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CMN577 > Module 2 > Flashcards

Module 2 Flashcards

1
Q

Types of cephalalgia

A

-migraines
-cluster
-tension
-subdural hematoma
-SAH
-viral or bacterial meningitis
-tumor
-temporal arteritis
-rebound HA

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2
Q

With elderly patients, what can cause altered mental status other than dementia/delirium?

A

B12 deficiency
infection
polypharmacy
ETOH/drug abuse

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3
Q

When concerned about a patient’s altered mental status, what labs would you order? What other diagnostic tests would be ordered?

A

-UA, CBC, BMP (CMP), B12, RPR, ESR, TSH
-CXR, MRI vs CT, Cognitive testing

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4
Q

Is delirium chronic or acute?
Is dementia chronic or acute?

A

acute
chronic

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5
Q

Generalized treatments used for Alzheimer’s disease?

A

-cholinesterase inhibitors
-Memantine (Namenda)
-antidepressants

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6
Q

Alzheimer’s Disease
-what type of medications should be limited?
-labs to be drawn to dx, imaging for dx?
-how do you confirm dx?

A

-antipsychotic
-CBC, CMP, TSH, B12, RPR; CT head
-spinal tap

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7
Q

Alzheimer’s Disease
-cognitive testing
*types

A

-SLUMS - comparable to MoCa; scores: >26 = normal (27-30), 21-26 = mild decline, <21 = dementia; comparable specificity and sensitivity as MoCa
-MoCa - 30 point test, expensive ($125), greater specificity and sensitivity than MMSE
-MMSE
-Mini-cog test: word recall (0-3pts), clock drawing (2 or 0pts) = 5 points total; 0 points = positive test, 1-2 points = positive test, 3-4 points = negative test, 5 points = negative test.

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8
Q

Normal Pressure Hydrocephalus (NPH)
-def
-what type of imaging is initially needed for dx?
-age usually diagnosed
-more common in men or women?

A

-enlargement of ventricles without increased ICP (HA, N/V, etc.); extra fluid is fairly well distributed between four ventricles
-CT or MRI
->=60
-equal (minimally men)

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9
Q

Normal Pressure Hydrocephalus (NPH)
-Triad of Sx
-Tx (and what should you NOT treat?)

A

-Gait changes, altered thought processes, urinary incontinence
-Shunt, anticholinesterase inhibitors (helpful for memory loss), therapy for gait
*do not treat overactive bladder with medications

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10
Q

Stroke
-sx
-what impacts sx?
-preferred imaging for dx?

A

-Abrupt change in neurological status, often accompanied by hemiparesis or hemiplegia
-location and severity of stroke
-CT

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11
Q

Stroke
-TX
*ischemic stroke
*hemorrhagic stroke

A

-needs to be initiated within 4.5 hours onset of S/S (IV); ASA given by mouth, TPA to dissolve clot
-focus on controlling the bleeding; clipping of aneurysm; evacuation of hematoma

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12
Q

Stroke
-what kind of evaluation must take place via US?
-anticoagulation therapy (what anticoagulation therapy would patient be put on?)
-non-valvular afib (what meds could patient be put on to manage?)

A

-carotid US to check for carotid stenosis
-ASA 325mg; plavix; aggrenox; coumadin (INR goal 2-3)
-Pradaxa, Zarelto, Eliquis

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13
Q

Treatment with ASA
-what disease/issue does this help with?
-dose?

A

-Stroke, anticoagulation therapy
-325mg

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14
Q

Treatment with Plavix
-what disease/issue does this help with?

A

Anticoagulation therapy –> stroke

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15
Q

Treatment with Aggrenox
-what disease/issue does this help with?

A

Anticoagulation therapy –> stroke

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16
Q

Treatment with Coumadin
-what disease/issue does this help with?

A

Anticoagulation therapy –> stroke

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17
Q

Treatment with Pradaxa
-what disease/issue does this help with?

A

-non-valvular afib –> stroke

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18
Q

Treatment with Zarelto
-what disease/issue does this help with?

A

-non-valvular afib –> stroke

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19
Q

Treatment with Eliquis
-what disease/issue does this help with?

A

-non-valvular afib –> stroke

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20
Q

Parkinson’s Disease
-Sx
-more common in males or females?
-when is onset common?

A

-tremor, rigidity (cog-wheeling), bradykinesia, postural instability
-equal
-45-65yrs

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21
Q

Parkinson’s Disease
-HALLMARK SX

A

tremor, rigidity (cog-wheeling), bradykinesia, postural instability

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22
Q

Parkinson’s Disease
-what is the first sign noticed?
*is this sign present all the time?
-are symptoms present when active or at rest?
-what do sx do with intention?

A

-pill-rolling tremor; initially unilateral
*absent during sleep
-maximum sx at REST
-decrease with intention

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23
Q

Parkinson’s Disease
-what medications cause pseudo-Parkinson’s?

A

-metoclopramide
-reserpine
-anti-psychotics

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24
Q

Parkinson’s Disease
-what labs need to be collected for dx?
-TX
*what should be considered if <50yrs old?
*what type of consult?
*Medication therapy

A

-CBC, CMP, TSH, B12, RPR
-Huntington’s chorea; Wilson’s Disease (copper)
-Neurology (esp with younger onset <60yrs)
-Sinemet (Levadopa); Amantadine, Sinemet (ER)

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25
Q

What disease does Sinemet (Levadopa) treat?

A

-Parkinson’s

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26
Q

What disease does Amantadine treat?

A

-Parkinson’s

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27
Q

What disease does Sinemet (ER) treat?

A

-Parkinson’s

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28
Q

Essential Tremor
-what areas of the body are impacted?
-what exacerbates?
-dx

A

-hands, head voice
-exacerbated by stress, fatigue, stimulants (amphetamines)
-extend hands; Archimedes spiral

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28
Q

Essential Tremor
-present or absent at rest?
-present or absent with intention?
-age of onset?
-bilateral or unilateral? where is tremor mostly located?

A

-absent
-present
-20-60yrs
-Bilateral, distal upper extremities (fingers, hands) –> may be unilateral on presentation

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29
Q

Essential Tremor
-pill-rolling sx?
-what happens when sx progress?

A

-NO
-can progress and be present at rest

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30
Q

Essential Tremor
-TX

A

-Therapy
-Wrist weights
-Exercises
-Rest
-Beta blocker

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31
Q

Myasthenia Gravis
-at what age does this tend to occur?
-what may this be associated with?
-patho

A

-any age, any time
-autoimmune disease???
-decrease in number of acetylcholine receptors and their effectiveness

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32
Q

Myasthenia Gravis
-Sx

A

nonspecific
-asymmetric limb weakness, muscle fatigue, cranial nerves effected
*motor nerves of face and neck
*Diplopia (double vision), ptosis (lid lag), dysphagia (difficulty swallowing)
*possible respiratory difficulties

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33
Q

Myasthenia Gravis
-dx
*test
*labs
*imaging

A

-Tensilon Testing: administered IV –> improvement in strength of affected muscles = + test
-RA ANA, ESR
-CT

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34
Q

Dizziness
-def
-differential dx
-what must be ruled out?
-what should be considered with continuous unrelenting dizziness?

A

-sensation of motion even when being still
-vertigo (episodic), sinus infection complication
-orthostatic hypotension
-underlying psychological disorder(s)

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35
Q

Benign Paroxysmal Positional Vertigo
-what kind of trauma can cause this?
-Def
-Tx

A

-ear trauma, possibly
-displacement of otoliths into gelatinous capsule of semicircular canals
-particle repositioning therapy (PT) with Epley Maneuver

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36
Q

Seizures: generalized Epilepsy
-Nonmotor types

A

-absence seizures
-atypical absence seizures

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37
Q

Seizures: generalized epilepsy
-Absence seizure
*another name for absence seizure
*what age is this common among?
*does it go away? If so, when?
*unilateral or bilateral brain activity on EEG?

A

-Petit mal
-5-18yrs
-by age 20, but can be replaced by another type of seizure
-Bilateral brain activity on EEG

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38
Q

Seizures: generalized Epilepsy
-Motor types

A

-Tonic clonic seizure

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39
Q

Seizures: generalized epilepsy
-Tonic-clonic seizure
*another name for this seizure
*parts of the seizure progression

A

-gran mal
-possible aura –> sudden LOC (rigid, falls to ground, respiration arrested = tonic) –> jerking (clonic) –> flaccid coma (loss of postural tone and DTR; unconscious, apnea, cyanosis, urinary/fecal incontinence when awakening)

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40
Q

Seizures: generalized epilepsy
-Tonic-clonic seizure
*how long does tonic portion of seizure tend to occur?
*how long does clonic portion of seizure tend to occur?

A

-<1min
-2-3min

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41
Q

Seizures: tonic clonic seizure
-management
*prophylaxis
*intractable seizures

A

-dilantin, tegretol, phenobarbital, primidone, depakote
-surgery

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42
Q

Dilantin

A

Tonic clonic seizure

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43
Q

Tegretol

A

Tonic clonic seizure

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44
Q

Phenobarbital

A

Tonic clonic seizure

45
Q

Primidone

A

Tonic clonic seizure

46
Q

Depakote

A

Tonic clonic seizure

47
Q
A
48
Q

Focal Seizures
-also known as?
-same as generalized seizures?
-are both hemispheres of brain activated?
-types (2)

A

-partial seizure
-NO
-one hemisphere
-Simple Partial Seizure; Complex Partial Seizure

49
Q

Focal Seizure: simple partial seizure
-awake or unconscious?
-types of simple partial seizures
-involves large or small area of brain?

A

-awake
-motor and nonmotor
-focal area of brain (smaller portion)

50
Q

Focal Seizures: complex partial seizure
-def
-does seizure stay in one hemisphere of the brain?
-how long does this type of seizure last?

A

-impaired awareness or awareness; may be preceded, accompanied, followed by various motor and nonmotor sx
-starts in one hemisphere but travels
-30sec - 2min

51
Q

What is the most common type of seizure in adults?

A

Complex partial seizure

52
Q

What type of focal seizure has sx of LOC impaired?
What type of focal seizure has sx of LOC not impaired?

A

-Complex partial seizure
-Simple partial seizures

53
Q

Rolandic Epilepsy
-onset; stops by?
-When is onset? Where does it begin on the body?
-what can it progress to? What may present with this type of epilepsy?
-after how many years are these patients typically seizure free?
-tx

A

-mid childhood (peaks 8-9yrs); stops by age 18yrs
-nocturnal onset; begins in face
-tonic clonic seizure; status epilepticus
-5yrs
-NONE (seldom treated)

54
Q

Febrile Convulsions:
-at what age do these occur?
-more common in men or women?

A

-6MO-5YR
-men

55
Q

most common type of epilepsy in childhood?

A

Rolandic epilepsy

56
Q

most common type of seizure in childhood?

A

Febrile convulsions

57
Q

Dysautonomia:
-def
-type of acute Dysautonomia

A

-autonomic NS dysfunction; acute or chronic
-Guillain-barre (self-limiting)

58
Q

Dysautonomia:
-types

A
  1. orthostatic hypotension
  2. primary chronic autonomic failure
  3. Postural orthostatic intolerance (POTS)
  4. Panic disorder
  5. Neurologic essential HTN
  6. CHF
  7. Chronic fatigue syndrome
59
Q

Dysautonomia: Chronic orthostatic intolerance
-Postural orthostatic tachycardia syndrome (POTS)
*link between POTS and what disease?
*sx
*triggers
*relation to anxiety?
*TX

A

-COVID
-fatigue, lightheadedness, brain fog, forceful heart beat or palpitations, N/V, HA, excessive sweating, shakiness, intolerance to exercise
-warm environments, standing for long periods, low fluid/low salt intake, can get worse when fighting infection
-increase fluids, inc salt, caffeine; beta blockers to control HR; Midodrine to constrict blood vessels and raise BP

60
Q

Midodrine

A

constricts blood vessels and raises BP for POTS patients

61
Q

Multiple Sclerosis:
-sx
-DTRs and Babinski reflex
-DX by what imaging?
-types
-tx

A

-nonspecific/vague; blurred vision, diplopia, loss of balance, weakness, paresthesias, vertigo, slurred speech
-DTR brisk; + Babinski reflex
-MRI –> requires 2 episodes involving 2 CNS areas/sx or progression of sx over a 6MO period
-Relapsing-remitting; primary progressive; secondary progressive; progressive relapsing
-No cure; manage sx

62
Q

What is the #1 disability in young adults?

A

MS

63
Q

Neuralgias:
-what are the most common types?

A

-Trigeminal
-Post herpetic (post shingles) PHN

64
Q

Neuralgias:
-Trigeminal
*females vs males occurrence?
*sx
*onset (age)

A

-females
-sharp, electric, lancing, stabbing pain
->40yrs

65
Q

Neuralgias:
-post herpetic (post shingles) PHN
*females vs males occurrence?
*sx
*onset
*what type of pain occurs?

A

-females 2:1
-severe pain or severe rash; painful bursts that may lead to chronic prolonged episodes
->80yrs; peak onset 60-70yrs
-prodromal pain BEFORE rash

66
Q

Dementia: Alzheimer’s Disease
-cause
-women vs men
-Blacks vs Whites
-can it be prevented?
-can it be cured?
-can it be halted?

A

-generalized degeneration of the brain; middle or older age
-women
-blacks
-NO
-NO
-NO

67
Q

Dementia: Alzheimer’s Disease
-65yo life expectancy with this dx?
-when do you consider familial connection?
-R/F

A

-4-8 years, as much as 20yrs
-if dx before age 60yrs
-age, fam hx, APOE4 genotype, CAD R/F, education, social and cognitive engagement, traumatic brain injury, down syndrome

68
Q

Dementia: Alzheimer’s Disease
-APOE4
*how common in those dx with Alzheimer’s disease?
*where is this marker seen? (in what type of testing?)
*how many alleles in this gene?

A

-20-25%
-specialized cholesterol testing
-3 alleles

69
Q

Dementia: Alzheimer’s Disease
-APOE4
*how to treat if patient has allele E4 (or E3)?
*what allele is associated with inc risk of developing Alzheimer’s disease?

A

-Ezetimibe (zetia); not fishoil!!!
-E4

70
Q

Delirium
-is this seen in acute or chronic medical problems?
-what other factors can cause delirium?

A

-both
-substance abuse; medications can cause delirium

71
Q

Depression (and dementia)
-how common (%)?
-how is it diagnosed?

A

-25%
-5 or more sx present w/i 2 week period and are change from baseline:
*depressed mood
*decreased interest/pleasure in activities
*5% or greater wt change
*insomnia/hypersomnia
*psychomotor agitation
*fatigue
*Feelings of worthlessness or excessive/inappropriate guilt
*Diminished ability to concentrate or think
*Recurrent thoughts of death/suicide

72
Q

Beers Criteria
-what age do these criteria apply to the population?

A

> 65yrs

73
Q

Beers Criteria: antihistamines
-NOT to be prescribed
*but when can this be prescribed?
-SX

A

-Diphenhydramine/chlorpheniramine (Benadryl)**
*OAB
-dry mouth, confusion, blurred vision

74
Q

Beers Criteria: Phenergan
-SE

A

sedation, dry mouth, etc.

75
Q

Beers Criteria: Antidepressants
-what type of antidepressant should be avoided in patients with hx of falls w/ fracture?
*SE
*Drugs

A

-SNRI**
-dizziness
-Cymbalta, effexor

76
Q

Beers Criteria: Antiparkinson’s meds
-Drugs

A

-Benztropine**
Can use sinemet (carbidoba-levadopa)

77
Q

Beers Criteria: Antispasmodic
-drugs

A

-belladonna (hot flashes)
-Clidinium-chlordiazepoxide (Librax)
-Hyoscyamine (IBS)**
-Propantheline
-Scopolamine

78
Q

Beers Criteria: Short-acting dipyridamole
-SE

A

hypotension

79
Q

Beers Criteria: Macrobid (Nitrofurantoin)**
-what can long-term use cause?
-how should we do UTI tx?

A

-renal insufficiency
-culture driven UTI tx (unless running fever)**

80
Q

Beers Criteria: Alpha blockers**
-avoid in tx of what?**
-can use in tx of what?**

A

-HTN
-BPH

81
Q

Beers Criteria: Alpha agonist
-Drugs

A
  1. Clonidine**
  2. Guanabenz
  3. Guanfacine
  4. Methyldopa
  5. Reserpine (>0.1mg daily)
82
Q

Beers Criteria: Cardiac drugs
-antiarrhythmics (drugs - 5 drugs that we should not manage)
-antiarrhythmics (7 other drugs)

A

-amiodarone, flecainide, procainamide, sotalol, quinidine
-Disopyramide; rivaroxaban; dabigatran; dronedarone; digoxin; nifedipine, spironolactone

83
Q

Beers Criteria: Neurological drugs
-Tricyclic antidepressants
*drugs; SE

A

-Elavil, Tofranil, librax
-dizziness, dry mouth, inc risk of falls

84
Q

Beers Criteria: what five cardiac drugs should we as the NP not manage?

A

amiodarone, flecainide, procainamide, sotalol, quinidine**

85
Q

Beers Criteria: anti-psychotics
-Drugs

A

ALL - increased lethargy, AMS (altered mental status), and risk of stroke (esp dementia)**

86
Q

Beers Criteria: Hypnotics
-after how many days of consistent use, should hypnotics be stopped?
-sx
-what hypnotic is acceptable (off label use)?
-Drugs

A

-avoid using >90 days**
-hypersomnia, confusion, dry mouth, inc risk for falls**
-Trazadone** (acceptable; also used for anti-depressant)
-ambien, sonata, lunesta**

87
Q

Beers Criteria: Neurologic drugs
-other drugs

A

-benzodiazepines**
*avoid as much as possible
-chloral hydrate
-meprobamate (tranquilizer)
-Ergot mesylates

88
Q

Beers Criteria: Opioids
-what should be avoided when taking opioids?
-what opioid increases risk for SIADH if used a lot?

A

-avoid using opioids with benzodiazepines an gabapentin/Neurontin (includes pregabalin/Lyrica)**
-Tramadol/ultram

89
Q

Beers Criteria: hormones
-androgens
*who should androgens be avoided in (what sex, what hx)?
*what may androgens exacerbate?
*what androgen can increase risk of heart disease?
*androgens increase risk of what type of cancer?

A

-males, prostate CA**
-heart problems or prostate CA**
-testosterone**
-prostate CA**

90
Q

Beers Criteria: hormones
-estrogens with or w/o progestins
*increase risk of what types of CA?
*lntra-vaginal cream in what type of dose is okay?**

A

-endometrial and breast
-low

91
Q

Beers Criteria: hormones
-growth hormones
*what patients can received growth hormones?

A

Only those with pituitary removed**

92
Q

Beers Criteria: Desiccated thyroid

A

-may need armor thyroid (for pts who need extreme management of TSH)**

93
Q

Beers Criteria: sliding scale insulin
-risk for?
-what is best type of regimen for insulin?

A

-hypoglycemia**
-basal insulin**

94
Q

Beers Criteria: Megestrol (Megace)
-off label use
-increases risk of what?

A

-appetite stimulants** in CA pts.
-blood clots

95
Q

Beers Criteria: Gastro/muscle/pain meds
-Metoclopramide (reglan)**
*Med should be avoided in all pts except those with what?
*what is the max amount of time pt can use this med?
*can cause what Sx?

A

-gastroparesis
-4-6 weeks
-tardive dyskinesia

96
Q

Beers Criteria: proton pump inhibitors**
-longest amount of days can use?
-can try H2 blocker?**

A

-90
-yes!!

97
Q

Beers Criteria: Mineral oil**
-SE

A

increased risk for aspiration**

98
Q

Beers Criteria: Trimethobenzamide
-Promethazine (Phenergan)**
-Sx

A

-?
-confusion, dizziness, inc fall risk, dry mouth**

99
Q

Beers Criteria: NSAIDS**
-SX

A

GI bleeds**

100
Q

Beers Criteria: Meperidine (demorol**)
-Not effective pain reliever
-can cause what?

A

-seizures

101
Q

AD 8 Dementia Screening Tool
-def
-scoring
-what does this test determine?

A

-Informant interviews, helps to distinguish btw signs of normal aging and mild dementia
*tests memory, orientation, judgment, function
-0-1 normal
->=2 cognitive impairment likely

102
Q

Treatment for dementia: 4 types listed

A
  1. cholinesterase inhibitors
  2. Memantine
  3. Leqembi/Lecranemab
  4. Antipsychotics
103
Q

Dementia Tx: Cholinesterase inhibitors
-patho
-med (2)
*best dosed at what time of day?

A

-slows breakdown of neurotransmitters
-Donepezil (5 or 10mg)
*Dose at night
-Exelon patch (rivastigmine); works well (4.6, then 9.5, then 13.3mg dosed every 30d)

103
Q

Dementia Tx: Memantine
-patho
-what allows more cell damage?

A

-regulates activity of glutamate by blocking some of the NMDA receptor sites
-Glutamate is released in larger quantities by damaged cells, creating overload that allows for more cell damage

104
Q

Dementia Tx: Antiamyloid medication
-Leqembi/Lecranemab
*patho
*what type of antibody?
*common SE
*important EXTRAS

A

-amyloid beta plaque reduction
-monoclonal antibody
-HA, dizziness, vision changes, N, diarrhea, seizures, confusion
-BBW

105
Q

Dementia Tx: Antiamyloid medication
-at what point can this med be prescribed?

A

-need beta amyloid plaques in order to prescribe

106
Q

ARIA –> amyloid related imaging abnormalities
-asymptomatic or symptomatic?
-Sx
-Def

A

-asymptomatic
-higher mortality rates, diabetes, sedation (esp haldol)
-life threatening brain swelling and fatal brain hemorrhage

107
Q

ARIA
-population at highest risk
-occurs spontaneously or with antiamyloid therapy?

A

-POE4 genotype, blood thinners, previous hx of microscopic brain bleeds

108
Q

Dementia Tx: psychotics
-Rexulti
*consider…

A

-agitation associated with Alzheimer’s disease, MDD, , schizophrenia
*BBW: inc mortality in elderly pts with dementia; inc risk of hyperglycemia, stroke, tardive dyskinesia.

109
Q
A

CMN577 (4 decks)

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