Neuromuscular Pharmacotherapeutics - Mehdi

Cisatracurium

non-depolarizing neuromuscular blocker; used to produce myorelaxation (paralysis) adjunct to surgical anesthesia

Choline

once ACh is cleaved by AChE, this is recycled via uptake by a Na+/_____ cotransporter

ACh Receptor

upon binding to ACh, generates an end-plate potential by antiporting sodium out and potassium into the post-synapse

Tensilon Test

used to diagnose MG and to differentiate between myasthenic crisis and cholinergic crisis

Spasticity

velocity-dependent increase in resistance to passive movement; continuous clonic contraction produced by uninhibited stretch reflexes; sign of UMN lesion

Kinesin

motor protein involved in anterograde transport of ACh vesicles to the cell membrane (+ end)

Neostigmine

AChE inhibitor used to reverse paralysis post-surgery

V-type (H+ ATPase)

ATP-dependent importer of H+ into the ACh vesicle

3,4-Diaminopyradine

VGKC blocker used to treat LEMS

Hemicholinium

a drug that inhibits the uptake of choline from the synapse

Succinylcholine

agonist for AChR used as a depolarizing Nm blocker; overstimulation results in flaccid paralysis; adverse SE of anaphylaxis & malignant hyperthermia

Tetanus (Toxin)

an exotoxin that inhibits the release of mediators of the inhibitory neurons in the spinal cord; clinical f eatures include marked hyperextension of the back

P/Q-type (VGCC)

calcium channel that increases calcium contration in the presynaptic knob

Guanidine HCL

cholinergic agonist used to treat LEMS

Infantile Botulism

classic presentation of this condition is a floppy, constipated baby

ACh/H+ Antiporter

cotransporter if the ACh vesicle that takes in ACh and removes H+

Botulinum (Toxin)

degrades SNAP-25 & Syntaxin to prevent ACh release into the synapse

LEMS (Lambert Eaton Myasthenic Syndrome)

disease caused by an antibody against VGCC; decreasing ability of the presynaptic knob to intake calcium for ACh release; presents with difficulty walking; autonomic dysfunction present (dry mouth, constipation, erectile dysfunction)

Myasthenia Gravis

disease caused by antibody against nicotinic muscle ACh recetors; painless muscle weakness; starts as ptosis and increases with continued activity; rapid restoration with rest

Choline Acetyl Transferase

enzyme that catalyzes synthesis of acetylcholine

Halothane

general anesthetic that may cause malignant hyperthermia in patients with RyR mutation

Vesamicol

inhibitor of vesicle ACh/H+ antiporter in cholinergic nerve endings: prevents storage of ACh; no clinical applications

Opisthotonos

marked hyperextension of the back caused by the tetanus toxin

Infection

principal adverse effect of immunosuppressant drugs

Edrophonium

short-acting anticholinesterase inhibitor used to diagnose myasthenia gravis

Ice Pack Test

test used to help diagnose MG; lowering temparature at eyelids produces improvement in myasthenic muscle function and resolves temporarily resolves ptosis

IVIG (Intravenous Immunoglobulin)

treatment for MG; probably works through Fc receptor modulation and anti-idiotype interactions

Plasmapheresis

treatment for MG; removal of autoantibodies and immune complexes in patients whome autoimmune disease is resitant to other therapies

Thymectomy

treatment for MG; removal of the thymus gland

LES (EMG)

typical marked increase toward normal amplitude with rapid repetitive stimulation (20/sec)

MG (EMG)

typical pattern of decrement in the first four responses followed by slight increment at stimulation rate of 4/sec