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N216 A/B > [216B] Neuro Part 2 > Flashcards

[216B] Neuro Part 2 Flashcards

1
Q

Should you treat a headache if you’re not sure what the cause is?

A

No >:0

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2
Q

What is the tx for headaches if serious pathologies are ruled out?

A

Analgesics.

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3
Q

What are the criteria to diagnose chronic migraine?

A

Headache for more than 15 days per month for more than 3 months.

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4
Q

There is a higher incidence of chronic migraines in:

A

Adult women.

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5
Q

Chronic migraines are often linked to:

A

Genetics.

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6
Q

What do we call chronic migraines that begin in childhood?

A

“Childhood periodic syndrome”.

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7
Q

What is the primary sequelae associated with chronic migraines?

A

Trigeminal nerve irritation > inflammation within the meningeal vasculature (blood vessels in the meninges).

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8
Q

What are the 2 main categories of chronic migraines? Which is more common?

A
  1. Without aura - more common.

2. With aura.

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9
Q

Describe chronic migraines with auras.

A

More pronounced visual disturbances preceding the headache.

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10
Q

Which category of headache is more difficult to diagnose? Why?

A

With aura, because many people will experience some kind of symptom before the onset of a migraine (“prodrome fatigue”).

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11
Q

Which s&s of chronic migraines is particularly common in childhood periodic syndromes?

A

N&V.

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12
Q

Which analgesic class is particularly effective for tx of chronic migraines?

A

NSAIDs.

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13
Q

________ agonists may be used as tx for chronic migraines. Why?

A

Serotonin agonists are inhibitory in the CNS, so they have a calming effect and will balance out brain activity.

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14
Q

The ______ drug class consists of serotonin agonsist.

A

Triptan.

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15
Q

List 2 examples of meds from the triptan drug class.

A

Sumatriptan.

Zolmitriptan.

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16
Q

________ superficial scalp IM injections can be used as tx for chronic migraines. Why?

A

Botox is anti-inflammatory and decreases neurotransmitter hyperstimulation.

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17
Q

What are 2 adjunct meds that can be used for tx of chronic migraines?

A

Caffeine.

Antiemetics.

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18
Q

Which antiemetic class should be avoided when choosing an adjunct med for tx of chronic migraines? Why?

A

Avoid serotonin inhibitors - they would counteract the serotonin agonists (primary med for tx).

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19
Q

What is our primary resource used to classify psychiatric disorders on a biologic basis?

A

The DSM (diagnostic & statistical manual).

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20
Q

Common symptoms of psychiatric disorders (2):

A

Hallucinations.

Delusions.

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21
Q

Hallucinations are abnormalities of:

A

sensory perception.

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22
Q

Describe the expected pathway of perception (general).

A

Sensory organ > appropriate nerve > thalamus > appropriate cortical region.

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23
Q

The primary visual cortex is responsible for ______ the image, while the visual association cortex is responsible for __________ the image.

A

“Seeing”

“Interpreting”

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24
Q

Describe the 2 possible etiologies associated with hallucinations.

A

1, Sensory block: stored images replace real-time intel.

2. Neuronal dysfunction: image creation via neuronal hyperactivity/pathway dysfunction/disease.

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25
Q

In what 2 situations might we expect sensory block hallucinations?

A
  1. Sensory deprivation.

2. Sensory dysfunction (ex: blindness).

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26
Q

List 2 possible causes of hallucinations due to neuronal dysfunction.

A
  1. CNS drugs.

2. Pathology (ex: tumors).

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27
Q

Delusions are abnormalities of:

A

thought.

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28
Q

Delusions are abnormalities of:

A

thought.

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29
Q

Delusions are caused by _________ or _____________ influences, such as:

A

Environmental or existential influences, such as:

  • Education
  • Religion
  • Social experiences
  • Stressors
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30
Q

What is psychosis?

A

A perceptive loss of reality.

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31
Q

Can someone be diagnosed with psychosis?

A

No, it is not a diagnosis but a presentation.

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32
Q

List 4 signs and symptoms of psychosis.

A
  1. Hallucinations.
  2. Delusions.
  3. Lack of awareness & judgement.
  4. Mood/affect alterations.
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33
Q

What are 5 potential causes of psychosis?

A
  1. Mental health illnesses.
  2. Drug side effects/toxicity (ODs)
  3. Electrolyte imbalances.
  4. Sepsis (elderly).
  5. Hospital induced overstimulation (ex: ICU) (infants/children/elderly).
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34
Q

Schizophrenia is the dysfunction of (2):

A

Thoughts & language expression.

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35
Q

What are the s&s of schizophrenia?

A

Abnormal behaviours & movement.

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36
Q

List the 3 types/dimensions of schizophrenic behaviour.

A
  1. Disorganized.
  2. Psychotic (positive symptoms).
  3. Negative symptoms.
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37
Q

Describe disorganized schizophrenic behaviour.

A

Incomprehensible speech (ex: invented words, disconnected words/thought processes, disorganized words).

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38
Q

List 3 positive schizophrenic symptoms.

A
  1. Hallucinations.
  2. Delusions (paranoias & disorganized thought processes).
  3. Agitation.
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39
Q

List 3 negative schizophrenic symptoms.

A
  1. Pt withdrawn.
  2. Apathy.
  3. Lack of motivation/happiness.
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40
Q

Which dimension of schizophrenic behaviour is hardest to treat? Which has the worse prognosis?

A

Negative symptoms for both.

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41
Q

Explain the neurotransmitter theory for schizophrenia.

A

Dopamine neurotransmitter theory: there is a dopamine excess, leading to hyperactivity (abnormal behaviours/movements).

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42
Q

What are the diagnostic criteria for schizophrenia?

A

At least 2 of the behavioural dimensions + 2 other functional alterations (ex: hygiene).

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43
Q

What drug class do we use for tx of schizophrenia?

A

Antipsychotics (narcoleptics).

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44
Q

What are the 2 target receptors for antipsychotics? What actions are taken at these receptors?

A
  1. D2 dopamine receptors in the limbic system - selective blocking.
  2. 5HT receptors - non selective + Ach blockade.
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45
Q

The limbic system D2 receptors are responsible for:

A

Mood, behaviour & emotion control.

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46
Q

Antipsychotics may unintentionally block:

This results in side effects known as:

A

D2 receptors in the basal ganglia.

Extrapyramidal side effects.

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47
Q

List 5 examples of extrapyramidal side effects.

A
  1. Tardive dyskinesia (tongue movement).
  2. Parkinsonism (rigidity).
  3. Tremors.
  4. Restlessness.
  5. Dystonias (muscle spasms).
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48
Q

List 3 anticholinergic side effects that may result from antipsychotic tx.

A
  1. Urinary retention.
  2. Dry mouth.
  3. Sexual dysfunction.
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49
Q

Should antipsychotic tx be stopped abruptly under normal circumstances? Why or why not?

A

No - will lead to withdrawal symptoms d/t physical dependence.

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50
Q

When is it okay to stop antipsychotic meds abruptly?

A

If s&s of neuroleptic malignant syndrome are noted.

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51
Q

List the s&s of neuroleptic malignant syndrome (4).

A
  1. Hyperthermia.
  2. Unstable BP.
  3. Diaphoresis.
  4. Incontinence.
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52
Q

List 7 s&s of depression.

A
  1. Loss of interest in activities.
  2. Inability to experience pleasure.
  3. Decreased concentration.
  4. Sleep alterations.
  5. Hallucinations/delusions (mostly in major depressive disorders).
  6. Appetite alterations.
  7. Suicidal ideations.
53
Q

Which 2 neurotransmitter theories are behind depression?

A
  1. Serotonin neurotransmitter theory: decreased levels of serotonin.
  2. Norepinephrine neurotransmitter theory: imbalanced levels of NE.
54
Q

List 3 potential causes of depression.

A
  1. Drug-induced.
  2. Contributing illnesses (ex: MI).
  3. Contributing factors (ex: loneliness in the elderly).
55
Q

List the 4 classes of antidepressants.

A
  1. SSRIs: selective serotonin re-uptake inhibitors.
  2. Atypical antidepressants (SNRIs: serotonin & NE re-uptake inhibitors).
  3. Tricyclic antidepressants.
  4. MAO inhibitors.
56
Q

SSRIs ______ serotonin levels by _______ re-uptake in the synaptic space.

A

Increase serotonin levels.

Decrease re-uptake.

57
Q

List 3 SSRIs.

A
  1. Fluvoxetine (Prozac).
  2. Setraline (Zoloft).
  3. Paroxetine (Paxil).
58
Q

Name 2 SNRIs.

A
  1. Mirtazapine (Remeron).

2. Bupropion (Wellbutrin).

59
Q

Why is serotonin helpful in tx of depression?

A

Mood balance/stabilization.

60
Q

Why is NE helpful in the tx of depression?

A

It is stimulating: helps with concentration, energy, motivation, etc.

61
Q

Will a pt on SSRIs or SNRIs be at greater risk for more side effects? Why? What additional side effects might we see?

A

SNRIs: risk of overstimulation.
Ex: insomnia, decreased appetite, nausea.

62
Q

Which drug class is first line tx for depression?

A

SSRIs.

63
Q

What do tricyclic antidepressants do?

A

Inhibit synaptic re-uptake of serotonin, NE and dopamine.

64
Q

Name a drug that is a tricyclic antidepressant.

A

Imipramine (Impril).

65
Q

Why are MAO inhibitors not first line tx for depression (only for pts who do not respond to other drug classes)?

A

Lots of drug-drug and food-drug interactions.

66
Q

List 2 non-pharmacological txs for depression.

A
  1. Brain implants (stimulation).

2. Counselling (CBT).

67
Q

List 3 side effects of SSRIs.

A

Sedation.
Lethargy.
Nausea.

68
Q

Serotonin syndrome occurs when there is _______ serotonin in the body.

A

Too much.

69
Q

List 7 s&s of serotonin syndrome.

A
  1. Changes to mental state.
  2. Dry mouth.
  3. Hypothermia, shock.
  4. Diarrhea.
  5. N&V.
  6. Tremors/reflex changes.
  7. Muscle rigidity.
70
Q

What should we do if we suspect serotonin syndrome?

A

Stop tx and treat the effects.

71
Q

Which drug is used as a PRN adjunct tx for depression?

A

Lithium (Lithonate).

72
Q

Lithium (Litionate) _____ serotonin & ______ Na+ cellular influx.

A

Increases serotonin, decreases Na+ cellular influx.

73
Q

Why is lithium (Lithionate) a helpful adjunct for tx of depression?

A

Helps increase serotonin further (stabilize mood).

Decreased Na+ cellular influx > decreased hyper-excitation > decreased mood swings, erratic behaviour & impulsivity).

74
Q

Because lithium (Lithionate) decreases impulsivity, when do we usually choose to use it as an adjunct in depression tx?

A

For suicide risk reduction.

75
Q

What are 7 considerations of using lithium (Lithionate)?

A
  1. Narrow TI: need serum monitoring (especially initially).
  2. Toxicity.
  3. High Vd.
  4. Crosses placenta.
  5. Slow onset of action: 1-3 weeks.
  6. Drug-drug interactions!!!
  7. Compliance.
76
Q

Is it possible to directly diagnose dementia? How do we “diagnose” it?

A

No direct dx; must rule out other possibilities to reach a “dx”.

77
Q

Alzheimer’s disease constitutes approximately __% of all dementia cases.

A

64%.

78
Q

Alzheimer’s is due to the progressive loss of _______ & ______ in the brain.

A

Neurons & synapses.

79
Q

Describe the pathology of Alzheimer’s.

A

Accumulation of beta-amyloid deposits d/t abnormal breakdown of amyloid proteins
+
Protein fibre tangles (abnormal recycling of byproducts ^)
= plaques > necrosis > dysfunction.
Decreased Ach synthesis also plays a role.

80
Q

Describe the s&s of Alzheimer’s as it progresses in severity.

A

Mild forgetfulness > behavioural changes > inability to complete ADLs.

81
Q

How do we treat Alzheimer’s? Is there a cure?

A

No cure: increase Ach with cholinesterase inhibitors.

82
Q

Cholinesterase normally __________ Ach, so cholinesterase inhibitors will result in __________ Ach levels.

A

Normally: breaks down Ach.

Inhibitors result in increased Ach levels.

83
Q

List 2 cholinesterase inhibitors.

A
  1. Rivastigmine.

2. Galantamine.

84
Q

_______ antagonists combat oxidative stress by ______________ and may be used in Alzheimer’s tx.

A

Glutamate.

Increase Vit C levels.

85
Q

Name 2 adjunct drug classes that may be used in Alzheimer’s tx.

A
  1. Mood stabilizers.

2. Antipsychotics.

86
Q

Describe the pathology of Parkinson’s disease.

A

Accumulation of Lewy bodies + destruction of dopamine neurons > reduced dopamine levels in basal ganglia.

87
Q

Parkinson’s Disease is the inability to filter out _______ movements and to focus ________ movements.

A

Filter out extra movements; focus purposeful movements.

88
Q

When Parkinson’s has progressed __%, that is when we will start to see defining symptoms.

A

75%.

89
Q

List 3 defining symptoms of Parkinson’s.

A

Rigidity.
Jerking.
Tremor.

90
Q

How do we treat Parkinson’s? What drug class can we use to do this?

A

Increase dopamine: use dopamine agonists.

91
Q

List 2 dopamine agonists that may be used in Parkinson’s tx.

A
  1. Levodopa.

2. Rotigotine (Neupro).

92
Q

Which 3 CNS neurotransmitters are present in the PNS/other regions of the body and will cause systemic effects?

A
  1. Acetylcholine (Ach).
  2. NE.
  3. Serotonin.
93
Q

Catecholamines are also known as _________ or ________, and will:

A

Adrenergics, sympathomimetics.

Will stimulate the SNS.

94
Q

Anticholinergics will:

A

Decrease the PNS (stimulating the SNS).

95
Q

Cholinomimetics are also known as _______ and will:

A

muscarinics; stimulate the PNS.

96
Q

Adrenergic antagonists will:

A

Decrease the SNS.

97
Q

Nicotinic agonists activate ____ at _______ receptors.

A

Ach at nicotinic receptors.

98
Q

Where are nicotinic receptors located?

A

All autonomic synapses and in the CNS.

99
Q

What effects will activation of Ach at nicotinic receptors have?

A

CNS & non-selective autonomic nervous system effects.

100
Q

List 4 s&s that we will see when Ach is activated at nicotinic receptors.

A
  1. Alertness.
  2. Increased BP.
  3. Peripheral vasoconstriction.
  4. Decreased GI activity.
101
Q

Name 1 example of a nicotinic agonist.

A

Nicotine (tobacco).

102
Q

List 3 endogenous catecholamines.

A
  1. NE.
  2. Epinephrine.
  3. Dopamine.
103
Q

Dopamine is a precursor for (2):

A

Epinephrine and NE.

104
Q

Which receptors does epinephrine act on?

A

Alpha and beta.

105
Q

Ventolin acts on _____-__ receptors.

A

Beta-2.

106
Q

Serevent acts on ____-_ receptors.

A

Beta-2.

107
Q

Ephedrine & phenylephrine are anti-________.

A

Secretions.

108
Q

List 3 amphetamine names (2 brand, 1 generic).

A
  1. Concerta (brand).
  2. Ritalin (brand).
  3. Methylphenidate (generic).
109
Q

Pseudoephedrine (Sudafed) is for relief of:

A

nasal congestion.

110
Q

Pseudoephedrine (Sudafed) enhances:

A

athletic performance.

111
Q

Amphetamines are part of which drug class?

A

Met

112
Q

Amphetamines increase _____ by stimulating _____.

A

Increase focus by stimulating RAS.

113
Q

List 3 side effects of amphetamines.

A
  1. Weight loss.
  2. Tachycardia.
  3. Insomnia.
114
Q

Amphetamines may be abused in the form of:

A

Crystal meth (amphetamine, methamphetamine).

115
Q

Crystal meth is a:

A

Stimulant.

116
Q

Anticholinergics/antimuscarinics enhance the ____ by blocking:

A

Enhance the SNS by blocking cholinergic receptors.

117
Q

List 4 examples of anticholinergics. What is each used to treat?

A
  1. Atropine (tx bradycardia).
  2. Atrovent (tx asthma).
  3. Ditropan (tx incontinence).
  4. Scopolamine (tx n&v).
118
Q

What do we need to be cautious of when using scopolamine (2)?

A
  1. Crosses BBB.

2. High doses > high CNS effects.

119
Q

List 7 s&s of high doses of scopolamine.

A
  1. Dilated pupils.
  2. Blurred vision.
  3. Increased sensitivity to light.
  4. Confusion.
  5. Amnesia.
  6. Sedation.
  7. Unconsciousness.
120
Q

Curare is an anti______ that has high specificity for the ________ nervous system.

A

cholinergic; somatic.

121
Q

Curare causes _________ by blocking ______ action. If toxic, it will cause:

A

paralysis; muscle; respiratory muscle paralysis.

122
Q

Clostridium botulinum is a gram _, (aerobic/anaerobic) microorganism that releases a:

A

+, anaerobic; neurotoxin.

123
Q

Clostridium botulinum’s neurotoxin is an anti_______ and has high specificity for:

A

cholinergic; somatic nicotinic receptors.

124
Q

Clostridium botulinum is often found in improperly stored ______, so we can prevent its growth by using _________ like:

A

meats; preservatives; nitrites (ex: potassium nitrate salt).

125
Q

Cholinomemetics stimulate:

A

Ach.

126
Q

List 2 examples of cholinomimetics. What does each do?

A
  1. Mucomyst: increases secretions.

2. Pilocarpine: decreases intraocular pressure.

127
Q

Pilocarpine is clinically used _________ (route of admin) for tx of ______.

A

topically; glaucoma.

128
Q

Which of the drug classes that we’ve learned about falls into the category of adrenergic antagonists? List some drugs from this class.

A

Beta blockers.

  1. Metoprolol.
  2. Propanolol.
  3. Labetalol.

N216 A/B (26 decks)

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