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Pass Program > Chapter 15 Neuromuscular Physiology > Flashcards

Chapter 15 Neuromuscular Physiology Flashcards

1
Q

Which part of the CNS controls head, neck, and below the belt?

A

Parasympathetic

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2
Q

Which part of the CNS controls between neck and belt (thoracolumbar)?

A

Sympathetic

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3
Q

Main inhibitory neurotransmitter in brain?

A

GABA

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4
Q

Main inhibitory neurotransmitter in spinal cord?

A

glycine

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5
Q

What toxins block glycine?

A

tetanus and strychnine

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6
Q

main excitatory neurotransmitter

A

glutamate

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7
Q

mostly excitatory neurotransmitter and stimulates NMDA pathway

A

Aspartate

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8
Q

an Alzheimer drug that inhibits the prolonged influx of Ca ions to prevent excitotoxicity in NMDA pathway

A

Memantine

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9
Q

Monoamines

A

serotonin, doopamine, epinephrine, norepinephrine, histamine

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10
Q

used to make epinephrine and norephinephrine

A

dopamine (need tyrosine!)

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11
Q

5 areas dopamine is used in brain

A
  1. chemotactic trigger zone and area postrema (vomiting centers)
  2. mediates psychosis antipsychotics are dopamine blockers
    3.mesolimbic system (urges): makes you feel “high”
  3. hypothalamus to inhibit prolactin (high levels of prolactin block GnRH and TRH)
  4. Basal ganglia and refining movement
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12
Q

What will increase with dopa inhibiting antipsychotic meds?

A

prolactin

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13
Q

dopa blocker to inhibit vomiting in children

A

promethazine

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14
Q

dopa blocker to inhibit vomiting in adults

A

prochlorperazine

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15
Q

methyl donor everywhere except for in nucleotides

A

SAM (S-adenosyl methionine)

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16
Q

methyl donor in nucleotides?

A

THF

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17
Q

Is epinephrine a neurotransmitter or a hormone?

A

hormone

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18
Q

at low levels epinephrine will stimulate which receptors?

A

B2

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19
Q

at high levels epinephrine will stimulate which receptors

A

alpha 2 (constrict vessels, up BP)

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20
Q

Which system does serotonin control?

A

RAS reticular activating system (helps you wake up and focus and located in raphe nucleus)

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21
Q

toxic dose of SSRI or interact with TCAs, flushing, wheezing, diarrhea, clonus, and hyperreflexia

A

serotonin syndrome

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22
Q

DOC serotonin syndrome

A

cyproheptadine

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23
Q

serotonin blocker in peripheral nervous system

A

octreotide

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24
Q

What serotonin blocker helps with GI vomiting?

A

ondansetron, granesetron

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25
Q

How does capsaicin stop pain?

A

blocks substance P (neuro polypeptide)

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26
Q

most abundant neuro polypeptide?

A

neuropeptide Y

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27
Q

main opioids

A

beta endorphins, dynorphins, enkelphalins

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28
Q

what electrolyte do opioids work on

A

cause K to leave cell making cell more negative, harder to depolarize

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29
Q

marijuana high symptoms

A
  1. blood shot eyes 2) hunger 3) laughter 4)paranoia
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30
Q

what amino acid makes NO

A

L-arginine

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31
Q

MOA nitric oxide

A

stimulates cGMP to vasodilate

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32
Q

What neurotransmitter does the sympathetic nervous system use at the pre ganglionic fibers?

A

Ach

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33
Q

What neurotransmitter does the parasympathetic nervous system use at the post ganglionic fibers?

A

norepinephrine

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34
Q

What does the sympathetic system use as second messenger?

A

cAMP (unless it is smooth muscle contraction which is IP3/DAG or smooth muscle distention which is calmodulin)

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35
Q

What breaks down Dopamine pre-synaptically?

A

MAO

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36
Q

What breaks down dopamine post synaptically?

A

COMT

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37
Q

what is Dopamine broken down into?

A

HVA

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38
Q

What is norepinephrine and epinephrine broken down into?

A

VMA and metanephrines

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39
Q

Which amino acid makes serotonin?

A

tryptophan

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40
Q

What is the rate limiting step?

A

tryptophan hydroxylase

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41
Q

What is the breakdown product of serotonin?

A

5HIAA

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42
Q

pt on SSRi and you want to switch to MAOi, how many weeks must you wait?

A

4 weeks

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43
Q

If on MAOi and you want to give SSRI, wait how many weeks?

A

2 weeks

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44
Q

What neurotransmitter is used for most parasympathetic receptors except ganglia or neuromuscular junctions (skeletal muscles)?

A

muscarinic

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45
Q

Which neurotransmitter is for parasympathetic receptors in ganglia and neuromuscular junctions ?

A

nicotinic

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46
Q

What do the M1 receptors control?

A

CNS, secretions

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47
Q

What do the M2 receptors control?

A

heart(bradycardia); decreased contractility

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48
Q

What do the M3 receptors control?

A

smooth muscle contraction like bladder, lungs, GI; miosis, and ciliary muscles to increase accomodation (adjusting to near and far objects)

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49
Q

Myasthenia gravis treatment

A

pyridostigmine

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50
Q

used to diagnose asthma

A

methacholine

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51
Q

used for post op urinary retention

A

bethanechol, carbachol

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52
Q

for glaucoma

A

pilocarpine

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53
Q

acetylcholinesterase inhibitors

A

organophosphates

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54
Q

tx for organophosphate poisoning

A

1) strip off clothing
2) atropine
3)pralidoxime

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55
Q

What are COMT inhibitors used for?

A

Parkinson’s to decrease degradation of dopa agonists

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56
Q

antimuscarinic for travel sickness?

A

scopolamine

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57
Q

antimuscarinic for COPD

A

ipratropium, tiotropium

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58
Q

anticholinergic used for dystonia

A

benztropine

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59
Q

best tx of dystonia

A

benadryl (easier to buy and cheaper)

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60
Q

used for surgery to dry up secretions

A

glycopyrrolate

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61
Q

tx for urge incontinence in adults

A

oxybutynin and toterodine

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62
Q

sympathetic receptors, nicotinic or muscarinic?

A

nicotinic, except for sweat which is muscarinic

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63
Q

alpha 1 agonists?

A

vasocontrict, tighten sphincters, mydriasis

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64
Q

alpha 1 antagonists

A

loosen sphincters and constrict pupils

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65
Q

DOC for septic shock

A

norepinephrine

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66
Q

DOC for anaphylactic shock

A

epinephrine

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67
Q

most common decongestant

68
Q

best for allergies

A

pseudo-ephedrine (Sudafed) Sudafed can be used for incontinence until you figure out what is the cause.

69
Q

DOC for neurogenic shock

A

phenylephrine

70
Q

tx for pheochromocytoma

A

phenoxybenzamine

71
Q

tx for BPH

A

terazosin, doxazosin

72
Q

Where can alpha 2 receptors be found?

A

all presynaptic fibers to prevent norepinephrine release; in islet cells of pancreas to prevent insulin release

73
Q

alpha 2 agonist

A

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
Q

Where are beta 1 receptors found?

A

CNS,SA node, JG apparatus; alpha cells of glucagon release

75
Q

beta 1 drugs

A

isoproterenol; metaproterenol both beta 2 and beta 1 not used much

76
Q

beta 2 agonists

A

brochodilation (albuterol)terbutaline (preterm labor); salmeterol (LABA)

77
Q

starts with A-M, but not C &L Beta 1 or Beta 2 blocker?

A

beta 1 blocker

78
Q

When to use beta 1 blocker?

A

heart failure, COPD, advanced heart block, diabetes, peripheral vascular disease

79
Q

1 beta blocker for stage fright?

A

propranolol

80
Q

shortest acting beta blocker

81
Q

for open angle glaucoma

82
Q

blocks potassium channel (Class III antiarrhythmic)

83
Q

HTN crisis or pheochromocytoma

A

labetalol, cardivelol

84
Q

reduce mortality after MI

A

carvedilol, bisoprolol, metoprolol

85
Q

How does morphine inhibit pain after injury?

A

causes K to leak out and hypopolarize the cell, harder to depolarize, lower pain

86
Q

Which muscle doesn’t need outside calcium to make it start working?

A

skeletal muscle (smooth and cardiac use outside Ca to stimulate inside Ca use for contraction)

87
Q

What do you need for anterograde movement (forward) in a nerve?

88
Q

what do you need for retrograde (backward) movement in a nerve?

89
Q

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

90
Q

drugs that block Ca

A

penicillamine
dimercaprol (BAL)
EDTA

91
Q

what receptors do botulin toxn block

A

block SNARES from binding to presynaptic terminals; no AcH release, hypotonia, paralysis of diaphragm, death

92
Q

Do you need ATP for muscle contraction?

A

No, only need for muscle release

93
Q

How does a myocyte cause muscle contraction?

A

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
Q

How does release from contraction work?

A

myosin binds to ATP and hydrolyzes it, splitting of P to provide energy for release

95
Q

What happens after release?

A

troponin I will cover tropomyosin, troponin C will bind troponin I, and Ca ATPase will pump Ca back into sarcoplasmic reticulum

96
Q

Eaton Lambert Syndrome

A

hard time sequestering Ca; Ca builds up in cytoplasm and get severe muscle spasms
2nd cause of Eaton Lamber Ab to Ca vesicles

97
Q

middle aged male with chest pain first three differentials

A
  1. acute MI
  2. dissection of aorta
  3. angina
98
Q

first sign of ischemia on EKG

A

peaked T wave (K leaked out); followed by ST depression

99
Q

tx of unstable angina or MI

A
  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
Q

inflammation timeline

A
  1. cell swells because Na/K pump stopped working
    1. 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
Q

If you cannot get patient to PCI hospital in 2 hours, give tPA immediately and transfer

102
Q

indication for bypass

A

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
Q

after stent replacement: if bare metal stent replacement what anticoagulant shouldyou use

A

aspirin + clopidogrel 30 days then stop clopidogrel and continue aspirin for life

104
Q

if you have drug eluting stent ?

A

aspirin and clopidogrel for one year; after one year just aspirin for life

105
Q

If you see T wave inversion on MI EKG which drug should you start and why?

A

Lidocaine to prevent v fib

106
Q

What is the functional unit of muscle called?

107
Q

The band between the two sarcomeres that contains only actin molecules?

108
Q

The band that will shorten when muscles contract?

109
Q

The band that contains CPK?

110
Q

Who usually has higher CPK and why?

A

Men usually have higher CPK than women because they have more muscle mass.

111
Q

If CPK is higher than expected, which conditions should you consider?

A

myositis, polymyositis, dermatomyositis

112
Q

MCC of myositis

A

hypothyroidism 2. statins or any fat soluble drug

113
Q

drugs that cause myositis (F-RIPS)

A

Fibrates, Rifampin, INH, Prednisone, Statins

114
Q

What marker is involved in polymyositis and dermatomyositis that signals lung fibrosis?

A

Anti-Jo1 (antithyroid synthatase)

115
Q

MCC of rhabdomyolysis?

A

crush injury (trauma)

116
Q

what marker is increased in rhabdomyolysis?

117
Q

How can you prevent injury to kidney in crush injury?

A

Use IV fluids and bicarbs before lifting off object causing crush injury.

118
Q

What is calcium dependent calcium release?

A

when extracellular calcium is used to cause intracellular calcium release (ventricles of heart)

119
Q

hyperactive bowel sounds

A

obstruction

120
Q

rebound, significant guarding or rigidity

A

peritonitis

121
Q

bowel sounds increased

A

gastroenteritis or GI obstruction

122
Q

MCC of ileus (bowels don’t move)

A

hypokalemia

123
Q

diastolic heart failure

A

hypertrophy of ventricles, cannot fill fully

124
Q

best NSAID for muscle spasm after strain?

125
Q

joint sprain RICE

A

rest, ice, compression and elevation

126
Q

muscle strain or sprain, ice or heat?

127
Q

Tx CHF (left sided)

A
  1. oxygen (for brain) 2. diuretics to lessen EDV and heart strain 3.inotropics digoxin, dobutamine 4)ACEi/ARB (decrease TPR)
128
Q

clue: orthopnea, paroxysmal nocturnal dyspnea

A

left sided heart failure (crackles)

129
Q

tx for right sided heart failure

A

fluids (Frank-Starling) increase volume, increase contractility (don’t take PCWP any higher than 18)

130
Q

MOA digitalis

A

blocks Na/K by competing with K; be careful to monitor Ca levels because if Ca gets trapped in cell, too much contractility

131
Q

tx for digitalis toxicity

A

digibind, digifab

132
Q

now first line drug MOA Sacubitril

A

inhibits neprilysin which normally breaks down ANP, increase ANP increase blood flow to kidneys eliminating excess fluid

133
Q

ADH blockers

A

Conivaptan, Tolvaptan

134
Q

MC cause of death in neuromuscular pathologies

A

respiratory failure (diaphragm)

135
Q

What can you get from eating raw bear meat? and what can it do?

A

trichenella spiralis; cause myositis

136
Q

What other parasite can cause myositis?

A

taenia solium

137
Q

dermatomyositis: you must rule out?

A

colon cancer; must order CT of the abdomen

138
Q

TX fibromyalgia

A

SSRI; gabapentin (serotonin modulates pain); amytriptyline

139
Q

TX fibromyalgia

A

SSRI; gabapentin (serotonin modulates pain); amitriptyline

140
Q

1 for chronic pain

A

amitriptyline

141
Q

chronic pain and HF

A

gabapentin

142
Q

shooting stabbing pain

A

carbamazepine

143
Q

next step in management for temporal arteritis

A

steroids (before biopsy or other investigations)

144
Q

tx for polymyalgia rheumatica and temporal arteritis?

A

prednisone (rule of 60s: age more than 60; ESR more than 60 need 60 mg of prednisone daily)

145
Q

early onset (Duchenne’s muscular dystrophy) most likely to be caused by what kind of mutation?

A

frameshift or nonsense

146
Q

later onset (Becker’s) most likely what kind of mutation?

147
Q

muscular dystrophy of trinucleotide repeats

A

myotonic CGT cataracts, gonads, toupee (also birds beak appearance because of tightness of muscles)

148
Q

autoimmune attack after C. jejuni?

A

Guillain Barre

149
Q

TX Guillain Barre

A

IVIG, steroids

150
Q

What is attacked in Argyll Robertson pupil and which microbe is responsible?

A

Edinger-Westphal nucleus of eyes; cause is tertiary syphilis

151
Q

tx for cholinergic crisis in myasthenia gravis

A

atropine to reverse effects and lessen dose of neostigmine

152
Q

autoimmune disease associated with neoplasia where presynaptic Ca channels are blocked

A

Eaton-Lambert

153
Q

Reversible anticholinesterase used for myasthenia gravis?

A

neostigmine

154
Q

irreversible anticholinesterase used as pesticides

A

end in –thion (Malathion, Parathion)

155
Q

antidote for anticholinesterase toxicity

A
  1. atropine 2. pralidoxime (2-PAM); don’t forget if someone who works on farm comes in; cut off all their clothes
156
Q

which neuropathy of children that have arysulfatase enzyme deficiency causes demyelination of neurons?

A

metachromatic leukodystrophy

157
Q

Tx for neuropathyies (MS and Metachromatic leukodystrophy)

A

steroids, IV gamma globulins, plasmapheresis if respiratory compromise

158
Q

descending paralysis; UMN and LMN; fasciculations; CST and ventral horn involvement; no sensory neuron involvement

A

Amyotrophic Lateral Sclerosis (ALS)

159
Q

newborn floppy baby syndrome; no motor neurons

A

Werdnig Hoffman’s Disease

160
Q

enterovirus hides in the dorsal root ganglia

161
Q

GAA trinucleotide repeat

A

Friedreich’s Ataxia

162
Q

Carnitine acyltransferase 1 deficiency; X linked recessive; cortical white matter involvement; adrenal gland failure

A

adrenoleukodystrophy (fatty acids trapped in cytoplasm, can’t get to mitochondria, no ketones)

163
Q

permanent neurological damage before age 21

A

cerebral palsy

164
Q

midline cortical problem, legs worse than arms

A

spastic diplegia (UMN)

165
Q

cortical problem on one side of body; one side more affected than other ; could be caused by herpes (temporal lobe) or toxoplasmosis (parietal lobe)

A

spastic hemiplegia

166
Q

no muscle tone; frontal cortex involved; involves corticospinal tract (puts body in tone)

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