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Nervous System
Questions Alerts!
Common questions in pharmacy exam is to ask!
• Blood brain barrier definition and functions
• What section of brain controls voluntary and involuntary movements?
• Types of Neurological disorders. Multiple sclerosis, Chronic spasticity, Bell's Palsy,
Neuralgia, Seizures or epilepsy, Fibromyalgia, and Parkinson's disease.
• Sciatica pain site is buttocks and back of thighs.
• Causes of multiple sclerosis

Fig 3.1

Fig 3.2
Question Alerts!
1) Voluntary and involuntary
movements are controlled by?
2) What section of brain coordination
and control balance?

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[Link] Nervous System

Nervous system divided into central nervous system and peripheral nervous system. The
central nervous system consists of brain and spine.

Brain
• Cerebrum. largest section of brain and Q. controls voluntary (Think and decide what to
say) and involuntary movements.
• Brain stem. Is the posterior part of the brain consist of pons and medulla oblongata and
mid brain.
• Cerebellum. Q. Controls balance and modifies body movements. Maintain body
coordination and balance.
• Spinal cord. vertebral column, epidural space, meninges, spinal cord, dorsal vertebra,
and spinal nerve.
• Thalamus. affects sensory levels, [Link] and alertness.

Vestibular system.

Reflex adjustment of head, eyes and postural muscles provide a stable visual
image and steady posture.

[Link] occular reflexes. Nystagmus

The direction of the nystagmus is defined as the direction of the fast (rapid
eye) movement. Therefore, the nystagmus occurs in the same direction as the
head rotation. Normally initial rotation of the head causes the eyes to move
slowly in the opposite direction to maintain visual fixation.

Meninges
• The meninges are three concentric membranes that surround and protect brain and spinal
cord.
• The dura mater: outer most membrane
• The arachnoid:
middle layer, Question Alerts!
1) Blood brain barrier is present at?
Copyright © 2000-2014 TIPS 2) [Link] that cross
Unauthorized BBB. Rifampin,
reproduction Cefuroxime
of this manual sodium,and it is
is strictly prohibited
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Cefotaxime,
illegal to reproduce without permission. Carabapenam,
This manual Atropine,
is being used physostigmine,
during review sessions conducted by
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[Link] Nervous System

transparent, flexible
• The pia mater: inner layer, is fine, and delicate

Cerebro Spinal Fluid (CSF). The CSF is outside of the brain and circulates through the cavities
inside the brain called ventricles.

Blood brain barrier. The blood brain barrier (BBB) is the barrier between cerebral capillary
blood and cerebrospinal fluid (CSF). Q. BBB is formed by capillary endothelial cells that
line cerebral microvessels forms tight junctions and lacks large intracellular spaces. Further
neural tissue covers capillaries. Together constitutes forms BBB.

The CSF fills the ventricles and the subarachoid space. Three functions of BBB
• Protects brain from endogenous or exogenous toxins. It prevents escape of
neurotransmitters from CNS into blood circulations.
• [Link] soluble drugs cross faster than water-soluble (polar) drugs.

Q. In capillary lining of BBB have, enzymes such as monoamine oxidase (MAO),

cholinesterase and some other enzymes. These enzymes prevents
catecholamine's, serotonin, acetylcholine, to enter into brain.

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[Link] Nervous System

Q. Peripheral Nervous System. All nerves of the body residing

outside of the brain and spinal cord comprise the
peripheral nervous system.
Periphery can be divided into sensory (somatic) and autonomic.
• Ulnar nerve. Passes through the shoulder to wrist.
• Q. Sciatic nerve runs through buttock, thighs down to foot. It
divides into tibial and common fibular nerve. which supplies
the muscles of posterior thigh and all of the leg and foot.
• Intercostal nerve are that anterior divisions of the thoracic
spinal nerves.
• Q. Radial nerve runs through wrist to finger tips. It supplies to muscles of forearm.
• Q. Popliteal nerve. Passes in knee joint.
• Q. Auxillary nerve (circumflex). It supplies the deltoid and teres minor muscles,
shoulder joint, and skin on back of arm.

The branch of the autonomic nervous system that induces the "flight or fight" response is
the sympathetic.

Ependymal cells are specialized epithelial cells in the CNS that produce cerebrospinal fluid. In
general, positively charged ions (cation) on the inner cell membrane surface of a resting
neuron, there is an accumulation of negative (anionic) charge.

In electrical terms, "potential" is synonymous with " voltage ".

An "excitable" cell is one that can quickly and dramatically change its resting membrane
potential. Two types of examples of excitable cells include muscle fibers and neuronal cells.
The typical neuronal resting membrane potential measures approximately -70mV. A neuronal
impulse is also referred to as an action potential , which indicates that it is a "moving" region
of "voltage change" that migrates along the neuronal cell membrane. Movement of Cl- into a
neuronal cell would make a neuron less likely to fire an action potential.

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[Link] Nervous System

Nerve Cell. Nerve cell consists of dendrite, cell body, axon, Q. myelin sheath, and
synapse.

Question Alerts!
What is NOT a part nerve cell?

Fig 3.3

Fig 3.2

Pathology of neurological disorders

Seizures or epilepsy. Excessive excitation of neurons due to disorderly inhibition of cortical
neurons.

Parkinson's disease. Q. Decrease in dopamine or imbalance of dopamine negrostratial

pathway.

Q. Extrapyramidal symptoms (EPS is side effect of antipsychotic drugs) = Akathisia,

Dystonia, Parkinsonism, Tardive Dyskinesia. These symptoms are the side effect of
antipsychotic drugs like haloperidol.
Ataxia = lack of muscle coordination in voluntary movements.
Akathisia = restlessness or cannot sit still.
Dyskinesia = involuntary movement or shaking
Dystonia = involuntary muscle spasm
Tardive dyskinesia = involuntary movement of lips, tongue, and chewing motion.
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Migraine Headache. Vasodilatation of intracranial extra cerebral blood vessels.

Vertigo. False sensation of moving or spinning or object moving usually accompanied by

nausea and loss of balance.

Q. Meniere's disease produces sudden episode attack of vertigo along with ringing in ears
(tinnitus) and progressive deafness. Episodes can last from minutes to hours. Associated
with nausea and vomiting. Q. Beta-histine is used for treatment.

Chronic spasticity. Spasticity is an involuntary velocity dependant increase in muscle tone

resulting in injury to motor pathway in brain or spinal cord. It is common in MS, stroke, spinal
cord injury and cerebral palsy. It can impair feeding, dressing, bowel function, hygiene and
gait.

Bell's Palsy. Paralysis of lower motor neuron of facial nerve. It is often due to herpes simplex
virus (HSV 1 ) infection causing inflammation and edema.

Q. Multiple Sclerosis. The multiple sclerosis (MS) is characterized by destruction of myelin

sheet (demylenation) and axonal degeneration & loss in CNS. The MS is chronic and can be
caused by autoimmune mediated action.
Q. Treatment. Interferons beta (first line therapy), glatiramer acetate (Immunomodulators
similar to interferon beta), Mitoxantrone, natalizumab, Fingolimod (spingosine-1-phosphate
receptor agonist), Teriflunomide, and laqinimod.

Temperature regulation
The homeostatic mechanisms regulate body temperature (37.5 C). .
Sympathetic nervous system innervate heat loss by vasodilatation and sweat production.
Sympathetic nervous system innervate adrenal gland than increase metabolic rate.
Thalamus  pituitary gland  thyroid  Increase metabolic rate.
Hyperthermia = >38.2 C
Hyperpyrexia (fever) = a fever >41.5 C
Hypothermia = <35 C, if <32 C it can cause ventricular arrhythmias.

Q.

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[Link] Nervous System

Malignant hyperthermia is the side effects of drugs that cause fever symptoms. Example.
Halothane, and succinylcholine.
Treatment. Dantrolene 2.5 mg/kg for Q5min
Q.
Neuroleptic malignant syndrome (NMS) induced by antipsychotic drugs. Characterized by
hyperthermia and muscle rigidity, autonomic instability e.g. cardiac arrhythmias.

Heat stroke. Core body temp. >40.6 C

Antipyretics (NSAIDs) reduce fever by inhibiting cyclooxigenase, this inhibits prostaglandin

synthesis. Therefore analgesics decrease set-point temperature. In response that cause heat
loss in the form of sweating, vasodilatation.

Diagnostic techniques.
Q. Electroencephalograph (EEG). The EEG consist of alternating excitatory and
inhibitory synaptic potential in the pyramidal cells of the cerebral cortex.

CT scan (computed tomography) of brain. Demonstrates generalized waves of

spike and wave discharge.

Cerebrospinal fluid (CSF) sample is taken by Lumbar puncture.

FMRI. The functional MRI is used brain scanning.

Tips
1. Sciatic nerve 2 Blood brain barrier 3 Adrenal medulla
4 Tardive dyskinesia Protects brain from endogenous 6 Bradykinesia
5 &exogenous toxins
7 Nissl substance 8 Multiple sclerosis 9 Cerebrum
10 it prevents escape of 11 lipid soluble drugs cross faster than
neurotransmitter from CNS H 2 O soluble drugs
into blood circulations
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[Link] Nervous System

• It is the barrier between cerebral capillary blood and cerebrospinal fluid (CSF) the CSF fills
the ventricles & the subarachnoid space ( )
• A CNS disease where the myelin sheath of motor neurons is degenerating or being
destroyed, which interferes with neuronal impulses ( )
• The nerve that pass through buttocks, thighs down to foot ( )
• What part of brain controls voluntary and involuntary movements ( )
• Inappropriate posture of neck, face and limbs is referred as ( )
• Epinephrine is released from ( )
• Functions of blood brain barrier ( )
• Slow movement ( )
• The dark granular inside neuronal cell bodies ( )
• GABA is  ( )
• Enkephalin are  ( )
• Serotonin consist of  ( )
• Sciatica is  ( )
• Nor epinephrine becomes epinephrine, this reaction is catalyzed by  ( )
• The longest and largest nerve is --> ( )
• Delirium is --> ( )
• Serotonin physiological actions include --> ( )
• Pain from shoulder to arm is called -->Referred pain

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[Link] Nervous System

Copyright © 2000-2014 TIPS Inc. Unauthorized reproduction of this manual is strictly prohibited and it is
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illegal to reproduce without permission. This manual is being used during review sessions conducted by
PharmacyPrep.