MIDTERM - PHARMA

• Cerebellum - Conscious
• BASAL GANGLIA - Unconscious
• SPINAL MOTOR NEURONS - allow us to move, speak, swallow and breathe by sending commands from the brain to the muscles that carry out these functions.
• • Simplest nerve pathway.
  • Monitor movement and posture.

  SPINAL REFLEXES
• Respond to stretch receptors or spindles on muscle fibers to cause a muscle fiber contraction

  SPINDLE GAMMA LOOP SYSTEM
• Pyramidal Tract - Muscle fibers that control precise, INTENTIONAL movement within the CNS
• Extrapyramidal Tract - Modulates or coordinates unconsciously CONTROLLED muscle activity.
• Neuromuscular Junction - Stimulates the muscle to contract.
• Stimulation of a neuron.

  Calcium Ions will be release.

  Calcium binds with the Troponin – chemical in sarcomere, to release the actin and the myosin


  DEPOLARIZATION
• Resting membrane potential.

  Troponin is being freed, prevents the actin and the myosin from reacting with each other.

  Relaxes the muscle

  REPOLARIZATION
• • Surgical Procedures
  • Diagnostic Procedures – Endoscopic
  • Mechanical Ventilation Facilitation

  Conditions that Suppress Neuromuscular Junction
• Muscle Spasm - Injury to the musculoskeletal system
• Muscle Spasticity - Damage to neurons within the CNS
• • Heat Applications
  • Physical Therapy
  • Anti-inflammatory Drugs
  • Muscle Relaxants

  Management of Muscle Spasm
• Spasmolytics

  • Centrally Acting
  • Directly Acting
• Neuromuscular Blockers

  • Non-depolarizing
  • Depolarizing
• Baclofen

  Chlorzoxazone

  Tizanidine

  Diazepam

  Cycloenzaprine

  Methocarbamol

  Carisoprodol

  Centrally Acting
• • Dantrolene
  • Incobotulinumtoxin A (Xeomin)
  • Onabotulinumtoxin A (Botox)
  • Rimabotulinumtoxin B (Myobloc)

  Directly Acting
• • Atracurium
  • Cisatracurium
  • Panucuronium
  • Rocuronium
  • Vecuronium

  Non-depolarizing
• Depolarizing - Succinylcholine
• • It works in the CNS to interfere with the reflexes that are causing the muscle spasms.
  • It involves action in the upper or spinal interneurons.
  • It relieves discomfort associated with acute painful musculoskeletal conditions.
  • It is adjunct to rest, physical therapy, and other measures

  CENTRALLY ACTING SKELETAL MUSCLE RELAXANTS
• Intrathecal - CSF

  Oral - Circulatory System
• Baclofen – should NOT be given for spasticity to prevent contribution to locomotion, upright position, or increased function
• It enters the muscle to prevent muscle contraction directly.

  DIRECT-ACTING SKELETAL MUSCLE RELAXANTS
• • Peripheral muscle contraction.
  • Spasticity associated with neuromuscular disease.
  • Acts within the skeletal muscle fibers, interfere with the release of calcium from the muscle tubules prevents the fiber from contracting

  Dantrolene
• Receptor sites of motor nerve terminals

  Inhibit the release of AcH – leading to local paralysis

  Botulinum Toxins A & B
• Rimabotulinumtoxin B - Severe abnormal head position and neck pain
• Onabotulinumtoxin A - Improve appearance glabellar lines, canthal lines, treat cervical dystonia
• Incobotulinumtoxin A - Decrease severity of the head position with cervical dystonia.
• Antagonist to Acetylcholine at the Neuromuscular Junction

  Prevent depolarization of the muscle cell

  requires or desires muscle paralysis

  NONDEPOLARIZING NEUROMUSCULAR JUNCTION BLOCKERS
• Acetylcholine agonist at the junction – stimulation of the muscle cell and staying on the receptor site, preventing from repolarizing.

  Prolonged depolarization.

  DEPOLARIZING NEUROMUSCULAR JUNCTION BLOCKERS