Neuro Forster Brainstem Respiration And Pain Ssom

Front 1

Diaphragm
(motor nerve, origin of motor nerve)

Back 1

Phrenic
C3-C5

Front 2

Intercostal and Abdominal
(motor nerve, origin of motor nerve)

Back 2

Intercostal
T2-L1

Front 3

Upper airway - striated muscle of pharynx and larynx & smooth tracheal/bronchial muscle
(motor nerve, origin)

Back 3

Vagus (X)
Dorsal vagus nucleus (smooth muscle)
Nucleus ambiguus (striated muscle)

Front 4

Stages of Respiration
Stage I

Back 4

Inspiration
diaphragm and external intercostal muscles contract

Front 5

Stages of Respiration
Stage IE

Back 5

Transition
inspiratory muscles progressively cease to contract while expiratory laryngeal muscles contract to control airflow from lungs

Front 6

Stages of Respiration
Stage E

Back 6

Expiration
expiratory internal intercostals and abdominal muscles contract

Front 7

Inspiratory Neurons
(name)

Back 7

NTS
Nucleus Ambiguus

Front 8

Inspiratory Neurons
NTS
(location, group, activates)

Back 8

dorsal medulla
DRG - dorsal respiratory group
activate phrenic and external intercostal neurons to produce inspiration

Front 9

Inspiratory Neurons
Nucleus ambiguus
(location, group, activates)

Back 9

ventral medulla
VRG - ventral respiratory group
activate phrenic and external intercostal neurons to produce inspiration

Front 10

Inspiratory-Expiratory Neurons
(name)

Back 10

dorsal vagus nucleus
nucleus ambiguus

Front 11

Inspiratory-Expiratory Neurons
Neurons of _ of the _ group and neurons of _ of the _ group give rise to the _ cranial nerve and _ (role)

Back 11

dorsal vagus nucleus (DRG)
nucleus ambiguus (VRG)
Vagus (X)
contract upper airway muscles

Front 12

Expiratory Neurons
(name)

Back 12

Botzinger complex

Front 13

Expiratory Neurons
Botzinger complex
(group, role)

Back 13

VRG
project to intercostal motor neurons to activate internal intercostal and abdominal muscles
particularly impo during increased ventilatory drive (exercise)

Front 14

Respiratory Rhythm Generator
(what)

Back 14

pre-Botzinger complex (PBC)
pace-maker activity

Front 15

Other Respiratory Nuclei in Brainstem
(name)

Back 15

parabrachial nucleus
Kolliker-Fuse nucleus

Front 16

Other Respiratory Nuclei in BS
parabrachial nucleus and Kolliker fuse nucleus
(role)

Back 16

not essential for generation of respiratory rhythm but these nuclei modulate breathing:
rate of respiratory rhythm
influence the timing of respiratory phases
regulate airway muscles during exercise and sleep
thought to also hold excitability of the pacemaker neurons in the PBC at necessary range

Front 17

Factors that influence BS control of respiration

Back 17

chemoreception
mechanoreception

Front 18

Chemoreception
(receptor location)

Back 18

peripheral:
carotid bodies, which send excite to NTS
Central:
VRG (NA, Botzinger complex)

Front 19

Mechanoreception pathway

Back 19

NTS receives info from peripheral mechanoreceptors via the vagus nerve

Front 20

Breuer-Hering reflex

Back 20

shortening of inspiratory duration in response to lung inflation

Front 21

Cough

Back 21

increased activation of diaphragm in conjunction with forceful activation of thorax-abdominal muscles
(two stages at same time)
(RAR)

Front 22

Respiratory Disorders
Damage above C3

Back 22

diaphragm paralyzed but phrenic nerve is viable
surgical placement of pacemaker

Front 23

Respiratory Disorders
Damage to C3-C5

Back 23

axonal loss in phrenic nerve
long-term mechanical ventilation
possible to replace phrenic with 4th intercostal nerve and then also need stimulator

Front 24

central hypoventilation

Back 24

likely damage to dorsal or ventral medullary groups or the pontine respiratory nuclei

Front 25

apneustic breathing

Back 25

prolonged inspiratory periods

Front 26

Lesion of pontine respiratory groups results in _

Back 26

apneustic breathing

Front 27

Apnea

Back 27

cessation of breathing during sleep for at least 10s at least 5 times per hour in sleep
3 Types:
obstructive, central, mixed

Front 28

Obstructive sleep apnea

Back 28

most common form
due to transient obstruction of upper airways that prevents inspiration

Front 29

central sleep apnea
(basic definition)

Back 29

occurs as result of a deficit in central drive of spinal motor neurons

Front 30

Brainstem nuclei implicated in modulation of pain

Back 30

midbrain: PAG
pons: LC
pons-medulla junction: RVM region

Front 31

Main component of RVM

Back 31

NRM
(nucleus raphe magnus)

Front 32

Neurons of LC project to the dorsal horn via _

Back 32

ventrolateral funiculus

Front 33

Facilitory axons descend to spinal cord via

Back 33

dorsolateral funiculus

Front 34

Neuropathic pain can manifest as:

Back 34

spontaneous pain
allodynia
hyperalgesia

Front 35

Tx Neuropathic pain
Mechanism
Opiates (eg. morphine)

Back 35

activate opioid receptors in the PAG, RVM and dorsal horn to enhance descending inhibition of dorsal horn nociceptive neurons

Front 36

Tx Neuropathic pain
Mechanism
Tx Neuropathic pain
Mechanism
In general

Back 36

designed to enhance brainstem descending inhibition or reduce the brainstem descending facilitation

Front 37

Tx Neuropathic pain
Mechanism
Tricyclic antidepressants (amitriptyline, Elavil)

Back 37

enhance serotonin and norepi levels, enhancing descending inhibition

Front 38

Tx Neuropathic pain
Mechanism
Clonidine

Back 38

activates alpha2 receptors to mimic descending BS inhib

Front 39

Tx Neuropathic pain
Mechanism
ondansetron

Back 39

blocks serotonin 3 receptors, reducing descending BS facilitation

Front 40

Tx Neuropathic pain
Mechanism
gabapentine and pregabalin

Back 40

bind voltage-gated Ca channels (impo for NT release and for induction and maintenance of synaptic strengthening) to prevent excessive activity of nociceptive neurons in dorsal horn
surprisingly clinically efficacious with minimal side effects

Front 41

Tx Neuropathic pain
Alternatives to pharmacotherapy

Back 41

TENS
Tractotomy

Front 42

Tx Neuropathic pain
TENS

Back 42

Transcutaneous electrical nerve stimulation
mild electric stimulation with electrodes in skin, activates Abeta fibers, competition b/w noci and nonnoci neurons, closing of pain gate at level of dorsal horn

Front 43

Inspiratory neurons
pathway

Back 43

while descending projections from NTS and NA are bilateral, the majority of axons cross at C1 and descend in contralat *lateral reticulospinal tract*