Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

MP422 CNS > L1 - L7 > Flashcards

L1 - L7 Flashcards

1
Q

3 Features of Childhood CNS Disorder

A
  1. may arise from impaired brain development or functional deficits. child takes a while reaching normal milestones
  2. can often occur as co-morbidities and lead to substance misues
  3. requires treating the mind (CBT, behavioural therapy) as well as the brain (medicines)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

ASD

  • Asperges, PDD-NOS, Autism
  • Neurodevelopment disorder
A
  • repetitive behaviour , communication deficit , poor social skills
  • 70% have co-morbid conditions (anxiety depression, ADHD)
  • if normal IQ with ASD they are likely to have increased visual and math ability
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

ASD Treatment

  • Rett’s caused by MECP2 gene
A
  • support of individual and family
  • no meds for Core Autism

unless : children with aggression give Risperidone (anti-psychotic)
- 2mg/day up to 45kg –> 3.5mg/day >45kg
- only for children

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

ADHD Overview (neurodevelopmental)

  • Hyperkinetic Disorder : more serious
  • inattention, hyperactivity, impulsivity
A

Pre Frontal cortex is compromised and has defective inhibitory response.

2/3 ADHD patients have co-morbidity
- tics , OCD , depression , substance misuse

methylphenidate - used in children over 6yrs old
- diagnosed by clinical interview and standardised reports

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Tourette’s Syndrome

  • 1st line CBT therapy
  • can use drugs risperidone
A

Tics - vocal and physical

  • often associated with ADHD or OCD
  • underlying problem in basal ganglia which controls motor skills/behaviours

Treatment
- habit reversal therapy (stop triggers)
- exposure response prevention (ERP)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

OCD

  • mild : <1hr / day
  • moderate : 1-3hrs / day
  • severe : >3hrs a day
A

Obsession: unwanted thoughts/urge that enters the mind repeatedly (anxiety)

Compulsion: repetitive behaviour to temporarily relieve unpleasant feelings brought by obsessive thought

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Body Dysmorphic Disorder (BDD)

  • Fears and anxiety about physical appearance
A

Treatment Same as OCD
- treat with SSRI’s (inc. serotonin levels)

1st line : sertraline in children with OCD
1st line : fluoxetine for children with BDD
OR children with OCD + depression

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Eating Disorders

  • anorexia nervosa , bulimia , binge eating
  • can also use CBT, interpersonal psychotherapy, dietary counselling
A

Anorexia Nervosa

  • pathological need for keeping weight as low as possible
  • caution with drugs because heart is weakened by emaciation
  • SSRI’s commonly prescribed or (SGA’s)

Bulimia

  • periods of binge eating and being deliberately sick or using laxatives
  • Fluoxetine given at higher dose than depression
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Neurodevelopmental Disorders

A

e.g. ASD & ADHD

  • impairments in cognition, behaviour or communication from abnormal brain development
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Emotional/Behavioural Disorders

A

internalising or externalising problems, usually as a consequence of stress

  • depression, anxiety, OCD, phobias, anorexia
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Psychotropic Drugs

A
  • Antidepressants - SSRI’s , SNRI’s
  • Antipsychotics - risperidone
  • AEDs -
  • Psychostimulants -

Miscellaneous – [hypnotics, anxiolytics,
adrenergic agents]

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Behavioural Therapies

A

CBT - identifying and modifying unwanted thought patterns/behaviours rather than symptoms

better than drug use: - no side effects
- tackles root problem
- no withdrawal symptoms like with drugs
- prevents dependency from drug use

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Anti Psychotics

  • for psychosis , BPD , compulsions/aggressions
A

1st gen typical (FGA’s)
- most effective is clozapine (treatment-resistant schizo)
- causes ED, breast discharge

2nd gen atypical (SGA’s)

  • less extra-pyramidal side effects because it doesnt fully block dopamine receptor
  • more cardiotoxic + causes weight gain
  • shows efficacy for positive and negative symptoms in CNS disorders
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Antipsychotic Monitoring Req’s

A

Weight - initial + every 3 months
U+E’s - baseline and annually
Blood Glucose - initial + every 3 months
Prolactin - if hyperprolactinaemia symptoms
ECG - if patient has cardia risk

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

ADHD Management Stages

A

Pre School Overactivity
- behaviour management from parents, teachers

Mild ADHD
- general behaviour management & ADHD-specific training
- no meds at this stage because it can cause long term damage

Moderate/Severe
- when symptoms impact learning, relationships, self esteem
- medicine used here for symptoms

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

ADHD Treatment

  • 1st line CBT
  • can use methylphenidate, dexamphetamine , atomoxetine , gaun
A

Drug Treatment

1st line - psychostimulants
- methylphenidate , then dexamphetamine

2nd line - Atomoxetine or Guanfacine

3rd line Clonodine

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Methylphenidate + Dexamphetamine

  • MoA
  • psychostimulant meds
A

Methylphenidate

  1. blocks dopamine and NA transporters which take the nt out of synaptic cleft
  2. more dop and NA in cleft
  3. increases neuronal transmission

Dexamphetamine

  1. facilitates dopamine release from pre-synaptic vesicle + blocks reuptake transporter
18
Q

Atomoxetine + Guanfacine

  • non-stimulants
A

Atomoxetine
1. NA inhibitor , A2 agonist.
2. reduced chance of misuse
3. metabolised by CYP2D6 (hepatic)

Guanfacine
- sustained release is licensed (long time till therapeutic effect)
- has calming effect

Clonidine
- inhibits NA release by stimulating alpha2 adrenergic system
- unlicensed. 2-3x / day dosing
- major S/E BP drop

19
Q

Tics Medication

A

AP’s - first and second gen

clonidine - but has s/e
- drowsiness , depression , major BP drop

Tics + Anxiety
- use SSRI’s

Co-morbid with ADHD
- atomoxetine non stimulant
- because stimulant drugs exacerbate tics

20
Q

OCD Medication

A

mainly psychological treatment
- CBT

antidepressants if severe : SSRI’s 1st

  • sertraline 150mg daily
  • clomipramine (ssri) 300mg daily
  • used to treat delusions
21
Q

Depression

  • only treat children in severe cases
A

mostly SSRI

1st line : fluoxetine 10mg/day
2nd - sertraline or citalopram

NOT paroxetine or venlafaxine
- discontinuation reduce by 25% weekly

22
Q

Seizures

  • costs £1.5B
  • affects 1/100
A

transient occurrence of signs due to abnormal excessive activity in the brain

  • due to abnormal or excessive activity
  • Diagnosis :
    1. at least 2 unprovoked seizures >24hr apart
    2. one unprovoked seizure with 60% recurrence chance within 10yrs of original seizure
    3. diagnosis of epilepsy syndrome
23
Q

Seizure Classification

  • Generalised Seizures
A

Atypical absence – can’t respond
Typical Absent - altered awareness
Clonic – both arms jerking
Tonic – both arms go stiff
Atonic – going limp

24
Q

Generalised Seizures - SE

  • arising in both hemispheres engaging bilaterally
A

Status Epilepticus

  • results from failure of mechanisms for seizure termination
  • failure of mechanisms responsible for abnormal seizure initiation
25
Q

Focal Seizures

  • one sided
A

Aura , Motor , Automatic , awareness/responsiveness

  • can also develop into secondary generalised seizures (bilateral convulsive)

Acquired : - accidents/injury
- genetic
infectious : bacterial or viral encephalitis
Metabolic : GLUT1 deficiency leading to more glutamate in brain, more excitation
Genetic : SCN1a , Dravet’s Syndrome causing epilepsy

26
Q

Seizure Sequence

  • stage 1 - 3
A

Initiation - abnormal voltage-gated channels

Synchronisation - abnormal receptor-operated channels

Propagation - recruitment of neurons via anatomical connection

27
Q

Treatment Strategies

  • AED’s Action
A
  1. inhibition of voltage gated Na+ channels , reducing sodium can reduce excitability
  2. promotes inhibitory neurotransmitters (GABA)
  3. inhibition of voltage-gated Ca2+ channels to stop muscle contraction
28
Q

AED Classes

A
  1. Na+ channel inhibition
    - phenytoin , carbamazepine , oxcarbazepine
    - lamotrigine ( 1 & 3 HVA Ca+ inhobition )
    - dont fully block Na+ channels , they just prolong inactive period (refractory)
  2. enhance GABA action
    - BZD’s - inc. frequency of GABAa channel opening
    - Phenobarbital - inc. probability of GABAa channel opening
    - Vigabatrin - inhibits GABA transaminase

–> they all calm the firing of nerves by influx of Cl- into neuron to hyperpolarise

  1. Inhibit Ca2+ Voltage Channels
    - ethosuximide - inhibits T-type Ca2+ channels (used for absence seizures)
    - pregabalin - inhibits HVA Ca2+ and glutamate
    - Gabapentin - inhibits HVA Ca2+ and NA+ channels
29
Q

Other Drugs

A
30
Q

Seizures Treatment Guidelines

A

Generalised Seizures
- 1st line sodium valproate
- 2nd lamotrigine/topiramate

Focal Seizures
- 1st lamotrigine
- 2nd carbamazapine

Absence Seizures
- 1st ethosuximide
- 2nd sodium valproate/lamotrigine

Status Epilipticus
-1st midazolam (buccal) cuz BDZ’s have fast action
- 2nd lorazepam/diazepam

31
Q

Neurological vs Psychiatric

  • differences
A

Neurological - issues of the brain
- physical issue
- drug therapy is usually essential
- parkinsons , epilepsy , tumour , migraine

Psychiatric - issues of the mind
- disorders of mood, thought, behaviour
- psychological and drug treatment
- anxiety , depression , schizo

32
Q

Enteric Coated Tablets

A
  • dissolve in duodenum at higher pH
  • sodium valproate
  • cannot crush or chew tablets as drug could be released too early
  • polyvinyl actetate phthalate is coating
33
Q

Oro dispersible Tablets

A

Co-beneldopa & lamotrigine

  • tablet disintegrates in mouth in 1min in the saliva
  • no difficulty swallowing
  • more accurate dosing in kids
34
Q

Modified Release Tablets

  • erosion controlled matrix
  • diffusion control
A
  1. Erosion Controlled Matrix (co-carbadopa sinemet)
    - drug dispersed in a wax matrix
    - matrix breaks down over time and drug is released slowly
  2. Diffusion Control (ropinirole (ReQuip XL)(PD)
    - drug dispersed in porous matrix formed of a water-insoluble polymer
    - drug diffuses from insoluble polymer
  3. Erosion and Diffusion Controlled matrix
    - sodium valproate (Epilim Chrono, Epival CR)
    - pramipexole ER (Mirapexin , PD)
35
Q

Transdermal Administration

  • requirements
A
  • have low molecular weight <400
  • aqueous solubility higher than 1mg/ml (to be removed by blood)
  • moderately lipophilic (LogP 1-5)
  • effective at low doses
  • Co-Beneldopa given as pump
  • Lorazepam given IM
35
Q

Extended Release Tablets

-carbamazepine (Tegretol XR) (epilepsy)

A
  1. overcoat disintegrated releasing 22% of drug instantly
  2. water permeates into osmotic layer, expanding this layer and pushing drug out over the span of a morning
  3. release rate inc. into the afternoon. more drug pushed out from push compartment expanding
35
Q

Headache Aetiology

A
  1. Pain stimuli activates nociceptors in skin, muscle, joints
  2. transmits signal from periphery nerves to brain - nociceptors in dura and pia.
  3. chemicals released from blood vessels near dura & pia activate nociceptors

= gives headaache

36
Q

Headache Types

  • Primary , Secondary
A

Primary - headache is main symptom
- stress/tension headache
- migraine
- cluster

Secondary - caused by something else
- symptom of something else

37
Q

Primary Headache Types

  • Tension , Migraine , Cluster
  • migraine is neurological
A

Tension
- slow onset , bilateral , dull pain
- pain in posterior

Migraine (no aura)
- unilateral , lasts 4-72hr , pulsating , moderate/severe , nausea vomiting

Migraine (with aura)
- headache with 1 of following :
- visual, sensory, speech, motor, retinal
- REFER

Cluster
- severe pain, one sided, behind the eye
- lasts weeks or months
- swelling & runny nose

37
Q

Primary Headache Treatment

A

paracetamol - inhibits prostaglandins production in pain pathway
- activates descending serotoninergic pathway

Ibuprofen - acts on COX1/2 receptors inhibiting prostaglandin synthesis

Buclizine - anti-histamine and anti-emetic. sedating

38
Q

General Headache Treatments

A

Triptans - selective 5-HT serotonin agonist causing cranial vasoconstriction
- sumatriptan
- 5-HT1B stimulation in smooth muscle causes this vasoconstriction

Pizotifen - acts on serotonin, histamine & tryptamine reducing blood flow & alters pain threshhold
- POM

Propanolol - blocks B-adrenoceptor reducing blood flow
- rizatriptan + propranolol bad reaction

MP422 CNS (2 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions