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anesthesia - epi-norepi

the biosynthesis of catecholamines (norepi-epi) begins when? conversion of phenylalanine to tyrosine in the cytoplasm of sympathetic nerve terminals.
what is the rate limiting step of catecholamine synthesis? tyrosine hydroxylation to dopa by enzyme tyrosine hydroxylase.
what converts tyrosine to dopa? hydroxylation, by enzyme tyrosine hydroxylase.
what happens to dopa in the making of catecholamine biosynthesis? dopa converted to dopamine by dopa decarboxylase.
once dopamine is formed what does it do? enters storage vesicles to be converted to norepi.
what is directly converted to norepi? dopamine.
how is norepi released into the synaptic cleft? action potential cause influx of calcium which cause vesicles to fuse with cell membrane of sympathetic nerve terminals to release norepi
inactivation of norepi is achieved by? both reuptake and metabolism.
which is the majority pathway to cause inactivation of norepi? the reuptake into nerve terminals. about 2/3rds
once reuptake of norepi occurs what happens next? most pumped back into vesicles and the rest are metabolized by MAO IN THE cytoplasm.
norepi not reuptaked goes through what? enters circulation to be metabolized by: 1. mao 2. comt
what blocks reuptake of norepi? 1. TCA 2. COCAINE 3. AMPHETAMINES.
HOW IS EPINEPHRINE FORMED? norepi converted into epinephrine in the adrenal medulla by PNMT
what enzyme causes the conversion of norepi into epinephrine/ phenylethanolamine-n-methyltransferase PNMT.
Etomidate may be hazardous in what setting? why? 1. ruptured globe - myoclonus activity 2. adrenosuppression in critically ill.
how does etomidate cause myoclonus? supression of sub-cortical structures.
what may reduce. etomidate myoclonus activity? premedication with versed or fentanyl. or valproate or clonazepam.
etomidate myoclonus may preclude its use in? cardioversion.
list the drugs that may cause myoclonus? 1. etomidate 2. normeperidine 3. opioids 4. metohexital 5. propofol 6. thiopental.
how does opioids cause myoclonus? due to depression on inhibitory neurons.
how does normeperidine cause myoclonus? a metabolite of meperidine. causes stimulation of the central nervous system. which manifest as myoclonus and seizures.
which drug may cause both seizures and myoclonus (not only myoclonus)? meperidine metabolite - normeperidine.
which drug is an imidazole? etomidate.
dose of etomidate? 0.1-0.4mg/kg.
what is the cause of cns depression from etomidate? gaba like activity.
awakening from etomidate is due to ? redistribution.
how does etomidate make ssep monitoring more reliable/ increases amplitude.
cns effect of etomidate? 1. activates epileptic foci - careful in pts. with seizures 2. increase ssep amplitude 3. cerbral vasoconstrictor - decrease cbf and cmro2 by 25-35%. similar to thiopental. 4. has not analgesic affect/
compared to thiopental the metabolism of etomidate is? like thiopental, etomidate in hydrolyzed in the liver but five times greater then thiopental.
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