FINALS Flashcards
everything in 1 (including medications)
Describe the concept of intracranial regulation.
-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.
Increased ICP
-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
Causes of ICP
-Opioids
-Cerebral edema
-Excessive/blocked CSF
-Hemorrhage/hematoma
-Tumors
-HTN
-Infections
Manifestations/Comps of ICP
-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
Medications for ICP
-Osmotic diuretics
-Antipyretics
-Antiseizure.
-Beta-blockers (for increased HTN).
-H2 blockers.
-Proton pump inhibitors.
Cerebral Edema
-Life-threatening condition that occurs when fluid builds up in the brain tissues causing increased pressure inside the skull.
-Vasogenic - extracellular
-Cytotoxic - intracellular
Treatment for Cerebral Edema
-Decrease ICP w/ Mannitol
-Oxygen
-Decrease Inflammation - glucocorticoids
-Support HTN
Epidural hematoma
-rapid arterial bleeding.
-unconsciousness & brief lucid period.
-most serious because of immense bleeding.
Subdural hematoma
-bridging veins.
-slower venous bleeding.
-gradual development over days & weeks.
Intracerebral hematoma
-single or multiple.
-more common in the frontal lobe.
-small vessel injury WITHIN the brain.
-trauma or hemorrhagic stroke.
-immediate or delayed.
Brain Injury
-Skull fractures.
-Focal brain fracture -> contusion (bruise), laceration, hemorrhage.
-Diffuse -> CONCUSSION, diffuse axonal.
-Secondary brain injury (diffuse or multifocal) -> edema, infection, hypoxic brain damage.
Concussion
-Mild traumatic brain injury -> leads to swelling.
-Second injury can result in permanent damage.
-Injured brain cells.
Complications of Concussion
-Post-concussion syndrome -> immediate no conscious, short amnesia.
-Post-traumatic seizures.
-Chronic encephalopathy.
-Headache
-Irritability
-Insomnia, poor concentration/memory.
Types of Brain Tumors
-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
Brain Tumor Manifestations
-Increased ICP
-Focal disturbances in brain function: edema, disturbance in blood flow, tumor infiltration, brain compression.
Brain Tumor Diagnoses
-MRI, CT scans, electroencephalogram, visual field examination, physical & neurologic examinations.
Brain Tumor Treatment
-Surgery, irradiation, chemotherapy.
Meningitis
-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.
Manifestations of Meningitis
-Stiff neck (nuchal rigidity), ALTERED MENTAL STATUS, confusion, fever.
-Headache, vomiting, nausea.
Meningitis Diagnoses
-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.
Meningitis Treatment
-Antibiotic (baterial)
-Viral - symptomatic treatment
Encephalitis
-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.
Encephalitis Diagnoses
-Culture for CSF
-High WBC
Stroke
-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.
Transient Ischemic Attack
-Focal ischemia - subsequent neurologic deficits.
-Lasts less than 1 hour.
-“Ministroke”.
-Temporary disturbance in blood flow.
Stroke Risk factors
-age
-sex
-race
-family history
-heart disease
-HTN
-cigarette smoking.
Stroke Manifestations
-Weakness of the face, arms, and legs; sudden, onset & focal (usually one-sided), language disturbance, slurred speech, sudden unexplained imbalance or ataxia (clumsiness).
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.
-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.
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.
-TBD
-Ischemic stroke = thrombolytic agents.
-Stroke = recombinant tissue-type plasminogen activator (tPA).
Spinal Cord Injury (Primary)
-Trauma & immediate tissue destruction.
-Inadequate mobilization following injury.
-Vertebral fracture/dislocation may or may not occur.
Spinal Cord Injury (Secondary)
-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.
Huntington
-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.
Spinal shock
-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.
Parkinson’s
-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.
ALS
-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.
Muscular Dystrophy
-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.
MS
-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.
MS Treatment
-Immunosuppressants/Immune system modulators.
-Corticosteroids (for acute flare-ups).
-Interferon-beta injection (immunomodulator).
MG
-Autoimmune disease.
-Antibodies attack Ach receptors.
MG Manifestations
Skeletal muscle weakness (usually eyes, face, neck, throat).
MG Treatment
-Cholinesterase Inhibitors (inhibit what’s destroying Ach).
-Neostigmine -> Prevent breakdown of Ach at receptor site -> Increase Ach at neuromuscular junction.
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.
-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.
Osmotic diuretic agent (mannitol)
-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
Hydantoins (phenytoin) - Antiseizure
-Supresses Na+; CNS DEPRESSION!
-Take with meals
-Narrow range
-Teratogen
-Gingival hyperplasia - maintain good oral health
Barbiturates (phenobarbital)
-Promotes GABA production.
-CNS depression.
-Physical dependence.
-Interferes with Vit D and K met - can cause rickets & bleeding.
Benzodiazepines (diazepam)
-Used for seizures
-Help relax muscles/muscle spams
-TBD
GABA modulator (valproic acid)
-Blocks Na+/Ca+ channels, potentiates GABA
-Hepatoxic
-Don’t mix with phenobarbital & phenytoin (can lead to tox) -> TOO CALM/TOO DEPRESSED
Treatment of partial seizures (carbamazepine)
-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
Tissue plasminogen activator (tPA)
Used for strokes
Dopaminergic agents: levodopa
-Drug for Parkinson’s disease.
-Increases dopamine synthesis.
Anticholinergics: benztropine
-Used for Parkinson’s disease.
-Improve balance between Ach & Dopamine
Acetylcholinesterase Inhibitors: pyridostigmine
-These drugs are used to prevent the breakdown of Ach.
-These are implicated in diseases such as Alzheimer’s and Parkinson’s.
