CP and Chronic Disease Flashcards
What is the anti-cholinergic toxidrome?
Mad as a hatter, dry as a bone, red as a beet, blind as a bat (mydriasis).
What is the treatment for urinary retention due to detrussor spasm?
Anti-cholinergics (ditropan)
What is the definition of spasticity?
Velocity dependant increase in tone (as opposed to contracture or dystonia).
What are three common pharmacologic therapies for spasticity?
Baclofen, diazepam, dantrolene
What treatments are available for increased secretions?
Glycopyrrolate, scopalamine, atropine, salivary gland botox or ligation, trach, nissen.
What is the leading cause of hospitalization and death in patients with CP?
Respiratory complications (infection, and fibrosis secondary to chronic aspiration).
What are the two types of pain?
Nociceptive (tissue damage and inflammation)
Neuropathic (abnormal excitation or transmission).
What are first line treatments for neuropathic pain?
- Gabapentin
- TCA
- SNRI (effexor, cymbalta, prestiq)
What are second line treatments for neuropathic pain?
- Tramadol
- Opioids
What are the treatment options for pain behavior of unclear etiology in developmentally delayed patients?
Basically, the same as neuropathic pain, with the additional considerations of clonidine, methadone.
What is the first line treatment for a patient with autonomic hyperactivity?
Clonidine
What is the differential for a patient with neurological impairment exhibiting signs and symptoms of discomfort in whom acute injury or illness (i.e. nociceptive pain) have been ruled out?
- Neuropathic pain
- Paroxysmal autonomic instability and dystonia
- Dystonia / Muscle spasm
- Delirium
- Reflux / Gastritis
What is the first line treatment for dystonic reactions?
Diphenhydramine or benztropine
What class of medication is glycopyrrolate?
Anti-cholinergic (works at parasympathetic receptors).
What are the risk factors for shunt infection?
- Recent placement (first 6 months)
- G-tube
- Prior revisions
- Young age (??)
What are the symptoms of baclofen withdrawal?
Fever, tachycardia, agitation, spasticity
What is the treatment for baclofen withdrawal?
Benzodiazepine (lorazepam)
(Note that oral baclofen has much lower bioavailability than intrathecal baclofen).
What are the major risk factors for CP (in decreasing order of relative risk)?
- Prematurity (the more premature, the greater the risk)
- Low birth weight (the lower the birthweight, the greater the risk)
- Neonatal depression
- Neonatal infection
- Placental abruption
- Neonatal seizure
- SGA
- Multiple gestation
- Chorio
- A bunch of others
(I have seen pre-eclampsia on a practice question…it is a risk factor but quite a bit smaller than 1-9 above.)
What are the subtypes of CP?
- Spastic (Most common, encompasses hemiplegia / diplegia / quadriplegia)
- Dyskinetic (encompasses dystonic and choreoathetotic)
What subtype of CP is most common among preterm infants?
Spastic diplegia
What are the neonatal characteristics (GA, weight) most commonly seen among patients with spastic hemiplegic CP?
Term, normal birthweight
What are the neonatal characteristics (GA, weight) most commonly seen among patients with spastic quadriplegia CP?
Term, SGA
Aside from oral medications, what other therapies are available to treat spasticity?
- Botulinum toxin or alcohol injection (for localized contractures)
- Dorsal rhizotomy (for LE spasticity)
- Intrathecal baclofen
What are common medications that can be used for dystonia?
- Anticholinergics (benztropine, diphenhydramine)
- Baclofen
- Carbidopa / Levodopa (very effective in a subset of patients that are dopamine responsive).
- Benzodiazepines
What is the difference between spasticity and dystonia?
Dystonia is abnormal (usually increased) muscle tone often affecting posture or positioning.
Spasticity is a velocity dependent increase in tone leading to abnormal movements. But the resting tone is normal.
