Intoxications of the Nervous System

Question 1

Tetanus

Exotoxin MOA

Answer 1

Binds interneurons of brain, brainstem, and spinal cord and prevents the release of inhibitory NTs GABA and Glycine

Leads to MOTOR DISINHIBITION

Question 2

Tetanus

How is it acquired?

Answer 2

Produced anaerobically

Acquired in dirty wounds, unsterile needles

Question 3

Tetanus

Symptoms

Answer 3

Motor disinhibiiton

Painful spasms in muscles near wound, or generalized spasms

Generalized convulsive seizures

Question 4

Tetanus

Treatment

Answer 4

ICU care, 
Neuromuscular blockade,
Sedation,
Anticonvulsants,
Tetanus immune globulin,
ABX

Question 5

Botulism

Exotoxin MOA

Answer 5

Binds presynaptic nerve terminals and prevents Ach release

Causes flaccid paralysis

Question 6

Botulism

How is it acquired?

Answer 6

Exotoxin produced anaerobically in improperly canned or prepared food

Question 7

Botulism

Symptoms

Answer 7

Ptosis, diplopia, dysphagia

Facial, limb, resp weakness

Question 8

Lead Poisoning

How is it acquired?

Answer 8

Workplace paint, Lead batteries, ingestion of flakes of lead based paint

Question 9

Lead Poisoning

Symptoms in Adults vs. Kids

Answer 9

Adults – peripheral neuropathy

Kids – encephalopathy, abdominal pain

Question 10

Organic Solvents Poisoning

How is it acquired? Symptoms?

Answer 10

Chemical plant exposure, Glue sniffers

Encephalopathy or peripheral neuropathy

Question 11

Carbon Monoxide (CO)
Symptoms of CO Poisoning

Answer 11

Early headache, vomiting, blurred vision

Later coma, seizures, cardiopulmonary arrest

Question 12

CO Poisoning

MOA

Answer 12

Odorless gas with a higher affinity for Hgb than O2

Sources are heaters, unventilated auto garages

Question 13

CO Poisoning

Diagnosis and Treatment

Answer 13

Diagnosis: elevated CO blood level

Treatment: hyperbaric O2 chamber

Question 14

Stroke syndromes in younger patients may be drug related. What is the MOA and some common drugs that may cause this?

Answer 14

Vasoconstriction or abrupt HTN causes cerebral infarction or hemorrhage

Cocaine is most common; also amphetamines, PCP, LSD

Question 15

Symptoms of Acute Alcohol Intoxication

Answer 15

Social disinhibition, impaired consciousness, cerebellar dysfunction

Secondary head trauma

Question 16

Alcohol Withdrawal Syndrome

What are the two stages (early and later)?

Answer 16

Early: Hypersympathetic (tremulous, sweaty, tachycardia)

Late: Delirium tremens (fluctuating motor and autonomic activity, confusion, hallucinations)

Question 17

Alcohol Withdrawal Syndrome

What is Delirium tremens?

Answer 17

3-4 days after drinking stops

Fluctuating autonomic and motor activity

Confusion and Hallucinations

Question 18

How do you treat Alcohol Withdrawal Syndrome?

Answer 18

Benzodiazepines for sedation and seizure control

Hydration and metabolic support

Thiamine

Question 19

When might seizures occur after alcohol withdrawal?

Answer 19

Seizures should occur within 3 days of alcohol withdrawal

If longer than that, worry about something else

Question 20

Wernicke Korsakoff Syndrome

What are the acute and chronic symptoms?

Answer 20

Acute Wernicke Encephalopathy (nystagmus, ophthalmoplegia, gait ataxia, confusion)

Chronic Korsakoff psychosis (amnesia, confabulation)

Question 21

How should Acute Wernicke Encephalopathy be treated?

Answer 21

Thiamine supplements