Neuro; A&P and Drugs Flashcards

1
Q

2 Parts of the NS and what do they Split into?

A
  • CNS (brain and spinal cord)
  • Peripheral NS (everything else) these divide into spinal and cranial nerve
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2
Q

What does the Peripheral Nervous System Split into?

A

Somatic - Controls skeletal muscle (conscious control)

Autonomic - Controls visceral (smooth) muscle, cardiac muscle, glands (unconscious control)

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3
Q

What does the Autonomic System Split into and what does it correspond to?

A

Sympathetic NS - fight/flight/freeze (speed up) Parasympathetic NS - rest/digest/feed/breed (slow down)

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4
Q

Difference Between the Sensory and Nervous Systems

A
  • Nerves are either afferent or efferent
  • Afferent - sensory neurones, travels towards the brain, informing it eg vision, smell
  • Efferent - motor neurones, travel away from the brain to carry out actions eg moving hand
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5
Q

Path of Neurone Transmission

A
  • Impulses are electrical signals that travel across neurones (cells) in a single direction across the nervous system
  • They start by travelling into the dendrites, then the cell body, then conduct down a (usually) myelinated axon to the terminals of the neurones
  • At the terminal, structures called synapses synthesise neurotransmitters which are released and travel across the synaptic cleft to another neurones dendrites
  • Receptors for the NTs live on the other side and continue the action potential of the message
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6
Q

Structure and Function of Neurones

A

Cell bodies - make up the grey matter of the NS. Contains all the organelles needed for survival

Axon - part of the white matter. The path the signal travels down. Can be insulated with myelin, a type of fat that speeds up the conduction of the impulse

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7
Q

Function of Neurones

A

Neurones make up nerves that make up the pathway for chemical signal to be made, to control organ function, movement of muscle and brain activity

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8
Q

How is the Spinal Cord Connected to the Brain? And how is it being Protected?

A
  • The spinal cord is a continuation of the medulla oblongata and brain stem
  • It’s surrounded by meninges and bathed in CSF
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9
Q

What are the Different Spinal Vertebrae and how many are there?

A
  • Cervical x7
  • Thoracic x12
  • Lumbar x5
  • Sacral x5 (fused)
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10
Q

How many Spinal Nerves are there? And What/Where is the Cauda Equina?

A
  • here are 31 pairs of spinal nerves extending from the spinal cords as ‘nerve root’s between each vertebrae
  • The Cauda Equina hangs from the conus medullaris at the 2nd lumbar vertebrae (L2) - responsible for sensory function to the legs and the bladder
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11
Q

Intervertebral Discs; What do they do?

A

Intervertebral discs or laminae made of cartilage act as shock absorbers, but the discs can slip and put pressure on the cranial nerve

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12
Q

Functions of the Spinal Chord

A
  • Transmitting nerve signals from the brain to the body and from the sensory neurons to the brain
  • Coordinating many reflexes and containing reflex arcs that can independently control them
  • Providing structural support and building a body posture
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13
Q

What is Grey Matter? And What is it responsible for?

A
  • Contains most of the brains neural cell bodies connected to unmyelinated axons
  • Includes regions of brain involved in muscle control, sensory perception (seeing, hearing, memory, emotion, speech, decision making and self-control)
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14
Q

What is Cerebral White Matter? And what is it responsible for?

A
  • Tissue in which messages pass between different areas of grey matter in the CNS
  • Contains myelinated axons connecting cells bodies in deep structures of the brain
  • Responsible for communication between cerebral cortex/lower CNS and cerebrum areas
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15
Q

What does the Cerebellum do?

A
  • Balance
  • Skill
  • Fine motor movement
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16
Q

What does the Hypothalamus do?

A
  • Regulates the heart
  • Regulates breathing
  • Maintaines body temp
  • Regulates sleep cycle
17
Q

What is the Cerebral Cortex do?

A

Enables sense, communication, memory, understanding, voluntary movements

18
Q

How is the Brain Protected?

A

By bone, meninges and cerebrospinal fluid (CSF). Harmful substances are shielded from the brain by the blood brain barrier.

19
Q

What does the Cerebrospinal Fluid do?

A
  • Forms cushion layer supporting CNS organs
  • Prevents brain crushing under its own weight
  • Absorbs pressure impact to CNS from blows and other trauma
  • Nourishes brain/carries chemical signals throughout it
20
Q

How does the Blood Brain Barrier Protect the Brain?

A
  • It has a selective barrier to allow nutrients to pass freely, stopping pathogens crossing. Allows hydrophobic (O2, CO2)
  • Separates bloodborne substances from neurones
21
Q

The Meninges Structure; What each Layer does

A
  • X3 Layers; Dura Mater, Arachnoid Mater and Pia Mater
  • Dura Mater - Outer layer, very hard to tear/extremely tough. Closely adhered to the skull
  • Arachnoid Mater - Between dura and Subarachnoid space. Bleeding in this area = subdural haematoma
  • Subarachnoid Space - Has CSF and large blood vessels. Vessel rupture called subarachnoid haematoma
  • Pia Mater - delicate connective tissue that clings to the brain
22
Q

What is the Munroe-Kelly Hypothesis?

A

The sum of volumes of the brain, CSF and intracranial blood stays constant so when one increases/decreases the other two decrease/increase

23
Q

Presentation of PR Diazepam

A

Suppository tube containing either 5/10mg in 2.5ml

24
Q

Indications of PR Diazepam

A
  • Convulsion of over 5 minutes, who are currently seizing where IV access can’t be established
  • Repeat convulsions of 3 or more in 1 hour who are currently seizing - not secondary to uncorrected hypoglycaemia or hypoxia - where IV access can’t be established
  • Eclamptic convulsion - if the seizure laster over 2 minutes and persists or is recurrent - where IV access cannot be established
25
Q

Contra-Indications of PR Diazepam

A
  • Known allergy to benzodiazepines
  • IV access has been established
  • Prior administration of 2 doses of a benzo
  • Children under 1 month old
  • Children under 1 month (requires CCP intervention)
26
Q

Actions of Diazepam

A

Diazepam works by acting on GABA receptors in the brain to release the NT GABA. GABA acts as a natural ‘nerve-calming’ agent keeping the nerve activity in the brain in balance by inducing drowsiness, reducing anxiety and relaxing muscles

27
Q

Dose of PR Diazepam

A

Adults (12-69):
INITIAL DOSE: 20mg*
REPEAT DOSE: 10mg
MAX DOSE: 30mg

Adults (Over 70/frail regardless of age):
INITIAL DOSE: 10mg
REPEAT DOSE: 10mg
MAX DOSE: 20mg

***if IV/IO access is obtained, first dose should be 10mg, max dose of 20mg

28
Q

Presentation of Diazepam (Injection)

A

Solution for Injection 10mg in 2ml

29
Q

Indications of Diazepam (Injection)

A
  • Prolonged convulsions lasting over 5 minutes
  • Repeated convulsions of over 3 in 1 hour
  • Suspected eclamptic convulsions lasting over 2 minutes where the pt is still convulsing
  • Symptomatic cocain toxicity (severe hypertension, chest pain or convulsions
30
Q

Contra-Indications of Diazepam (Injection)

A
  • Known allergy to benzo’s
  • Where prior administration may exceed the maximal dose
  • Presenting with psychogenic cause - follow individualised treatment plane
  • Where pt has a specific seizure management plan that doesn’t involve benzo’s
  • If the individual is pregnant over 20 weeks, suspect eclamsia and refer to JRCALC pregnancy-unduced hypertension guidance
31
Q

Route of Diazepam (Injection)

A

Slow IV over 2 minutes (adults)
Slow IV over 3-5 mins (children under 17)

Doses may be titrated in symptomatic cocaine toxicity

32
Q

Dose of Diazepam (Injection)

A

Adult (Elderly/frail):
INITIAL DOSE: 5mg in 1ml
REPEAT DOSE: 5mg after 10 minutes
MAX DOSE: 10mg

Adult (Normal):
INITIAL: 10mg in 2ml
REPEAT DOSE: 10mg after 10 minutes
MAX DOSE: 20mg

33
Q

Presentation of Buccal Midazolam (Pt own)

A

An Oro mucosal solution. Pre-filled syringe containing 2.5, 5, 7.5 or 10mg in 5ml

34
Q

Indications of Buccal Midazolam (Pt own)

A
  • Pt who are currently having a prolonged seizure (over 5 minutes) - not secondary to an uncorrected hypoxic/hypoglycaemic episode
  • Convuslsion continuing 10 minutes after first dose of medication
35
Q

Contra-Indications of Buccal Midazolam (Pt own)

A

None in the emergency situation

36
Q

Actions of Buccal Midazolam (Pt own)

A

A short-acting benzodiazepine with anxiolytic, sedative and anticonvulsant properties. Usually starts working wthin 5 minutes if done buccal. The sedative effect decreases from 15 minutes onwards

37
Q

Route of Buccal Midazolam (Pt own)

A

Goes between the cheek and teeth - this is called the buccal cavity.

38
Q

How to Administer Buccal Midazolam (Pt own)

A
  1. Fully remove the cap from the syringe
  2. Using your finger and thumb, gently pinch and pull back the patient’s cheek
  3. Place the tip of the syringe into the back of the space between the inside cheek and the lower gum
  4. Slowly adminster the solution over 4 or 5 seconds. Check whether the dose may need to be divided by two
  5. Dispose of the cap and syringe safely
39
Q

Dose of Buccal Midazolam (Pt own)

A

Adult:
INITIAL DOSE: 10mg in 5ml
REPEAT DOSE: 10mg after 10 minutes
MAX DOSE: 20mg