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Neuromusc phys
| Question | Answer |
|---|---|
| What is the motor neurotransmitter? | AcH |
| Does an action potential happen presynaptically? | yes |
| What electrolyte is released presynaptically? | calcium |
| Calcium stimulates the release of what? | ACh |
| ACh is released into where? | neuromuscular junction |
| Drugs work at the site of the NMJ? | yes |
| What is the post junctional membrane also known as? | motor end plate |
| At the post junctional membrane you have an influx of _____ and _____, and an outflux of _____. | Na and Ca |
| When the membrane becomes depolarized, what occurs? | action potential |
| What could be the causes of skeletal muscle disorders? | autoimmune, defect in muscle protein, pharmacologic effects |
| This disorder is caused by autoimmune destruction or inactivation of the post synaptic ACh receptor? | Myasthenia gravis |
| In myasthenia gravis, the destruction of ACh receptors, leads to a __________ in the receptors and loss of the folds on the synaptic vesicles. | decrease |
| 65% of the patients with MG are thought to have a ______________ _______________ gland. | hyperplastic thymus |
| MG is known for its episodes of ___________ & ______________. | remission and exacerbation |
| T/F Exacerbation can be generalized or confined to a muscle group. | T |
| What could happen if there is ocular muscle involvement in MG? | diplopia or ptosis |
| In MG, if there is bulbar involvement, what would you see? | laryngeal weakness and dysphasia |
| In a severe diagnosis of MG, there is proximal muscle involvement, which includes which muscles? | neck, shoulders, & respiratory muscles |
| With MG, when does muscle strength improve? | with rest |
| When is exacerbation of MG enhanced? | stress, pregnancy, surgery, infection |
| What is the diagnostic tool (drug) for MG? | edrophonium (tensilon, enlon, reversol) |
| What is the adult does of edrophonium? | 0.1-0.2 mg IV; 1-2mg IV if no response; 5-9 mg slow IV if still no response |
| What is the pediatric dose of edrophonium? | 0.2 mg/kg slow IV; not to exceed 10mg |
| What drugs may decrease the effects of edrophonium? | atropine nondepolarizing muscle relaxants, procainamide, quinidine |
| What drugs may increase the effects of edrophonium? | succs, digoxin, IV acetazolamide, neostigmine, physostigmine |
| What drug, used to treat MG, acts on smooth muscle, CNS, and secretory glands where it blocks the action of ACh at parasympathetic sites? | pyridostigmine (mestinon, regonol) |
| What is the adult dose of pyridostigmine? | 60mg PO tid initially, followed by a maintenance dose of 60-1500 mg/d, 2mg IV/IM q 2-3hr; or 1/30 of PO dose |
| What drug is a longer acting cholinesterase inhibitor that can be used when edrophonium is effective? | neostigmine (prostigmin) |
| What is the adult dosage of neostigmine? | 15mg PO q3-4h; not to exceed 375mg/d; 0.5-2.5 mg IV/IM/SC q1-3h; not to exceed 10 mg/d |
| What is the pediatric dose of neostigmine? | 2 mg/kg/d PO divided q 3-4h; 0.01-0.04 mg/kg IV/IM/SC q2-4h |
| How can you tell between myasthenic crisis and cholinergic? | tensilon test |
| An increase in weakness with 10mg tensilon indicates what? | cholinergic crisis |
| An increase in strength indicates? | myasthenic crisis |
| Other medical treatments for MG include: | thymectomy or plasmaphoresis |
| Other drugs that could be used for MG: | immunosuppressants, steroids, anticholinergics, B2 agonists |
| Prior to surgery, what may you want to give a pt with MG? | an H2 blocker for aspiration prevention |
| Consider omitting what for MG patients having surgery? | sedatives, muscle relaxants |
| What may pts with MG require more of, but its duration will be increased? | Succs |
| Precheck this prior to administering nondepolarizing MR and base dose on response? | TOF |
| What drugs will inhibit both true cholinesterase and plasma cholinesterase activity? | anticholinesterase drugs |
| What is a rare disorder of neuromuscular transmission that resembles MG, is usually associated with small cell carcinoma of the lung, and is a paraneoplastic disorder affecting the lower extremities? | eaton lambert syndrome |
| With eaton lambert syndrome, muscle weakness generally improves with exercise. T/F | T |
| In eaton lambert syndrome, there is a prejunctional deficit in the release of ACh, which is thought to be related to antibodies on the __________ channels. | calcium |
| Eaton lambert syndrome is unaffected by which drugs? | anticholinesterases |
| Pts with eaton lambert may be prone to what? | orthostatic hypotension, cardiac irritability, gastroporesis, and urinary retention |
| Where do people with eaton lambert exhibit muscle weakness? | trunk, pelvis, legs |
| Pts with eaton lambert are sensitive to depolarizers and non depolarizers. T/F | T |
| Should eaton lambert patients use deep inhaltionals or light anesthesia? | deep |
| What is pseudo hypertrophic muscular dystrophy and is the most common and most severe childhood progressive NMD? | Duchene's Muscular Dystrophy |
| Is Duchene's caused by an X or Y linked recessive gene? | X |
| What are the signs/symptoms of duchene's? | waddling gait, difficulty climbing stairs, frequent falls |
| What lab result is 30-300 times normal in kids with ducenes? | Creatinine |
| In duchenes, skeletal muscle shows _________ and phagocytes of the muscle fiber. | necrosis |
| People with ducenes have a degenerative cardiac muscle. T/F | T |
| Duchene's pts tend to have this problem, due to papillary muscle dysfunction. | mitral regurg |
| People with duchene's have good or bad respiratory function? | bad |
| What is contraindicated for surgery on duchene's people? | sucs |
| What would succs do to a person with duchene's? | rhabdo, hyperkalemia, cardiac arrest |
| What has a prolonged effect in people with duchene's? | non depolarizing muscle relaxants |
| What should be readily available for duchene's pts because they are at high risk for MH? | dantroline |
| Can you use regional anesthesia on pts with duchenes? | yes, do it whenever possible |
| How many hours post-op could pts be respiratory depressed with duchenes? | 36 hours |
| In MH, there is a defect in what? | calcium regulation |
| What are MH triggering agents? | Succs, inhalationals, K salts |
| What is an electrically insulating di-electric phospholipid layer that surrounds only the axon of many neurons? | myelin |
| The main purpose of the myelin is to increase the speed of impulses along the nerve cells. T/F | T |
| What part of the brain is myelinated? | the white matter |
| What refers to the loss of the myelin sheath? | demyelination |
| Demyelination occurs with what diseases? | MS, ALS, guilliane barre |
| What disease is characterized by demyelination of several sites of the brain and spinal cord with chronic inflammation and scarring? | MS |
| MS usually occurs between what ages? | 20-40 |
| What are the signs and symptoms of MS? | motor weakness, parasthesia, visual disturbances |
| What worsens the symptoms of MS? | increases in body temp |
| What drugs are given to treat the spasms in MS? | dantroline, bachlofin, and diazapam |
| What treats urinary retention in MS? | bethanechol |
| What decreases MS exacerbations? | ACTH , gluccocorticoids |
| What drugs are immunosuppressants in MS? | interferon B, AZT, cyclophosamide |
| What should be avoided by anesthesia for a pt with MS? | sux and increases in body temp |
| What kind of anesthesia should be avoided in MS pts? | spinal |
| What is the most common and most rapidly progressing neurologic disease in adults that occurs during the 5th and 6th decade of life? | ALS |
| What is ALS characterized by? | muscle weakness, atrophy, fasciculations, and spasms |
| Avoid what MR in pts with ALS? | sux |
| Acute demyelinating polyneuropathy is what syndrome? | guillian barre |
| Guillian barre is the most common acute form of neuropathy. T/F | T |
| GB is seen 2-4 weeks after what? | viral infection |
| What kind of paralysis do GB patients develop? | ascending |
| What occurs in GB patients over 3-4 mos, with full recovery in most cases? | remyelination |
| In GB there is an immunologic response against the myelin sheath of the ____, especially the lower motor neurons? | PNS |
| GB can also be seen in par-neoplastic disease such as: | hodgkins lymphoma or HIV |
| Sux should be avoided in pts with GB. T/F | T |
| What is a disorder characterized by sadness and pessimism? | depression |
| Treatment of depression is based on the premise that depression is due to a decrease in which receptors in the brain? | dopamine and norepi |
| What are the 3 major classes of drugs used to treat depression? | MAOIs, Tricyclics, and SSRIs |
| What class of drugs blocks the oxidative deamination of naturally occurring amines? | MAOIs |
| MAOIs are used when pts don't respond to other drug therapies. T/F | T |
| What are the MAOIs? | Phenelzine (Nardil), Isocarboxazide (Marplan), Tranylcypromine (Parnate) |
| MAOIs do not sensitize the heart to the effects of _____ as does tricyclics. | epi |
| The principle effect of MAOIs is that systemic htn occurs as a result of increased inhibition of monoamine oxidase which increases the availability of what? | norepi |
| If a pt is on an MAOI, ephedrine will increase the release of what? | norepi |
| MAOIs cause the metabolism of what to decrease? | opioids |
| Opioids form what in the presence of MAOIs? | toxic metabolite |
| What is the most commonly prescribed drug class to treat depression? | SSRIs |
| What are the SSRIs? | prozac (fluoxetine), zoloft, paxil, lexapro, celexa |
| SSRIs lack _______________ effects? | anticholinergic |
| SSRIs also do not sensitize the heart to the effects of epi. T/F | T |
| What are the side effects of SSRIs? | headache, agitation, nausea, insomnia, and sexual dysfunction |
| Which SSRI has been shown to inhibit the CYP450 system? | Prozac |
| What can mixing an SSRI with an MAOI lead to? | serotonin syndrome |
| What are the signs and symptoms of serotonin syndrome? | anxiety, restlessness, chills, ataxia, insomnia, tachycardia, htn, and hyperthermia |
| What are the tricyclics that are commonly used? | amytrityline, nortriptyline |
| What xan produce a sedative effect and are often used for insomnia? | tricyclics |
| Tricyclics have an anticholinergic effect. T/F | T |
| What are the side effects of tricyclics? | CV abnormalities, orthostatic hypotension, slow atrial and ventricular depolarization, increased PR and QT, and a wide QRS |
| Pts on tricyclics may require more anesthesia because of the increased availability of what catecholamine? | norepi |
| What is at high risk for occurring during the first 14-21 days of tricyclic treatment? | hypertensive crisis |
| What is used for the treatment of depression that is unresponsive to drug therapy, or for an acute episode with suicidal ideations? | ECT |
| What are side effects of ECT? | initial vagal response followed by HTN and tachycardia |
| What is the most common cause of death with ECT treatment? | MI |
| ECT also causes this side effect which causes muscle spasms and long bone fractures? | seizures |
| ECT causes increased intrathoracic pressure, which causes decreased what? | venous return |
| ECT also causes increased cerebral metabolic requirements for oxygen and increased ICP. T/F | T |
| Because of the risk of MI, what should be given to a pt on ECT therapy 45 mins preop? | nitro paste |
| What are the induction drugs that should be used for pts on ECT? | methohexitol 0.5-1mg/kg, prop 1.5mg/kg, sux 0.3-0.5mg/kg |
Created by:
Jmw015