puncture on a patient with papilledema?
adsf
53
What are the Biochemical events that happen in the photoreceptors?
light->rhodopsin conf. chg->transducin binds GTP->PDE activity incr->cGMP levels decreased->close Na+ ch.->hyperpolarization->Reduce Glu release
54
What causes retinitis pigmentosa?
mutations->severe degeneration of rod photoreceptors and patient has Impaired night vision
Impaired peripheral vision
55
Purposes of the visual info sent to LGN, Pretectal Nuc, and the suprachiasm?
LGN-Pattern, Pretectal Nuc.-Light reflex, Suprachiasmatic Nuc. of hypoth.->ciracadian rhythm
56
What areas of the brain cortex are responsible for visual info?
Areas 18-19 Visual Assoc., Sent here 1st->Area 17:Principal visual cortex, Areas 18-19 Visual associtation areas
57
What part of the brain initiates the pupillary reflex?
Information processing in the visual cortex
| can initiate pupillary dilation reflex
58
What are the Nerves of the midbrain?
Trochlear (CN IV) & Oculomotor (CN VIII)
59
Where can CN 4 be found in the midbrain?
Somatic Motor (GSE, MYOTOME)
60
Where does CN4 decussate?
Superior Medullary Velum
61
Common place for LESIONS of TROCHLEAR?
```
NUCLEUS (Rare):
1) Contralateral SO
2) Possibly with Horner’s syn.
NERVE:
1) Before Decussation (Rare) = Contralat. SO
2) At Decussation = Bilateral SO’s
3) After Decussation = Ipsilateral SO
```
62
Signs of lesions in the trochlear?
1) Extorsion (Can’t Look Down & In)
2) Vertical Diplopia (Double Vision) when Reading or Walking Down Stairs
3) Head Tilt + Chin Down Contralat. to Affected SO
63
Oculomotor Nucleus myotome and function?
Somatic Motor (GSE, MYOTOME), Motor TO Levator Palpebrae Superioris & Extrinsic Eye Muscles
64
MM and Func. Visceral Motor (GVE)?
Nuc. of Edinger-Westphal->Parasymp. TO Ciliary Ganglion To Pupillary Constrictor & Ciliary Body
65
Common clinical causes of Oculomotor Palsy?
```
Posterior Cerebral Artery Stroke
JUST OCCULOMOTOR NERVE:
Posterior Communicating Aneurysm
Increased Intracranial Pressure
Diabetes (spares pupil)
```
66
Horner’s Syndrome vs. Lesion CN III
```
Horner’s Syndrome
Sympathetics Lost:
Partial Ptosis (Muller’s m.), Miosis (Pin Point Pupil), Anhydrosis
Lesion CN III
Somatic Motor Lost:
Full Ptosis (Levator m.)
Down and Out
Parasympathetics Lost:
Mydriasis (Dilated Pupil)
```
67
What are the parasymp. of the midbrain
3,7,9
68
Path of Optic nerve in Diencephalon? how are they myelinated?
Retinal Ganglion Cells TO Lateral Geniculate Body. Oligodendroglia
69
Why do both eyes blink w/ pupillary light reflex?
Optic Nerve Innervates both E-W and Pretectal Nucleus so both eyes are in conj.
70
What is th SVA fund. of the olfactory N
Bipolar Neurons Olfactory Epithelium to Olfactory Bulb
71
What is the SENSORY Component of “MOTOR” Cranial Nerves?
Proprioceptive Fibers (GSA) To Mesencephalic Nuc. of V (not in ganlia, scattered)
72
What supplies blood for the CN I & II?
Ant. Cerebral
73
What areas does PCA supply?
III Oculomotor Nucleus, Edinger-westphal, and Trochlear Nucleus
74
What Areas does AICA supply?
V Motor nuc. ,VI Abducens, VIII Facial Nucl., Sup Salvatory nuc, Facial n.
75
What Area does PICA supply?
VIII Cochlear nuclei Vestibular Nuclei, IX All components, X Nuc. amb.
76
What supplie blood to XI and XII?
ANT. SPINAL A. ->Accessory nuc. and Hypoglossal nuc.
77
Effects of Lesions of the Ventral Pons?
Raymond’s Syndrome LCST & CN VI=Contralateral Hemiparesis, Ipsilateral Medial Strabismus
78
Effects of lessions in the middle pons?
(Millard-Gubler Syndrome) LSCT & CN VII = Contralat., Hemiparesis, Ipsilat. Facial Paralysis
79
Effects of lessions in the Dorsal Pons?
LOCKED IN SYNDROME
Foville’s Syndrome
Nuc. VI (MLF) & VII and CN VII = Ipsilat. Medial Strabismus & Facial Paralysis,
Loss of Conjugate Movement of Contralat. Med. Rectus
80
What is Weber's syndrome?
Lesion in LCST and CN II -> Contralat. Hemiparesis, Ipsilat. Ocular Paresis
81
What is Parinaud's Syndrome?
Superior Colliculi-cant look up: Paralysis of Upward Gaze
82
What is the RF function? (PAPA D)
1) Pain Suppression System (Nuc. Raphe Magnus in Pons)
2) Autonomic Reflexes – Pattern Generators (Physiology)
RESPIRATORY CENTERS (Medulla, Pons)
CARDIOVASCULAR CENTERS (Medulla)
3) Descending Sympathetics (from Hypothalamus)
Lesion = ipsilat. HORNER’S SYNDROME
4) Arousal & Consciousness
-Ascending Reticular Activating System (ARAS)
5) Posture (Reticulospinal Tracts)
83
What are the 3 Longitudinal Zones?
```
Median Zone:
Raphe Nuclei (5-HT)
-Medial Zone:
Ascending & Descending Projections
-POSTURE TRACTS:
Medullary & Pontine Reticulospinal Tracts (Motor Sys. Lectures)
-Lateral Zone:
CN Reflexes & Visceral Functions
```
84
Location and function of the NE Sys in the midbrain?
Located in the locus ceruleus,Solitary Nucleus, Lateral Area of Medullary Reticular Formation
has wide spread projections and is secreted for attention
85
Location and function of the DA Sys int the midbrain?
Initiation of Movement, Motivation, Cognition axons to striatum located in Substantia Nigra and axons to limbic system located in VTA where DA is made
86
Location and function of the 5-HT (serotonin) Sys in the midbrain?
Widespread Projections, Arousal, Pain Control. Located in Raphe Nuclei
87
Location and function of the Ach Sys int the midbrain?
- Muscarinic R’s in CNS, Sleep/Wake Cycle
- -Reticular Formation (to Thalamus)
- -Basal Forebrain (Nucleus Basalis of Meynert to Cortex, Amygdala, & Hippocampus)
- -Striatum (Interneurons)
88
Important meds of brainstem?
--Antipsychotics
Block DA receptors in VTA (Thorazine, Rx Schizophrenia)
--Antidepressants
NE (LC) & 5-HT (Raphe) receptor alterations?? (2o & 3o amines)
Increase levels of NE & DA (e.g., MAOI’s)
--Replacement Therapy
ACh (Nuc. Basalis) given to Alzheimer’s Disease Patients
DA (Substantia Nigra) given to Parkinson’s Patients
89
AFF somatic and visceral sensory for CN IX?
1) Somatic Sensory:
GSA: FROM Skin of Outer Ear (sup. gang.)->Spinal Trigeminal Nuc.
2) Visceral Sensory:
GVA:
a) FROM Mucosa of Pharynx, & medial surf. Ear Drum, Carotid Body & Sinus (inf. gang.)->Solitary Nuc.
b) FROM Pharynx & post. Tongue (inf. gang.) Spinal Trigeminal Nuc.(pain)
SVA: FROM Taste Buds on Post. 1/3 Tongue (inf. gang.)->Solitary Nuc.
90
EFF Branchial motor and visceral motor for CN IX?
1) Visceral Motor:
GVE: Inferior Salv. Nuc. = Parasymp. (via lesser petrosal n.) TO Otic Ganglion->Parotid Gld
2) Branchial Motor:
SVE: Nucleus Ambiguus = Branchial motor TO->Stylopharyngeus m
91
What is nerves are responsible for Gag reflex? What about the Carotid Sinus Reflex?
- AFF limb = Glossopharyngeal n. (IX, Solitary Nuc.)
- EFF limb = Vagus n. (X, Nucleus Ambiguus)
- Carotid Sinus Reflex involves AFF IX to EFF X Ambiguus or Dorsal Motor
92
Which trigeminal system does Touch and proprioception travel through? Pain and Temperature?
- Touch and prop.-Main sensory Nuc.
| - Pain and Temp.-Spinal Tract Nucleus
93
Where do the Trigeminothalsmics cross?
- Spinothalamics crossed = Sp. Nuc. V (caudal = pain & temp) (rostral = gen. tactile, blink)
- Medial Lemniscus - crossed = Main Sens. Nuc. (gen. tactile)*
- Cerebellum->uncrossed = Mesenceph. Nuc.(joint position)
94
What is the diff. btwn parasymp. and symp. axons?
symp.-short pre;long post
| parasymp-long pre; short post
95
What type receptors are at the somatic and cardiac/smoth musc?
Nicotinic Receptors Mediate Somatic Motor and the
| Autonomic Ganglia Synapse
96
What NT is released by Postsynaptic Parasympathetic Neurons
and Sympathetic Neurons Innervating Thermoregulatory Eccrine Sweat Glands? On what receptor?(cardiac and SM post para too)
Ach on Muscarinic (M1-5
97
Diff. btwn Nicotinic Receptor versus Muscarinic Receptor Signalling?
Nicotinic-Ligand-Gated Ion Channel
| Muscarinic-GPCR Receptors
98
What NT do Sympathetic Ganglionic Neurons and Adrenal Medulla release?
Sympathetic Ganglionic Neurons Primarily Release Norepinephrine;
Adrenal Medulla Releases Epinephrine/Norepinephrine
99
What type receptors are used for sympathetic neurons?
Adrenergic Receptors: Alpha: alp. 1, alp. 2 Beta: beta 1, Beta 2, (beta3)
100
What are the different G protiens for alpha and beta receptors?
- Alpha1 receptors-Gq->increase IP3, DAG
- Beta receptors-Gs ---> increase cAMP
- Alpha2 recep-Gi-> decrease cAMP
101
What muscle groups have Beta 1,2,3 receptors?
Beta1-Cardiac Muscle
Beta2-SM, liver, heart
Beta3-Fat cells
102
What is the job of Presynaptic Alpha2 Adrenergic Autoreceptors?
Regulate Neurotransmitter
| Release in the CNS and the PNS via neg. feedback
103
What do dopaminergic receptors do?
Regulation of Renal and Splanchnic Vasculature Smooth Muscle; increase camp like Gs recep.
104
Sympathetic response?
Blood from skin/visceral to skeletal, inc. sweat, inc. adrenalin
105
What does parasymp not effect?
body wall and surarenal gland
106
What is a lytic NT?
Blocks the action of endogenous neurotransmitter;Parasympatholytic
Sympatholytic
107
Symp. and parasymp efects on Dilator pupillae mm
Symp.-contracts (mydriasis) alpha 1
| -no para
108
Symp. and parasymp efects on Sphincter pupillae mm
No symp
| -Para-contracts (miosis) M recep.
109
Symp. and parasymp efects on Ciliary mm?
No symp
| -Para-contracts (miosis) M recep.
110
Symp. and parasymp efects on heart SA node?
SA node
- symp->accelerates, beta1 & 2
- parasymp->decelerates on M recep
111
Symp. and parasymp efects on Aqueous humor?
- symp-inc. outflow and dec. secre.-alpa agonist and beta blocker
- parasymp-dec. outflow on M recep.
112
Symp. and parasymp efects on heart contractility?
- Symp. incre. Beta1 & 2,
| - Parasymp-decel on M recep.
113
Symp. and parasymp efects on bld vess. of skin, splanic?
Symp-Constricts on alpha recep.
| no para
114
Symp. and parasymp efects on bld vess. of Renal (splanchnic)?
Relaxes on D1 recep.
| no para
115
Symp. and parasymp efects on bld vess. of Skeletal mus.
Relaxes on Beta 2 recep.
| no para
116
Symp. and parasymp efects on bronchilolar SM
Symp-relaxes Beta2
| parasymp-Contracts on M recep.
117
Symp. and parasymp efects on GI Smooth Wal mm
Symp-relaxes on Beta 2
| Para-contracts on M recept
118
Symp. and parasymp efects on GI Sphincters
Symp Contracts-Alpha 1
| Parasymp-relaxes on m recep
119
Symp. and parasymp efects on GI secretion
Sympathetic-Inhibits Alpha 2
| Parasymp-Stimulates M recep.
120
Symp. and parasymp efects on Genitournary SM mm Blad wall (detrussor)
-Symp. Relaxes on Beta 2 recep.
| Parasymp-contracts M recep.
121
Symp. and parasymp efects on Genitournary SM mm Sphincter (trigone)/prostate
Symp. Contracts-alpha 1
| Parasymp relaxes on m recep
122
Symp. and parasymp effects on Genitournary SM mm Uterus, pregnant?
Symp. Relaxes w/ Beta & contracts w/ Alpha
| Parasymp. contracts w/ m recep
123
Symp. and parasymp efects on Genitournary SM mm of penis, seminal vesicles?
Symp-Ejaculation on alpha recep.
| Parasymp-erection on m recep
124
Symp. and parasymp efects on metabolic renin, gluconeo, glycogenolys, and lipolysis
Symp. Stimulation on Beta 1, 2, and 3
| No para
125
Symp. and parasymp efects on Skin pilomotor, eccrine sweat, and apocrine sweat?
Symp. stim. on a alpha or M recep
126
What neuronal tone is the sympathetic system responsible for?
Arterioles and Sweat glands
127
What neuronal tone is the para-sympathetic system responsible for?
Iris, GI tract, Heart, Salavary glands, Urinary glands
128
What fibers carry out baroreceptor sensory input?
CN IX and CN X afferent fibers to the vasomotor centers in the medulla.
129
What is the Baroreceptor Reflex (also seen in Autonomic drugs)?
Monitors periph. bld. press. and activates barorecep. to alter CNS and provide quick homeostatic responses
130
What is a sign of postural hypotension
Absent reflex in patients with autonomic failure (diabetic autonomic neuropathy)
131
What are the Five Sites of Action for Pharmacological Manipulation of ANS?
```
Synthesis
Storage
Release
Termination
Receptor
```
132
Direct vs indirect effect of autonomic receptors?
Direct effect - Act directly on autonomic receptors
| Indirect effect - Act indirectly through changes in endogenous transmitter levels in the terminal or synaptic cleft
133
What are the Five Classes of Autonomic Drugs
- Direct-acting cholinomimetics
- Cholinoceptor blockers
- Indirect-acting cholinesterase inhibitors
- Sympathomimetics (direct/indirect)
- Adrenoceptor blockers
134
What are the Direct-Acting Cholinomimetics?
choline esters-acetylcholine, bethanecol
| naturally occuring alkaloids- muscarine,nicotine,
135
Use of Nicotinic agonists?
used to produce skeletal muscle paralysis (depolarization block) and smoking cessation
136
Use of Muscarinic agonists?
clinically useful drugs are non-selective for the receptor subtypes (M1-5)
137
Signs of Muscarinic toxicity? (Mushroom poisoning)
SLUDGE (Salivation, Lacrimation, Urination, Defecation, GI upset (diarrhea), Emesis
138
How do muscarenic agonist activate the sympathetic system?
muscarinic receptors are located on endothelial cells (intima),
receptor activation->release of nitric oxide (NO).
NO diffuses to adjacent vascular smooth muscle (media)
activates guanylyl cyclase, increases cGMP
results in relaxation of vessels
139
What are the sympath. effects of cholinomemetic musarenic agonist?
Vasodialation, tachycardia, and thermoregulatrory sweating
140
What do Anti-nicotinic cholinoceptor blockers do?
Are ganglionic blockers that prevent nicotinic receptors from mediating the autonomic ganglia synapse
141
What are 2 ex. of an anti-muscarinic cholinorecep. blocker?
Atropine-prototypical anti-muscarinic drug
| Scopolamine - used as an anti-motion sickness drug
142
What are 3 Anti muscarinic contraindications?
Glaucoma: elderly, especially acute angle-closure
Prostatic hyperplasia: Urinary retention
Children: danger of hyperthermia
143
Signs of Atropine toxicity?
- Dry as a bone: blocks thermoregulatory sweating, salivation, lacrimation
- Red as a beet: Dilation of blood vessels “atropine flush” (unknown mechanism)
- Mad as a hatter: CNS effects leading to delirium and hallucinations
144
What are 3 cholinesterase inhibitor types?
- carbamate esters (neostigmine)
- phosphoric acid esters (organophosphates)
- alcohol
145
How do cholinesterase inhibitors work?
Indirect-Acting Cholinomimetics->compete with ACh for the enzyme
->hydrolysis by AChE
Augment the effects of physiologically released Ach (endogenous)
146
Cholinesterase Inhibitor poisoning symptoms?
"DUMBBELSS”
-> diarrhea, urination, miosis, bronchoconstriction, bradycardia, excitation CNS/NMJ, lacrimation,
salivation, sweating
147
Antidote for Cholinesterase Inhibitors?
Atropine!
148
Contraindications for Cholinesterase Inhibitors?
Exacerbates COPD, asthma, peptic ulcers
149
What receptors do epi act on? Norepi?
Epinephrine (protypical agonist) - acts at all alpha and beta receptors
Norepinephrine - acts at alpha and beta 1 receptors
150
What receptors do phenylephrin and albuterol act on?
Phenylephrine-alpha agonists
| Albutero-beta agonists
151
What receptors does dopamine act on?
Dopamine > Beta> Alpha (DoPA = DoBA)
152
Effects of Sympathomimetic Drugs: Indirect Acting?
Increase the concentration of “endogenous” catecholamines in the synaptic cleft
153
2 modes of action for Sympathomimetic Drugs?
- increase release of transmitter
| - inhibit reuptake (thereby effectively increasing action
154
Examples of Sympathomimetic Drugs?
Tyramine (in fermented cheeses)- induces release of stored catecholamines from terminal
Amphetamine (methamphetamine)- induces release of stored catecholamines from terminal
Cocaine - blocks reuptake at the NE or DA transporter
Tricyclic antidepressants- blocks reuptake at the NE transporter (NET)
155
Examples of Adrenoreceptor blockers: alpha versus beta blockers
Prazosin-alpha 1 selective blocker)
| Propranolol-(protypical) non-selective beta blocker
156
Clinical uses of adrenoceptor blockers?
Glaucoma, Pheochromocytoma (adrenal tumour), cardioselective blockers (beta1), benign prostatic hyperplasia (alpha blkr)
157
Where are the Barorecep. sensory afferent sensors and chemosensors?
aortic arch, carotid sinus, carotid body
158
Where can centrl control of ANS output be found?
Presynaptic alpha 2 Receptors
159
What is considered the ANS "head ganglia"?
Hypothalamus
160
Causes and Incidence of Neurogenic Bladder Dysfunction?
dfjkl;
161
What do Muscle relaxants do different from anesthesia?
Cause paralysis NOT anesthesia. They DO NOT cause unconsciousness, amnesia or analgesia
162
What subunits of Ach recp. bnd Ach?
Only two α subunits bind Ach molecules although there are
| Five protein subunits; Two α; single β,δ and ε subunits
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What is the Muscle Relaxant Mechanism of Action?
They are water sol. and don't cross lip. mem.
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What are the two types of muscle relaxants?
Depol. and non-depol.
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What is the Mechanism of Action for Succinylcholine?
Depolarizing N M Blockers bind to Ach receptor and generate action potential but stays at the recep and doesn't move causing prolonged depolarization of muscle end plate
166
Phase I block vs. Phase II block?
Prolonged end plate depolarization cause muscle relaxation due to time limited closure of lower gate sodium channel causes Phase I Block. More depol. causes conformational changes in Ach receptors causing Phase II Block
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Mech of Non-depolarizing N M Blockers like Rocuronium?
Bind to Ach receptors as Competitive antagonists but can NOT produce conformational changes for action potential
168
How is Sch metabolized?
Once in blood, rapid metabolism into Succinyl-monocholine by blood enzyme Pseudocholinesterase
169
Why is Sch is AVOIDED in pediatric patients?
high incidence of undiagnosed mypopathies and resulting severe hyperkalemia and associated complications
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Side effects & Clinical Considerations for Sch?
Severe hyperkalemia, Malignant hyperthermia,Increase in intracranial, intra-ocular and intra-gastric pressures
171
Characteristics of Rocuronium?
Monoquarternary steroid; Non-depol. relaxant; elim. by liver can cause severe liver disease
Intubation 0.8 – 1.2 mg/kg; maintenance 0.15 mg/kg
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Charachteristics of action of Cistracurium?
Non-depo. Degraded in plasma by organ-independent Hofmann eliminationIntubating dose 0.2 mg/kg
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Charachteristics of action of Vecuronium?
Non-Depol. Intubating dose 0.12 mg/kg Biliary excretion (75%) and renal excretion (25%)
Women 30% more sensitive
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Charachteristics of action of Cholinesterase Inhibitors ?
Increase Acetylcholine (Ach) in Nicotinic AND Muscarinic Ach receptors and is used to reverse neuromuscular blockade by non-depolarizing muscle relaxants
175
What are the effects of Excessive cholinesterase inhibitors?
potentiate non-depolarizing motor blockade Ach channel blockade
176
How are muscarinic side effects avoided when using Cholinesterases Inhibitors?
by using specific Muscarinic Ach receptor blockers such as Atropine, Glycopyrrolate
177
What MUST be present before reversal agent use is attempted?
Some evidence of spontaneous recovery from muscle relaxation
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Characteristics of Neostigmine?
Water soluble quaternary ammonium compound
Does not cross the blood brain barrier
Dose: 0.04 – 0.08 mg/kg; Maximum 5 mg.
Always given with Atropine 0.01 mg/kg or Glycopyrrolate 0.02 mg/kg iv to prevent the muscarinic side effects
179
What is the Equilibration Time?
Amt of time it takes for the alveolar concentrations to equal inspired concentrations and maximum concentrations exist in the tissues (Fa=F1
180
What is the FGF rate and how does it affect the F1?
F1=inspired gas conc. and is determined by Fresh Gas Flow (FGF) from the vaporizer, breathing circuit volume and circuit absorption
181
With a drug existing in the lung, what are 3 determinants of rate of rise of lung concentrations?
1. Inspired gas partial pressure
2. Ventilation rate-minute alveolar ventilation-
3. Functional residual capacity (FRC)
182
What is the effect of FRC on inhaled drugs?
slows washin (i.e., flow of agent into the lung) ;induction time is increased (slowed);increases the volume of lung that must be filled to obtain an effect
183
What are the three Primary Determinants of Tissue Uptake of a drug?
1. Solubility of agent
2. Pulmonary blood flow (i.e. cardiac output)
3. Arterio(alveolar)-venous concentration gradient in lung
184
Define solubility
relative content of a gas in 2 phases when (at equilibrium) the partial pressure of the gas in the 2 phases is equal
185
Relationship of cardiac output and equilibration time?
Increases in CO decrease rate of alveolar concentration rise, and slow equilibration time
186
What would using the same drug doses, with bigger volumes result in?
Decreasedblood concentrations, Reduced concentration gradients to drive drug into the brain, Slower (increased) equilibration time
187
What is the relationship of tissue uptake and blood conc?
Increased tissue uptake decreases blood concentrations which increases blood uptake from lungs
188
What are the usual targets of of inhailed drugs?
1. Nicotinic acetylcholine (nACh) receptors
2. 5-HT3 receptors
3. Amino acid receptors (esp GABA)
189
Mechanism of Action
| for GABA?
Cl- conductance (freq and duration) increases, hyperpolarizes, and inhibits neuron
190
Relationship btwn. GABA and Inhaled anesthetics
Inhaled anesthetics are GABA agonists
191
What is the MAC?
Minimum alveolar concentratio-Primary measure of potency
| equilibrium concentration required to prevent movement to skin incision at 1 ATM in 50% of patients
192
Effects of distribution on drug anesthetics?
Results in termination of effects of most anesthetics
193
What is the trend of drug distribution in the body?
Bld. 1st->1min-60% in brain,->4-256 min-80% in lean tiss and 40% in fat
194
Thiopental charachtersitics?
Rapid unconsciousness
Good amnesia, poor analgesia
Poor muscle relaxation
Pleasant induction for the patient
195
What is Thiopental's Mechanism of Action?
Binds to Inhit neurons w/ GABAa receptor
Increases chloride ion flux into cell
Increases the duration channel opening
196
What are Thiopental's Effects on the brain?
Protects the brain BEST against hypoxic/ischemic injury Reduces cerebral metabolism, bld flw, and O2 use
197
What are Thiopental's cardiovascular effects?
Direct effects->hypotension and hrt contractility
| Indirect effects->HR increased via barostatic reflex
198
Pos. features of Benzodiazepines ?
Best amnestic agents,
| Excellent anxiolytics, anti-convulsants, muscle relaxants
199
Effect of Midazolam Physicochemical Properties?
In plasma, lipid solubility increases access to neuronal recept.
200
Effects of Midazolam on the brain?
reduction in cerebral metabolism and blood flow
| Raises seizure threshold. Antegrade, not retrograde amnesia
201
Opioids Actions
Not reliable for amnesia used for postoperative pain control
202
Opioid Effects?
Pruritis and forget to breathe
| due to Chest wall rigidity
203
Remifentanil
Shortest acting opioid
| Termination of action is due to elimination, not redistribution
204
Hydromorphone
Used as adjunct with inhaled agents for intraoperative and postoperative analgesia
205
Meperidine
Only indicated for shivering
206
Morphine
Used in all phases of anesthesia
207
Alfentanil
Used intraoperatively as IV infusion
208
What is Ketamine's Mechanism of Action?
Non-competitive NMDA antagonist only iv agent discussed that works mainly by inhibition of stimulatory systems
209
Ketamine: Organ System Effects
Sympathamimetic in increased heart rate, blood pressure, epinephrine and nor-epi levels
Causes bronchodilation via SM
Nystagmus and phonation!
210
Etomidate Mechanism of Action
Imidazole derivative
Activates GABAA receptors
Not an analgesic
211
Etomidate: Organ System Effects
Lowers cerebral blood flow, metabolic rate for O2 and thus intracranial pressure
Lower risk of apnea
good for short procedures
212
What drug is best to use in patients with cardiovascular risk factors?
Etomidate-Best when hemodynamic stability is a must
| Does NOT block sympathetic effects
213
Propofol: Organ System Effects
Reduces cerebral blood flow and metabolism, burns going in, patient feels better next day, fast acting!
214
Dexmedetomidine
Central a-2 stimulation results in sedation and analgesia
