Intro to Neuro Flashcards

1
Q

Blood brain barrier (BBB) general

-talk about the different components of the BBB

A
  • Capillaries = endothelial cells ONE layer thick surrounded by basement
    membrane
  • Non-neural capillaries have small gaps (intercellular clefts) and fenestra for small molecules to pass
  • Within the brain, capillaries have intercellular clefts which are closed by a network of astrocytes and pericytes, forming tight junctions. Fenestra are absent.
  • Astrocytes surround about 85% of capillaries
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2
Q

Blood brain barrier - purpose, transporters and what can and cannot get through

A
  • Reduces diffusion of ionized or hydrophilic molecules
  • CNS drugs must be nonionized &/or lipid soluble
  • Water-soluble materials are moved by specific transport processes (sugars,
    amino acids) by facilitated diffusion with carrier proteins
  • P-glycoprotein transporters can exclude certain compounds from the brain
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3
Q

Areas of BBB with higher permeability? (3 specific areas)

A
  1. Area Postrema: adjacent to the chemoreceptor trigger zone (CTZ)
    › Allows toxins in blood to stimulate vomiting
    › Apomorphine induces vomiting
  2. The median eminence of the hypothalamus:
    › Hypothalamic releasing factors transported by pituitary gland
  3. Pineal gland: releases hormones into blood
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4
Q

Pharmacological uses of the BBB

-drugs or drug classes and how they can be affected by the BBB)

A
  1. 2nd Generation Antihistamines (loratadine/Claritin)
    › Blocks H1 receptors in periphery but does not cross BBB
  2. Carbidopa – dopa decarboxylase inhibitor that does not cross BBB
    › Prevents conversion of levodopa into dopamine in periphery
  3. Naloxegol (Movantik)
    › Pegylated derivative of naloxone, does not cross BBB & reverses constipation produced by systemic opiate agonists
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5
Q

Anatomy of the brain: Spinal cord

A

Spinal cord: transmits messages via afferent & efferent neurons from periphery to CNS
› Site of action of some muscle relaxants & opioids

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6
Q

Anatomy of the brain: Brain Stem and cerebellum/ it’s clinical syndromes (which is located within)

A

-Brain stem: medulla, pons, cerebellum & midbrain
› 12 cranial nerves originate here
› Mediate sensory & motor function associated with special senses (visual, auditory, taste, smell, respiration, heart rate, GI functions)
.
-Cerebellum: coordinates motor movement via inputs from vestibular system & cortices (auditory, visual, sensory, motor)
› Clinical syndromes characterized by awkwardness of intentional movements
—— Ataxia: awkwardness of posture & gait, poor motor coordination, balance & speech. Eye movement problems (nystagmus). Sometimes are a side effect of antiepileptic drugs (phenytoin, phenobarbital, alcohol, benzodiazepines & lithium)
——–Asthenia: muscles tire more easily than normal
——- Tremor: usually “intention tremors” evident during purposeful movements

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7
Q

Anatomy of the brain: Reticular formation (RAS)

A
  • Reticular formation (RAS): medulla to midbrain
    › One neuron in RF may have input from 10,000 other neurons & makes contact with over 25,000 other neurons
    › Regulates alertness/sleep, bp, heart rate & respiration
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8
Q

Anatomy of the brain: Thalamus

A

Relays motor & sensory signals to cerebral cortex

› Important in consciousness, sleep and sensory interpretation

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9
Q

Anatomy of the brain: midbrain

A

relay nuclei for auditory and visual systems
› DA neurons in substantia nigra (motor control); Parkinson’s disease
› DA neurons in ventral tegmental area (emotion/cognition); Schizophrenia

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10
Q

Anatomy of the brain

-Extrapyramidal motor system: Basal ganglia

A

Basal ganglia: consist of Caudate nucleus, Putamen (striatum), and Globus Pallidu
› Receives dopaminergic innervation from substantia nigra.

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11
Q

Disorders and diseases of the basal ganglia . . .

A

1.) Parkinsonism: rigidity, slowness, resting tremor, masked facies, shuffling gait
› assoc with degeneration of basal ganglia & substantia nigra
› Treat by increasing DA function in BG
2.) Chorea: brief/abrupt, irregular, non-repetitive, purposeless jerky involuntary movements affecting especially the shoulders, hips, and face (Sydenham’s chorea, Huntington’s Chorea)
› Treat with decreasing DA or enhancing GABA
3.) Athetosis: slow writhing/snake-like movements, esp. fingers & wrists
› Treat by decreasing DA
4.) Tardive Dyskinesia: characterized by repetitive, involuntary, purposeless movements caused by longterm antipsychotic treatment.
› Treat by decreasing DA

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12
Q

Anatomy of the brain: Hypothalamus

A

integrating region for ANS

- Regulates body temp, water balance, hunger & hormone levels in blood

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13
Q

Anatomy of the brain: Limbic system/ it’s components/ functions?

A

Limbic system: hippocampus, amygdala, septum, and projections into the prefrontal cortex, cingulate cortex, and enterorhinal cortex
— Responsible for complex emotions, motivation, short term memory

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14
Q

Anatomy of the brain: Cerebral cortex

A

Cerebral cortex: higher cognitive & emotional functions

- Information processing by modality: somatosensory, visual, auditory, olfactory, motor, association, sleep

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15
Q

Describe neuron synapses

A

Inside the axon terminal of a sending cell are many synaptic vesicles. These are membrane-bound spheres filled with neurotransmitter molecules. There is a small gap between the axon terminal of the presynaptic neuron and the membrane of the postsynaptic cell, and this gap is called the synaptic cleft.
.
When an action potential, or nerve impulse, arrives at the axon terminal, it activates voltage-gated calcium channels in the cell membrane. Ca2+ which is present at a much higher concentration outside the neuron than inside, rushes into the cell. The Ca2+ allows synaptic vesicles to fuse with the axon terminal membrane, releasing neurotransmitter into the synaptic cleft.
.
The molecules of neurotransmitter diffuse across the synaptic cleft and bind to receptor proteins on the postsynaptic cell. Activation of postsynaptic receptors leads to the opening or closing of ion channels in the cell membrane. This may be depolarizing—make the inside of the cell more positive—or hyperpolarizing—make the inside of the cell more negative—depending on the ions involved.

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16
Q

Cell membrane structure and its transporter/ how they behave

A
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17
Q

Process of when a neurotransmitter/ other messenger binds to receptor . . . what happens?

A
18
Q

POSTSYNAPTIC RECEPTORS: Receptor number is dependent on the

concentration of agonist!!!

A
  • Chronic excess of agonist = decrease in # of receptors
    DOWNREGULATION: results in desensitization to the agonist
    .
  • Chronic deficit of agonist (due to denervation, depletion of nt, or presence of an antagonist blocking receptors
    UPREGULATION: results in supersensitivity to the agonist
19
Q

Transporters: Uptake and reuptake

A
  • Transporters are on presynaptic terminals (purple)
    › Control the reuptake of nt back into the presynaptic terminal
    › Transporter antagonists (blockers) bind directly to transporters and prevent reuptake
  • Causes a higher concentration of nt (or agonist) to evoke a response in postsynaptic neuron
20
Q

Transporters: Derived from a genetic family of transporters. . . list the dif transporters

A

› NET : norepinephrine transporter
› SERT: serotonin (5-hydroxytryptamine; 5HT) transporter
› DAT: dopamine transporter
› GAT 1,2,3: GABA transporter

21
Q

Characteristics of transporters:

A
  • DAT & NET may transport both ways (amphetamine)
  • Cocaine blocks all 3 monoamine transporters
  • Tricyclic antidepressants (i.e. amitriptyline) only block SERT & NET
  • SSRI’s (Selective Serotonin Reuptake Inhibitors) i.e. fluoxetine, paroxetine
  • SNRI’s (Selective Norepinephrine Reuptake Inhibitors) i.e. venlafaxine, duloxetine
22
Q

Define Neurotransmitter and Neuromodulator

A
  1. ) Neurotransmitter: a substance released from one neuron that induces activity in another neuron or tissue (ex: dopamine, serotonin, norepinephrine, GABA, Glu)
  2. ) Neuromodulator: substance released from one neuron that has little effect by itself but alters the response to other neurotransmitters (i.e benzodiazepines)
23
Q

Neurotransmitter: Acetylcholine

A
  1. Acetylcholine: chief neurotransmitter of the parasympathetic nervous system (Rest portion) that
    contracts smooth muscles, dilates blood vessels, increases bodily secretions, and slows heart rate.
    - Synthesized by choline transferase stored in vesicles
    - Degraded in synaptic cleft by Acetylcholinesterase to be recycle
24
Q

Cholinergic receptors: two main types

A

1.) Nicotinic Receptors: bind Ach & nicotine
› Ligand gated Ion channel “inotropic”
› Receptor activation usually results in excitation
› 2 subtypes: N1 & N2 (N1 located on skeletal muscle @ NMJ (somatic nervous system))
.
2.) Muscarinic receptors: bind Ach and muscarine
› G-protein coupled receptors “metabotropic”
› Effects depend on the subtype of receptor
› 5 subtypes: M1 - M5
—- M1: Gq (excitatory) found in CNS, salivary glands, gastric glands
—–M2: Gi (inhibitory) found in heart, smooth muscle of bladder
—–M3: Gq(excitatory) found in exocrine glands, eye, lungs, GI, bladder

25
Q

Cholinergic receptor: nicotinic vs muscarinic receptor . . . how do they differ?

A
26
Q

Cholinergic receptor: nicotinic vs muscarinic receptor. . . the different effects of NTs !

A

The

27
Q

Action of acetylcholine . . . the effects, the receptor, the action that caused that effects?

A
28
Q

Cholinomimetics: Substances that mimic Ach & bind to Ach receptor . . . MEDICATION

A

a) Direct agonists
- Bethanechol (M3) in gut & bladder
- Carbachol (M3) in eye
- Pilocarpine (M3) in eye
- Methacholine (M3) in lungs [methacholine challenge test/asthma]
.
b) Indirect agonists (inhibit acetylcholinesterase → increased Ach)
- Edrophonium – Tensilon test
- Neo/Pyridiostigmine
- Physostigmine (crosses BBB; atropine toxicity tx)
- donepezil, galactamine, rivastigmine
.
c) Organophosphates block acetylcholinesterase (pesticides/insecticides. Toxicity similar Ach only intensified, symptoms include DUMBBELS, seizures, death)
.
d) Nerve gases (i.e. sarin)

29
Q

Anticholinergic: Substances that block Muscarinic receptors . . . MEDICATIONS

A

a) Atropine – dilates airways, decreases lung secretions, increases hr, decreases GI motility
b) Scopolamine: M1 in CNS: decreases motion sickness
c) Benztropine: M1 in basal ganglia; decreases tremor
d) Tropicamide: M3 in eye; mydriasis, cycloplegia
e) Ipra/Tiotropium: M3 in lung; bronchodilation, decreased secretions
f) Glycopyrrolate: M3 in lung; bronchodilation and decreased secretions (for intubation)
g) Oxybutynin: M3 in bladder; overactive bladder
h) Dicyclomine: M3 in gut; IBS

30
Q

Anticholinergic toxic

A

Belladonna Alkaloids i.e. Jimson weed
→Too much anticholinergic activity
→HOT as HELL (inability to dissipate heat)
→DRY as a BONE (decreased exocrine gland production)
→RED as a BEET (inability to sweat; flushing of skin)
→BLIND as a BAT (mydriasis, ciliary muscle paralysis)
→MAD as a HATTER (delirium, agitation, confusion

31
Q

List of catecholamine . . .general

A
  • Norepinephrine
  • Epinephrine aka Adrenaline
  • Dopamine
32
Q

Catecholamine: Norepinephrine

A

› Originates in RAS
› Direct & Indirect agonist @ a1 adrenergic receptors → causes peripheral vasoconstriction
› Coronary artery vasodilation
› Increased pulmonary vascular resistance
› Used to maintain bp & systemic vascular resistance (sepsis)
› Metabolized by MAO-A

33
Q

Catecholamine: Epinephrine aka Adrenaline. . . general, use, side effects?

A

› Synthesized from tyrosine released in adrenal medulla
.
Nonselective a & b agonist
—-At higher doses, ALPHA effects dominate
 alpha-1 : peripheral vasoconstriction
 alpha-2: autoreceptors
.
——At lower doses, BETA effects dominate “b-low”
 beta-2 stimulation: bronchodilation (EpiPen)
 beta-1 stimulation: increases HR & contractility →increased (CO & SBP)
.
Clinical uses
› Cardiac arrest resuscitation
› Bronchospasm in acute asthma & anaphylaxis
› Open-angle glaucoma (decreases IOP by decreased production of aqueous humor)
.
Side effects
› Hypertension
› Tachycardia
› Cardiac dysrhythmias
› Anxiety

34
Q

Catecholamine: Dopamine + system

A

› Nigrostriatal system: substantia nigra projects to caudate nucleus & striatum
› Mesolimbic & Mesocortical system: ventral tegmental area projects to frontal cortices & nucleus accumbens
› Tuberoinfundibular system: hypothalamus projects to pituitary gland. Tonically inhibits prolactin secretion
.
- D1, D5 receptors structurally similar
- D2,3,4 receptors are structurally similar
- D2 receptors play a predominant role in
› Parkinson’s disease
› Antipsychotics
- Metabolized by MAO-B

35
Q

Serotonin (not a cate! lol)

A
  • 5-hydroxytryptamine (5-HT): INDOLAMINE synthesized from tryptophan; projects from raphe to DA rich brain regions
  • 5-HT1 receptors: g-protein linked & decrease adenylyl cyclase
  • Metabolized by MAO-A to 5-HIAA
  • Clinical use
    › Antidepressants (SSRI’s) block reuptake of 5-HT, leaving more nt in the synaptic cleft to elicit response
    —— i.e. fluoxetine, paroxetine, sertraline, citalopram, escitalopram, fluvoxamine, vortioxetine, vilazodone
    › Generalized Anxiety Disorder, Obsessive-compulsive disorder, PTSD, PMDD, social anxiety disorder
36
Q

Serotonin syndrome

A

-5-HT1A postsynaptic receptors
› Follows overdose of SSRI or various combinations of L-tryptophan or administration of 5-HT uptake inhibitor &/or an MAOI, or dose of MDMA (ecstasy)
› Symptoms include: myoclonus, tremor, ataxia, akathisia, diaphoresis, delirium, life threatening hyperthermia

37
Q

Clinical use of serotonin: in dept and information on it’s different receptors

A

1.) 5-HT1A autoreceptors:
› Buspirone (Buspar) selective partial agonist used in treatment of anxiety
2.) 5-HT1B mediates vasoconstriction in cerebral vasculature
› Triptans, i.e. sumatriptan, rizatriptan are selective agonists in treatment of migraine
3.) 5-HT2 receptors: g-protein linked to phospholipase C
› 5-HT2A Mediates forebrain cortical excitation i.e. 2nd generation antipsychotics are selective antagonists here
› 5-HT2B mediates/regulates appetite i.e. lorcaserin (Belviq)
4.) 5-HT3: ligand gated ion channel in area postrema where they influence mechanisms of emesis i.e. ondansetron (Zofran), granisetron (Kytril) are selective antagonists

38
Q

Gamma Aminobutyric Acid (GABA)

A
  • Primary inhibitory neurotransmitter in CNS
  • GABA-A is ligand gated Cl- channel, GABA enhances chloride permeability
    resulting in neuronal hyperpolarization
    › Clinical uses:
    benzodiazepines, barbiturates, EtOH, volatile anesthetics
39
Q

GABA-B: G-protein coupled receptor

A

› Presynaptic GABA-B receptors decrease calcium conductance and transmitter release
› Postsynaptic GABA-B receptors mediate IPSP by opening K+ channels
› NOT modulated by benzodiazepines or barbiturates

40
Q

Glutamate, Aspartate, and NMDA receptor (focus on glutamate)

A
  • Excitatory (opposite of GABA) amino acids in high concentrations in the brain increase neuronal activity
  • Synthesized from glutamine
  • Ligand-gated ion channel (Ca++ & Na+)
  • Glutamate: opens Ca++ & Na+ to enter neuron causing depolarization & excitation
41
Q

Clinical use of glutamate

A
  • Memantine (Namenda): competitive antagonist at glutamate receptors; Alzheimer’s
    .
  • Phencyclidine (PCP) & ketamine (Ketalar): binding site inside the channel
    › Noncompetitive antagonist that indirectly antagonizes glutamate; dissociative anesthetic