[216B] Neuro Part 2 Flashcards
Should you treat a headache if you’re not sure what the cause is?
No >:0
What is the tx for headaches if serious pathologies are ruled out?
Analgesics.
What are the criteria to diagnose chronic migraine?
Headache for more than 15 days per month for more than 3 months.
There is a higher incidence of chronic migraines in:
Adult women.
Chronic migraines are often linked to:
Genetics.
What do we call chronic migraines that begin in childhood?
“Childhood periodic syndrome”.
What is the primary sequelae associated with chronic migraines?
Trigeminal nerve irritation > inflammation within the meningeal vasculature (blood vessels in the meninges).
What are the 2 main categories of chronic migraines? Which is more common?
- Without aura - more common.
2. With aura.
Describe chronic migraines with auras.
More pronounced visual disturbances preceding the headache.
Which category of headache is more difficult to diagnose? Why?
With aura, because many people will experience some kind of symptom before the onset of a migraine (“prodrome fatigue”).
Which s&s of chronic migraines is particularly common in childhood periodic syndromes?
N&V.
Which analgesic class is particularly effective for tx of chronic migraines?
NSAIDs.
________ agonists may be used as tx for chronic migraines. Why?
Serotonin agonists are inhibitory in the CNS, so they have a calming effect and will balance out brain activity.
The ______ drug class consists of serotonin agonsist.
Triptan.
List 2 examples of meds from the triptan drug class.
Sumatriptan.
Zolmitriptan.
________ superficial scalp IM injections can be used as tx for chronic migraines. Why?
Botox is anti-inflammatory and decreases neurotransmitter hyperstimulation.
What are 2 adjunct meds that can be used for tx of chronic migraines?
Caffeine.
Antiemetics.
Which antiemetic class should be avoided when choosing an adjunct med for tx of chronic migraines? Why?
Avoid serotonin inhibitors - they would counteract the serotonin agonists (primary med for tx).
What is our primary resource used to classify psychiatric disorders on a biologic basis?
The DSM (diagnostic & statistical manual).
Common symptoms of psychiatric disorders (2):
Hallucinations.
Delusions.
Hallucinations are abnormalities of:
sensory perception.
Describe the expected pathway of perception (general).
Sensory organ > appropriate nerve > thalamus > appropriate cortical region.
The primary visual cortex is responsible for ______ the image, while the visual association cortex is responsible for __________ the image.
“Seeing”
“Interpreting”
Describe the 2 possible etiologies associated with hallucinations.
1, Sensory block: stored images replace real-time intel.
2. Neuronal dysfunction: image creation via neuronal hyperactivity/pathway dysfunction/disease.
In what 2 situations might we expect sensory block hallucinations?
- Sensory deprivation.
2. Sensory dysfunction (ex: blindness).
List 2 possible causes of hallucinations due to neuronal dysfunction.
- CNS drugs.
2. Pathology (ex: tumors).
Delusions are abnormalities of:
thought.
Delusions are abnormalities of:
thought.
Delusions are caused by _________ or _____________ influences, such as:
Environmental or existential influences, such as:
- Education
- Religion
- Social experiences
- Stressors
What is psychosis?
A perceptive loss of reality.
Can someone be diagnosed with psychosis?
No, it is not a diagnosis but a presentation.
List 4 signs and symptoms of psychosis.
- Hallucinations.
- Delusions.
- Lack of awareness & judgement.
- Mood/affect alterations.
What are 5 potential causes of psychosis?
- Mental health illnesses.
- Drug side effects/toxicity (ODs)
- Electrolyte imbalances.
- Sepsis (elderly).
- Hospital induced overstimulation (ex: ICU) (infants/children/elderly).
Schizophrenia is the dysfunction of (2):
Thoughts & language expression.
What are the s&s of schizophrenia?
Abnormal behaviours & movement.
List the 3 types/dimensions of schizophrenic behaviour.
- Disorganized.
- Psychotic (positive symptoms).
- Negative symptoms.
Describe disorganized schizophrenic behaviour.
Incomprehensible speech (ex: invented words, disconnected words/thought processes, disorganized words).
List 3 positive schizophrenic symptoms.
- Hallucinations.
- Delusions (paranoias & disorganized thought processes).
- Agitation.
List 3 negative schizophrenic symptoms.
- Pt withdrawn.
- Apathy.
- Lack of motivation/happiness.
Which dimension of schizophrenic behaviour is hardest to treat? Which has the worse prognosis?
Negative symptoms for both.
Explain the neurotransmitter theory for schizophrenia.
Dopamine neurotransmitter theory: there is a dopamine excess, leading to hyperactivity (abnormal behaviours/movements).
What are the diagnostic criteria for schizophrenia?
At least 2 of the behavioural dimensions + 2 other functional alterations (ex: hygiene).
What drug class do we use for tx of schizophrenia?
Antipsychotics (narcoleptics).
What are the 2 target receptors for antipsychotics? What actions are taken at these receptors?
- D2 dopamine receptors in the limbic system - selective blocking.
- 5HT receptors - non selective + Ach blockade.
The limbic system D2 receptors are responsible for:
Mood, behaviour & emotion control.
Antipsychotics may unintentionally block:
This results in side effects known as:
D2 receptors in the basal ganglia.
Extrapyramidal side effects.
List 5 examples of extrapyramidal side effects.
- Tardive dyskinesia (tongue movement).
- Parkinsonism (rigidity).
- Tremors.
- Restlessness.
- Dystonias (muscle spasms).
List 3 anticholinergic side effects that may result from antipsychotic tx.
- Urinary retention.
- Dry mouth.
- Sexual dysfunction.
Should antipsychotic tx be stopped abruptly under normal circumstances? Why or why not?
No - will lead to withdrawal symptoms d/t physical dependence.
When is it okay to stop antipsychotic meds abruptly?
If s&s of neuroleptic malignant syndrome are noted.
List the s&s of neuroleptic malignant syndrome (4).
- Hyperthermia.
- Unstable BP.
- Diaphoresis.
- Incontinence.
List 7 s&s of depression.
- Loss of interest in activities.
- Inability to experience pleasure.
- Decreased concentration.
- Sleep alterations.
- Hallucinations/delusions (mostly in major depressive disorders).
- Appetite alterations.
- Suicidal ideations.
Which 2 neurotransmitter theories are behind depression?
- Serotonin neurotransmitter theory: decreased levels of serotonin.
- Norepinephrine neurotransmitter theory: imbalanced levels of NE.
List 3 potential causes of depression.
- Drug-induced.
- Contributing illnesses (ex: MI).
- Contributing factors (ex: loneliness in the elderly).
List the 4 classes of antidepressants.
- SSRIs: selective serotonin re-uptake inhibitors.
- Atypical antidepressants (SNRIs: serotonin & NE re-uptake inhibitors).
- Tricyclic antidepressants.
- MAO inhibitors.
SSRIs ______ serotonin levels by _______ re-uptake in the synaptic space.
Increase serotonin levels.
Decrease re-uptake.
List 3 SSRIs.
- Fluvoxetine (Prozac).
- Setraline (Zoloft).
- Paroxetine (Paxil).
Name 2 SNRIs.
- Mirtazapine (Remeron).
2. Bupropion (Wellbutrin).
Why is serotonin helpful in tx of depression?
Mood balance/stabilization.
Why is NE helpful in the tx of depression?
It is stimulating: helps with concentration, energy, motivation, etc.
Will a pt on SSRIs or SNRIs be at greater risk for more side effects? Why? What additional side effects might we see?
SNRIs: risk of overstimulation.
Ex: insomnia, decreased appetite, nausea.
Which drug class is first line tx for depression?
SSRIs.
What do tricyclic antidepressants do?
Inhibit synaptic re-uptake of serotonin, NE and dopamine.
Name a drug that is a tricyclic antidepressant.
Imipramine (Impril).
Why are MAO inhibitors not first line tx for depression (only for pts who do not respond to other drug classes)?
Lots of drug-drug and food-drug interactions.
List 2 non-pharmacological txs for depression.
- Brain implants (stimulation).
2. Counselling (CBT).
List 3 side effects of SSRIs.
Sedation.
Lethargy.
Nausea.
Serotonin syndrome occurs when there is _______ serotonin in the body.
Too much.
List 7 s&s of serotonin syndrome.
- Changes to mental state.
- Dry mouth.
- Hypothermia, shock.
- Diarrhea.
- N&V.
- Tremors/reflex changes.
- Muscle rigidity.
What should we do if we suspect serotonin syndrome?
Stop tx and treat the effects.
Which drug is used as a PRN adjunct tx for depression?
Lithium (Lithonate).
Lithium (Litionate) _____ serotonin & ______ Na+ cellular influx.
Increases serotonin, decreases Na+ cellular influx.
Why is lithium (Lithionate) a helpful adjunct for tx of depression?
Helps increase serotonin further (stabilize mood).
Decreased Na+ cellular influx > decreased hyper-excitation > decreased mood swings, erratic behaviour & impulsivity).
Because lithium (Lithionate) decreases impulsivity, when do we usually choose to use it as an adjunct in depression tx?
For suicide risk reduction.
What are 7 considerations of using lithium (Lithionate)?
- Narrow TI: need serum monitoring (especially initially).
- Toxicity.
- High Vd.
- Crosses placenta.
- Slow onset of action: 1-3 weeks.
- Drug-drug interactions!!!
- Compliance.
Is it possible to directly diagnose dementia? How do we “diagnose” it?
No direct dx; must rule out other possibilities to reach a “dx”.
Alzheimer’s disease constitutes approximately __% of all dementia cases.
64%.
Alzheimer’s is due to the progressive loss of _______ & ______ in the brain.
Neurons & synapses.
Describe the pathology of Alzheimer’s.
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.
Describe the s&s of Alzheimer’s as it progresses in severity.
Mild forgetfulness > behavioural changes > inability to complete ADLs.
How do we treat Alzheimer’s? Is there a cure?
No cure: increase Ach with cholinesterase inhibitors.
Cholinesterase normally __________ Ach, so cholinesterase inhibitors will result in __________ Ach levels.
Normally: breaks down Ach.
Inhibitors result in increased Ach levels.
List 2 cholinesterase inhibitors.
- Rivastigmine.
2. Galantamine.
_______ antagonists combat oxidative stress by ______________ and may be used in Alzheimer’s tx.
Glutamate.
Increase Vit C levels.
Name 2 adjunct drug classes that may be used in Alzheimer’s tx.
- Mood stabilizers.
2. Antipsychotics.
Describe the pathology of Parkinson’s disease.
Accumulation of Lewy bodies + destruction of dopamine neurons > reduced dopamine levels in basal ganglia.
Parkinson’s Disease is the inability to filter out _______ movements and to focus ________ movements.
Filter out extra movements; focus purposeful movements.
When Parkinson’s has progressed __%, that is when we will start to see defining symptoms.
75%.
List 3 defining symptoms of Parkinson’s.
Rigidity.
Jerking.
Tremor.
How do we treat Parkinson’s? What drug class can we use to do this?
Increase dopamine: use dopamine agonists.
List 2 dopamine agonists that may be used in Parkinson’s tx.
- Levodopa.
2. Rotigotine (Neupro).
Which 3 CNS neurotransmitters are present in the PNS/other regions of the body and will cause systemic effects?
- Acetylcholine (Ach).
- NE.
- Serotonin.
Catecholamines are also known as _________ or ________, and will:
Adrenergics, sympathomimetics.
Will stimulate the SNS.
Anticholinergics will:
Decrease the PNS (stimulating the SNS).
Cholinomimetics are also known as _______ and will:
muscarinics; stimulate the PNS.
Adrenergic antagonists will:
Decrease the SNS.
Nicotinic agonists activate ____ at _______ receptors.
Ach at nicotinic receptors.
Where are nicotinic receptors located?
All autonomic synapses and in the CNS.
What effects will activation of Ach at nicotinic receptors have?
CNS & non-selective autonomic nervous system effects.
List 4 s&s that we will see when Ach is activated at nicotinic receptors.
- Alertness.
- Increased BP.
- Peripheral vasoconstriction.
- Decreased GI activity.
Name 1 example of a nicotinic agonist.
Nicotine (tobacco).
List 3 endogenous catecholamines.
- NE.
- Epinephrine.
- Dopamine.
Dopamine is a precursor for (2):
Epinephrine and NE.
Which receptors does epinephrine act on?
Alpha and beta.
Ventolin acts on _____-__ receptors.
Beta-2.
Serevent acts on ____-_ receptors.
Beta-2.
Ephedrine & phenylephrine are anti-________.
Secretions.
List 3 amphetamine names (2 brand, 1 generic).
- Concerta (brand).
- Ritalin (brand).
- Methylphenidate (generic).
Pseudoephedrine (Sudafed) is for relief of:
nasal congestion.
Pseudoephedrine (Sudafed) enhances:
athletic performance.
Amphetamines are part of which drug class?
Met
Amphetamines increase _____ by stimulating _____.
Increase focus by stimulating RAS.
List 3 side effects of amphetamines.
- Weight loss.
- Tachycardia.
- Insomnia.
Amphetamines may be abused in the form of:
Crystal meth (amphetamine, methamphetamine).
Crystal meth is a:
Stimulant.
Anticholinergics/antimuscarinics enhance the ____ by blocking:
Enhance the SNS by blocking cholinergic receptors.
List 4 examples of anticholinergics. What is each used to treat?
- Atropine (tx bradycardia).
- Atrovent (tx asthma).
- Ditropan (tx incontinence).
- Scopolamine (tx n&v).
What do we need to be cautious of when using scopolamine (2)?
- Crosses BBB.
2. High doses > high CNS effects.
List 7 s&s of high doses of scopolamine.
- Dilated pupils.
- Blurred vision.
- Increased sensitivity to light.
- Confusion.
- Amnesia.
- Sedation.
- Unconsciousness.
Curare is an anti______ that has high specificity for the ________ nervous system.
cholinergic; somatic.
Curare causes _________ by blocking ______ action. If toxic, it will cause:
paralysis; muscle; respiratory muscle paralysis.
Clostridium botulinum is a gram _, (aerobic/anaerobic) microorganism that releases a:
+, anaerobic; neurotoxin.
Clostridium botulinum’s neurotoxin is an anti_______ and has high specificity for:
cholinergic; somatic nicotinic receptors.
Clostridium botulinum is often found in improperly stored ______, so we can prevent its growth by using _________ like:
meats; preservatives; nitrites (ex: potassium nitrate salt).
Cholinomemetics stimulate:
Ach.
List 2 examples of cholinomimetics. What does each do?
- Mucomyst: increases secretions.
2. Pilocarpine: decreases intraocular pressure.
Pilocarpine is clinically used _________ (route of admin) for tx of ______.
topically; glaucoma.
Which of the drug classes that we’ve learned about falls into the category of adrenergic antagonists? List some drugs from this class.
Beta blockers.
- Metoprolol.
- Propanolol.
- Labetalol.
