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Foundations 4 SG > AMS 2 > Flashcards

AMS 2 Flashcards

1
Q

Sxs of what?

  • Autonomic hyperactivity (diaphoresis, tachycardia, systolic HTN)
  • Tremors
  • Insomnia
  • Transient hallucinations
  • Nausea or vomiting
  • Psychomotor agitation, restlessness
  • Anxiety
  • Seizures
  • Loss of appetite / rejection of all food
  • Confusion
A

Acute Alcohol Withdrawal

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2
Q

Tx what w/ Benzos??

AMS is never tx w/ Benzos, but this is the 1 exception.

A

Acute Alcohol Withdrawal

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3
Q

Result of what?

  • Medical emergency manifest by extreme autonomic hyperactivity w/ delirium
  • Can have psychosis, agitation, withdrawal seizures
  • Hyperadrenergic activity –> cause of mortality (if not tx appropriately)
A

Delirium Tremens (DTs)

(Severe Alcohol Withdrawal)

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4
Q

W/ Delirium Tremens from Severe Alcohol Withdrawal, what is the usual cause of mortality if pt is not treated appropriately?

A

Hyperadrenergic activity

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5
Q

Wernicke’s Encephalopathy

  • Medical emergency caused by ____.
  • Characterized by what 3 things?
  • Most cases associated w/ which 2 things?
A
  • Thiamine deficiency
  • Ophthalmoplegia / Ataxia / Confusion
  • Alcoholism / Malnutrition (or both)
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6
Q

Failure to tx/recognize Wernicke’s Encephalopathy may result in which 2 things?

A
  • Death
  • Permanent neurologic impairment
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7
Q

Wernicke’s Encephalopathy

  • What are the 2 main treatments?
  • Tx if associated w/ ETOH?
A
  • Thiamine & Multivitamin
  • Benzos if ETOH
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8
Q

A toxin of AMS called Anti-Freeze

A

Ethylene glycol

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9
Q

2 types of tests for AMS to test for Toxins

A
  • Urine Drug Screen
  • Serum Screening
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10
Q

Which test?

  • Opioids
  • Benzos
  • Cocaine
  • THC
  • Barbiturates
  • Amphetamines/Methamphetamines
  • TCAs
  • Buprenorphine
A

Urine drug screen

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11
Q

Which test?

  • Acetaminophen
  • Salicylate
  • Carboxyhemoglobin
  • Digoxin
  • Lithium
  • Valproic acid
  • Iron
  • Ethylene glycol
  • Lead / mercury
A

Serum screening

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12
Q

Management of AMS

Address the ABCs:

A
  • Airway
  • Breathing
  • Circulation
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13
Q

What 7 things need to be addressed before initiating interventions for AMS?

A
  • VS
  • mental status
  • Pupil size
  • skin temp
  • pulse ox
  • cardiac monitoring
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14
Q

Why do you give Thiamine in the SNOT cocktail before giving glucose?

A

To avoid inducing Wernicke-Korsakoff Syndrome

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15
Q

Tx of AMS is: Identify underlying cause and tx this underlying cause

  • what is the “SNOT” cocktain for pts w/ AMS?
A
  • Sugar (glucose)
  • Naloxone (Narcan)
  • Oxygen
  • Thiamine
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16
Q

Which condition?

  • A progressive intellectual decline
  • NOT due to delirium or psychiatric disease
  • 4 types
A

Dementia

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17
Q
  • 5 risk factors of Dementia
  • What are the 4 types?
A
  • Age >65
  • Family hx
  • Vascular Disease
  • DM
  • Hx of significant head injury

Four Types:

  • Alzheimers (MC)
  • Vascular dementia
  • Dementia w/ Lewy Bodies
  • Frontotemporal dementia (Luis)
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18
Q

Dementia

  • Typically begins after age ___.
  • Prevalence doubles every __ yrs after age ___.
  • By ___ y/o approximately 50% have some form of dementia
  • Cause is mostly acquired or genetic?
  • More prevalent among men or women?
A
  • 65
  • 5 years after age 65
  • 85 y/o
  • Acquired, (some genetic for early onset)
  • Women
19
Q

_____ is the most common form of dementia.

  • Major public health issue
  • How is definitive dx made?
  • What is the only therapy available?
A

Alzheimer Disease

  • Autopsy or brain biopsy
  • Symptomatic therapies
20
Q

Which condition?

  • Type of progressive dementia caused by microscopic deposits that damage brain cells over time
A

Dementia w/ Lewy Bodies

21
Q

Lewy Bodies are found in Dementia w/ Lewy Bodies and what other 2??

A
  • Alzheimer Disease
  • Parkinson Disease (more common in this one)
22
Q

Dementia w/ Lewy Bodies

  • Deposits of beta-amyloid?
  • Twisted fiber of tau protein?
A
  • Plaques
  • Tangles
23
Q

Which condition?

  • Caused by impaired blood flow to the brain
  • Often occurs after stroke
  • Multifocal ischemic change
  • “dramatic onset” - Impairment is often more sudden than Alzheimer Dz
A

Vascular Dementia

24
Q

3 risk factors of Vascular Dementia

A
  • HTN
  • HLD
  • Smoking
25
Q

Dementia have short or long term memory loss?

A

Short

26
Q
  • Pts w/ ____ are susceptible to episodes delirium.
  • Recognition of ____ is not possible until _____.
  • ___ is typically dx in what setting?
  • Pt should be stable when diagnosed, not acutely ill.
A
  • Dementia
  • Dementia / the delirium lifts
  • Dementia / Outpatient setting
27
Q
  • ____ can lead to impaired cognition in patients w/ depression or anxiety
    • (–> poor ___ and ____)
  • ___ sxs should improve w/ tx
  • Can be early symptom of ______.
  • If untreated, what disorder may predispose an individual to age related dementia?
A
  • Psychiatric disease
    • poor focus & concentration
  • psychiatric sxs
  • dementia
  • Persistent modd disorder
28
Q

Although ____ and/or ___ are signs of both Delirium and Dementia, these are different conditions.

A
  • Confusion &/or Disorientation
29
Q
  • Acute confusional state
  • Is potentially reversible
  • Usually occurs over a period of days to months
A

Delirium

30
Q
  • Slow & insidious
  • Progresses slowly over months to years
  • NOT reversible
  • (can slow sxs w/ meds, but cannot be cured)
A

Dementia

31
Q
  • What needs to be established when pt presents w/ Dementia?
  • Document pt’s current ability to complete ____.
A
  • Time of symptom onset
  • Activities of daily life (ADL)
32
Q

Dementia psych workup:

  • ____
  • Periodic screening for pts ___ y/o or over
  • Evaluation by ______.
A
  • MMSE
    70
  • trained neuropsychologist
33
Q

What test for Dementia is indicated if:

  • Pts w/ new / progressive complaint
  • ___ is preferred test
  • ____ is used to r/o amyloid pathology
A

Brain imaging

  • MRI preferred
  • Positive-emission tomography (PET)
34
Q

7 labs to obtain for Dementia workup

A
  • Serum B12
  • TSH
  • RPR
  • CBC
  • CMP
    Lipids
  • ApoE gene testing
35
Q

What lab should you order if Alzheimer disease is in differential? Why?

A

ApoE gene testing (esp young patients bc/ good to catch early to tx)

36
Q

2 treatments for Dementia

A
  • Aerobic exercise (45 mins)
  • Frequent mental stimulation
37
Q

Tx for Dementia w/ Lewy Bodies

(Small effect on cognition, mood, behavior)

A

Memantine

38
Q

3 treatments for Alzheimer Disease and what type of drug they are.

A

Cholinesterase Inhibitors

  • Donepezil (mild to moderate dz)
  • Rivastigmine
  • Memantine (moderate to severe dz)
39
Q

Mood/Behavioral tx for Dementia

  • _____ are generally safe
  • Avoid ____ due to anticholinergic effect
  • _____ for insomnia
A
  • SSRI
  • Paroxetine
  • Trazadone
40
Q

What is the name of a Psychostimulant used for apathy for select patients w/ Dementia?

A

Methylphenidate

41
Q
  • ____ is the most common cause of rapidly progressive dementia
  • ___ gene can test for familial susceptibility for ____ disease
A
  • Creutzfeldt-Jakob disease
  • PRNP / Prion Disease
42
Q

Driving and Dementia

A
  • Recommended to stop driving
  • Most states have laws concerning dementia/driving
43
Q

Dementia

  • Admit all pts w/ ____ to tx underlying cause
  • Refer all pts w/ new cognitive decline to ____.
A
  • delirium
  • Neurology
44
Q
A

Foundations 4 SG (19 decks)

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