Week 2

Question 1

Central Nervous System (CNS)

Answer 1

• Brain

- Spinal cord

Question 2

Peripheral Nervous System (PNS)

Answer 2

-All nervous tissue outside the CNS including sensory and motor neurons

Question 3

Basic functions of the Nervous System

Answer 3

-Recognize, processing, and reacting to changes in the internal and external environment

Question 4

Adrenergic response

Answer 4

• Activated under stress
• Fight or flight response
• Ready the body for an immediate response to a potential threat

Question 5

Cholinergic response

Answer 5

• Activated under non-stressful conditions
• Rest-and-digest
• Digestive process promoted: heart rate and blood pressure decline

Question 6

Autonomic Nervous System: Sympathetic and Parasympathetic Divisions

Answer 6

• Produce opposite effects
• Body tries to maintain proper balance of the two (homeostasis)
• Don’t always produce opposite effects

Question 7

Synapse

Answer 7

• Juncture of neurons

- Includes a pre and post ganglionic neuron

Question 8

5 Mechanisms by which drugs can affect synaptic transmission

Answer 8

• Affect the synthesis of the neurotransmitter in the pre-synaptic nerve
• Prevent storage of the neurotransmitter in the vesicles within the pre-synaptic nerve
• Influence release of the neurotransmitter from the pre-synaptic nerve
• Prevent the normal destruction or repute of the neurotransmitter
• Bind to the receptor site on the postsynaptic target tissue

Question 9

Primary Neurotransmitters of the Autonomic Nervous System

Answer 9

• Norepinephrine

- Acetylcholine

Question 10

Norepinephrine

Answer 10

• Released by most postganglionic nerves
• Class of agents called catecholamines
• Adrenergic receptors

Question 11

Acetylcholine

Answer 11

• Released by cholinergic nerves

- 2 types: Muscarinic and Nicotinic receptors

Question 12

Norepinephrine is synthesized…..

Answer 12

• In the nerve terminal
• Requires amino acid phenylalanine and tyrosine
• Can be renewed, recycled, and reused

Question 13

Acetylcholine is synthesized…..

Answer 13

• In persynaptic nerve terminal from choline and coenzyme A

- In the synaptic cleft is rapidly destroyed by acetycholinesterase

Question 14

Cholinergic receptors of Ach

Answer 14

• Nicotinic

- Muscarinic

Question 15

Nicotinic

Answer 15

• In sympathetic and parasympathetic divisions

- -Stimulate smooth muscle and gland secretion

Question 16

Muscarinic

Answer 16

• In parasympathetic target organs except the heart

- Stimulates smooth muscle and gland secretions

Question 17

2 types of Adrenergic receptors

Answer 17

• Alpha

- Beta

Question 18

Seizures

Answer 18

• Abnormal or uncontrolled neuronal discharges in the brain
• Affects consciousness, motor activity, sensation
• Treated with Anti Epileptic Drugs (AED)

Question 19

Known causes of seizures

Answer 19

• Infectious disease
• trauma
• metabolic disorders
• vascular diseases
• pediatric disorders
• neoplastic disease
• medications
• high dose of local anesthetics
• eclampsia
• drug abuse
• withdrawal syndromes
• sedative-hypnotic drugs

Question 20

Epilepsy

Answer 20

• Seizures occurring chronically

- Types: partial (focal), generalized, special epileptic syndromes

Question 21

Simple Partial Seizures

Answer 21

• Olfactory, auditory, and visual hallucinations
• Intense emotions
• Twitching of arms, legs, and face

Question 22

Complex Partial (psychomotor) seizures

Answer 22

• Aura (preceding)
• Brief period of confusion or sleepiness afterward with no memory of seizure (postictal confusion)
• Fumbling with or attempting to remove clothing
• No response to verbal commands

Question 23

Absence seizures

Answer 23

• Lasting a few seconds
• Seen most often in children
• Misdiagnosed often (especially in children) as ADD or daydreaming

Question 24

Tonic-Clonic seizures (Grand mal)

Answer 24

• Preceded by aura
• Intense muscle contraction (tonic phase) followed by alternating contraction and relaxation of muscles (clonic phase)
• Crying at beginning as air leaves lungs; loss of bowel and bladder control; shallow breathing with periods of apnea; usually lasting 1-2 min
• Disorientation and deep sleep after seizure (postictal state)
• May become cyanotic in the face

Question 25

Febrile seizure

Answer 25

- Tonic-clonic activity lasting 1-2 min - Rapid return to consciousness - Occurs in children usually between 3 months and 5 yrs of age - Usually benign

Question 26

Myoclonic seizures

Answer 26

- Large jerking movements of a major muscle group, such as an arm - Falling from a sitting position or dropping what is held

Question 27

Status Epilepticus

Answer 27

- Considered a medical emergency | - Continuous seizure activity, which can lead to coma and death

Question 28

The choice of a seizure drop depends upon

Answer 28

- Type of seizure - Patient's hx - Associated pathologies

Question 29

The main FDA warning with anti seizure medications is

Answer 29

-They double the risk of suicidal behavior and ideation

Question 30

When taking phenytoin (Dilantin), what is a common teaching point with oral care

Answer 30

-Brush with a soft bristle toothbrush

Question 31

Effective pharmacotherapy depends on

Answer 31

- Assessment of the degree of pain | - Determining the underlying disorders

Question 32

Substance P

Answer 32

- Neurotransmitter | - Passes on pain message

Question 33

Opioids

Answer 33

- A natural or synthetic morphine-like substance responsible for reducing moderate to severe pain - Receptors: mu, kappa, sigma, delta, epsilon - For pain management mu and kappa receptors are most important

Question 34

What are important considerations when administering pain medication

Answer 34

-Degree of pain and underlying disorders

Question 35

Malignant Hyperthermia

Answer 35

- Fast rise in temperature with severe muscle contractions when succinylcholine is administered - Dantrolene Sodium is the preferred tx (muscle relaxant specific for malignant hyperthermia)

Question 36

Alzheimer's Disease

Answer 36

- Most common degenerative disease of CNS - Progressive loss of brain function, memory loss, confusion, dementia - Etiology unknown - Acetylcholine function affected

Question 37

Parkinson's Disease

Answer 37

- 2nd most common CNS disease - Progressive loss of dopamine, tremor, muscle rigidity, abnormal movement and posture - Fall risk

Question 38

Amyotrophic Lateral Sclerosis (Lou garricks) Disease

Answer 38

-Progressive weakness and wasting of muscles, destruction of motor neurons

Question 39

Multiple Sclerosis

Answer 39

- Demyelination of neurons in the CNS - Progressive weakness, visual disturbances, mood alterations, cognitive deficits - No cure, tx aimed at providing relief from recurring symptoms

Question 40

Huntington's Chorea

Answer 40

-Autosomal dominant genetic disorder, progressive dementia, involuntary spasmodic movements, muscles of limbs and face affected

Question 41

Tx for Parkinson's

Answer 41

- Pharmacotherapy doesn't cure the disorder, but attempts to reduce symptoms - Drug action: restore dopamine function or stimulate dopamine receptors in the brain - Types of drugs: Dopaminergic (Levodopa) & anticholinergics (Benadryl)

Question 42

Tx for Alzheimer's

Answer 42

- Supportive tx of symptoms | - Drugs

Question 43

Tonic spasm

Answer 43

-single, prolonged contraction

Question 44

Clonic spasm

Answer 44

-rapidly, repeated contraction

Question 45

Spasticity

Answer 45

- muscle stays in continual state of contraction | - Usually due to CNS damage

Question 46

Causes for muscle spasms

Answer 46

- Excess use or local injury to skeletal muscle - Overmedication with antipsychotics - Epilepsy - Hypocalcemia pain - Neurologic disorders

Question 47

Pharmacological tx of muscle spasms

Answer 47

- Centrally acting skeletal muscle relaxant - Direct-acting antispasmodics - Neuromuscular blockers