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70 Cards in this Set
- Front
- Back
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first address this when considering visceral stuff
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treat facilitation
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primary method to normalize sympathetics?
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rib raising
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assess Chapman's points before...
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performing manipulation to address sympathetics
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compencated vs. decompensate fascial patterns
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compensated alternates, decompensated fascia runs in same direction
start at right to left at top then left to right etc. through lumbosacral region |
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5 components of primary resp mechanism
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mobility of cranial and spinal membrane,s flcutant CSF, motilit of the CNS, mobiliy of crnial bone articulations, involuntary mobility of the sacrum
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cranial torsion
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occiput and sphenoid rotate in opposite directions, named for direction of great wing
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sidebending/rotation
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rotates towards side of dysfunction, side that gets big
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vertical strain/lateral strain
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named for direction of base of sphenoid, slide right = R lateral strain, slide up = superior vertical strain
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inidications for cranial OMT
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Sbs strin, head trauma, newborns post partum
dont do to bleeds, fracture ir uncreased ICP |
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low MAC =
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high potency, also increased lipid solubility
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pros and cons of the fluranes
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all hepatotox and malignant hyperthermia, halothane is worst
enflurane- arrymias, contraindicated in kidney failure isoflurane- less toxic, litle metabolism desflurane and sevoflurane are preffered, sevo nephrotoxic |
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potency of IV anesthetics determined by...
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lipid solublity
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Txs for parkinson's
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antichoniergics, COMT inhibitors (capones can cause neuroleptic malignant syndrome), dopaminergics and MAOs (inhibit dopamine breakdown)
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pramiprexole
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dopaminergic agent, dopamine receptor aggonist, binds D3 and D2, does not have NV, blood dycrasia, tachycardia or htpotension like L-Dopa
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Ropinerole and rotigotine
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dopamine receptor agnists, side effects, N, dizziness
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Bromocriptine
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vasoconstricitve action, direct DA agonist can cause nausea, hallicoatmopns and orhtostatic hypotension
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Amantadine
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antiviral that enhances presenc of dopamine
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Anti-cholinergics for parkinson's
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benzotropine, procyclidine, triheyphenidyl, biperidin, enhances dopamine effects by decreasing ACh
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Defect in PArkinson's
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decreaed dopamine in substanttia nigra nd corpus stiatum, prob for basal ganglia (motor control)
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First Gen Neurleptics
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block dopamine in brain and tperiphery, act as antipsychotics
chrlopromzine, haloperidol, loxapine, molindone, perpheazine, thioridzine |
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Chlorpromazine, flupehazine, buyrophenones
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all have significant anticholinergic and extrapyramidal side effects, to some extent sedatiion adn hypotension, chlorpromazine is worst
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Second gen neuroleptics
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atypical antisychotics, apirpazole, cloazipine, paliperidone, risperidone, weight gain, hyperlipidemia, hyperglycemia, DM, block serotonin reeptors in additon to dopamine
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Clozapine major side effect
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severe agranulocytosis
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Extrapyramidal side effects
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high potency psychotics more likely to cause, dysonias, parkisnoian sympotms, tardive dyskinesia
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Neuroleptic malignant syndrome
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potentially fatal, fevere, encephapolathy, elevated muscle enzymes and rigidity, treated with dantrolene
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CTZ vs. vomiting center
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CTZ- area posterma outside BBB, responds to chemical stimulus
Vomit center- in lateral reticular formation of medulla, repsonds to vestibular system, riphery and brainstem |
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Metoclopromaide
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antagonizes dopamine used for post op and chemo nausea, risk of tadive dyskinesia, blocks dopamine in CTZ and M3 recepotr agonist in GI tract, prochlorperzine is similar
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Ondansetron
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5HT-3 inhibitors, potent anti-emetic drugs, reserved for NV with malignancy
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DOC for focal seizures
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carbamezipine, ma also use phenyoin
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First Gen Neurleptics
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block dopamine in brain and tperiphery, act as antipsychotics
chrlopromzine, haloperidol, loxapine, molindone, perpheazine, thioridzine |
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Chlorpromazine, flupehazine, buyrophenones
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all have significant anticholinergic and extrapyramidal side effects, to some extent sedatiion adn hypotension, chlorpromazine is worst
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Second gen neuroleptics
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atypical antisychotics, apirpazole, cloazipine, paliperidone, risperidone, weight gain, hyperlipidemia, hyperglycemia, DM, block serotonin reeptors in additon to dopamine
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Clozapine major side effect
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severe agranulocytosis
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Extrapyramidal side effects
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high potency psychotics more likely to cause, dysonias, parkisnoian sympotms, tardive dyskinesia
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Neuroleptic malignant syndrome
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potentially fatal, fevere, encephapolathy, elevated muscle enzymes and rigidity, treated with dantrolene
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CTZ vs. vomiting center
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CTZ- area posterma outside BBB, responds to chemical stimulus
Vomit center- in lateral reticular formation of medulla, repsonds to vestibular system, riphery and brainstem |
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Metoclopromaide
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antagonizes dopamine used for post op and chemo nausea, risk of tadive dyskinesia, blocks dopamine in CTZ and M3 recepotr agonist in GI tract, prochlorperzine is similar
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Ondansetron
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5HT-3 inhibitors, potent anti-emetic drugs, reserved for NV with malignancy
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DOC for focal seizures
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carbamezipine, ma also use phenyoin
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Drugs that act on GABA for seizures
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valproic acid, gabapentin (partial seizure, post-herpetic neuralgia), felbamate (aplastic anemia, liver failure), Tigabine (inhibits GABA reuptake, ADRs new onset seizures), pregabalin (rhabdo, vision changes)
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Drugs that act on sodium conductance for seizures
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ethotoin, fosphenytoin, lamotrigine, oxcarbazepine
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Levetiracetam
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used for partical seizures, gneeralized and juvenile myocloinc epilepy, binds to SV2A on synpatic vesicles reventing NT release, can cause psych distrubances
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IP3 signaling
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involves G protein receptor, activales PLC leads to IP3 and DAG, leads to increased CA and activation of protein kinase C (leads to phosphorylations
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Histamine on H2 receptor leads to...
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Gs and increased cAMP, stimulates HCL release
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NE or Epi on alpha 2 receptor leads to...
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Gi -> decreased cAMP, dereased SNS activity
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Hormones that activate G proteins
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ACTH FSH, LH, FSH, PTH, calcitonin, ADH and glucagon
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Endothelial deried factor
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contains NO, release when endothelial cells are under shear stress, help maintain GFR at basal levels, act on guanylyl cyclase to promote cGMP, increased Ca into SR leads to vascular relaxation
(PDE5 inhibitors prevent breakdown of cGMP) |
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SMC contraction
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hormone binds G protein causing increased intracelular Ca leads to binding of calmodulin which activates myosine liht chain kinase, causes SMC contraction
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Steroid hormone signalling
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crosses membrane and binds and cytoplasmic receptor which forms traanscription factors leading to inititation of protein synthesis
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Tyrosine kinase mech
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insulin for example, binds alpha subunits of receptors, resulting in autophosphorylation by tyrosine kinase, receptor then enters the cells and phsophorylates enzymes
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Nystagmus direction determiend by...
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fast movements of the eyes point, cold causes opposite nystagmus, warm water in ear causes same side
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Vertical nystagmus
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downward- cervicomedullary lesions, arnold ciari syndrome, CVA or MS
upward- brainstem and vermis leasions, CVA, MS, tumors |
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Horizontal nystagmus
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periodic- fast pahase repeatedly to one side for certain period, then switches to oters, vestibuloerbellar disease
gaze-evoked- ocurs or is exacerbated when looks to particular side, EtOH intox vestibular- labrynthitis, Meneiere.s vertigo, tinnitus, deafness, fast phase is alwats one particular size, inner ear disease |
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Unilateral vs. bilateral hearing loss
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unilateral- cochlea damage
bilateral- thalmus or cortex eharing dt increase K conductanse leading to hypolarization... NEAT. |
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Weber and Rinne test
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Weber-lateralization to bad ear in conductive, good ear in sensorineural
Rinne- longer bone conduction on bad ear in conductive, sensorineural no diff |
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Sensorinueral vs. conductive etiology of hearing loss
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sensorineural- noise exposure, drugs, inner ear infections, aging
conductive- OM, eardrum perf, obstruciton in ear |
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Muscle spindle
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responds to length, prevents overstretching, IA fi afferent s send signlas to spinal cord to cause contaction of skeletal muscle
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Golig tendon organ
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measures tension, 1B afferents lead to inhibition of A-alpha motorneurons with too much tension
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ACh and msucle contraction
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bins ACh receptors at the NMJ. large number of sodium ions diffuse leading to opening of voltage gated calcium channels
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Steps of skeletal muscle contaction
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1. myosin ehad binds ATP
2. head intrisic ATPase activity cleaves ATP 3. troponin binds Ca 4. troponin tugs tropomyosin exposing actin active sites for mysoin binding 5. cross-bridge formation 6. power stroke 7. release of ADP/Pi |
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Type II pneumocytes produce
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surfactant, derease surface tension preventing alveolar collapse, lechinthin (dipalmitoylphsophatidylcholine)
present at 34 weeks and beyond, want a ratio of 2:1 lecithin to sphingomyelin |
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Increasing radius of airway leads to...
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decreased resistance, increased flow
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Lung complance
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inversely proprotional to chest wall stiffness, decreased in ankylosing spondylitis or acute rib fracture, allows for increase in volume without significant increase in pressure, increased compliance in emphysema, decreased in restricitve
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During inspiration pressures in chest
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are lower tha atmospheric,
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Control of respirations
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voluntary - cerebral cortex
carotid bodies and aortic bodies contain peripheral chemorecetpros (respond to O2 also CO2 acutely), cenral control responds to increased pCO2 but is delayed, nerves from gloospharnygeal, dorsal resp area of medulla in nucles tractus soliatrius |
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Apex V/Q ratio
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more ventilation leads to higher pressure leads to decreased perfusion, V/Q is lowest in the base, highest at the apex
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Hering Breuer reflex
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distension of airways leads to stimulation causing decreased respiration
irritant receptors carried through vagus nerve to initiate cough |
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V/Q mismatch
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pulmonary embolism, obstruction of blood flow in pulmonaryt arteral system, causes increased V/Q ratio, obstruction in aiway causes decreased V/Q ratio (shunt)
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SERMs
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competitive inhibitors/activatros of estrogen receptors
tamoxifen is agonist on bone and endometrium (endometrial CA), antagonist of breast (yay) and CV (yay) raloxifene- works just as well but does not increase risk for endometrial CA still have risk fo DVT and PE |
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Bisphosphonates
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DOC for osteoporosis prevenetion, Pagets disease
analog of pyrophosphate with storng affinit for calcium phsophate, heads to bone tissue and inhibits bone resorption can cause oteoclast apptosis though.. inhibit farnesyl dispohsphate synthase not for poor renal function, history of GI probs, inflamamtory bone disorders, causes heartburn, N, Abd pain, otential for erosive esophagitis |
