A&P Test 3 Flashcards by Rae Perry

what is the space on the skeletal muscle called where the neuron comes in close contact with the skeletal muscle, Where ACh should be concentrated

junctional

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if we look outside of the junctional area, what is this area called?

peri junctional

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What is the area called that is placed past the peri junctional area?

post junctional

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What areas regarding an normal nACh synapses should be affected with succs?

junctional
maybe peri junctional

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in a normal synapse with ACh, which area should be able to repolarize easily after being given succs?

the post junctional area

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how can we keep tabs on how well our paralytics are working?

neuromuscular monitoring
place electrodes on a nerve and run current through them. This should generate an action potential and cause contraction of nearby muscles

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what is the physiology of using an electrical current to stimulate a contraction?

the inside of the cell is negative and outside is positive in a normal resting neuron.

We have one cathode and one anode. We send electrons (negative charge) on the outside of the cell from one electrode to the other thereby making the outside of the cell more negative.

When the outside and inside of the cell are both negative, there is no polarity between them and so that depolarizes it.

fast sodium channels are triggered

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no polarity from the outside of the cell and inside of the cell means that it is

depolarized

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when we start looking at EKGs, we will start looking at the current that runs

outside of the heart

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What is the voltage called that creates a strong enough depolarization that it should not have a hard time generating action potentials in all the underlying neurons?

supramaximal stimuli

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why do we use supramaximal stimuli?

Because it gives us a good baseline

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what are some of the settings that can be dialed into the electrodes to produce a muscle contraction?

single twitch
TOF
Tetanic
*post-tetanic count (PTC)
Double -burst stimulation (DBS)

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What is the frequency that TOF uses?

2Hz/2S

2 impulses over 1 second for a total of 4 impulses over 2 seconds

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Which type of block creates a pattern of the first twitch being stronger than the following twitches?

an incomplete non-depolarizing block

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Which type of block creates a pattern of the all of the twitches being equal but not at baseline?

incomplete depolarizing block

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what is a post-tetanic count?

a measure of the health of the synapse after a tetanic impulse.
is it ready to go after it’s fired 100 AP?

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what is a double burst stimulation?

when you use tetany in short succession

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what muscle group does the ulnar nerve innervate?

the adductor pollicis

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what happens when you stimulate the adductor pollicis?

the thumb will move towards the palm
and/or
the pinkie will move toward the palm

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What are the electrodes that are placed on the side of the palm and pinkie?

sensory electrodes that measure and graph the reaction of the muscle

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what are other places than the adductor pollicis that you can monitor your neuromuscular blockade?

ophthalmic branch of the facial nerve (orbicularis oculi)
peroneal nerve (butt area)
posterior tibial nerve

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in a NDMR, onset takes a few minutes to kick in, and then depending on which drug you use, you have different

half lives
minutes to hours

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what does NDMR stand for?

non depolarizing muscle relaxant

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why is succs very popular?

it’s cheap
-quick onset
-short half life

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Succs can be given through which routes?

IM IV

NDMR's have a ____ half life

long

What should a base line TOF graph look like?

all of the twitches should be even

the twitches come back in ______ with a NDMR

stages

If we quantify the strength of the twitches of the first and last twitches on a NDMR, we should be able to express this as a ratio. what is this called?

the TOF ratio

what part of the TOF ratio relates to the last twitch?

the numerator

what part of the TOF ratio relates to the first twitch?

the denominator

when the NDMR is first wearing off, you would expect the TOF ratio to be

very small

The TOF ratio tends to _____ when we get closer to baseline

increase

all 4 twitches recover ______ in a depolarizing block

evenly

non-depolarizing and depolarizing drugs work on what two places?

the skeletal muscles and the neuron

What type of ACh receptor is found on the neuron that releases Ach?

an autoreptor called alpha3beta2. It has 3 alpha subunits and 2beta subunits

how many ACh are required to open an ACh autoreceptor?

2, although there is a third spot for ACh to bind it doesn't require the 3rd to open

where does the ACh come from that activates the autoreceptor?

from the synapse from that neuron

what comes in through an autoreceptor on a neuron? What does it do?

Na+ and Ca++ causes the VP1's to move down towards the cell wall to replace VP2

A NDMR works on both the _____ and ______

skeletal muscle- blocks EPP neuron- blocks auto receptor

if we block the auto receptor, we don't have ________ which makes the subsequent action potential

VP1 converting to VP2 weaker d/t less neurotransmitter being available at the synapse

depolarizing drugs effect the auto receptor by

holding it open and continuously stimulating VP1 to convert to VP2

what breaks down succs? (a&P)

plasma cholinesterases that come from the liver

what is not required, but helps the P-type calcium channels on the neuron?

L-type calcium channels. fairly fast to open

why can't we paralyze someone with a high dose L-type calcium channel blocker?

because they're not required for normal motor function

if you're hungover and shaky, what kind of drug would help calm you down?

L-type calcium channel blocker

what are the extra fetal nACh receptors called that are added in motor deficiencies?

post-junctional nACh receptors

less important muscles are ____ effected by paralyzing agents?

More. sensitive

What is one of the last muscles to be paralyzed?

diaphragm

the diaphragm is what type of muscle?

skeletal muscle. only skeletal muscle.

important muscles are very ________ and has a higher receptor and neurotransmitter density

robust

where does the nerve originate that control the diaphragm? what is it called?

C3 C4 C5 Phrenic nerve

what is the benefit to having the phrenic nerve originate high in the neck?

it protects the diaphragm from being effected by spinal damage until C5

what is the first muscle to recover from paralytics?

diaphragm muscle

If you have a twitch in the adductor pollicis, you can assume that which muscle is no longer paralyzed?

diaphragm

4th twitch disappears when what percent of nACh-R blocked? Probably associated with non depolarizing drugs.

75-80 %

3rd twitch disappears when what percent of nACh-R blocked? Probably associated with non depolarizing drugs.

85%

2nd twitch disappears when what percent of nACh-R blocked? Probably associated with non depolarizing drugs.

85-90 %

All twitches disappear when what percent of nACh-R blocked? Probably associated with non depolarizing drugs.

90-95 %

If your patient can lift their head, you can assume that what percent of nACh-R are blocked?

70% or less

How many mili Amps could you set your stimulator to and expect a supramaximal stimuli? assuming you have a fairly high voltage

50-80mA

What is voltage in a stimulator?

the force that pushes electrons through the tissue.

what is current in a stimulator?

the amount of electrons that move through the tissue

what does potassium leave through when succs is bound?

mostly potassium leak channels some vg potassium channels

a little bit of Calcium leaks in when Succs is bound to nAChr. if we have a bunch of fetal receptors placed throughout the muscles, we would expect more calcium to come into the cell and therefore the muscle to

contract, which is what you're trying to prevent

the muscles in the eyes are controlled by several motor neurons , which means we have several NMJ. If we hit this muscle with succs and it holds those receptors open, we would be worried about what side effects?

Increase IOP

what is the one muscle in the body that does not cooperate and relax when you give succs?

intraoccular muscles

what does GABA do in the CNS?

increases Cl- conductance, thereby decreasing CNS activity

What does Glycine do in the CNS?

It's inhibitory especially in the spinal cord, acts like GABA

What are the 2 most important inhibitory neurotransmitters in the spinal cord?

GABA Glycine

Ach does what in the CNS?

increases awareness via muscarinic ACh receptors

What is an OTC mAChr blocker?

Benadryl

central histamine receptors are very similar to what receptors?

central mAChr

if you have an old antihistamine drug that isn't very specific, they also tend to bind to

mAChr

Why would you see a spike in HR with Benadryl?

it blocks the mAChr in the heart

Benadryl is what class of drug?

antihistamine with anticholinergic effects too

If you could increase ACh at a central synapse you would probably see what effect in the patient

increase their awareness

What would increase the amount of ACh in the synapse?

inhibition of AChE

If you want to reverse a paralytic with a AChE but you don't want to wake them up, what would you use?

An AChE inhibitor that does NOT cross the blood brain barrier

what is one of the treatments for Alzheimer's disease to help "wake them up"

an AChE inhibitor that crosses the BBB Stigmine drugs

what are some side effects of AChE inhibitors?

waking someone up that you don't want awake augmented ACh activity at any ACh receptor Decrease in HR Increase in secretions from glands (i.e. saliva/mucous)

what do histamines do in the CNS?

increase awareness, similar to ACh

what is characteristic of Glutamate in the CNS?

stimulatory neurotransmitter that increases neuronal activity when it is increased in the CNS. meth: good awareness

What happens if you have too much glutamate?

they will burn out the brain cells and those cells won't be replaced. damaging to the CNS

Dopamine is associated with what area of the brain?

pleasure/reward

dopamine is a potent motor ___________

inhibitor

Parkinson's patient have abnormally low _____ Levels which leads to _______

dopamine hyperactive motor system

norepinephrine increases _______

awareness

Many of the older antidepressants that are used in chronic pain increase what neurotransmitter. why are they helpful?

norepinephrine, Norepi reuptake inhibitor it increases awareness

Which neurotransmitters increase awareness in the CNS?

Ach histamines glutamate norepinephrine

Which neurotransmitters work in the background in the CNS to prevent overactivity in the CNS?

GABA Glycine Dopamine

How does acidosis (low pH) effect CNS activity?

it is reduced

How does alkalosis (high pH) effect CNS activity?

it is increased

what buffers acids in the blood?

bicarb HCO3-

when bicarb combines with acid, we produce

carbonic acid H2CO3

carbonic acid can disassociate into

co2 and h20

what is the most significant plasma protein?

albumin

Is albumin charged?

Yes, very negative

How does albumin buffer positively charged things?

it is very negative so it attracts positives like calcium and protons

the amount of free Ca++ is dependent on what?

how many protons we have hanging around. if there are a lot of protons, they hog the albumin so that Ca++ can't bind, leaving a lot of Ca++ free in the blood.

Increased free Ca++ _____ CNS activity

reduces

if we have a lot of protons in the ECF we would call that

acidosis

if we have alkalosis, we would expect to have ______ free Ca++

decreased

the more Ca++ we have bound to albumin leads to an ________ in CNS activity

Increase

If someone hyperventilates, a bunch of CO2 will be blown off, resulting in alkalosis. This allows Ca++ to bind to Albumin which leads to

increase in CNS activity which can lead to seizures

if someone hypoventilates, you would expect the patient to become more acidodic which would boot Ca++ off the albumin and result in a _______ in CNS activity

decrease