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A/P > Lecture 10/4 - Refelxes pt 2 > Flashcards

Lecture 10/4 - Refelxes pt 2 Flashcards

Test 2

1
Q

What happens to our fetal nAch-R as we grow?

A

They are swapped out for Adult nAch-R

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2
Q

When there’s a problem with contracting skeletal muscle, what will our body do to fix that?

A

Add more nAch-R

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3
Q

Describe these areas in the post synpase:
Junctional area
Perijunctional area
Postjunctional area

A

Junctional: Center, right under clefts

Perijunctional: on the side, side of clefts

Postjunctional: on the side of perijunctional

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4
Q

Where should nAch-R be?

A

NMJ - junctional area only.

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5
Q

Where can fetal nAch-R appear in skeletal muscle?

A

NMJ in the junction, perijunctional, and postjunctional areas

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6
Q

What are ways to assess neuromusclar activity?

A

TOF
Single Twitch
PTC (Post-tetanic count)
DBS (Double burst stimulation)

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7
Q

What muscle does the ulnar nerve activate?

A

Adductor Pollicis

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8
Q

Define the Supramaximal Stimuli

A

Voltage strong enough to fully recruit all motor neurons and fully activate the skeletal muscle cells

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9
Q

What happens if you dont get a twitch at all?

A

Not enough voltage or something wrong at the NMJ

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10
Q

What is TOF?

A

Train of Four

Repetitive stimulation at 2hz/2sec

Ex) 2 secs = 4 twitches
4 secs = 8 twicthes

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11
Q

Define tetanic

A

Contractions when stimulated at a high frequency repeatedly

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12
Q

What is post-tetanic count?

A

Number of contracts after tetanic contraction

Helps determine health of the synapse

Increases PTC = light block
Decreases PTC = deep block

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13
Q

What is DBS?

A

Double Burst Stimulation

2 short burst of 3 electrical stimuli at 50 Hz with brief pause in between

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14
Q

What is the Hz with DBS?

A

50 Hz

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15
Q

What happens if you stimulate the ulnar nerve and get a really big contraction?

A

Block is not deep enough

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16
Q

What happens if stimulate the ulnar nerve and get no contraction?

A

Deep block

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17
Q

What happens while stimulating a nerve?

A

Electrons depolarize the outside which changes the polarity of the outer cell…

This indirectly depolarizes the inside of the cell causing an AP and muscle contraction

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18
Q

What fingers muscles are affected and what fingers move when the ulnar nerve is stimulated?

A

Adductor Pollicis

Thumb twitches forward
Pinky twitches
one or both will happen

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19
Q

What will happen if you are completely paralyed and the ulnar nerve is stimulated in TOF?

A

Nothing - no twitches

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20
Q

What are some alt sights for nerve stimulation if you cant use ulnar nerve?

A

Ophthalmic branch of Facial Nerve (outer side of eye socket)
Peroneal nerve (butt)
Posterior tibial nerve (lower extremity)

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21
Q

T/F: Depolarizing blocks have a short half life

A

T

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22
Q

Onset/Half life nondepolarizing block:

A

Few minutes

lasts extremely long

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23
Q

Onset/Half life depolarizing block:

A

quick

short lasting

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24
Q

In TOF responses: Which twitch is A? B?

A

1st twitch = A
Last = B

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25
Q

What is the TOF ratio?

A

B/A

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26
Q

What does a higher TOF ratio mean?

A

drug is wearing off

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27
Q

Which paralytic can you have a TOF ratio in?

A

Nondepolarizing Block

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28
Q

T/F: In TOF, all 4 twitches will be the same height and highest as before you give the drug

A

T

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29
Q

In TOF responses: which twitch is often the strongest?

A

1st
A

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30
Q

In TOF responses: what does the 4 twitches being different heights mean?

A

Incomplete block

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31
Q

T/F: In TOF responses: The twitches all come back at the same rate as the drug wears off

A

F

The twitches come back in different stages

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32
Q

What is the TOF ratio in depolarizing block? Why?

A

1

All the twitch as the same size because this is a complete block

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33
Q

Describe an Alpha-3 Beta-2 Receptor

A

nAch-R on motor nueron = autoreceptor

3 alpha subunits; 2 beta subunits

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34
Q

What does the Alpha-3 Beta-2-R do?

A

When activated by Ach, Na+ and Ca++ flows in.

This moves VP1 vesicles towards to to synapse and VP2 vesicles to the membrane for exocytosis

35
Q

What is Succs broken down by?

A

Plasma Cholinesterase

36
Q

Nondepolarizing blockers inhibit ________of the synapse

A

both sides

37
Q

Depolarizing blockers inhibits _________ of the synapse

A

more of the skeletal muscle side

38
Q

What are the L-type Ca++ channel’s role in the motor neuron?

A

Supplement the P-Type

Faster than P-type

39
Q

What type of drug can you give an alcoholic who has tremors?

A

CCB

40
Q

If you give an _______ dose of CCB you will not paralyze them

A

High

41
Q

What happens when you give Succs with fetal nAch-R present?

A

Prolonged depolarization in MULTIPLE areas
Increased K leaving the cell.
Vfib

42
Q

What are the nerves called that connect to the diaphragm?

A

Phrenic nerves

43
Q

Where do the phernic nerves originate and connect to the diaphragm?

A

C3, C4, C5

44
Q

Where does Adductor Pollicis inhibition start?

A

20 micrograms/kg

45
Q

Where does Adductor Pollicis have total inhibition?

A

40 micrograms/kg

46
Q

T/F: If there are 4 strong twitches in the adductor pollicis, pt can probably breath on their own.

A

T

PROBABLY

47
Q

Where does Diaphragm inhibition start?

A

40 micrograms/kg

48
Q

Where does Diaphragm have total inhibition?

A

90 micrograms/kg

49
Q

In less important muscles: They are the ____ to be paralyzed and the _____ to recover.

A

1st

Last

50
Q

In more important muscles: They are the _____ to be paralyzed and the ______ to recover.

A

Last

1st

51
Q

What type of neuromusclar blocker are you generally using TOF for?

A

Non depolarizing

52
Q

In TOF: What happens when the 4th twitch disappears?

A

75-80% of nAch-R blocked

53
Q

In TOF: What happens when the 3th twitch disappears?

A

85% of nAch-R blocked

54
Q

In TOF: What happens when the 2th twitch disappears?

A

85-90% nAch-R blocked

55
Q

In TOF: What happens when the All twitches disappears?

A

90-95% nAch-R blocked

56
Q

If the patient is coming out of a block and can lift their head, what can we assume?

A

All 4 twitches are present

Maybe able to breathe on their own

57
Q

What are your stimulator settings (TOF Voltage)?

A

50-80 mA

58
Q

Define voltage

A

Force/push stimulator applies

59
Q

T/F: Your stimulator settings is equal to the supramaximal stimuli

A

T

60
Q

What additional aspect is needed to cause contractions with fetal nAch-R when using Succs?

A

Bad motor deficits

61
Q

Why does Succs cause an increase in IOP?

A

IOP = intraocular pressure

Ocular muscle is controlled by mulitple motor neurons = multiple NMJ

Ca++ coming in causes contractions which increases the pressure

62
Q

What can happen with increased IOP?

A

Blindness

63
Q

Describe GABA

A

inhibitory neurotransmitter in CNS
increases Cl- conductance

64
Q

What happens if you suppress GABA?

A

uncontrolled activity of CNS —> seizures

65
Q

Describe Gylcine

A

inhibitory neurotransmitter in CNS
Similar to GABA
Very important in spinal cord

66
Q

What are the 2 main neurotransmitters in the CNS/spinal cord?

A

GABA
Glycine

67
Q

What neurotransmitters increase alertness and awareness?

A

Ach
Histamine
Glutamate
NE

68
Q

What is the neurotransmitter in the PNS?

A

Ach

69
Q

Anticholinergics block ____ and cause _______

A

Ach

Drowsiness

70
Q

What type of drug is Benadryl? What can a large dose do?

A

Central histamine and central anticholinergic

Increase heart rate d/t mAch-R in the heart

71
Q

What happens if you inhibit Ach-ase?

A

Increase alertness/awareness

72
Q

What types of drugs can we give to reverse a paralytic without waking the patient up?

A

Drugs that inhibit Ach-ase that DO NOT cross the BBB

NOT -STIGMINES

73
Q

What is the main neurotransmitter for pain?

A

Glutamate

74
Q

What does too much glutamate cause?

A

Brain cell death

75
Q

What drug Tx Parkinsons?

A

Dopamine

76
Q

What is dopamine?

A

Potent motor inhibitor

77
Q

What are 3 inhibitory neurotransmitters?

A

GABA, Dopamine, Glycine

78
Q

What were NE reuptake inhibitors used for?

A

Chronic pain

79
Q

What does severe acidosis do?

A

decrease CNS activity

80
Q

What does severe alkalosis do?

A

increase CNS activity

81
Q

How are Acid-Base imbalances related to Ca++?

A

Albumin is largely present in blood plasma & negatively charged

-The less H+ ions = The more Ca++ the albumin will attract
This means less free Ca++ in the blood stream = increased CNS activity (alkalosis)

-The more H+ ion = less Ca++ the albumin will attract
This means more free Ca++ in the blood = decreased CNS activity (acidosis)

82
Q

Hypoventilate =

A

increase H+

83
Q

Hyperventilate =

A

decrease H+

A/P (25 decks)

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