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PATHOPHARM > FINALS > Flashcards

FINALS Flashcards

everything in 1 (including medications)

1
Q

Describe the concept of intracranial regulation.

A

-The mechanisms or conditions that impact intracranial processing and function.

-Refers to the body’s processes to maintain a stable and balanced environment within the skull to ensure proper brain function.

-Factors contributing to intracranial regulations are cerebral blood flow, CSF production and absorption, intracranial pressure, and brain tissue volume.

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2
Q

Increased ICP

A

-Common pathway for brain injury.

-Can obstruct cerebral blood flow, destroy brain cells, displace brain tissue, damage delicate brain structures, can cause brain herniation (comps).

-10% blood, 10% CSF, 80% brain tissue

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3
Q

Causes of ICP

A

-Opioids
-Cerebral edema
-Excessive/blocked CSF
-Hemorrhage/hematoma
-Tumors
-HTN
-Infections

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4
Q

Manifestations/Comps of ICP

A

-Early: decreased alertness, drowsy, small/sluggish reaction pupils, hemiparesis, no vitals change, headache & slurred speech.

-Late: stupor/coma, large & nonreactive pupils, hemiplegia, *HTN, *wide pulse pressure, *bradycardia, *abnormal resp pattern, vomiting

**Cushing triad

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5
Q

Medications for ICP

A

-Osmotic diuretics
-Antipyretics
-Antiseizure.
-Beta-blockers (for increased HTN).
-H2 blockers.
-Proton pump inhibitors.

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6
Q

Cerebral Edema

A

-Life-threatening condition that occurs when fluid builds up in the brain tissues causing increased pressure inside the skull.

-Vasogenic - extracellular
-Cytotoxic - intracellular

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7
Q

Treatment for Cerebral Edema

A

-Decrease ICP w/ Mannitol
-Oxygen
-Decrease Inflammation - glucocorticoids
-Support HTN

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8
Q

Epidural hematoma

A

-rapid arterial bleeding.
-unconsciousness & brief lucid period.
-most serious because of immense bleeding.

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9
Q

Subdural hematoma

A

-bridging veins.
-slower venous bleeding.
-gradual development over days & weeks.

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10
Q

Intracerebral hematoma

A

-single or multiple.
-more common in the frontal lobe.
-small vessel injury WITHIN the brain.
-trauma or hemorrhagic stroke.
-immediate or delayed.

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11
Q

Brain Injury

A

-Skull fractures.
-Focal brain fracture -> contusion (bruise), laceration, hemorrhage.
-Diffuse -> CONCUSSION, diffuse axonal.
-Secondary brain injury (diffuse or multifocal) -> edema, infection, hypoxic brain damage.

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12
Q

Concussion

A

-Mild traumatic brain injury -> leads to swelling.
-Second injury can result in permanent damage.
-Injured brain cells.

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13
Q

Complications of Concussion

A

-Post-concussion syndrome -> immediate no conscious, short amnesia.
-Post-traumatic seizures.
-Chronic encephalopathy.
-Headache
-Irritability
-Insomnia, poor concentration/memory.

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14
Q

Types of Brain Tumors

A

-Primary intracranial (from neuroepithelial tissue): Neurons, neuroglia
-Primary intracranial (skull cavity): Meninges, pituitary gland, pineal gland, primary CNS - not derived from brain.
-Metastatic tumors.
-Benign & malignant.

Types (continued)
-Gliomas
-Meningiomas
-Primary CNS lymphomas

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15
Q

Brain Tumor Manifestations

A

-Increased ICP
-Focal disturbances in brain function: edema, disturbance in blood flow, tumor infiltration, brain compression.

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16
Q

Brain Tumor Diagnoses

A

-MRI, CT scans, electroencephalogram, visual field examination, physical & neurologic examinations.

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17
Q

Brain Tumor Treatment

A

-Surgery, irradiation, chemotherapy.

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18
Q

Meningitis

A

-Inflammation of the pia mater, arachnoid & subarachnoid space.

-Inflammation spreads rapidly because of CSF circulation around the brain & spinal cord.

-Usually caused by infection; chemical possible.

-Bacterial - acute purulent meningitis.

-Viral - acute lymphocytic.

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19
Q

Manifestations of Meningitis

A

-Stiff neck (nuchal rigidity), ALTERED MENTAL STATUS, confusion, fever.

-Headache, vomiting, nausea.

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20
Q

Meningitis Diagnoses

A

-Lumbar puncture to examine CSF

-CLOUDY CEREBROSPINAL FLUID

-bacterial -> a lot of protein & neutrophil content. reduced sugar.

-viral -> a lot of lymphocyte content. moderate protein. reduced sugar content.

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21
Q

Meningitis Treatment

A

-Antibiotic (baterial)
-Viral - symptomatic treatment

21
Q

Encephalitis

A

-Infection of the tissues - of the brain or spinal cord.

-Can be caused by viruses, sometimes fungi or bacteria.

-Similar manifestations to meningitis.

-Lethargy, disorientation, seizures, focal paralysis, delirium & coma.

-Progressive degeneration of neurons due to necrotizing hemorrhages.

21
Q

Encephalitis Diagnoses

A

-Culture for CSF
-High WBC

22
Q

Stroke

A

-Ischemic = interrupting blood flow in a cerebral vessel (thrombo clot stays in place).

-Hemorrhagic = bleeding into brain tissue!!!
-blood vessel rupture from HTN, aneurysms, & head injury.

23
Q

Transient Ischemic Attack

A

-Focal ischemia - subsequent neurologic deficits.
-Lasts less than 1 hour.
-“Ministroke”.
-Temporary disturbance in blood flow.

24
Q

Stroke Risk factors

A

-age
-sex
-race
-family history
-heart disease
-HTN
-cigarette smoking.

25
Q

Stroke Manifestations

A

-Weakness of the face, arms, and legs; sudden, onset & focal (usually one-sided), language disturbance, slurred speech, sudden unexplained imbalance or ataxia (clumsiness).

26
Q

Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug-drug interactions associated with drugs used for the treatment of seizure disorders.

A

-The #1 medications used to stop seizures are Lorazepam & Diazepam

-Antiseizure medications are supposed to suppress Na/Ca influx, promote more potassium, more GABA for calm.

-Major drugs are: phenytoin, carbamazepine, phenobarbital, valproic acid, & Gabapentine.

-Nurses should monitor for CNS depression, rash, bone marrow suppression & hepatotoxicity.

-Monitor for suicide risk.

-Withdraw antiepileptic drugs slowly - or could cause status epi.

-Lowest dose possible during pregnancy - take with folic acid.

27
Q

Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug-drug interactions associated with drugs used for the treatment brain injuries and stroke.

A

-TBD
-Ischemic stroke = thrombolytic agents.
-Stroke = recombinant tissue-type plasminogen activator (tPA).

28
Q

Spinal Cord Injury (Primary)

A

-Trauma & immediate tissue destruction.
-Inadequate mobilization following injury.
-Vertebral fracture/dislocation may or may not occur.

29
Q

Spinal Cord Injury (Secondary)

A

-It can occur following the primary spinal injury.

-Caused by hemorrhage, inflammation, edema, ischemia.

-Pathophysiologic cascade -> continues for weeks.

-LIFE-THREATENING - if it occurs in the cervical region -> cardiovascular & respiratory control may be lost.

30
Q

Huntington

A

-Rare autosomal dominant genetic condition.

-Lifespan = 15-20 years.

-Will die due to pneumonia.

-Basal ganglia degeneration (that controls voluntary movement), GABA depletion.

-No known treatment.

31
Q

Spinal shock

A

-Loss of motor function below the level of the injury.

-Neurogenic shock: loss of sympathetic function below the level of injury (if injury occurs above T6).

-The higher the injury, the more effect it will have:
-Cervical: All 4 limbs & breathing.
-Thoracic: Paraplegic (2 legs); pelvis & organs.
-Lumbar: Legs & leaky bladder.

32
Q

Parkinson’s

A

-Degenerative disease of basal ganglia & substantia nigra.

-Progressive disorder loss of neurotrans dopamine (needed for coordinated muscle movement).

-No dope in the park! (higher ACTH responsible for movement).

-Slowwwww, shuffling movement.

-Decrease in voluntary movement.

33
Q

ALS

A

-Degeneration of nerves in the spinal cord, brainstem, and motor cortex.

-Distal neurons degenerate first then progress up the spinal cord.

-Loss of voluntary movement.

-Meds: Riluzole - for als that begins in medulla -> glutamate antagonist.

34
Q

Muscular Dystrophy

A

-Deteriorates skeletal muscles.

-Combo of hypertrophy, atrophy & necrosis.

-This is disorder of motor function, not a nervous system problem.

-Muscles become fragile.

-X-linked disorder.

35
Q

MS

A

-Demyelination & inflammation of neuronal nerves.

-T & B cells attack the myelin & release inflammatory cytokines.

-Symptoms: tinnitus, blurred vision, vertigo, slurred speech, muscle weakness, urine retention or bladder spasticity, constipation.

36
Q

MS Treatment

A

-Immunosuppressants/Immune system modulators.

-Corticosteroids (for acute flare-ups).

-Interferon-beta injection (immunomodulator).

37
Q

MG

A

-Autoimmune disease.
-Antibodies attack Ach receptors.

38
Q

MG Manifestations

A

Skeletal muscle weakness (usually eyes, face, neck, throat).

39
Q

MG Treatment

A

-Cholinesterase Inhibitors (inhibit what’s destroying Ach).

-Neostigmine -> Prevent breakdown of Ach at receptor site -> Increase Ach at neuromuscular junction.

40
Q

Describe the therapeutic actions, indications, pharmacokinetics, contraindications, most common adverse reactions, and important drug-drug interactions associated with drugs used in the treatment of neuromuscular disorders.

A

-Benztropine (improve the balance between Ach & Dopamine).

-Cholinesterase inhibitors: Prevents breakdown of Ach at the receptor site.

-Anticholinergics: Blocks Ach; Achieve balance between dopamine/Ach; May cause CNS effects.

-Acetylcholinesterase Inhibitors:
-MG - neostigmine
-Alzheimers - donepezil
-Side effects: Cholinergic effects - excessive salivation, Increased gastric secretions, urinary urgency, bradycardia, sweating, respiratory arrest.

41
Q

Osmotic diuretic agent (mannitol)

A

-Action: reduction of increased intracranial pressure; creates an osmotic effect that reduces swelling.

-Indications: ICP

-Adverse effects: related to sudden drop in fluid levels -> nausea, vomiting, HTN, light-headedness, confusion & headache

42
Q

Hydantoins (phenytoin) - Antiseizure

A

-Supresses Na+; CNS DEPRESSION!
-Take with meals
-Narrow range
-Teratogen
-Gingival hyperplasia - maintain good oral health

43
Q

Barbiturates (phenobarbital)

A

-Promotes GABA production.
-CNS depression.
-Physical dependence.
-Interferes with Vit D and K met - can cause rickets & bleeding.

44
Q

Benzodiazepines (diazepam)

A

-Used for seizures
-Help relax muscles/muscle spams
-TBD

45
Q

GABA modulator (valproic acid)

A

-Blocks Na+/Ca+ channels, potentiates GABA
-Hepatoxic
-Don’t mix with phenobarbital & phenytoin (can lead to tox) -> TOO CALM/TOO DEPRESSED

46
Q

Treatment of partial seizures (carbamazepine)

A

-Suppresses Na+
-Induces bone marrow suppression - can cause fatal aplastic anemia, leukopenia, and thrombocyto.

-CBC before admin

-Withdraw this medication when WBC drops below 3000/mm3

47
Q

Tissue plasminogen activator (tPA)

A

Used for strokes

48
Q

Dopaminergic agents: levodopa

A

-Drug for Parkinson’s disease.
-Increases dopamine synthesis.

49
Q

Anticholinergics: benztropine

A

-Used for Parkinson’s disease.
-Improve balance between Ach & Dopamine

50
Q

Acetylcholinesterase Inhibitors: pyridostigmine

A

-These drugs are used to prevent the breakdown of Ach.
-These are implicated in diseases such as Alzheimer’s and Parkinson’s.

PATHOPHARM (9 decks)

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