Neuro Flashcards
1
Q
Neural development
- differentiation initiated by
- after plate
- remnant of notochord
- dorsal vs ventral
A
- notochord, telling ectoderm to form neural plate
- plate forms into neural tube and crest cells
- nuc pulposus of inter vertebral disk
- dorsal is sensory and ventral is motor
2
Q
Regions of brain
- fore brain: other name, becomes, which differentiates into
- mid brain: other name, differentiates into
- hind brain: other name,
A
- prosencephalon, telencephalon -> cerebrum && diencephalon -> hypothal and thal
- mescencepahlon -> midbrain
- rhombocephalon, metencephalon -> pons and cerebellum && myelencephalon -> medulla
3
Q
Central and Peripheral nervous system origin
- CNS: components; origin
- PNS: components; origin
- Microglia: what is it, origin
A
- CNS neurons, oligodendrocytes, and astrocytes; neural tube
- PNS neurons, schwann cells; neural crest
- marophage like cells, mesoderm
4
Q
Neural tube defects
- spina bifida occulta: what is it, assocaited with
- meningocele: what is it
- myelomeningocele: what is it
- myeloschisis: what is it
- anencephaly: what is it
A
- failure of caudal neuropore to close, w/o herniation; tuft or hair or skin dimple at bony defect
- failure of caudal neuropore to close, w/ herniation of meninges
- failure of caudal neuropore to close, w/ herniation of meninges and neural tissue
- exposed unfused neural tissue w/o skin/meningeal covering
- failure of rostral neuropore to close; no forebrain and open calvarium
5
Q
Holoproencephaly
- what is it
- mutation
- sxs
- associated w/
A
- failure of forebrain to separate into 2 cerebral hemispheres
- sonic hedge hog
- cleft lip/palate to cyclopia
- trisomy 13 and fetal EtOH syndrome
- monoventricle and fusion of basal ganglia
6
Q
Lissencephaly
- cause
- result
A
- failure of neural migration
- smooth brain w/o sulci and gyri
7
Q
Posterior Fossa Malformation
- Chiari I: what is it; cause; sxs
- Chiari II: what is it; associated w/
- Dandy Walker: what is it; associated w/
A
- displacement of cerebellar tonsils inferior to foramen magnum; congenital; headaches and cerebellar sxs
- herniation of cerebellar vermis and tonsils through foramen magnum w/ aqueductal stenosis; lumbosacral myelomeningocele
- agenesis of cerbellar vermis causing cystic enlargement of 4th ventricle; noncommunicating hydrocephalus and spina bifida
8
Q
Syringomyelia
- what is it
- what is affected and what sxs does that cause
- location
A
- cystic cavity in central canal of spinal cord
- fibers in anterior white commisure -> cape like symmetrical loss of pain and temp in upper extremities
- cervical > thor> lumbar
9
Q
Tongue Development
- anterior 2/3 formed from, sensation, taste
- posterior 1/3 formed from, sensation, taste
- motor innervation
- hyoglossus
- genioglossus
- styloglossus
- palatoglossus, innervation
A
- 1st and 2nd pharyngeal arches; CN V3; CN VII
- 3rd and 4th pharyngeal arches; CN IX
- XII
- retracts and depresses tongue
- protrudes tongue
- draws sides of tongue up to make trough when swallowing
- elevates posterior tongue during swallowing, CN X
10
Q
Cells of Nervous system
- Neurons: function; adult; staining
- Astrocytes: function, derived from, marker
- Microglia: function; activation
- Ependymal cells: cell type; location; function
- Myelin: function; location; produced by
- Schwann cells: function
- Oligodendrocyte: function, derived from; histo; involved in
A
- signal transmitting cells of nervous system; do not divide; Nissl staining for dendrites and cell body
- repair, remove extra NT, part of BBB, glycogen fuel reserve; neuroectoderm; GFAP
- scavenger cells of CNS; line ventricles and central canal of spinal cord; response to tissue damage
- ciliated simple columnar glial cells; ventricles and central canal of spinal cord; produce/ absorb/ and circulate CSF
- wraps and insulates axons; nodes of ranvier; oligodendrocytes
- promote axon regeneration in PNS
- myelinate axons in CNS; neuroectoderm; fried egg appearance; injured in MS
11
Q
Sensory Receptors
- Free nerve endings: A delta, C; detect
- Meissner corpuscles: time frame; detect
- Pacinian corpuscles: time frame; detect
- Merkel discs: time frame; detect
- Ruffini corpuscles: time frame; detect
A
- A: fast, myelinated; c: unmyelinated, slow; pain, temp
- quick, fine light touch
- quick, vibration/pressure
- slow, pressure
- slow, finger tips and joints; pressure, slippage of objects, joint angle change
12
Q
Peripheral nerve Layers
- endoneurium: function
- perineurium: function
- epineurium: function
A
- thin, supportive CT that ensheaths and support individual myelinated nerve fiber
- surrounds fasicle of nerve fibers
- dense CT that surround entire nerve
13
Q
Chromatolysis
- what is it
- changes
- wallerian degeneration: what is it, compensation
A
- reaction of cell body to axon injury
- round cellular swelling, displacement of nuc to periphery, dispersion of nissl substance throughout cytoplasm
- disintegration of axon and myelin sheath distal to site of axon injury; axon proximal to injury will retract and cell body sprouts new protrusions that grow toward other neurons for potential re-innervation
14
Q
Meninges
- what is it
- dura: composition, derived from
- arachnoid: composition, derived from
- pia: composition, derived from
- CSF location
- epidural space
A
- layers that surround and protect brain and spinal cord
- thick outer layer closest to skull; mesoderm
- middle, web-like; neural crest
- thin, fibrous inner layer, adheres to brain/SC; neural crest
- between arachnoid and pia
- above dura, filled with fat and vessels
15
Q
Blood Brain Barrier
- function
- formed by
- damaged by
- areas w/o
A
- prevents circulating blood substances from reaching CSF
- tight junctions between endothelial cells in capillaries, basement membrane, astrocyte foot processes
- infarction/ neoplasm bc it destroys tight junctions of endo cells
- vommitting center and neurohypophysis
16
Q
Vomiting center
- coordinated by
- info from
- CTZ receptors
- tx of vommitting
A
- nucleus tract solitarius in medulla
- chemoreceptor trigger zone in area postrema in 4th ventricle
- muscarinic, dopaminergic, histamin, serotonin, neurokinin
- musc and histamine for motion sickness and histamine, dopamine and neurokinin for chemo
17
Q
Sleep
- regulated by
- pathway
- awake eyes open: description, waves
- awake eyes closed: waves
- Non Rem: N1: description, waves; N2: description, waves; N3: description, waves
- Rem: what happens, when does it occur, effects of depression, waves
A
- suprachiasmatic nuc of hypothal
- SCN- > nor epi released -> pineal gland -> increase melatonin
- alert, Beta
- alpha
- N1: light sleep, theta; N2: Deeper sleep, bruxism occurs, sleep splindels and K complexes; N3: deepest non REM sleep, sleepwalking/ night terrors/ and bed wetting occurs; delta
- loss of motor tone; dreaming, nightmares, woody, extra-ocular movements; every 90 min and duration increases throughout night; depression increases REM and decreases N3; beta
18
Q
Hypothalamus
- lateral nuc
- ventromedial nuc
- ant nuc
- post nuc
- suprachiasmatic nuc
- supraoptic and paraventricular nuc
- preoptic nuc
A
- hunger, stimulated by grehlin; anorexia; lat makes lean
- satiety, stimulated by leptin; hyperphagia; ventromed makes very massive
- cooling, parasympathetic; Ant -> cooling A/C
- heating, sympathetic; hot pot
- circadian rhythm; sun sensing nuc
- synthesizes ADH and oxytocin
thermoreg, sex beahvior, releases GnRH
19
Q
Thalamus
- ventral-postero-lateral: senses, input, destination
- ventral- postero- medial: senses, input, destination
- lateral geniculate nuc: senses, input, destination
- medial geniculate nuc: senses, input, destination
- ventral lateral: senses, input, destination
A
- sensory from body; spinothalamic and dorsal columns; cortex
- sensory from trigeminal; trigeminal and gustatory pathway; cortex
- vision; CN II, optic tract; calcarene sulcus
- hearing; sup oliver and inferior colliculus; auditory cortex of temporal lobe
- motor: cerebellum and basal ganglia; motor cortex
20
Q
Limbic System
- what is it
- structures involved
- function
A
- collection of neural structures involved in emotion, long term memory, olfaction, behavior mod
- hippocampus, amygdala, mammillary bodies, thalamic nuc, cingulate gyrus
- feeding, feeling, fighting, fleeing, Sex
21
Q
Dopamine pathways
- mesocortical: decrease causes
- mesolimbic: increase causes
- nigrostriatal: decrease causes
- tuberoinfundibular: decrease causes
A
- negative sxs in schizo
- positive sxs in schizo
- extrapyramidal sxs
- increase in prolactin -> decreased libido, sex dysfunction, galactorrhea, gynecomastia
22
Q
Cerebellum
- function
- lateral lesion
- medial lesion
A
- modulated movement, aids in coordination and balance
- affects voluntary movement of extremities
- truncal ataxia, nystagmus, head tiliting
23
Q
Basal Ganglia
- function
- overall pathway
- direct pathway
- indirect pathway
A
- important in voluntary movement and adjusting posture
- cortex sends info, decides whether to supress or activate and send signal back to cortex
- cortex activates striatum -> signal intensified with dopamine from sub nig binding to D1 receptors-> globus pallidus is inhibited -> stop inhibiting activation of thal to cortex
- cortex activates striatum -> signal intesifies with dopamine from sub nig binding to D2 receptors -> striatum inhibit subthalalmic nuc -> allows activation Globus pallidus externus which will activate globus pallidus internus to inhibit thalamus which inhibits cortex
24
Q
Cerebral Cortex Locations
- primary motor
- premotor
- frontal eye field
- pre frontal
- broca
- limbic area
- primary auditory cortex
- Wernicke area
- primary visual cortex
- primary somatosensory
A
- primary motor: frontal lobe, anterior to central sulcus
- pre-motor: in front of primary motor
- frontal: in front of pre motor
- pre-frontal: in front of frontal eye field
- broca: lateral side of frontal lobe
- limbic: anterior temporal lobe
- primary auditory: central temporal lobe
- wernicke: posterior temporal lobe
- primary visual: posterior occipital lobe
- primary somatosensory: parietal lobe, right after central sulcus
25
Cerebral Perfusion
- regulation
- driven by
- therapeutic hyperventilation
- tx
- on auto,
- pCO2
- decreases pCO2 -> vasoconstriction -> decreased cerebral blood flow -> decrease intracranial pressure
- acute cerebral edema
26
Homunculus
- sensory
- motor
- genitals, lower extremities, upper extremities, face, abdomen, pharynx
- lower extremities, upper extremities, face, swallowing
27
Cerebral Arteries
- anterior
- middle
- posterior
- lower extremities, medial cortex
- trunk, upper extemities, face, head (lat cortex); temporal area
- occipital region
28
Watershed zones
- location
- infarct due
- sxs
- between ant and middle cerebral a and between post and middle cerebral a
- severe htn
- proximal upper and lower extremity weakness
29
circle of willis
| - which vessels
- internal carotid -> middle cerebral -> ant cerebral -> ant communicating -> middle cerebral -> posterior cerebal
30
dural venous sinuses
- what are they
- function
- drain into
- venous sinus thrombosis: sxs, leads to, caused by
- venous channels that run through periosteal and meningeal layers of dura
- drain blood from cerebral v and receive CSF from arachnoid granulations
- internal jugular v
- signs and sxs of increased ICP, leading to venous hemorrhage; hypercoagulable state
31
ventricular system
| - pathways
- lat ventricles -> foramina of monro -> 3rd ventricle -> cerebral aqueduct -> 4th ventricle -> foramina of luscha and foramen of magendie -> subarachnoid space -> reabsorbed by arachnoid granulations -> drains into venous sinuses
32
Cranial Nerves and outlets
- cribiform plate
- optic canal
- sup orbital fissure
- foramen rotundum
- foramen ovale
- foramen spinosum
- internal auditory meatus
- jugular foramen
- hypoglossal canal
- foramen magnum
- I
- II
- III, IV, V1, VI
- V2
- V3
- VII, VIII
- IX, X, XI
- XII
- brain stem
33
Cranial Nerves
- Olfactory
- Optic
- Oculomotor
- Trochlear
- Trigeminal
- Abducens
- Facial
- Vestibulocochlear
- Glossopharyngeal
- Vagus
- Accessory
- Hypoglossal
- smell
- sight
- inferior oblique, super and inferior rectus and medial rectus
- superior oblique
- 3 divisions: Face sensation - opthalmic, maxillary, mandibular; matication, sensory from anterior 2/3 of tongue
- lateral rectus
- taste from ant 2/3 of tongue, facial movement, salivation
- hearing, balance
- taste and sensation from post 1/3 tongue, monitor carotid body and sinus
- taste, uvula, talking, parasympathetic thoracoabdominal viscera
- SCM
- tongue movement
- some say marry money but my brother says big brains matter more
34
Vagal nuclei
- nuc tractus solitarius
- nuc ambiguus
- dorsal motor nucleus
- visceral sensory info
- motor innervation of pharynx, larynx, and upper esophagus
- parasympathetics to heart, lungs, upper GI
35
Cranial Nerve reflexes
- corneal: afferent innervation, efferent innervation
- lacrimation: afferent innervation, efferent innervation
- jaw jerk: afferent innervation, efferent innervation
- pupillary: afferent innervation, efferent innervation
- gag: afferent innervation, efferent innervation
- V1 opthalmic, VII temporal branch - orbicularis oculi
- V1 opthalmic, VII
- V3, V3
- II, III
- IX, X
36
Mastication muscles
- muscles close
- muscle opens
- innervation
masseter, temporalis, medial pterygoid
- lateral pterygoid
- V3
37
Spinal nerves
- how many: total, cervical, thoracic, lumbar, sacral, coccygeal
- location of nerves
- end
- 31, 8, 12, 5, 5, 1
- C 1-7 above vert, C8 through T1 below vert
- L2
38
Lumbar puncture
- location
- function
- needle passes through
- L3-L4 OR L4-L5
- obtain sample of CSF w/o damaging spinal cord
- skin, sub cu, supraspinous lig, interspinous lig, lig flavum, epidural space, dura mater, arachnoid mater, subarachnoid space
39
Tracts in spinal cord
- sensory
- motor
- dorsal: function, pathway
- spinothalamic: function, pathway
- lateral corticospinal: function, pathway
- dorsal medial lemniscus, lateral spinothalamic
- corticospinal tracts, ant and lateral
- pressure, vibration, touch; sensory nerve into spinal cord, ascends up, synapses at nucleus gracilus or cuneatus, crosses over in medulla and ascends in medial lemniscus -> VPL
- lateral- pain and temp, ant - pressure; sensory nerve into spinal cord, synapses in dorsal horn, crosses over through ant white commisure ascends up contralateral side -> VPL
- voluntary movement of limbs; cortex -> descends ipsi through posterior limb of internal capsule -> crosses over in medulla at pyramids -> descends contralaterally -> synapses at cell body in anterior horn
40
Neuro Exam Reflexes
- achilles
- patellar
- bicep
- tricep
- cremasteric
- S 1, 2
- L 3, 4
- C 5,6
- C 6, 7
- L 1-2
41
Primitive Reflexes
- present vs asent
- Moro
- Rooting
- Sucking
- Palmar
- Plantar
- Galant
- present in newborn absent in adult
- startle reflex, abduct/extend arms when startled
- movement of head toward side of cheek that is stroked
- sucking response when roof of mouth is touched
- curling of fingers if palm is stroked
- curling of fingers if palm is stroked
- babinski, toe dorsiflexes and fan out
- lateral flexion of lower body towards side of stroked spine while pt face down
42
Dermatomes
- C2
- C3
- C4
- C5
- C6
- C7
- C8
- T4
- T7
- T10
- L1
- L4
- S2,3,4
- 2: post half of skull
- 3: turtle neck
- 4: low collar
- 5: collar bones and lateral arm
- 6: thumb and lateral arm
- 7: index and middle
- 8: ring and pinky; medial arm
- 4: nipple
- 7: at xiphoid
- 10: at umbilicus
- 1: at inguinal lig
- includes knee cap and medial leg
- penis
43
Brain lesions
- frontal lobe
- fontal eye field
- paramedian pontine reticular formation
- medial longitudinal fasiculus
- dominant parietal coretx
- nondominant parietal cortex
- hippocampus
- basal ganglia
- subthalamic nucleus
- mamillary bodies
- amygdala
- dorsal midbrain
- reticular activating system
- cerebellar hemisphere
- red nucleus
- cerebellar vermis
- frontal lobe: deficits in concentration, orientation, judgement
- frontal eye field: eyes look toward side of lesion
- medial long: eyes look toward side of hemiplegia
- dominant: impaired adduction of ipsi eye and abduction of contralateral eye
- non dom parietal: agnosia of contralateral side
- hippocampus: inability to make new memories
- basal ganglia: tremor at rest
- subthalamic: contralateral hemiballismus
- mamillary: wernicke-kosakoff syndrome -> confusion, ataxia, nystagmus, opthalmoplegia
- amygdala: kluver-bucy syndrome: disinhibited behavior (hyperphagia, hypersex)
- dorsal mid: perinaud sndrome:
- reticular: reduced level of arousal
- cerebellar: intention tremor, limb ataxia, loss of balance
- red nuc: decorticate if above, decerebrate if below
- Vermis: truncal ataxia
44
Ischemic stroke
- pathogenesis
- types
- irreversible damage
- histo: 12-24 hrs, 24-72 hrs, 3-5 days, 1-2 wks, > 2 wks
- procedure/ tx
- 8acute blockage of vessels -> disruption of blood flow -> ischemia -> liquefactive necrosis
- thrombotic: clot forms directly at site of infection, embolic: clot formed in other part of body and traveled to brain where it got stuck, hypoxic: caused by hypoperfusion
- after 5 min
- 12-24 hrs: eosinophilic cytoplasm and pyknotic nuclei, 24-72: necorsis and neutrophils, 3-5 days macrophages, 1-2 wks: reactive gliosis and vascular proliferation, > 2 wks: vascular scar
- get CT, make sure not hemmorrhagic stroke and give TPA if sxs started within 3-4.5 hrs
45
Neonatal intraventricular hemorrhage
- what is it
- risk
- starts
- sxs
- bleeding into ventricles
- premature or low birth weight
- germinal matrix
- altered level of conciousness, bulging fontanelle, hypotension, seizure, coma
46
Epidural Hematoma
- vessel affected
- cause
- sxs
- CT
- middle meningeal a
- skull fracture
- transient LOC and rapid deterioriation
- CT does not cross suture lines
47
Subdural Hematoma
- vessel affected
- causes: acute vs chronic
- CT
- bridging veins
- acute bc of trauma
- chronic seen in older and infants, mild trauma
- CT crosses suture lines
48
Subarachnoid Hemorrhage
- location
- cause
- sxs
- Dx
- sequale
- increased risk for
- bleeding between pia and arachnoid
- trauma or rupture of aneurysm
- worst headache of life
- bloody or yellow LP
- vasospasm -> ischemic infarct; nimodeipine
- communicating or obstuctive hydrocephalus
49
Intraparenchymal Hemorrhage
- cause
- location
- systemic hypertension or amyloid angiopathy
| - hypertensive hemm normally occur in basal ganglia, thalamus, pons
50
Effects of stroke
- ACA: location affected and sxs
- MCA: location affected and sxs
- PCA
- lenticulo-striate artery: location affected and sxs
- ant. spinal a: location affected and sxs (2)
- PICA: location affected and sxs (3)
- AICA: location affected and sxs (4)
- basilar: location affected and sxs
- motor and sensory to lower limb, contralateral
- motor and sensory to upper limb and face, contralateral and aphasia w/ wernicke and broca affected
- occipital lobe; contralateral hemianopia
- striatum and internal capsule affected, conralateral paralysis w/o cortical signs (neglect, aphasia)
- lateral corticospinal tract -> contralateral paralysis and medial lemniscus -> contralateral proprioception
- lateral medulla : nuc ambigus -> dysphagia, hoarseness, decreased gag reflex and vestibular nuc -> vertigo, nystagmus and lateral spinothalamic -> decreased pain and temp on contralateral side
- lateral pons: facial nucleus -> paralysis of face and vestibular nuc -> vertigo, nystagmus and spinothalamic tract -> decrease pain and temp from contralateral side and labrynthine a -> ipsilateral sensorineural deafness
- pons, medulla, lower mid brain -> locked in syndrome and corticospinal/bulbar tracts -> quadriplegia and loss of face, mouth, tongue movements and ocular CN nuclei -> loss of horizontal but not vertical eye movements
51
Central poststroke pain syndrome
- what is it
- sxs
- how common
- neuropathic pain bc of thalamic lesion
- starts w/ paresthesia and then causes allodynia (painless stimuli cause pain)
- 10% stroke pts
52
Diffuse axonal injury
- caused by
- results in
- MRI
- traumatic shearing forces during rapid acceleration or deceleration
- devastating neuro injury -> causing coma or veg state
- multiple lesions of white matter tracts
53
Aphasia
- broca
- wernicke
- conduction
- gobal
- transcortical motor
- transcortical sensory
- transcortical mixed
- able to understand and wants to speak but cannot
- able to speak but does not make sense, poor comprehension but able to speak
- damage to arcuate fasiculus, good comprehension and good speech but poor repitition
- everything is affected
- good repetition and comprehension but no speech
- good repetition and speech but no comprehension
- good repetition but non fluent speech and poor comprehension
54
Aneursym
- what is it
- saccular: other name, occurs, mort common location, sxs
- charcot- bouchard: associated w, type vessel, causes, agiography
- dilation of artery due to weakening in the wall
- berry; bifurcation in circle of willis, Acomm and ACA; silent until rupture -> subarachnoid bleed -> worst headache of life
- chronic HTN, small vessels, hemorrhagic intraparenchymal stroke, not visible
55
Seizure
- partial vs generalized
- simple partial
- complex partial
- absence
- myoclonic
- tonic clonic
- tonic
- atonic
- epilepsy
- status epilepticus
- partial is only one area of brain while generalized is entire brain
- seizure w/ concoiusness still intact
- impaired conciousness
- blank stare, no postictal confusion
- quick repetitive jerks
- alternating between stiffness and jerking, positical confusion, incontinence, and tongue biting
- stiffness
- drop seizures
- recurrent, unprovoked seizures
- continuous seizure for >5 min
56
Causes of seizure
- children
- adult
- eldery
- genetic, infection, trauma, congenital, metabolic
- tumor, trauma, stroke, infection
- stoke, tumor, trauma, metabolic, infection
57
Fever vs Heat Stroke
- patho phys
- temp
- complication
- tx
- F: cytokine activation during infection, H: inability of body to dissipate heat
- F: below 104, H: above 104
- F: benign, H: CNS dysfxn, ARDS, rhabdo
- F: tylenol, ibuprofen, antibiotic; H: rapid coolingm rehydration
58
Headache
- cluster: localized, duration, description, tx
- migraine: localized, duration, description, tx
- tension: localized, duration, description, tx
- unilateral, 15 min to 3 hr, repetitive, excrutiating pain w/ lacrimation and rhinorrhea, sumatriptan and verapimil
- unilateral; 4-72 hr; pulsating pain w/ nausea, photophobia, or phonophobia, can have aura, caused by irritation of CN V, meninges or blood vessels; NAIDS, triptans, dihydroergotamine
- bilateral; less than 30 min; steady band like pain; analgesics, tricyclics
59
Neurodegenerative disorder
- Parkinson: sxs, caused by/ histo
- Huntington: cause, sxs, gross, neuro chemicals
- Alzheimers: genes; gross, histo
- Frontotemporal dementia: sxs, gross, histo
- Lewy body dementia: sxs, histo
- vascular dementia: cause; sxs; MRI
- Creutzfeldt- Jakob: what is it/ sxs; gross; cause
- idiopathic intracranial htn
- pill rolling tremor, cogwheel rigidity, bradykinesia, shuffling gait; loss of dopaminergic neurons in sub nigra and lewy bodies (alpha synuclein)
- auto-dom trinuc (CAG) in HTT gene on chrome 4; chorea, aggression, depression, dementia; atrophy of caudate and putamen; increase in dopamine decrease in epi and Ach
- Apo E2 is protective, Apo E4 is risk for sporadic, APP causes familial which is earlier onset; widespread cortical atrophy (hippocampus), Beta amyloid plaques and neurofibrillary tangles
- early changes in personality or behavior; frontotemporal degeneration and hyperphosphorylated tau or ubiquinated TDP43
- visual hallucinations and dementia, get cognitive abnormalities before physical abnormalities and onsets must be greater than 1 yr apart; lewy bodies in cortex
- multiple arterial infarct and chronic ischemia; step wise decline in cognitive ability w/ late onset memory impairment; MRI shows multiple cortical or subcortical infarcts
- rapidly progressive dementia w/ myoclonus and ataxia; spongiform cortex, and prion
- increased ICP w/o cause; female, tetracycline, obesity, excess vit A, danazol; headache, tinnitus, diplopia; impaired optic N axoplasmic flow -> papilledema; enlarged blind spot on visual field test, and increased opening pressure on LP and provides temporary headache relief
60
Hydrocephalus
- what is it
- communicating: what is it, sxs
- normal pressure: affects, when does it occur, sxs, tx
- noncommunicating: what is it
- ex vacuo vantriculomegaly: what is it
- increased CSF
- decreased CSF absorption by arachnoid granulations -> increased ICP, papilledema, herniation
- affects elderly, CSF pressure elevated only episodically; does not result in increased volume in subarachnoid space; urinary incontinence, gait apraxia, cog dysfunction; reversible with shunt placement
- structural blockage of CSF circulation in ventricular system
- appearance of increased CSF on imaging but due to decreased brain tissue and neuronal atrophy, ICP is normal
61
MS
- what is it
- sxs
- exacerbated
- clinical course
- affects
- dx
- tx
- AI inflammation that demyelinates CNS
- acute optic neuritis (painful unilateral vision loss), brain stem syndrome (ataxia, scanning speech, intention tremor), pyramidal demylenation (weakness), spinal cord syndromes (electric shock like sensation)
- increased boy temp
- relapsing and remitting
- women in 20s and 30s
- high IgG levels and myelin basic protein in CSF, MRI is gold standard w/ multiple white matter lesions disseminated in space and time
- stop relapses and halt/slow progression w/ beta interferon, glatiramer, natalizumab
62
Other demyelinating and dysmyelinating disorders
- osmotic demyelination syndrome: what is it/ cause; sxs
- acute inflammatory demyelinating: subtype, what is it, facilitated by, sxs, CSF, tx
- acute disseminated encephalomyelitis: what is it, sxs
- charcot-marie-tooth: what is it, genetics, sxs,
- progressive multifocal leukoencephalopathy: what is it, secondary to, risk to pt, areas involved,
- massive axonal demyelination in pontine white matter secondary to osmotic changes; iatrogenic bc of hyponatremia and rapid shifts of osmolytes; acute paralysis, dysarthria, dysphagia, diplopia; locked in syndrome
- subtype of guillian-bare syndrome; AI condition that destroys schwann cells via inflammation; facilitated by molecular mimicry and triggered by innoculation or stress (campylobacter jejuni); symmetric ascending muscle weakness and depressed DTRs in LE, facial paralysis, and respiratory failure; increase in CSF protein w/ normal cell count; plamapharesis or IV Ig
- multi-focal inflammation and demyelination after infection or vaccination, presents w/ rapidly progressive multifocal neuro sxs
- hereditary nerve disorder relate to defective production of proteins involved in structure and function of peripheral nerves or myelin sheath; typically auto dominant; associated w/ foot deformities, LE weakness and sensory deficits; CMT1A is caused by PMP22 gene duplication
- demyelination of CNS because of destruction of oligodendrocytes secondary to reactivation of JC virus, seen in 2-4% of patients w/ AIDS, rapidly progressive, involves parietal and occiptal areas, visual sxs are common
63
Neurocutaneous disorders
- struge-weber
- tuberous sclerosis
- neurofibromatosis type I
- neurofibromatosis type II
- von hippel lindau dx
- congenital nonhereditary anomaly of neural crest derivatives, somatic mosaicism of activating mutation; affects capillary sized blood vessels -> port wine stain in V1/2 distribution and ipsilateral leptomeningeal angioma -> seizures/epilepsy
- Auto dom, TSC1 mutation on chrom 9 or TSC2 mutation on chrom 16; hamartoma in CNS, angiofibromas, mitral regurg, ash leaf spot, cardiac rhabdomyoma, mental retardation
- AD, mutation in NF1 on chrom 17; cafe au lait spot, intellectual disability, cutaneous neurofibromas, lisch nodule, optic glioma
- AD, mutation in NF2 on chrom 22; bilateral vestibular schwannomas, juvenile cataracts, meningiomas, ependymomas
- AD, deletion of VHL on chrom 3; hemangioblastoma in retina, brain stem, cerebellum, spine, angiomatosis, bilateral renal cell carcinoma, pheochromocytoma
64
Adult brain tumors
- glioblastoma multiforme: what is it, prognosis, location
- oligodendroglioma: common, location, prognosis, x-ray
- meningioma: common, prognosis, epi, location, sxs
- hemangioblastoma: location, associated w/ , produces
- pit adenoma: types
- schwannoma: location, involves, along
- grade IV astrocytoma, highly malignant, 1 yr survival rate, cerebral hemisphere
- rare, slow growing, in frontal lobe, calcified
- common, benign, common in females, parasaggital extra-axial region, asymptomatic or present w/ seizures or focal neuro sign
- cerebellar, von hippel lindau when round with retinal angioma, can produce EPO -> secondary polycythemia
- nonfunction (do not produce hormone) or functioning (produce hormones)
- at cerebellopontine angle involving both VII and VIII but can be along any peripheral nerves, resection or radiosurgery
65
Child brain tumors
- pilocytic astrocytoma
- medulloblastoma
- ependymoma
- craniopharyngioma
- pinealoma
- low grade astrocytoma, most common tumor in childhood, well circumscribed, posterior fossa, supratentorial, benign, good prognosis
- malignant brain tumor in childhood, involves cerebellum, can compress 4th ventricle cauing headaches and papilledema; form of primitive neuroectodermal tumor
- found in 4th ventricle, can cause hydrocephalus, poor prognosis
- most common childhood supratentorial tumor, can be confused with pit adenoma
- tumor of pineal gland, can cause parinaud syndrome ( compression of tectum -> vertical gaze palsy)
66
Herniation syndromes
| - what is it
- causes tonsillar herniation into foramen magnum
67
Motor Neuron Signs
- weakness
- atrophy
- fasiculations
- reflexes
- tone
- babinski
- spastic paresis
- flaccid paralysis
- clasp knife spasticity
- weak - UMN: +, LMN:+
- atrophy - UMN: -, LMN: +
- fasiculation - UMN: -, LMN: +
- reflexes - UMN: increased, LMN: decreased
- tone - UMN: increase, LMN: decreased
- babinski - UMN: +, LMN: -
- spastic - UMN: +, LMN: -
- flaccid - UMN: -, LMN: +
- clasp - UMN: +, LMN: -
68
Spinal Cord Lesion
- spinal muscular atrophy
- AML
- tabes dorsalis
- syringomyelia
- vit B12 def
- congenital degeration of ant horn of spinal cors, symmetric weakness, floppy baby w/ marked hypotonia and tongue fasiculations, auto recessive SMN1 mutation
- combined UMN and LMN degeneration, no sensory deficits; defect in superoxide dismutase 1
- caused y tertiary syphilis, results from degeneration/demyelination of dorsal columns and roots -> progressive sensory ataxia, + romberg sign and absent DTR, argyll robertson pupils
- syrinx expands and damages ant white commisure of spinothalamic tract -> bilateral symmetrical loss of pain and temp sensation in cape distribution, chiari I malformation
- subacute demyleination of spinocerebellar tracts lateral coticospinal and dorsal columns; ataxic gait, paresthesia, impaired vibration sense
69
Poliomyelitis
- polio virus -> replicates in oropharynx and small intestine before spreading through blood into CNS
- destruction of cells in anterior horn of spinal cord
- signs of LMN lesion
- CSF shows increased WBC and slight increase of protein
70
Brown-Sequard syndrome
- hemi-section of spinal cord
- ipsilateral loss of all sensation at level oflesion, ipsi LMN signs at level and ipsi UMN signs above lesion
- ipsi loss of proprioception, vibration, light touch below level of lesion
- contra loss of pain, temp, and crude touch below level of lesion
71
Friedreich ataxia
- auto recessive tri nuc repeat on chrom 9
- impairs mito functioning
- degeneration of lateral corticospinal tract, spinocerebellar tract, dorsal column; staggering gait, frequent falling, nystagmus, dysarthria, hammer toes, DM, HCM
72
Bells palsy
- most common cause of peripheral facial palsy
- develops after HSV reactivation
- corticosteroids +/- acyclovir
- lyme dx, herpes zosterm sarcoidosis, tumor, DM
73
Cholesteatoma
- what is it
- sequalae
- type hearing loss
- sxs
- overgrowth of desquamated keratin debris within middle ear space,
- may erode ossicles or mastoid air cells
- conductive hearing loss
- painless otorhea
74
Auditory physiology
- outer ear: consists of, function
- middle ear: consists of, function
- inner : consists of, function
- pinna, auditory canal and TM; transfers sound waves via vibration of TM
- air filled space w/ 3 bones that conduct and amplify sound from TM to inner ear
- Snail shaped fluid filled cochlea; basilar membrane w/ hair cells vibrates secondary to sound waves causing the hair cells to move and send signal; low is heard at apex and high heard at base
75
Diagnosing hearing loss; Weber vs Rinne
- Normal
- Conductive
- Sensorineural
- W: equal, R: air> bone
- W: localize to affected ear; R: bone>air
- W: localize to unaffected ear; R: air> bone
76
Types of hearing loss
- noise induced hearing loss: damages, frequency lost, sudden/extreme causes
- prebycusis: related to; kind; frequency; caused by
- damage to stereociliated cells in organ of Corti; Loss of high frequency hearing first; Sudden extreme loud noises can produce hearing loss due to tympanic membrane rupture
- aging related progressive, bilateral sensorineural hearing loss, higher frequencies first, destruction of hair cells at cochlear base
77
vertigo
- what is it
- peripheral
- central
- sensation of spinning while actually stationary
- inner ear etiology (semi circ canal debris, vestibular nerve infection), menniere dx (vertigo, tinnitus, hearing loss) -> low salt diet and diuretics, BPPV (otolith out of place in semi-circ canals) -> epley maneuver
78
vertigo
- what is it
- peripheral: etiology, meniere, BPPV
- central: etiology, sxs
- sensation of spinning while actually stationary
- inner ear etiology (semi circ canal debris, vestibular nerve infection), menniere dx (vertigo, tinnitus, hearing loss) -> low salt diet and diuretics, BPPV (otolith out of place in semi-circ canals) -> epley maneuver
- brain stem or cerebellar lesion; directional or purely vertical nystagmus, diplopia, dysmetria and focal neuro findings
79
Conjunctivitis
- what is it
- allergy: sxs
- bacterial: sxs, tx
- viral: bug, sxs, tx
- inflammation of conjunctiva
- allergic: itchy eyes, bilateral
- bacterial: pus, treat w/ anti biotics
- viral: most common, often adenovirus, sparse mucus discharge w/ swollen pre-auricular node, self limited
80
Refractive errors
- what is it
- hyperopia: what is it, pathogenesis, tx
- myopia: what is it, pathogenesis, tx
- astigmatism: what is it, pathogenesis, tx
- cause of impaired vision, corrected with glasses
- farsighted (can only see far), eye too short for refractive power of cornea and lens -> light focused behind retina, convex lenses
- nearsightedness (can only see near), eye too long for refractive power of cornea and lens -> light focused in front of retina, concave lenses
- abnormal curvature of cornea -> different refractive power at diff axes, cylindrical lenses
81
presbyopia
- what is it
- caused by
- tx
- aging related impaired accomodation
- decrease in lens elasticity, changes in lens curvature, decreased ciliary muscle strength
- reading glasses
82
cataract
| - what is it
- opacification of lens
- painless, bilateral, glare and decreased vision
- age, smoking, EtOH, sunlight, prolonged corticosteroid, DM, trauma, infection
- galactokinase def, trisomy 21, TORCHES infections, marfans, alport syndrome
83
aqueous humor pathway
- pathway
- prostaglandin agonists
- M3 agonists
- beta blockers
ciliary bodies produce AQH -> travels through posterior chamber between iris and lens -> into anterior chamber -> into trabecular meshwork -> into canal of shlemm to nose or drains into uvea and sclera
- increased drainage into uvea and sclera increased
- increased into canal of schlem
- decrease formation of AQH from ciliary body
84
Glaucoma
- what is it
- open: primary and secondary cause
- closed: cause, chronic, acute
- optic disk atrophy w/ cupping bc of increase intraocular pressure and progressive peripheral visual field loss
- primary cause is unknown but can be caused secondarily to uveitis, vitreous hemorrhage or retinal detachment -> causes blockage of meshwork
- enlargement or anterior movement of lens against iris blocking outflow of AQH -> iris pushed up against cornea -> flow impeded into trabecular meshwork; chronic- asynptomatic w/ damage to optic nerve and peripheral vision, acute- opthalmic emergency, painful red eye with sudden vision loss, frontal headache, fixed pupil, n/v
85
Uveitis
- what is it
- anterior
- posterior
- sxs: hypopyon
- associated with
- inflammation of uvea
- iritis
- choriditis, retinitis
- accumulation of pus in ant chamber or conjunctivits
- sarcoidosis, RA, juvenile idiopathic arthritis
86
Age related macular degeneration
- what is it
- lose
- dry: cause, tx
- wet: onset, cause, tx
- degenration of macula
- loss of central vision
- depostion of drusen in between bruch membrane and retinal epi cells; multivitamin and antioxidant supplement
- rapid; caused by bleeding secondary to chorioid neovascularization; anti-VEGF injection (bevacizumab)
87
Diabetic retinopathy
- what is it
- non prolif: pathogenesis, tx
- prolif: pathogenesism, tx
- retinal damage caused by chroni hyperglycemia
- non prolif: damaged capillaries leak blood -> fluid and lipid seep into retina -> hemorrhage and macular edema; control blood sugar
- prolif: chronic hypoxia results in new blood vessels; anti-vegf injection
88
Hypertensive retinopathy
- what is it
- histo/ sxs
- retinal damage bc of chronic uncontrolled HTN
| - flame shaped retinal hemm, cotton wool spots, papilledema
89
Retinal vein occlusion
- what is it
- histo
- blockage of central or branch retinal v bs of compression from nearby arterial atherosclerosis
- retinal hemm and venous engrogement
90
Retinal detachment
- pathogenesis
- opthalmic exam
- common in
- preceded by
- sequlae
- separation of neurosensory layer of retina from outermost pigmented epi -> degeneration of photoreceptors -> vision loss
- crinkling of retinal tissue and change in vessel direction
- common in patient w/ myopia or hx of head trauma
- preceded by posterior vitreous detachment
- monocular loss like curtain coming down
91
Central retinal A occlusion
- what is it
- opthalmic eval
- next step
- acute, painless monocular vision loss
- retina cloudy w/ attenuated vessels and cherry red spot at fovea
- evaluate for embolic source
92
Retinitis pigmentosa
- what is it
- sxs
- opthalmic eval
- inherited retinal degeration
- painless, progressive vision loss beginning with night time blindness
- bone spicule shaped depostis around macula
93
Papilledema
- what is it
- sxs
- opthalmic eval
- optic disc swelling due to increased ICP
- enlarged blind spot
- elevated optic dic w/ blurred margins
94
Leukocoria
- what is it
- causes
- loss of red reflex
| - RB, congenital cataract, toxcariasis
95
Pupillary control
- miosis: function, controlled by, pathway
- mydriasis: function, controlled by, pathway
- constricton; controlled by PS; edinger westphal nuc to ciliary gangion vic CNIII, synpase on short ciliary nerves to sphincter pupillae muscles
- dilation, sympathetic; hypothal to ciliospinal center (syn)-> exit at T1 to sup cervical ganglion (synapse) travel along vessel -> onto long ciliary N to pupillary dilator muscle
96
Pupillary light reflex
| - pathway
light in either retina sends signal via CN II to pretectal nuc -> activated bilateral edinger-westphal nuc -> pupils constric bilaterally
97
Marcus Gunn pupil
- what happens
- caused by
- when light is shined into one eye, both eyes constrict, but when light is swung to other eye both eyes dilate
- impaired conduction of light signal along injured optic nerve
98
Horner syndrome
- what is it
- sxs
- cause
- sympathetic denervation of face
- ptosis (eyelid drops, miosis (pupil constricts), anhydrosis (no sweat)
- lesions along symp chain
99
Movement of eye muscles
- SR
- IR
- LR
- MR
- IO
- SO
- SR: up and lateral
- IR: down and lateral
- LR: lateral
- MR: medial
- IO: up and medial
- SO: down and medial
100
CN III damage
- causes
- motor
- parasympathetics
- ischemia, PCOmm aneursym, cavernous sinus thrombosis, midbrain stroke
- motor primarily affected by vascular dx; ptosis, down and out gaze
- paraymathetic mostly affected by compression; diminished or absent pupilary light reflex
101
CN IV damage
- affected eye
- compensation
- pupil is higher in affected eye
| - head tilt to contralateral side to compensate for lack of intortion of affected eye
102
CN VI damage
| - affected eye
- affected eye unable to AB-duct
103
Visual field deficits
- right anopia: what is it
- bitemporal hemianopia: what is it; cause
- left homonymous hemianopia: what is it
- left upper quadrantanopia: what is it; cause
- left lower quadrantanopia: what is it; cause
- left hemianopia w/ macular sparing: what is it; cause
- central scrotoma: what is it; cause
- vision loss from entire right eye
- vision loss from the lateral vision fields in both eyes; pit lesion
- vision loss from the left vision fields in both eyes
- vision loss from the left upper vision fields in both eyes; right temporal lesion, MCA
- vision loss from the left lower vision fields in both eyes; right parietal lesion, MCA
- vision loss from the left vision fields in both eyes but with central vision spared; right occipital lesion, PCA
- central vision loss; macular degeneration
104
Meyer loop and Dorsal Optic radiation
| - what are they
- Meyers: lower retina, loops around inferior horn of lateral ventricle
- Dorsal: superior retina, takes shortest path to internal capsule
105
Internuclear opthalmoplegia
| - MLF: what is it
- medial longitudinal fasiculus: pair of tracts that allows for cross talk between nuclei of CN III and VI; both eyes
106
Internuclear opthalmoplegia
- MLF: what is it
- lesions
- naming
- medial longitudinal fasiculus: pair of tracts that allows for cross talk between nuclei of CN III and VI; both eyes are able to move in same horizontal direction
- a conjugate horizontal gaze palsy; lack of comm so that when VI activates ipsi lateral rectus contralateral III does not stimulate medial rectus to contract
- named by eye unable to adduct
107
Epilepsy drugs
- Benzo: type of seizure, MOA, side effects, also used for
- Carbamazepine
- Ethosuximide
- Gabapentin
- Lamotrigine
- Levetiracetam
- Phenobarbital
- Phenytoin
- Topiramate
- Valproic acid
- Vigabatrin
- benz: status epi; increased GABA action; sedation,tolerance, dependence, resp depression; eclampsia
- carb: partial, and tonic clonic; blocks Na channels; diplopia, ataxia, liver tox, teratogens
- etho: absence; blocks thalamic T-type Ca channels; fatigue, GI distress, headache, itching
- gaba: partial, inhibits high voltage activated Ca channels, GABA analog; sedation, ataxia
- lamo: partial, tonic-clonic, absence; blocks voltage gated Na channels, inhibits release of glutamate; SJS
- leve: partial, tonic clonic; modulate GABA and glut release; neuro sxs
- pheno: partial, tonic-clonic, status epi; increased GABA action; sedation, tolerance, dependents
- pheny: partial, tonic- clonic, status epi; block Na channels; P450 induction, hirsutism, nystagmus
- topira: partial, tonic-clonic; blocks Na channels and increase GABA action; sedation kidney stones, weight loss; used for migraine prophylaxis
- valproic: parital, tonic-clonic, absence; Increase NA inactivation and increase GABA concentration; GI disress, hepatotox; migraine prophylaxis
- viga: partial; increase GABA, irreversible; permanent visual loss
108
Barbituates
- suffix
- MOA
- indication
- side effect
- barbital
- facilitate GABA action by increased durationof Cl channel opening
- sedative for anxiety, seizures, insomnia, induction of anesthesia
- resp and cardio depression
109
Benzos
- suffix
- MOA
- indication
- side effect
- pam and lam
- facilitate GABA action by increasing frequency of Cl channel opening, long half life
- anxiety, panic disorder, status epi, detox
- dependence, CNS depression
110
Non-benzo hypnotics
- ex
- indication
- mech
- reversed by
- side effect
- zolpidem, zaleplon, esZopiclone
- insomnia
- act via the BZ GABA receptor
- flumazenil
- ataxia, headache, confusion
111
Suvorexant
- indication
- MOA
- side effects
- insomnia
- orexin receptor antagonist
- CNS depression, headache
112
Ramelteon
- indication
- MOA
- side effect
- insomnia
- melatonin receptor agonist, binds MT1 and 2 in suprachiasmatic nuc
- dizziness, nausea, fatigue, headache
113
Triptans
- indication
- MOA
- side effect
- acute migraine, and cluster headache
- 5-HT antagonist, inhibit trigeminal N activation, prevent vasoactive peptide release, induce vasoconstriction
- coronary vasospasm, mild paresthesia
114
Parkinsonian drugs
- Dopamine agonists
- increase dopamine availability
- increase L-DOPA availability
- prevent dopamine breakdown
- curb excess cholinergic activity
- bromocriptine -> ergot derivative, pramipexole, ropinirole -> non ergot derivative
- amatadine
- carbidopa -> inhibits DOPA decarboxylase; entacapone -> prevents peripheral L-DOPA degradation by inhibiting COMT
- act centrally to inhibit breakdown of dopamine; selegiline: block coversion of dopamine into DOPAC, entacapone
- benztropine: antimuscarinic, improves tremor and rigidity but has little effect on bradykinesia
115
Neurodegenerative dx durgs
- alzheimers: drugs, MOA
- ALS: drug name, MOA
- Huntington dx: drug name, transporter,
- donepezil; AchE inhibitor OR memantine; NMDA receptor antagonist, helps prevent excitotoxicity; used for moderate to advanved dementia
- riluzole; decrease neuron glutamate excitotoxicity; only to increase survival
- tetrabenazine: inhibit vesicular monoamine transporter -> decrease dopamine vesicle packaging and release
116
Inhaled anesthetics
- effects
- side effects
- myocardial depression, respiratory depression, post op nausea and vomiting, increased cerebral blood flow
- hepatotox, nephrotox, proconvulsant
117
Intravenous anesthetics
- thiopental: drug type, used for, side effects
- midazolam: drug type, used for, side effects
- propofol: MOA, used for, side effects
- ketamine: MOA, used for, side effects
- barbituate; short surgical procedures; decreased cerebral blood flow, high lipid solubility
- benzo; procedural sedation; cause severe post op respiratory depression
- potentiates GABA; rapid anesthesia induction, ICU sedation; may cause resp depression
- NMDA receptor antagonist; dissociative anesthesia, increased cerebral blood flow
118
Local anesthetics
- MOA
- given with
- used for
- block Na channels
- given with vasoconstrictors to enhance local action
- minor surgical procedures, spinal anesthesia
119
Neuromuscular blocking drugs
- depolarizing neuromuscular blocking drugs: what is used MOA, complications
- nondepolarizing: MOA, in the middle
- succinylcholine: strong Ach receptor agonist, procedures sustained depolarization and prevents muscle contraction; reversal of blockade; complication include hypercalcemia, hyperkalemia, malignant hyperthermia
- Ach anatognist; cur
120
Spasmolytics
- baclofen: MOA, indication
- cyclobenzaprine: MOA, indication
- dantrolene: MOA, indication
- tizanidine: MOA, indication
- GABA receptor agonist in spinal cord, muscle spasticity dystonia; MS
- acts within CNS at brainstem, muscle spasticity
- prevents release of Ca from SR of skeletal muscle by inhibiting ryanodine receptor; malignant hyperthermia
- alpha 2 agonist, acts centrally; muscle spasticity, MS, ALS, cerebral palsy
121
Opioid analgesics
- MOA
- efficacy
- indication
- side effects
- acts as agonist at opioid receptors to modulate synaptic transmission; close pre-synaptic Ca channels opens K channels -> decrease synaptic transmission
- full agonist: morphine, codeine, heroine; partial: buprenorphine; mixed: nalbuphine, antagonist: naloxone
- moderate to severe or refractory pain, acute pulm edema, maitenance for heroin addicts
- nausea, vomitting, pruritis, addiction, resp depression
122
Mixed opioid analgesics
- pentazocine: MOA, indication
- butorphanol: MOA, indication
- k opioid receptor agonist and mu opioid receptor weak atagonist or partial agonist; analgesia for moderate to severe pain
- k opioid receptor agnist and mu opioid partial agonist; severe pain
123
Tramadol
- MOA
- indication
- very weak opioid agonist, also inhibits reuptake of norepi and serotonin
- chronic pain
124
Glaucoma drugs
- Beta blocker: MOA
- alpha agonist: MOA, adverse effect
- diuretics: name, MOA
- prostaglandin: MOA
- cholinomimetics: MOA
- decrease AQH synthesis
- decrease AQH synthesis and vasoconstriction; do not use in closed-angle glaucoma
- acetazolamide; decrease outflow of AQH synthesis via inhibition of carbonic anhydrase
- increase outflow of AQH via decrease resistance of flow through uveoscleral pathway
- increase outflow of AQH via contraction of ciliary muscle and opening of trabecular meshwork
